Thomas Jefferson University

Improving patient outcomes by design: architecture’s role in healthcare outcomes

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Project Summary

Africa’s underdeveloped healthcare infrastructure is overwhelmed by rapid urbanization and population growth, marking an acute humanitarian crisis that affects patients from infancy to end-of-life care. Better design with faster construction of resilient, sustainable facilities can mitigate the lethal combination of overcrowding and lack of adequate services worsening with population growth. We will establish a collaborative health and design research centre at the University of Malawi, provide a framework for resilient healthcare infrastructure development, construct proof-of-concept facilities at all tiers of care, and evaluate/refine context-specific impacts for design, construction, usage and life cycle of African’s healthcare infrastructure. Our collaborative healthcare-informed architectural research and design will create facilities that are environmentally, economically and culturally resilient, advancing patient-centered healthcare delivery for 20 million Malawians as a replicable model. Measurable impacts include patient outcomes, worker satisfaction, rate of delivery, improved sustainability and building performance. We will produce a replicable model for global use in

Problem Statement

Africa’s underdeveloped healthcare infrastructure is overwhelmed by rapid urbanization and population growth, marking an acute humanitarian crisis that affects patients from infancy to end-of-life care. Many of these challenges are human resources based, e.g., Malawi has 1 doctor for every 50,000 patients, compared to a 1:370 ratio in the US. Architectural and infrastructural challenges are even less well-researched and funded. Surgical centres have the highest cancellations in the world, often due to inconsistent electricity and water access. African patients are at higher risk for airborne nosocomial infection due to poor ward design. Maternal mortality, impacted by environmental and architectural issues, is estimated as 634 deaths per 1000,000 live births; overcrowding worsens quality of care and increases cesarean-section and post-partum sepsis rates. Nearly half of Malawi’s population is under the age of 14, demanding more pediatric-specific facilities, which are slow to build and difficult to maintain. In emergency and trauma, mass casualty events overwhelm physical infrastructure. Africa needs 100,000 new health centres by 2050 to reach 2.5 billion people. In Malawi, the plan to build 250 centres will take a decade at the current rate. Better design with faster construction of resilient, sustainable facilities can mitigate the lethal combination of overcrowding and lack of adequate services. With a population estimated to double in 30 years, Malawi is at a critical juncture where architectural design policy can catalyze sustained healthcare network growth. Healthcare-informed architectural research and design will create health centres that are environmentally, economically and culturally resilient, directly impacting 20 million

Solution Overview

Determining long-term strategies for healthcare development in Malawi expands upon our interdisciplinary research – examining patient and staff experiences directly, to advance the evidence base and inform design decisions. We will establish a collaborative health and design research centre to research, test, design, build and evaluate future healthcare facilities. Together, we will provide a framework for resilient healthcare infrastructure and development, constructing a proof-of-concept health centre (catchment area: 10,000), that will be evaluated to refine context-specific impacts for the design, construction, usage and life cycle. Health-informed design strategies will immediately measurable impacts on people, processes and places. We will directly improve patient outcomes, health worker efficiency, and patient/worker satisfaction (users). The rate of delivery (construction pace) will increase, with improved sustainability of building materials, and enhanced building performance (reduced demand for grid-based electricity and water resources and improved indoor air quality.) Informing the design of 250 new health centres in Malawi will improve the health of 2.5 million people over the 5-year grant period. The Research Centre will continually produce a pipeline of architects and healthcare workers with the expertise required to continue to advance our ambitious charge. Building the engine of sustainable development will stimulate new building industry – creating more responsive and efficient construction. We will produce a replicable model to be deployed globally in other low-resource settings, from rapidly developing urban India to the rural U.S.

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Project Funders

  • Fulbright Scholarship 2017
  • Malamulo Adventist Hospital

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