I’ve spent the past several weeks crisscrossing the country on residency interviews, a process that has been both exhilarating and exhausting. While each interview day has its own unique flavor, one constant has been the hospital tour.
In many ways, the tour is one of the least informative aspects of an interview. A patient room in one hospital typically looks like a room in another. The cafeterias tend to have a lot in common. Emergency rooms in large trauma centers have the same core components. All told, the ways in which we provide medical care and the buildings in which we do so have many similarities.
With that said, I’ve recently spent quite a bit of time reflecting on the differences. The physical structure of the hospital has been one interesting manifestation of those differences, with three features standing out to me: the entrance, the layout of departments, and physician workrooms.
Hospitals have a tremendous amount of variability in their entrances. Many have simple lobbies, often little more than a hallway with a welcome desk. At the other extreme, some entrances are architectural marvels, complete with soaring ceilings and waterfalls that draw comparisons to luxury hotels.
The difference reflects a trade-off between maximizing functional space versus improving the patient experience by making the hospital more welcoming. Interestingly, I've found that the type of entrance doesn't necessarily correlate with patient demographics or the busyness of the hospital --
On a more practical level, it has been fascinating to see how hospitals choose to arrange clinical departments. Some place their inpatient wards alongside outpatient clinics while others set clinics in a separate building. Some hospitals have designated floors for specific specialties while many rely on general floors that have a mix of patients. I’ve noticed that patterns in departmental layout sometimes reflect patient acuity or organizational choices, but in many cases, it is simply due to historic decisions.
Finally, I’ve paid attention to physician workrooms in hospitals (in large part because I’ll be spending a lot of time in them). Workrooms have traditionally been in the middle of the floor with the patient rooms arranged around the outside. On my tours though, a sizable number of hospitals noted that they have moved physician workrooms to the outside as a wellness initiative to increase window space and natural light.
Hospital design is certainly not a glamorous topic, particularly for people preoccupied with decisions about where to go for residency. Even so, I've increasingly come to think of it as not just a simple matter of aesthetic preferences but as a critical component of patient care. A growing body of literature is evaluating how the physical environment of a hospital affects quality and safety, with preliminary research suggesting its relevance to issues as diverse as infection control, pain management, and hospital length of stay.
As researchers start to identify best practices in hospital design, I hope to see more deliberate decision-making around choices like lobbies, departmental layout, workrooms, and more. I’m confident that doing so will improve both patient care and future tours.
Stanford Medicine Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week during the academic year; the entire blog series can be found in the Stanford Medicine Unplugged category.
Akhilesh Pathipati is a fourth-year MD/MBA student at Stanford. He is interested in issues in health care delivery.
Photo by corgaasbeek