A new campaign calls for single-bed hospitals, and a shift towards hospitality in Ireland's healthcare
THE IRISH Hospice Foundation is to launch a campaign demanding single rooms and hospice-friendly policies for all patients in all hospitals, whether or not they are terminally ill.
Traditional, multi-bed hospital wards spread infection, cause stress, impair recovery, prevent privacy and insult dignity, according to the foundation, which has enlisted the support of actor Gabriel Byrne and Prof Roger Ulrich, an internationally renowned expert on hospital design.
Even though there are new hospitals with multi-bed wards yet to be opened, the hospice foundation wants to see these renovated. Meanwhile, the HSE should sell off land that it owns around old hospitals to fund the construction of state-of-the-art single-bed hospitals that improve patient survival, says Mervyn Taylor, programme manager of the Irish Hospice Foundation's hospice-friendly hospitals programme.
"We need to put 'hospitality' back into 'hospital'," says Taylor.
The foundation is confident that irrefutable research evidence backs up its call for hospice-friendly hospitals, which, it says, are more cost-effective, as well as being humane.
The current ward system means that more patients are getting more infections and remaining ill for longer, while medical staff are being "run off their feet" in foraging missions for medicines and medical records that involve running for several kilometres per day in badly designed traditional hospitals, it says.
"Patients and their families are putting up with appalling conditions - this seems to be accepted even by advocacy groups that focus on conditions in A&E," says Taylor.
"Government parties are defending the indefensible while Opposition parties are defining themselves by being on the attack - somehow we have to find a middle ground where everyone can work together to improve things," says Taylor.
There are few purpose-built hospice facilities in Ireland. Many elderly people end their lives in dormitory-style community hospitals with as little as 16 inches between beds, Taylor says.
These dormitories are in effect hospices where dying patients may be moved to single rooms at the last moment, he adds. "Our threshold for what is acceptable is so low."
For most people, the word "hospice" means a purpose-built facility for dying people - a concept that will be challenged on June 19th by the Irish Hospice Foundation when actor Gabriel Byrne launches its new Design & Dignity Guidelines.
The foundation will argue that all patients benefit, whether or not they are terminally ill, when hospitals are properly designed. Byrne will chair a lecture by Ulrich, an internationally renowned expert on evidence-based hospital design.
Ulrich will present compelling evidence that traditional hospital buildings, with crowded wards and shared bathrooms, cause needless stress to patients, families and medical staff, shortening lives and wasting money for the State in the long term. He will say that dozens of studies on patients prove that hospital-induced stress shortens life expectancy.
The Irish Hospice Foundation's message is that "hospice is a way of thinking, a frame of mind", says Taylor. "The reality is that people in hospital today are sicker and spending more time in and out of hospital than in the past, due to improved medical interventions."
But the accommodation hasn't kept up, he says.
"Many people are dying in what are effectively overcrowded dormitories, lacking dignity and privacy," he says.
Single-bed rooms are the bedrock of the design and dignity guidelines. Ulrich will cite dozens of studies showing that single-bed rooms, with views of nature, improve outcomes and quality of life not just for terminally ill patients, but for all patients, including new mothers and babies.
"The case for evidence-based design is so compelling with respect to both patient outcomes and cost that 44 out of 50 US States no longer permit hospitals with anything but single-patient rooms to be built," says Ulrich.
Three new hospitals that are being completed in Sweden have only single-bed rooms, as do new hospitals in Australia and the Netherlands, he says.
Taylor adds that in Sweden, Norway, Australia and the Netherlands, building patient-friendly hospitals is a matter of national pride, whereas in Ireland we're still building hospitals that offer wards for public patients and private rooms for patients with insurance.
Ulrich's research will show that uninformed medical staff still believe that multi-bed wards are more efficient, when research has proven that nurses in these traditional hospital settings walk many more kilometres in corridors and spend more time fetching and carrying than they would in well-designed single-bed hospitals.
"Nurses become exhausted, and being exhausted means being more likely to make mistakes and more likely to be in a less than positive mood dealing with patients," says Taylor.
Ulrich's research has proven that single-bed rooms - when properly designed so that nurses can see patients through windows, while also having easy access to medicines and medical records - reduce stress for patients, their families and medical staff.
Wards with four or more beds (which can easily become six or eight beds) spread infection between patients, visitors and medical staff as they bustle in and out.
Single-bed rooms, it has been proven, prevent the spread of infection, as well as reducing stress by limiting noise and interruptions. Less stressed patients heal better and live longer.
Ulrich became interested in hospital design when, as a teenager, he spent several years in and out of hospital due to a kidney complaint. Around him in hospital were overworked nurses and patients with "long faces", several of whom died. He realised that it was difficult to get well in a ward that resembled a bus station, with constant noise, interruptions from nurses and a lack of privacy.
Ulrich is Beale Endowed Professor of Health Facilities Design at Texas A&M University and his research on the effects of healthcare facilities on patient safety and medical outcome has influenced the architecture and planning of hospitals internationally.
He made his name with a research article in the journal, Science ('View through a window may influence recovery from surgery') documenting that patients whose window views included nature required less pain medication, had better emotional wellbeing, and shorter stays- findings since confirmed by other medical studies.
Ulrich's other work includes an influential theory of psychologically supportive healthcare design, as well as research on how aspects of the hospital's physical environment actually cost healthcare services less money in the long run, even if initial capital expenditure is more.
"Hospice is a frame of mind - not a 'hospice' building. If we can give people at the end of their lives a single room, privacy to communicate with their families, the dignity of being kept clean and comfortable, even having natural light rather than artificial light - all these factors help to ease the dying process for everyone," says Taylor.
In Norway, the latest hospital to be built is so pleasant that part of the hospital is a tourist hotel, he says. This is what we need: hospitals that are designed more like hotels, with 'hospitality' in mind, so that all the patients benefit from a healing environment, young and old, short-stay and long-stay, rich and poor - and, especially, those who are dying.
• Gabriel Byrne will launch the Irish Hospice Foundation's new design and dignity guidelines and Prof Ulrich will present the evidence on which they are based at St Ann's Church, Dawson Street, 7pm, June 19th
