There's very little that's sexy about the health care industry. Within the tangled threads connecting government regulation, opaque insurance policies, and the actual work of patient care itself, there's not a lot of room for glitz or style, and certainly very little time for those working within the health care machine to step back, take inventory of the larger system, and reflect on what's working, what's not, and what could be better if only someone would stop and think through certain problems. This aspect of health care ensures that virtually nobody in the industry has the time or the inclination to dwell on the role of design.

    According to a small group of architects and designers, this lack of design-thinking is precisely why the health care industry struggles to deliver on so many levels. Design, after all, isn't just about form. It's about function. "We think that design has the power to revolutionize industries, just as it has in electronics, in cars, in everything else," Salley Whitman says. "But in health care we haven't tapped into that in a systematic way."

    Whitman is the Executive Director of NXT Health, a non-profit health care design organization that she describes as something like the research and development shop that the health care industry has always lacked. NXT Health got its start back in 2006 via a Department of Defense grant asking the organization to lead a design collaboration in producing the hospital room of the future -- not a futuristic operating theater or a suite of new treatment technologies, but a patient room that could improve health care outcomes at the individual level. The room itself and the design principles underpinning it have undergone some changes and alterations in the interim, but fundamentally the objective has remained the same: to create better patient care strictly through better design -- no game-changing technological breakthroughs or federal legislation required.

    The final product of that effort -- christened Patient Room 2020 -- was unveiled this month at the DuPont Corian Design Studio in New York City. On its face the differences between the patient room of the present and the patient room of the future might appear largely cosmetic. But the NXT Health team and its collaborators -- more than 30 industry partners kicked in technology, materials, and know-how to produce the prototype -- insist that Patient Room 2020 not be taken at, well, face value. The streamlining and packaging of disparate technologies for patient and caregiver use might seem like obvious solutions, the redesign of the bathroom a nice aesthetic touch. But what this really represents, the team says, is a wholesale rethinking of the patient environment, which has remained largely unchanged for decades.

    "The health care industry itself is really at a crossroads, it's really being turned upside down from a clinical perspective," says Andrew Quirk, senior vice president for the Health Care Center of Excellence at the U.S. outpost of global construction firm Skanska (SKBSY), a collaborator on the Patient Room 2020 project. "So when you turn to the built environment, you can't expect to deliver health care in the future the same way -- and in the same space -- as you did in the last few decades." 

    医疗业一向有些平淡无奇。政府管制、缺乏透明度的医保政策，还有护理病患的繁重工作构成了一个错综复杂的网络，时尚元素在里面基本没有多少容身之地。身在其中的工作人员也很少会有余暇退后一步，审视一下整个医疗体系，同时反思一下，如果有人能放慢节奏、认真思索一些具体问题，就能了解哪些做法是行之有效的，哪些无法奏效，以及哪些方面能有所改观。医疗业的这个特点决定了，这个行业里实际上没人有时间、有兴趣考虑设计的作用。

    据一些建筑师和设计师反映，在设计上缺乏思考正是医疗业之所以在众多方面难以达标的重要原因。毕竟设计不是光关乎形式，它还与功能休戚相关。萨莉•惠特曼说：“我们认为，设计拥有推动各个行业实现变革的潜力，正像它已在电子工业、汽车业和其他众多领域所表现的那样。但在医疗业，我们还没有系统地开发设计的潜能。”

    惠特曼是NXT Health的执行总监，这是一家致力于医疗业设计的非营利组织。用她的说法就是，这是一家医疗业长期以来一直付之阙如的研发工作室。它于2006年经美国国防部（Department of Defense）批准成立。当时国防部要求由这家机构主导，与其他机构合作设计未来的病房——不是充满未来感的手术室，也不是一套全新的治疗技术，而是能在个体层面上改善疗效的病房。这种病房本身及其设计原则几经改变，但基本目标始终如一：严格地通过更好的设计，而不是什么颠覆行业的技术突破或联邦法律的强制要求，来为病患创造更好的护理体验。

    现在，这种种努力的最终成果终于横空出世了。它名为“2020病房”（Patient Room 2020 ），这个月在位于纽约的杜邦可丽耐设计工作室（the DuPont Corian Design Studio）正式揭幕。从表面上看，现在的病房和未来的病房之间的差别可能主要体现在装修上。但NXT Health团队与其合作者——30多位来自各行业的合作伙伴，他们分别贡献了打造这个样板病房所需的技术、材料和技术诀窍——坚称，看待“2020病房”不应该只着眼于表面价值。对供病人和医护人员所用的各种技术进行简化和整合可能看似容易，重新设计过的卫生间也颇为美观，但这支团队表示，这些改变真正代表的是对病人所处的环境从整体上所做的重新思考。多年来，这个环境在很大程度上一直都一成不变。

    国际建筑公司斯堪斯卡公司（Skanska）是“2020病房”项目的合作者之一。安德鲁•奎克是该公司美国分公司的卓越医疗中心（Health Care Center of Excellence）资深副总裁。他说：“医疗业正处在发展的十字路口，从临床角度看，它正在经历一场颠覆性的变革。所以，现在当你开始关注医院的建筑环境时，就不能指望今后还像过去几十年一样用同样的方式、在同样的空间提供医疗服务。” 

    What drew him to the project, Quirk says, was the idea that for the first time in the history of modern health care, a team of designers was being seriously challenged to integrate technology and architecture into a seamless environment rather than retrofit a handful of pre-existing health care technologies into a pre-existing space. "Every other time I've heard, 'This is the patient room of the future, there's nothing new about it," Quirk says. "This project really took a leap of faith in integrating technology and architecture and really incorporating all of the activities that will typically go on in a patient room into the design."

    Patient Room 2020 is indeed a highly integrated orchestration of technologies, materials, and plug-and-play capabilities, encompassing the customary technologies one would expect to find in a hospital room as well as wholly new ones aimed at enhancing patient comfort and care or caregiver efficiency. For instance, the so-called patient ribbon wraps all the way around the bed, from headwall to ceiling to footwall. The headwall contains the necessary machinery for capturing vital signs as well as any oxygen tanks or other hardware that might be necessary. The overhead panel contains patient-controlled lighting, while the footwall contains a display that can be used for everything from video-consulting with doctors to pulling up hospital information to viewing entertainment (all controlled from the bed via tablet computer). Caregiver tech in the room includes a hand-washing station, built-in RFID tech for tracking instruments, and simulated UV sanitation of workstations to cut down on the risk of hospital-acquired infection.

    The underlying technologies were provided by more than two dozen companies large and small -- Osram Sylvania provided some of the lighting, fabrics-maker Milliken customized antibacterial textiles for linens and scrubs, Duracell chipped in charging technology -- and largely packaged up in DuPont's (DD) Corian, a non-porous surface material selected by the design team for its ease of cleaning and the fact that it is thermoformable, leaving few seams or joints where bacteria might thrive. Taken altogether, Patient Room 2020 is designed to address some glaring shortcomings rife in the health care system today: a lack of patient engagement in his or her own treatment, hospital-acquired infections, caregiver inefficiency, and overall patient discomfort, which can distract from rehabilitation and generally can make hospital rooms miserable environments.

    That's why Patient Room 2020 isn't just technology for technology's sake, Whitman says. Each element was chosen for a reason and placed in the right location to enhance both patient engagement and caregiver performance and efficiency. It's a systems approach -- something that has long been employed to boost efficiency in other industries but has been sorely lacking in basic patient care, where things are often still done piecemeal with pen and clipboard. Most importantly, it's design influencing behaviors and outcomes, Whitman says, and in a health care environment where fixed costs and other inefficiencies are often beyond an individual hospital's control, enhanced human performance through design gives administrators a unique tool for cutting costs and improving care.

    奎克称，吸引他加入这个项目的是现代医疗史上首次出现的理念，即一队设计师认真接受挑战，将技术和建筑整合到一个无缝环境中，而不是将一些已有的医疗技术重新用于现有空间中。他说：“其他时候我总能听到人们这么说，‘这就是未来的病房吗，好像没什么新鲜的地方啊’。而现在这个项目确实实现了飞跃，它将技术和建筑整合了起来，还将病房里所有常见的活动都纳入到了设计之中。”

    “2020病房”确实是各种技术、材料和即插即用功能高度整合的杰作，它既包含了一般病房常见的各种技术，又有各种旨在提高病人舒适度或医护人员工作效率的全新技术。比如，所谓的“病人环带”（patient ribbon）就从床头墙到天花板再到床尾墙把病床一路围绕了起来。床头墙中埋设了监测生命体征的仪器，还有氧气罐及其他必需的设备。病床上方的面板含有由病人控制的照明设施。床尾墙上装了一个显示器，它能用于和医生进行视频咨询，调看医院信息，还可以观赏娱乐节目（所有这些功能都通过一台平板电脑在病床上控制）。护理技术则包括一个洗手台，用于追踪仪器设备的内置无线射频识别（RFID）技术，以及用于降低医源性感染风险的仿紫外线消毒台。

    这些技术是由大大小小的二十多家公司提供的——欧司朗公司（Osram Sylvania）提供了一些照明设备，面料生产商美利肯公司(Milliken)提供了用于床单和抹布的定制抗菌面料，金霸王公司(Duracell)捐助了充电技术——而房间大量应用的是杜邦公司（DuPont）的可丽耐。它是一种无孔表面材料，设计团队之所以选它，是因为它便于清洁，而且可热成型，这就使房间里很少会有可供病菌繁殖的缝隙或接口。总的来看，“2020病房”的设计旨在解决当今医疗系统的一些突出问题：病人无法参与自己的治疗，医源性感染，医护人员效率低下，以及病人总体舒适度差。而这些问题会影响康复，同时让病房的环境更令人难受。

    惠特曼称，这就是为什么“2020病房”不是纯粹为了技术而打造的。所有要素都精心选择，合理配置，目的就是要让病人更好地参与治疗进程，同时提高医护人员的工作绩效和效率。这是一种系统方法——它早已在其他众多行业中用于提高效率了，但在基础医护领域却始终严重缺位，导致这个领域还停留在经常用笔和写字板来零敲碎打完成任务的水平上。惠特曼还表示，最重要的是，这是能影响行为和产出的设计。当前医疗领域中的固定成本和其他效率低下的现象常常超出个别医院的掌控范围，而通过设计提高的人员绩效能让医院管理者获得一个削减成本、同时提高护理水平的独特工具。

    "I do not believe that building things the same way but at lower cost is going to help with things like readmission, with hospital-acquired infections," Whitman says. "These are some of the big issues we're dealing with payment reform, because you're paying for performance. Hospitals are going to get paid because their patients don't fall, because they don't get sicker while they're there, because they understand their care so when they leave they don't come back -- these are all performance metrics the federal government is tracking. So this is not just about putting in technology so we can have fancier electronic medical records."

    Rather it's about a value proposition for the industry. The kinds of technologies and materials integrated into Patient Room 2020 certainly aren't less expensive than the contemporary alternatives. But long-term they'll improve both patient outcomes and bottom lines. In the near term, converting patient rooms to something like Patient Room 2020 will likely remain somewhat cost-prohibitive for many hospitals, Quirk says, but over time costs will decline and ROI for these technologies will come more quickly.

    And besides, Whitman says, the idea behind Patient Room 2020 isn't for hospitals to graft this model directly onto their hospitals, but to inspire a paradigm shift in the way the health care industry thinks about the role of design in general. The prototype provides a practical model from which administrators and architects can directly borrow or simply draw inspiration. But more than that it provides a clear example of how meaningful good design can be, even in an industry as unsexy as health care.

    "In the future there are going to be fewer hospitals, so when we build those hospitals we better build them right," Whitman says. "We need to build them in a highly engineered, highly technological way so that they are actually part of the care process, not just an appendage." 

    惠特曼说：“我不相信，如果还按老套方法，同时以更低成本来建病房能解决再入院和医源性感染等问题。这就是现在医保支付改革（payment reform）要解决的一些大问题，因为大家是为结果买单的。今后，只有病人不再因住院而病倒，不再因住院而病得更重，因为他们了解自己的治疗，所以一旦出院就不必再入院，医院才能让病人掏钱。而这些都是联邦政府正在跟踪考核的绩效指标。所以，这不是什么通过采纳新技术让电子病历变得更漂亮这么简单。”

    实际上这是事关医疗业价值主张的问题。“2020病房”所用的技术和材料并不比现在的一些可替代品便宜多少，但长期来看它们会让病人得到更好的护理，还能改善医院的经营状况。奎克表示，对多数医院来说，近期要把病房都改造成“2020病房”成本上吃不消。但随着时间推移，成本将会下降，同时采用这些技术所获得的投资回报将会更快地获得体现。

    惠特曼还表示，“2020病房”的理念不是让各家医院在自己院内照搬这个样板房，而是要启发大家在思维模式上有所改变，让医疗行业认真考虑设计所具有的普遍价值。这个样板房提供了一种实用模型，它可让医院管理者和建筑师直接借鉴或启发思考。但更要紧的是，它提供了一个清晰的范例，证明即使是在医疗业这样一个缺乏设计感的行业里，优秀的设计也是何等意义深远。

    惠特曼说：“今后医院的数量将减少，所以修建这些医院时我们最好修得好一些。我们必须采用工程技术含量极高的方式来建造它们，让它们成为治疗过程的一部分，而不再仅仅是一个附属物。”（财富中文网）

    译者：清远