Contemporary Issues in Healthcare Architecture

e ho wa u ke m rs a of dr fte th e y ains r th da ge o e y ts ne ve sto s fo try ra rfl rm llo i to o is ng rs we pa win w to an d w ss g t ha e d e h t l nte th ith d, t e K ea r e w h a ac d an en ate e h trin h to d tir r, o a al ev e p th spi st an of th l o ac o e ta or d e f t ua we ho l lo m ju ab pa he te r sp s , M dg le ti en co al sys ita t po em e t o y d t nt l 1 te l b w o 2’ to sit s in ro 87 m eg er ria s, b u ve p in an re l ith th e p/ th rs at th t qu Ho le en ver wa e h y. ie e o th f y lk os nt b ta irin spit al ina ill ; 2 p s uil ke g al do lly . A ’s ita th di o us in at ng n e N se 3 ga wh l a w . wa of ew s ’s. in e nd er H t t of M st re c d e os er he O a p m t th be p b rl or any he ati teg e in ita lea ac ean ph 3 ge en or w pa l g k in ’s ne ts ize ith ti ca off din up s w e di r w d i g c r on a ent to ed all ho th ed ia to ge as ,“ r y es pla s w e w fo ls w th ner fac re ig ac e m -lo w n h r i e e at in lie ht ce re in se ho of o w n re fa or g t v a p o w s th fo ilu s. di e w te ic t si th h er s e r a h t tu in ic e k d h y r fa rce e o Ho ast em w p er ee at k h in c d r io th ev th re ilit t f th we er. o he ac an g n a

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w in . m ep 1’ an en he sp o l, th I d er g J or te s w no I q d ey on te h ita u e ph d e be ca r a os l i u t ’ be to t st sh t t th es in pr re ve teg h nd pit n N h in e ho ou in e ac th in tio u al ew g re ry or k to ti o l e k d n ca fail rs th t va be , “ ce se in ill. ize t b h u O h a re , re re aft je e at cu ga r tt e e ct Ag d th lie do wh le d th th a d h n ed a e te t an fo of r th e es o e c v e t e r i th e fir d tra ig al o t s w ins m th ors wer in n e s st oc l 1 ak wa ith t t in ns n o e th em to e d th o t h m t e 8 o e s f o f r ne r e in le e or th 7 o fa c t w ew o ’ t i fa erg m p h g m s n pa ha e re s f t de fai e ho o c c w e w o i he d r h tie a ng ilit en as l d ne e rs ele ut ou th rst t t y cy se g r n o o e e h s a c d o ld in he ts r se lly ro al -t g d h e t i f e r s k o l up ic th ha l t va th th le as he e , th s u th alth le a a e h at a te ld l of cc s: cu an ve at , ve a ev ner e h h t d t t at d ha ra w in r. m ep 1’ o b th I d l, ac ato o sp e er g J he e a or te s w ve ns no I q ey on e b u ua rs sp e 1 p i y f t ta n or o st ’s le t t ue hi d p er b ’ b s w t tio an ital l a e e ho th . th ho m ne ra e hi s fir to e b e i n d lo n E e e nk tio r l t n ul ink e st, sit g rs to cti ho ith e t se th st fa urs p d e c th n t o , c s f l u i b er c qu e po xp ol p ar lu a ac e be tha “re e, e at he l f r e / o i o e en en w w e w t e n w d t e l d th th th d rie w a d g ie o ho ay me r o ce tire er an f e e e es c v t or f t th nc d lk; he pla ,t u e to w fir e d tra ig s e h is po req he p in e s th rs er in by 2’ re ce st oc ns n o w w ui g s w e ke was t t e e d d o d t o 2 he m r .” m e in to ha er rin o ith w fo f t o n ’ s o m c r on fa h ct be n es ’s rm he of id fa ,t e t l sy fa erg p a o l c ea s he re at w in gi y f ci e a th ed ir er e rs pl ou wo ie at g l n s e ee ity nc s d te n pa an s le w t o ul to he nt e d w h to s f c e y e t i d t a ho tri n i e s r - is o d ft h ev lt ie th ab re f ge , t a l al l th le as h ca n h h . u l av th ac a ly ts e n the l ov in wh e a l t d l a a e e tw d r ev r :1 ua nd 3’ w ho e tra e a ich t h h . a i s b th te a ac to o av n th lo ’s sp e er ng J . ho ey 1 b se ev e ua rs sp e sfo e M w ita en to ust d we l g ’ i e e b b s an er w tio an tal lo ry ro l. ab pr re ee rm ei th h t f e o se o y un n d lo a ng e ou Ei le er re irst s n n 3’ to cti tho se th st th to d. si e , f it u pl s b e s ca fail rs , “ ce se e t e q w x p a o u a u p r w co pe llo / Ev ue e ow re , re re ft ce ein at ou w n e lie do wh d io ld rie w a nc ti e d g en ay me fo of r th n. a ve ct o th pl e re r re nc ed lk; ,t u t r t o w e h a e pp h p is do he p in e s th rs er in by 2’ re ce o q ow u u w ro g s w em d e ct t t e d g o i d t 2 he m r .” ha er rin o e ve h oc ith ’s, wh be on es or’s of cid in fa t g o fa erg m p . s e t a t l o l f y ea s us he re fic gi y f ci e a th ed ir rs pl ou wo t l n s e ia ity nc s d em e n pa w an t o ul w eet ls he to hea to of fin t e d - y e i o Students will maintain a written and graphic journal that relates course content to contemporary issues and problems. Students will be assigned reading in current newspapers, blogs, online sites or other media. the student shall briefly summarize the reading and comment on the relationship between the reading and issues addressed during class. Respond to the reading and online comments. These entries are to reveal the relevance of the course to life outside the academy.

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s’ C os e w ts ho a Sk ur ke yr m s a of oc dr fte th ke e a r y ins th da t; ge o e y Sp s ts ne ve sto fo ec try ra rfl rm llo ia t o lis in or w p w ts is g s e a in ’I d a g t s w o n w s nc th ha e d e i d om e t t l nte th h , t K e e w h es r a ad a e a e tr ac nd nt ter ho in So h t i o a ar al ev re p , th spi st an of th l o ac o e ta or d e f t ua we ho l lo m ju ab pa he te r sp s , M dg le ti en co al sys ita t po em e t o y d t nt l 1 te l b w o 2’ to sit s in ro 87 m eg er ria s, b u ve p in an re l ith th e p/ th rs at th t qu Ho le en ver wa e h y. ie e o th f y lk os nt b ta irin spit al ina ill ; 2 p s uil ke g al do lly . A ’s ita th di o us in at ng n e N se 3 ga wh l a w . wa of ew s ’s. in e nd er H t t of M st re c d e os er he O a p m t th be p b rl or any he ati teg e in ita lea ac ean ph 3 ge en or w pa l g k in ’s ne ts ize ith ti ca off din up s w e di r w d i g c r on a ent to ed all ho th ed ia to ge as ,“ r y es pla s w e w fo ls w th ner fac re ig ac e m -lo w n h r i e e at in lie ht ce re in se ho of o w n re fa or g t v a p o w s th fo ilu s. di e w te ic t si th h er s e r a h t tu in ic e k d h y r fa rce e o Ho ast em w p er ee at k h in c d r io th ev th re ilit t f th we er. o he ac an g n a

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01

Elisabeth Rosenthal

In this article, author Elisabeth Rosenthal discusses the soaring costs of medical procedures - particularly in the dermatology field - that have led to the rise in the average doctor income in the United States. She quotes that the incomes of dermatologists, gastroenterologists, and oncologists rose 50% between 1995 and 2012 (after adjusted for inflation). This sharp rise in income is the result of doctors thinking more entrepreneurially. Doctors have realized that minor procedures typically offer the best return on investment. Rosenthal illustrates this by stating that a cardiac surgeon can perform only a couple of bypass operations a day, but other specialists can perform a dozen procedures in that time span.

ee of en ct nd gro n. at ve he ty to he ev . er f th e ice w up - t tur th ryo w , e m , d ou s gr eet ey n or h n e he er o ld : 1 e st ou be s e w g c ll ho o he va hi nd lo th en tor req ’s w nk . w ul uld al cu c s a u e t d t t y p d ir re h, th Ev sea a b e e h at en e pp I d ow ci m th e l y th ro o th th ev w er ded ore ose e v n’ e o el er w t fir e. t t tra ug , I e as o st R hi ns h qu ex l n o a k o ne nk t fo ff es pe os h rm ici ti s i ri- t, a ou ng t t er als on s t t o hu he sh rep he f t ma ou or de he n ld ted sig ha th n ve at of be m the en aki pl ng ac ed

Not only have the increased salaries of medical specialists sharply raised the cost of medical procedures, they have also resulted in fewer doctors entering the primary physician field - an area that experts say front-line doctors are badly needed. Only an estimated 25% of new physicians end up in primary care.

Furthermore, Rosenthal states that many general doctors in private practice say they are struggling to survive.

It is tough to regulate the cost of medical procedures - especially procedures that could be a matter of life and death. When human lives are at stake, people are more apt to pay a premium for the procedures that they need without regard to cost - one of the reasons that I believe have caused medical prices to soar.

I have never thought of a hospital as a business until now. In this entrepreneurial light, I find it frightening to think that doctors are constantly considering how to increase profits or increase their return on investment. I do not think that limiting the total costs of procedures is the answer but rather, the answer is in the limiting of unnecessary procedures and prescriptions. On a more frequent basis (if they have the power), patients should request second opinions from medical professions at other medical institutions to help limit the number of unnecessary procedures that are performed on a yearly basis.

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dl y e C ho ho wa k ic ur e es m s a of at dr fte th e M y ains r th da em ge o e y or s ts ne ve sto fo ia try ra rfl rm llo l” in tor ow p w is g s e a in w to an d w ss g t ha e d e h t l nte th ith d, t e K ea r e w h a ac d an en ate e h trin h to d tir r, o a al ev e p th spi st an of th l o ac o e ta or d e f t ua we ho l lo m ju ab pa he te r sp s , M dg le ti en co al sys ita t po em e t o y d t nt l 1 te l b w o 2’ to sit s in ro 87 m eg er ria s, b u ve p in an re l ith th e p/ th rs at th t qu Ho le en ver wa e h y. ie e o th f y lk os nt b ta irin spit al ina ill ; 2 p s uil ke g al do lly . A ’s ita th di o us in at ng n e N se 3 ga wh l a w . wa of ew s ’s. in e nd er H t t of M st re c d e os er he O a p m t th be p b rl or any he ati teg e in ita lea ac ean ph 3 ge en or w pa l g k in ’s ne ts ize ith ti ca off din up s w e di r w d i g c r on a ent to ed all ho th ed ia to ge as ,“ r y es pla s w e w fo ls w th ner fac re ig ac e m -lo w n h r i e e at in lie ht ce re in se ho of o w n re fa or g t v a p o w s th fo ilu s. di e w te ic t si th h er s e r a h t tu in ic e k d h y r fa rce e o Ho ast em w p er ee at k h in c d r io th ev th re ilit t f th we er. o he ac an g n a

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02

Sheri Fink

In the wake of the days following the Katrina storm, Memorial Hospital in New Orleans was facing disaster. Just hours after the storm passed, the hospital lost power requiring use of the backup generators. However, as storm drains overflowed with water, the hospital began to take on water - leading to the failure of the emergency generators and the entire power system in the building. Hospital officials were forced to turn away patients trying to enter and evacuate all 187 patients that were being cared for in the facility - the evacuation sequence is what lead to all of the controversy.

ee of en ct nd gro n. at ve he ty to he ev . er f th e ice w up - t tur th ryo w , e m , d ou s gr eet ey n or h n e he er o ld : 1 e st ou be s e w g c ll ho o he va hi nd lo th en tor req ’s w nk . w ul uld al cu c s a u e t d t t y p d ir re h, th Ev sea a b e e h at en e pp I d ow ci m th e l y th ro o th th ev w er ded ore ose e v n’ e o el er w t fir e. t t tra ug , I e as o st R hi ns h qu ex l n o a k o ne nk t fo ff es pe os h rm ici ti s i ri- t, a ou ng t t er als on s t t o hu he sh rep he f t ma ou or de he n ld ted sig ha th n ve at of be m the en aki pl ng ac ed

Doctors evaluated each of the patients in the hospital and categorized them into three groups: 1’s were those who were in fair health and able to sit up/walk; 2’s where patients who were sicker and would require more assistance; and 3’s were judged to be very ill. Against the generally accepted practice, doctors decided to evacuate 1’s first, followed by 2’s, then finally 3’s. Many 3’s died right away when emergency power was lost, however a few were injected with lethal doses of morphine to, “relieve them of the hell that they were experiencing.”

While I think that I would have evacuated the patients who were in the worst health, I don’t think that the doctor’s would have been able to come up with a plan of which everyone would approve.

Ranking human beings is tough since each patient has loved ones who think that they should be the first ones out of the hospital.

Either way, the doctors were in a lose-lose situation.

Given that the hospital was constructed on ground three feet below sea-level, I question the design of the electrical transformers being placed only feet above the ground. Even though officials reported that making the necessary fixes were prohibitively expensive, I do not think that the transformers should have been placed there to begin with.

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gi vi e ng w ho a ou ur ke rs m s a of el ve dr fte th s e a r y ins th da C an ge o e y s ce ts ne ve sto fo r” try ra rfl rm llo in tor ow p w is g s e a in w to an d w ss g t ha e d e h t l nte th ith d, t e K ea r e w h a ac d an en ate e h trin h to d tir r, o a al ev e p th spi st an of th l o ac o e ta or d e f t ua we ho l lo m ju ab pa he te r sp s , M dg le ti en co al sys ita t po em e t o y d t nt l 1 te l b w o 2’ to sit s in ro 87 m eg er ria s, b u ve p in an re l ith th e p/ th rs at th t qu Ho le en ver wa e h y. ie e o th f y lk os nt b ta irin spit al ina ill ; 2 p s uil ke g al do lly . A ’s ita th di o us in at ng n e N se 3 ga wh l a w . wa of ew s ’s. in e nd er H t t of M st re c d e os er he O a p m t th be p b rl or any he ati teg e in ita lea ac ean ph 3 ge en or w pa l g k in ’s ne ts ize ith ti ca off din up s w e di r w d i g c r on a ent to ed all ho th ed ia to ge as ,“ r y es pla s w e w fo ls w th ner fac re ig ac e m -lo w n h r i e e at in lie ht ce re in se ho of o w n re fa or g t v a p o w s th fo ilu s. di e w te ic t si th h er s e r a h t tu in ic e k d h y r fa rce e o Ho ast em w p er ee at k h in c d r io th ev th re ilit t f th we er. o he ac an g n a

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03

Rita F. Redberg and Rebecca Smith-Bindman

In this article, redberg and Smith-Bindman, both practitioners in the medical field, discuss the dangers associated with CT “Cat” Scans. According to their research, our exposure to medical radiation had increased six fold between the 1980’s and 2006 leading to hundreds of thousands of excess cancer cases and deaths over that generation’s lifetime.

ee of en ct nd gro n. at ve he ty to he ev . er f th e ice w up - t tur th ryo w , e m , d ou s gr eet ey n or h n e he er o ld : 1 e st ou be s e w g c ll ho o he va hi nd lo th en tor req ’s w nk . w ul uld al cu c s a u e t d t t y p d ir re h, th Ev sea a b e e h at en e pp I d ow ci m th e l y th ro o th th ev w er ded ore ose e v n’ e o el er w t fir e. t t tra ug , I e as o st R hi ns h qu ex l n o a k o ne nk t fo ff es pe os h rm ici ti s i ri- t, a ou ng t t er als on s t t o hu he sh rep he f t ma ou or de he n ld ted sig ha th n ve at of be m the en aki pl ng ac ed

Much of this increased exposure is due to the evolving technology; clearing and more accurate imagining comes at a result of a much higher dose of radiation. Since there is no regulation of the size of dose other than ‘reasonable’, the dose at one hospital could be 50 times larger than the dose at another. Doctors also play a major role in the increase of radiation exposure. In an effort to detect problems early, many doctors are referring patients directly to CT scans more and more frequently. The authors also point out that some doctors tend to send patients for CT scans because of corporate ties with the machinery or to help recoup costs for the multi-million dollar equipment.

It is always a tough call when lives are at risk - especially when the treatment can lead to health problems in it of itself. One commenter explained that malpractice laws are just too stiff for any doctor to think about breaking them. Another says that the individual chance of someone receiving cancer from CT scans is very small - much smaller than if the person were to skip the imaging and deal with the problems they are having.

I do not think that this much attention and potential blame needs to be placed on doctors. We must look back at the source of the problem - why cancer diagnoses have been increasing over time. I believe that the products we use are slowly killing us; not the treatment. As architects we must look out for the health, safety, and welfare of the public by specifying products that have not been doused in chemicals rather than the cheapest or most fashionable product of the time.

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lin e e of ho wa Em ur ke er m s a of ge dr fte th e nc a r y ins th da y ge o e y C ar ts ne ve sto s fo e” try ra rfl rm llo in tor ow p w is g s e a in w to an d w ss g t ha e d e h t l nte th ith d, t e K ea r e w h a ac d an en ate e h trin h to d tir r, o a al ev e p th spi st an of th l o ac o e ta or d e f t ua we ho l lo m ju ab pa he te r sp s , M dg le ti en co al sys ita t po em e t o y d t nt l 1 te l b w o 2’ to sit s in ro 87 m eg er ria s, b u ve p in an re l ith th e p/ th rs at th t qu Ho le en ver wa e h y. ie e o th f y lk os nt b ta irin spit al ina ill ; 2 p s uil ke g al do lly . A ’s ita th di o us in at ng n e N se 3 ga wh l a w . wa of ew s ’s. in e nd er H t t of M st re c d e os er he O a p m t th be p b rl or any he ati teg e in ita lea ac ean ph 3 ge en or w pa l g k in ’s ne ts ize ith ti ca off din up s w e di r w d i g c r on a ent to ed all ho th ed ia to ge as ,“ r y es pla s w e w fo ls w th ner fac re ig ac e m -lo w n h r i e e at in lie ht ce re in se ho of o w n re fa or g t v a p o w s th fo ilu s. di e w te ic t si th h er s e r a h t tu in ic e k d h y r fa rce e o Ho ast em w p er ee at k h in c d r io th ev th re ilit t f th we er. o he ac an g n a

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04

Jason Silverstein

According to author, Jason Silverstein (Ph.D. student in anthropology), more and more emergency care centers are closing their doors around the country. Emergency care centers provide critical trauma care in many types and scales of situations - especially in terrorist situations. Referring to the Boston Marathon bombings, Silverstein stated that the emergency care centers played a pivotal role in saving livings immediately following the events bombings. He stated that many injured runners arrived at emergency centers within an hour - some people being transported in 20 minutes. This is the way a healthcare system should run states Silverstein.

ee of en ct nd gro n. at ve he ty to he ev . er f th e ice w up - t tur th ryo w , e m , d ou s gr eet ey n or h n e he er o ld : 1 e st ou be s e w g c ll ho o he va hi nd lo th en tor req ’s w nk . w ul uld al cu c s a u e t d t t y p d ir re h, th Ev sea a b e e h at en e pp I d ow ci m th e l y th ro o th th ev w er ded ore ose e v n’ e o el er w t fir e. t t tra ug , I e as o st R hi ns h qu ex l n o a k o ne nk t fo ff es pe os h rm ici ti s i ri- t, a ou ng t t er als on s t t o hu he sh rep he f t ma ou or de he n ld ted sig ha th n ve at of be m the en aki pl ng ac ed

Despite the effectiveness of emergency care centers, nearly 11% have closed their doors between 1991 and 2010, despite an astounding 44% increase in emergency room visits during that same period. This affects everyone, particularly those in at risk areas (inner city neighborhoods, poverty stricken areas, and rural locations). Silverstein argues that emergency care centers are the ‘safety net’ of the healthcare system - providing care to those in need regardless of their health coverage.

Many readers commented that emergency care centers should not be considered to be the safety net of the health care system.

Many quoted articles illustrating that emergency centers are closing because they are losing money due to the policy that no patient can be turned away regardless of an ability to pay for care.

I think that this an issue of health coverage for the lower classes of the United States. If people of low socioeconomic class were able to receive care from a physician on a regular basis, then emergency rooms may not be as crowded. Also, if programs like MediCare were able to fully reimburse emergency rooms, then they would not be losing as much money on a yearly basis.

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of e Ag w ho a in k g” ur e m s a of dr fte th e y ains r th da ge o e y ts ne ve sto s fo try ra rfl rm llo i to o is ng rs we pa win w to an d w ss g t ha e d e h t l nte th ith d, t e K ea r e w h a ac d an en ate e h trin h to d tir r, o a al ev e p th spi st an of th l o ac o e ta or d e f t ua we ho l lo m ju ab pa he te r sp s , M dg le ti en co al sys ita t po em e t o y d t nt l 1 te l b w o 2’ to sit s in ro 87 m eg er ria s, b u ve p in an re l ith th e p/ th rs at th t qu Ho le en ver wa e h y. ie e o th f y lk os nt b ta irin spit al ina ill ; 2 p s uil ke g al do lly . A ’s ita th di o us in at ng n e N se 3 ga wh l a w . wa of ew s ’s. in e nd er H t t of M st re c d e os er he O a p m t th be p b rl or any he ati teg e in ita lea ac ean ph 3 ge en or w pa l g k in ’s ne ts ize ith ti ca off din up s w e di r w d i g c r on a ent to ed all ho th ed ia to ge as ,“ r y es pla s w e w fo ls w th ner fac re ig ac e m -lo w n h r i e e at in lie ht ce re in se ho of o w n re fa or g t v a p o w s th fo ilu s. di e w te ic t si th h er s e r a h t tu in ic e k d h y r fa rce e o Ho ast em w p er ee at k h in c d r io th ev th re ilit t f th we er. o he ac an g n a

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05

Linda Fried

Dr. Freid, a geriatrician, is a very motivated, passionate professional eagerly analyzing frailty that comes with old age hoping to find answers to aging for both the elderly and their caregivers. Over her years of work at Columbia University and as head of many research initiatives, she explains in the article that: good eating habits generally lead to a longer, healthier life; staying active is of utmost importance to a long life; and that the elderly have a lot to offer that can be both learned and passed on to coming generations.

ee of en ct nd gro n. at ve he ty to he ev . er f th e ice w up - t tur th ryo w , e m , d ou s gr eet ey n or h n e he er o ld : 1 e st ou be s e w g c ll ho o he va hi nd lo th en tor req ’s w nk . w ul uld al cu c s a u e t d t t y p d ir re h, th Ev sea a b e e h at en e pp I d ow ci m th e l y th ro o th th ev w er ded ore ose e v n’ e o el er w t fir e. t t tra ug , I e as o st R hi ns h qu ex l n o a k o ne nk t fo ff es pe os h rm ici ti s i ri- t, a ou ng t t er als on s t t o hu he sh rep he f t ma ou or de he n ld ted sig ha th n ve at of be m the en aki pl ng ac ed

It is great that there are devoted researches in the world that are as passionate as Dr. Fried is. Age is something that every human being faces regardless of class, gender, race, or location in the world so her research has the largest potential to make the biggest improvement on the world’s quality of life. I do question however, how broad her research on aging a frailty expands. It seems like there are many seemingly unrelated factors that could lead to frailty. One commenter mentioned that he had issues with his feet that ultimately lead to weight gain and muscle loss due to lack of walking. These foot problems could have been caused by previous athletic injuries or from years of exercise in general (he thought he was doing is body good, but in the end, he still ended up losing muscle mass and gaining weight).

To me the most benefit from Dr. Fried’s research does not come from describing what we should be doing while we’re young(er).

Many of us recognize the risks of poor diet and little exercise so we do the best we can to be healthy. The real benefit of the research on frailty comes in the form of helping us to solve and manage the unpredictable problems that are associated with age.

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06

Various

Despite being the greatest medical discovery of the 20th century, antibiotics may become useless in the following century. Several authors debate the most effective ways to avoid a future in which antibiotics are no longer useful.

David Gilbert - Fight Fear with Science Statistics show that more than 50% of prescriptions written to patients for antibiotics are not needed but doctors keep prescribing antibiotics because, according to Gilbert, they are too afraid that they might miss something. He argues that doctors should be afraid but should rather use scientific methods to detect if a patient has a bacterial infection or a viral infection.

ee of en ct nd gro n. at ve he ty to he ev . er f th e ice w up - t tur th ryo w , e m , d ou s gr eet ey n or h n e he er o ld : 1 e st ou be s e w g c ll ho o he va hi nd lo th en tor req ’s w nk . w ul uld al cu c s a u e t d t t y p d ir re h, th Ev sea a b e e h at en e pp I d ow ci m th e l y th ro o th th ev w er ded ore ose e v n’ e o el er w t fir e. t t tra ug , I e as o st R hi ns h qu ex l n o a k o ne nk t fo ff es pe os h rm ici ti s i ri- t, a ou ng t t er als on s t t o hu he sh rep he f t ma ou or de he n ld ted sig ha th n ve at of be m the en aki pl ng ac ed

Brad Spellberg - Government Needs to Aid Industry Research Spellberg argues that we need new economic approaches to rekindle and jumpstart the antibiotic pipeline. He believes that the government should enact ‘push’ incentives that alleviate upfront costs in the development of a new drug (typically economic incentives do not kick in until after a drug is approved which can be prohibitive to small antibiotic developers.

Louise Slaughter - Mandatory Limit on Farm Use Given that 80% of antibiotics in this country are sold for agricultural use, Slaughter believes that any solution to the antibiotic-resistance crisis has to start on a farm. Her solution would be to limit antibiotic use to only humans and sick animals.

Matti Jalasvuori - Develop Viruses to Fight Resistant Bacteria Jalasvuori suggests that we should capitalize on the qualities of a virus to exploit vulnerabilities in cell by using (harmless on humans) viruses to attack and destroy antibacterial infections.

John Bartlett - Adopt a National Plan Bartlett argues that no lasting changes will be made unless the United States adopts a nation-wide antibiotic plan that tracks the usage and other data of antibiotics. This data can be used to better illustrate how antibiotics evolve or to help doctors make more confident decisions.

Ramanan Laxminarayan - Change is Doubly Great for the Developing World The author describes that the great success of the use of antibiotics in the United States is due to the clean water supply, excellent sewage management, etc of the county. He goes on to say that poorer countries without these amenities have the most to gain from antibacterial usage.

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in g Pu e bl ho wa ic ur ke H m s a of ea dr fte th lth e y ains r th da fro ge o e y m s ts ne ve sto fo C lim try ra rfl rm llo t o in or w p w at is g s e a in e d a g t s C w o n w s t ha ha e d e h i d e t ng t l nte th h , t K ea r e w h a e” ac a e e a t d nd nt ter ho rin h t i o a al ev re p , th spi st an of th e l a t d e of cu ow h al orm ju ab pa th at er os los , dg le ti e e s pi t M e co al ys ta po em y ed to s nts nt l 1 te l b w o 2’ to it in ro 87 m eg er ria s, b u ve p in an re l ith th e p/ th rs at th t qu Ho le en ver wa e h y. ie e o th f y lk os nt b ta irin spit al ina ill ; 2 p s uil ke g al do lly . A ’s ita th di o us in at ng n e N se 3 ga wh l a w . wa of ew s ’s. in e nd er H t t of M st re c d e os er he O a p m t th be p b rl or any he ati teg e in ita lea ac ean ph 3 ge en or w pa l g k in ’s ne ts ize ith ti ca off din up s w e di r w d i g c r on a ent to ed all ho th ed ia to ge as ,“ r y es pla s w e w fo ls w th ner fac re ig ac e m -lo w n h r i e e at in lie ht ce re in se ho of o w n re fa or g t v a p o w s th fo ilu s. di e w te ic t si th h er s e r a h t tu in ic e k d h y r fa rce e o Ho ast em w p er ee at k h in c d r io th ev th re ilit t f th we er. o he ac an g n a

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07

Josh Karliner

With the tide of climate change in our wake, author Josh Karliner, warns that there is more to worry about than shrinking of the ice caps or the spike in annual temperatures. With the warmer temperatures brings viral spreading insects like mosquitoes, earth warms, and tics that are being discovered in new places on earth.

Between the years 2001 through 2007, the number of Dengue cases reported in Mexico have increased 600% - an alarming rate that should worry the rest of the world.

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He calls not only on the general public to make a stand in reducing emissions, but also challenges healthcare officials to step up and make their energy siphoning facilities more efficient. He refers to the power and influence that the healthcare sector had on the fight against cigarettes a decade ago. When leaders in healthcare banned cigarettes from their medical campuses and brought to light the risks of smoking, the general public jumped on board and supported their concerns. Karliner suggests that healthcare leaders must harness this influence and make their facilities energy efficient, in turn, leading to the support of the general public.

I had never considered the spread of mosquitoes and infection to be related to the increase in temperature. It is a scary thought to think that in just a relatively short period of time, there is potential that many places in the United States can be breeding grounds for these insects.

While I appreciate Karliner’s optimism in the influence of the healthcare system, I think that he is comparing apples to oranges.

The fight against cigarettes was a challenging fight, but it could be backed by indisputable evidence that smoking caused poor health problems no matter how the data was manipulated. There are lots of data studies about climate change but the data from these studies can almost be interpreted in more than one way. I believe that the healthcare system does have a massive influence on the general public, and hospital facilities have a lot to gain from becoming more energy efficient, but I find it hard to believe that healthcare will be the main driving force behind reducing emissions and our carbon footprint.

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Ad ve e rti w ho a se ur ke m m s a of en dr fte th tb e y y ains r th da Th ge o e y riv ts ne ve sto s fo e try ra rfl rm llo Pe in tor ow p w rm is g s e a in an w to an d w ss g t ha e d e en h i d e t t l nte th h , t K te ea r e w h a ac an en ate e h tri d h to d tir r, o na al ev e p th spi st an of th l o ac o e ta or d e f t ua we ho l lo m ju ab pa he te r sp s , M dg le ti en co al sys ita t po em e t o y d t nt l 1 te l b w o 2’ to sit s in ro 87 m eg er ria s, b u ve p in an re l ith th e p/ th rs at th t qu Ho le en ver wa e h y. ie e o th f y lk os nt b ta irin spit al ina ill ; 2 p s uil ke g al do lly . A ’s ita th di o us in at ng n e N se 3 ga wh l a w . wa of ew s ’s. in e nd er H t t of M st re c d e os er he O a p m t th be p b rl or any he ati teg e in ita lea ac ean ph 3 ge en or w pa l g k in ’s ne ts ize ith ti ca off din up s w e di r w d i g c r on a ent to ed all ho th ed ia to ge as ,“ r y es pla s w e w fo ls w th ner fac re ig ac e m -lo w n h r i e e at in lie ht ce re in se ho of o w n re fa or g t v a p o w s th fo ilu s. di e w te ic t si th h er s e r a h t tu in ic e k d h y r fa rce e o Ho ast em w p er ee at k h in c d r io th ev th re ilit t f th we er. o he ac an g n a

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08

Thrive Permanente

Thrive Permanente is an umbrella service that helps patients by serving as conduit between the different health sectors. The company has many different advertisements that illustrate how Thrive Permanente takes the hassle out of healthcare by bringing doctors, imaging experts, pharmacists, etc. under one roof.

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To me it is a strange concept to think of healthcare as a business.

In each of Thrive Permanente’s advertisements, they promote themselves as a company that can help you reach your health goals (almost as if you need them to reach your health goals).

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ne fit e s w of ho a k M ur e ob m s a of ile dr fte th e H a r y ins th da ea ge o e y lth s ts ne ve sto fo ,o try ra rfl rm llo n t o H in or w p w ol is g s e a in d” d a g t s w o n w s th ha e d e i d e t t l nte th h , t K ea r e w h a ac d an en ate e h trin h to d tir r, o a al ev e p th spi st an of th l o ac o e ta or d e f t ua we ho l lo m ju ab pa he te r sp s , M dg le ti en co al sys ita t po em e t o y d t nt l 1 te l b w o 2’ to sit s in ro 87 m eg er ria s, b u ve p in an re l ith th e p/ th rs at th t qu Ho le en ver wa e h y. ie e o th f y lk os nt b ta irin spit al ina ill ; 2 p s uil ke g al do lly . A ’s ita th di o us in at ng n e N se 3 ga wh l a w . wa of ew s ’s. in e nd er H t t of M st re c d e os er he O a p m t th be p b rl or any he ati teg e in ita lea ac ean ph 3 ge en or w pa l g k in ’s ne ts ize ith ti ca off din up s w e di r w d i g c r on a ent to ed all ho th ed ia to ge as ,“ r y es pla s w e w fo ls w th ner fac re ig ac e m -lo w n h r i e e at in lie ht ce re in se ho of o w n re fa or g t v a p o w s th fo ilu s. di e w te ic t si th h er s e r a h t tu in ic e k d h y r fa rce e o Ho ast em w p er ee at k h in c d r io th ev th re ilit t f th we er. o he ac an g n a

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09

Tina Rosenberg

Pulitzer Prize winning author, Tina Rosenberg discusses the impact that mobile technology has had on the world’s population.

With the number of cell phones exceeding the total population in many countries, mobile phones have the potential to greatly affect the quality of life for individuals all over the world. One way to do this is through the relatively new concept of mHealth where users can track health information, log medical issues, and receive health reminders.

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This is powerful technology that can greatly extend the life expectancy of many, but Rosenberg discusses that mHealth has many hurdles to overcome before becoming an effective tool.

She mentions that many people, especially those in third world countries (where this technology could have the greatest potential impact) does not have the infrastructure to support phone and data connections. Rosenberg also points out that even if there were wide range phone and data connections, the complicated interface could prove challenging since surveys have shown that many people of under-developed countries do not know how to make calls or send text messages.

I think that mHealth could be very beneficial to the world’s population but it is dependent on the fact that each individual have a mobile device which could be a stretch for those in first and third world countries alike. However, donation programs could work for to get mobile devices to those around the world. Once this happens, I believe that the ability to receive health information, tips, and reminders paired with the ability to track one’s own health, mHeatlh could serve on the front line for people’s health - eventually alleviating the overcrowded doctor’s offices and emergency rooms.

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H ea e lth bo ho wa ok ur ke ,A m s a of dr fte th pp e le y ains r th da ’s ge o e y Fi ts ne ve sto s fo rs tM try ra rfl rm llo t o in or w p w aj is g s e a in or d a g t s w o n w s St t ha e d e h ep t l nte th ith d, t e K e e w in h r a ad a e a e tr ac to nd nt ter ho in h he t i o a , r al al ev e p th spi st an of th th l o ac o e ta or d e h w l m f an u o l ju ab pa e t a o he te r sp s , M d dg le ti t s ita p e Fi en y c a e t o s o m tn y d nt ll 1 te l b ow o es 2’ to sit ts in ro 87 m eg er ria s, b u s ve p in an re l ith th e p/ th Tr H r e a q w t v ac sy ti he to u os le en er a h . en b ta iri p th f y lk os ki ng al ina ill ; 2 p ts u k ng ita do lly . A ’s ita ” th ildi e o us l in at ng n e N se 3 ga wh l a w . wa of ew s ’s. in e nd er H t t of M st re c d e os er he O a p m t th be p b rl or any he ati teg e in ita lea ac ean ph 3 ge en or w pa l g k in ’s ne ts ize ith ti ca off din up s w e di r w d i g c r on a ent to ed all ho th ed ia to ge as ,“ r y es pla s w e w fo ls w th ner fac re ig ac e m -lo w n h r i e e at in lie ht ce re in se ho of o w n re fa or g t v a p o w s th fo ilu s. di e w te ic t si th h er s e r a h t tu in ic e k d h y r fa rce e o Ho ast em w p er ee at k h in c d r io th ev th re ilit t f th we er. o he ac an g n a

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10

Mark Gurman

After dominating many sectors of the mobile and mobile application industry, Apple has now set its sights on healthcare through mobile fitness tracking via use of the iPhone. Codenamed Healthbook, Apple looks to revolutionize the way people track and record their health, fitness, and diet. Through Apple’s trademark easy-to-read, gorgeous interface, Healthbook offers users the ability to track fitness, nutrition, heart rate and blood pressure, oxygen saturation and blood sugar levels, hydration and respiratory rate, sleep, as well as emergency identification and contacts.

ee of en ct nd gro n. at ve he ty to he ev . er f th e ice w up - t tur th ryo w , e m , d ou s gr eet ey n or h n e he er o ld : 1 e st ou be s e w g c ll ho o he va hi nd lo th en tor req ’s w nk . w ul uld al cu c s a u e t d t t y p d ir re h, th Ev sea a b e e h at en e pp I d ow ci m th e l y th ro o th th ev w er ded ore ose e v n’ e o el er w t fir e. t t tra ug , I e as o st R hi ns h qu ex l n o a k o ne nk t fo ff es pe os h rm ici ti s i ri- t, a ou ng t t er als on s t t o hu he sh rep he f t ma ou or de he n ld ted sig ha th n ve at of be m the en aki pl ng ac ed

Endeavors such as Heathbook is just another (of many) examples of how technology can not only improve the quality of life but also the quality of health. Mobile technology shifts the responsibility of health back to the individual rather than making better health the responsibility of doctors and physicians. In doing so, users will be able to keep a better eye on their individual health throughout the year rather than relying on the emergency room when health conditions worsen - alleviating the already overcrowded emergency rooms.

MHealth has a great opportunity to help all people, particularly those who live in areas where doctors and/or hospitals are few and far between. The hard part would be figuring out how to get a mobile phone in the hands of those living below the poverty line or those who live in third world countries (where I believe that this technology could have the greatest potential impact).

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Ef fic e ie w ho a nc k ur e y C m s a of om dr fte th e es a r y ins th da to ge o e y th ts ne ve sto s fo e try ra rfl rm llo H os in tor ow p w is g s e a in pi d a g t s ta w o n w s t ha e d l” e h t l nte th ith d, t e K ea r e w h a ac d an en ate e h trin h to d tir r, o a al ev e p th spi st an of th l o ac o e ta or d e f t ua we ho l lo m ju ab pa he te r sp s , M dg le ti en co al sys ita t po em e t o y d t nt l 1 te l b w o 2’ to sit s in ro 87 m eg er ria s, b u ve p in an re l ith th e p/ th rs at th t qu Ho le en ver wa e h y. ie e o th f y lk os nt b ta irin spit al ina ill ; 2 p s uil ke g al do lly . A ’s ita th di o us in at ng n e N se 3 ga wh l a w . wa of ew s ’s. in e nd er H t t of M st re c d e os er he O a p m t th be p b rl or any he ati teg e in ita lea ac ean ph 3 ge en or w pa l g k in ’s ne ts ize ith ti ca off din up s w e di r w d i g c r on a ent to ed all ho th ed ia to ge as ,“ r y es pla s w e w fo ls w th ner fac re ig ac e m -lo w n h r i e e at in lie ht ce re in se ho of o w n re fa or g t v a p o w s th fo ilu s. di e w te ic t si th h er s e r a h t tu in ic e k d h y r fa rce e o Ho ast em w p er ee at k h in c d r io th ev th re ilit t f th we er. o he ac an g n a

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11

Julie Weed

This article accentuates the issue of access to supplies in hospitals all over the country. Weed explains several stories of nurses having to stash supplies in hidden drawers and cabinets just so that they’ll have the correct medical supplies when patients need them most. To remedy this problem, many hospitals are adopting LEAN methods to efficiently regulate the flow of medical supplies and time that nurses spend performing medical procedures. This ‘factory efficiency’ has reportedly saved hospitals millions of dollars in revenue and thousands of hours of time.

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I am still having a hard enough time viewing hospitals as businesses let alone viewing them with the efficiency of a factory.

It is strange to think about people visiting hospitals being exposed to the same techniques and efficiencies as those in a factory that produces automobiles. But the numbers do not lie.

Many studies have shown that hospitals that have utilized these methods have saved lots of money (that hopefully translates to lower procedure costs) and saved nurses miles of walking (leading to a better environment for them to work). I think that this mindset works really well in the hospital setting so long as it does not become to procedural. If too much emphasis is put on the procedure for many, the experience of the individual may drop dramatically.

Selected Notes and Vocabulary

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t th eual e b eat ha for ujums . A t-q tiv cr “W od tnrad ing em b es ec d go raet e los d th ulhdigh t-eff s an mtoh e c ee hothe t cos stake mnd ar at n s out mos er mi for e a ts th fe rns the ew es” s or en s li “It tu is ke f om an c .m tm itie n also ma outc tr alth y “.. par un a we tter ll he g be ica de mm um t ile kin coo h d.” ma ob rac “N ste .dra e m ss-t “.. g th tne wa

Construction cost of a hospital generally equals one year of operating costs - so hospitals are more concerned with lifecycle costs rather than construction costs.

Any electrical outlet or switch in a hospital that is red, means that it is connected to the generator.

Carle Hospital in Champaign has 96 hours of fuel to run emergency generators - they rely on tankers to supply more fuel (assuming that the road system is still usable in a crisis).

Emergency generators are typically placed in basements of hospitals because they are extremely heavy and exhaust large amounts of gas (requiring for them to be located near exterior walls).

Average price to construct a hospital in the United States is approximately $450 per square foot.

Small hospital = 1-100 beds, Medium hospital = 101-500 beds, Large hospital = 501 or more.

Large awnings outside of hospital entry doors are designed to serve as a decontaminating shower - fire sprinkler looking heads shoot water down so that people who might be chemically contaminated in a crisis can be decontaminated before entering.

Artwork, millwork, drapery, etc in hospital waiting rooms are spaced at proper bed spacing - many times artwork is on hinges that can open up to medical panels for nurses to use should the hospital need extra bed space.

Many old hospitals are demolished because of low ceiling heights - most equipment is suspended in the air (they want to minimize the amount of equipment touching the floor).

Ambulatory Care a personal health care consultation, treatment, or intervention using advanced medical technology or procedures delivered on an outpatient basis (where the patient’s stay at the hospital or clinic, from the time of registration to discharge, occurs on a single calendar day). It is the single fastest growing sector in the US health care industry.

Lean The Toyota Production System, which was developed from the late 1940s through the mid-1970s by top Toyota executives to improve the company’s manufacturing processes, is now used by numerous companies across various industries to reduce inefficiencies and improve the overall value of their end product to customers. Although originally developed for the manufacturing industries, the key goals of lean production — eliminating waste, valuing employees and continually improving — can be applied to service providers, such as hospitals.

Medicare a U.S. government program of hospitalization insurance and voluntary medical insurance for persons aged 65 and over and for certain disabled persons under 65.

Medicaid a U.S. government program, financed by federal, state, and local funds, of hospitalization andmedical insurance for persons of all ages within certain income limits.

Healthcare Network It is a group of physicians, hospitals and other healthcare providers that agree to provide medical services at pre-negotiated prices and rates. This often means significant savings for you. The larger your insurance company’s network, the more doctors and hospitals you can choose from.

Healthcare System organization of people, institutions, and resources to deliver healthcare services to meet the health need of target populations.

Acuity (High/Low) the level of severity of an illness. This is one of the parameters considered in patient classification systems that are designed to serve as guidelines for allocation of nursing staff, to justify staffing decisions, and to aid in long-range projection of staffing and budget.

Translational Research Scientific research that helps to make findings from basic science useful for practical applications that enhance human health and well-being.

ACO (Accountable Care Organization) A healthcare organization characterized by a payment and care delivery model that seeks to tie provider reimbursements to quality metrics and reductions in the total cost of care for an assigned population of patients. A group of coordinated health care providers forms an ACO, which then provides care to a group of patients.

Stent A stent is a small mesh tube that’s used to treat narrow or weak arteries.

Post-Anesthesia Care Unit (PACU) An area, normally attached to operating theater suites, designed to provide care for patients recovering from anesthesia.

Sterile Field An area immediately around a patient that has been prepared for a surgical procedure. The sterile field includes the scrubbed team members, who are properly attired, and all furniture and fixtures in the area.

Nosocomial (of a disease) originating in a hospital.