Resourceful researchers plan the perfect ‘regenerative’ hospital

Planners and builders of new hospitals, take note: For the modest added spend of $25 million to $30 million—just 3% of typical total construction costs—you can incorporate architectural and design features that will not only healthify the structure but also pay for themselves within two years. 

In the bargain, the extra elements will enhance curb appeal from the outside while optimizing patient outcomes and boosting staff performance on the inside. 

So promise researchers who have re-imagineered “Fable Hospital” into its third iteration.  (The hypothetical Fable Hospital debuted in 2004, and Fable Hospital 2.0 followed in 2011.)

For Fable Hospital 3.0, current members of the design team continue to posit the dream hospital as a 750,000-square-foot, 300-bed community workhorse with 85% occupancy and an average length of stay of five days.

Marcelo Bernal, PhD, and colleagues had their proposed model published this month in BMJ Leader. 

“The success of this model depends in part on factors outside the institution itself,” Bernal and co-authors note. “A significant share of the quantified benefits, such as those related to reductions in length of stay, relies on the implementation of biophilic strategies, the performance of the broader healthcare system and the communities in which hospitals operate.”

Benefits justify costs  

As described in the peer-reviewed article, the plan rethinks conventional approaches to everything from airflow and lighting  to building materials, energy systems and access to nature. 

The content is presented as a cost-benefit analysis. Standout points include:

• The proposal’s regenerative design approach integrates disparate systems so as to “heal living systems and enhance conditions for life in the future,” Bernal and colleagues write. “It transcends the past’s mitigation mindset by moving beyond merely reducing infrastructure’s negative footprint and considering how to repair damage and foster conditions that promote life and vitality for the future.”
   
• Excluding the cost of the land, the analysis uses conservative cost estimates based on national averages and industry benchmarks, quantifying ROI reductions in medical errors, energy and water consumption, staff turnover, renovation costs and inpatient length of stay, along with improvements in operational resiliency, material first costs and speed to market.
   
• Key annual projected savings include a major contribution of ~$7.25 million from reduced inpatient length of stay, ~$1.0 million from fewer medical errors, ~$1.2 million from improved staff retention, ~$500,000 from maintaining operations during emergencies, ~$250,000 from energy savings, ~$1.5 million from lowered renovation costs, ~$5.4 million from lower material first costs and ~$100,000 from water use reduction.

Immediately applicable?  

In their discussion section, the authors suggest they’re already looking further ahead.  

“We can only guess what our next horizon may be, but the continued integration of advancing digital technologies into physical space may hasten the Fable 3.0 transformation and quicken the creation of Fable 4.0,” they write. “There is an opportunity also in the next iteration to further study the input cost and the impact on the environment at the source, as we work on the further ripples of regenerative design impacts.”

In a news item posted by Texas A&M University, co-author Leonard Berry, PhD, MBA, of that institution remarks that designing a better hospital is not a luxury but a smart investment. 

“When you build with evidence in mind, you improve care, support staff and reduce costs all at the same time,” he says. 

“These are not abstract ideas,” Berry adds. “They’re practical strategies that can be implemented today. The real opportunity is putting them together in a way that delivers meaningful results.”

The journal paper is posted in full for free.