New Design Research Partnership Identifies Spatial Interventions that Can Help Mitigate Infection Risk Among Healthcare Workers
New York City, NY - As pressure to protect healthcare workers and patients continues to build in the midst of the COVID-19 outbreak, a team of clinicians and designers from The Mount Sinai Hospital, MASS Design Group, and Ariadne Labs has come together to identify spatial interventions that can mitigate infection risks among healthcare workers, patients, and our communities. The goal of this three-week study was to identify different “design hacks” that were occuring on the fly in a hospital on the frontlines in order to identify design strategies and renovations that can help reduce infections across the world. The findings can help healthcare providers develop better “spatial literacy” by making existing invisible risks more visible (e.g., clearly marking zones where there is a high risk of infection) and creating visual aids that are applicable across other health care settings. The partnership seeks to develop a learning collaborative, work with additional healthcare facilities across the US, and measure before and after conditions to track adherence to infection control protocols, so that our healthcare spaces can be better prepared to respond to both the current and future pandemics.
“We have always operated under the assumption that design has the power to heal,” said Michael Murphy, founding principal and executive director of MASS Design Group, which launched a COVID-19 Design Response Team to respond to partner needs and share strategies for infection control. “Architecture has been relegated as a passive backdrop, but if deployed as an active agent now in the fight against the pandemic, we can recapture trust over our public spaces, and solve problems. The spatial choices we make today, during this emergency, are critical to better protect healthcare workers on the frontlines going forward.”
Mount Sinai’s Fight Against the Spread. During the beginning of the COVID-19 crisis, Mount Sinai had to adapt its existing spaces to treat the influx of patients. By early March, during the research phase of this case study, Mount Sinai worked quickly to help treat more than 600 patients each day, 150 of whom were on ventilators. Despite extensive protocols, health care workers at Mount Sinai and hospitals around NYC were still getting sick, spurring doctors at the hospital to question what additional opportunities existed to help keep everyone safe.
“We had been following what was happening globally and knew that New York had to be ready for COVID-19. We knew healthcare workers were at risk ,” says Dr. Michael Dolinger, a Chief Pediatric Fellow within the Mount Sinai Kravis Children’s Hospital. “I asked myself if there was more than just spatial distancing and PPE—How could we make the invisible threat visible? I discussed it with Dr Bucuvalas, and he immediately thought of his previous work with colleagues at MASS Design Group. That got the ball rolling…”
Design Research Matters Now. Mount Sinai, MASS, and Ariadne Labs did a review of three different COVID-19 care spaces within the hospital (pediatric unit, adult medical unit, and the adult ICU) that would allow them to remotely “peer in” to active coronavirus care units and that would be easy to replicate at other hospitals. The research methods included virtual tours conducted by clinicians, a floorplan “heatmap” annotation developed by clinicians from each unit, interviews with clinical operations and facilities teams, photos of temporary space and a review of hospital COVID-19 policy communication. This process allowed partners to get a holistic sense of the environment inside hospitals and identify spatial problems that can be remedied to prevent the further spread of the disease.
“This work has so many implications—not only nationally, but also globally—as other urban centers rapidly expand their health care capacity and design new spaces to treat COVID19,” says Dr. Neel Shah, Assistant Professor of Obstetrics, Gynecology and Reproductive Biology at Harvard Medical School, and director of the Delivery Decisions Initiative at Ariadne Labs. “It has shown that we can apply our understanding of both the biology and sociology of preventing infections to keep patients, staff and the wider community safe.”
Findings. Historically, most evidence-based design has been conducted at the level of the patient room because that’s easiest to control for and study; but within COVID-19 floors, we observed that spaces are also shaping important behaviors at the scale of the entire care unit. Despite some differences among hospital care units, the team generally observed similar clinician interactions and space use patterns across all three units. Key takeaways include:
- While infection control protocols have been quickly adopted, hospitals are not designed to easily pivot to support the infrastructural changes needed at the scale of a pandemic surge. One major shift is the focus from individual patient care to unit care, creating caregiving processes for COVID-19 units that place a heavy reliance on interstitial spaces. This lesson means that enforcing proper infection control protocols in hallways and key thresholds may be as important as in patient rooms.
- Variability exists both in the adaptations from floor to floor and unit by unit, as well as in personal perception of risk zones within care units. These differences affect how health workers behave and interact, sometimes introducing new elements that may impact the risk of infection among staff and patients.
- Spatial literacy (i.e., the ability to read and understand space) can be a powerful tool to orient healthcare workers within unfamiliar and rapidly-changing COVID-19 caregiving environments. Simple visual aids and design nudges can help mitigate infection transmission by clearly conveying risk zones, creating mental “anchors” for specific activities, and aligning behavior with policy. Design can help advance the sociology of infection control, along with our developing understanding of its biology.
Preliminary Conclusions. The key takeaway from the report is that the design and layout of a hospital are crucial to ensuring the safety of health care workers, patients, and prevent the further spread of COVID-19 in our communities. More research conducted in partnership with healthcare staff and designers is needed to help develop “spatial literacy” (i.e., healthcare providers’ understanding of space and how to behave within it) to use the built environment to facilitate this knowledge. Together, this partnership can help create situational awareness for COVID-19 units, set clear and consistent protocols for thresholds, align appropriate behavior within well demarcated risk zones, and identify opportunities to better scale up and scale down ICUs during surge conditions.
To learn more about these findings and recommendations, you can access a more detailed summary report by visiting our website.
About MASS Design Group:
MASS Design Group is an architecture and design collective that researches, builds, and advocates for architecture that promotes justice and human dignity. A team of 140 people working in 6 cities across the world, MASS has built 21 healthcare and support facilities, with another 13 in construction and underway. In 2017, they won the Cooper Hewitt National Design Award and the National Arts and Letters Award. Their recent architectural projects include a Cholera Treatment Center in Haiti and the Memorial for Peace and Justice in Montgomery, Alabama.
About Ariadne Labs:
Ariadne Labs is a joint health system innovation center at Brigham and Women’s Hospital and Harvard T.H. Chan School of Public Health. Ariadne develops simple, scalable solutions that dramatically improve the delivery of health care at critical moments to save lives and reduce suffering.