Hrev_master [page 20] [Healthcare in Low-resource Settings 2023; 11:11183] Improving healthcare value: integrating medical practitioners into hospital design in developing countries Carlos Machhour Noujeim Port Harcourt Government House Clinic, Nigeria Abstract The cost of healthcare is a burden in most developing countries, and this is expo- nentially increasing in the context of popu- lation growth, pandemics, and rapidly evolving medical necessities. A customized healthcare typology should rely on data col- lection and architectural requirements, before moving to aesthetically compelling designs, so hospitals in low-resource or developing countries will not mimic their Western counterparts. The greatest bearing that improves the patient’s outcome and well-being would engage a productive interaction between the hospital designers and the medical practitioners, this will also allow for evidence-based hospital planning. As the author of this short report, I use the best of my experience as a physician and healthcare planner to translate a successful interaction with multinational designers building hospitals in Rivers State, Nigeria. Introduction Most developing countries are affected by a sort of healthcare turmoil as rapidly growing populations and aging groups put more pressure on the medical system, there- by, unmasking the healthcare point line deficiencies and the typologies of their facilities. This continuous struggle is out- lined by the lack of sustainable means for expansion, but mostly by economic gover- nance, funded development, and the scarci- ty of resources. Adaptivity through the merging of archetypes with the local envi- ronment and medical needs In challenging conditions, it is important to embrace a seamless balance between a myriad of factors for economic evidence- based hospital planning. To answer this, a hybrid model for good design principles should rely on a multidisciplinary collabora- tion between the featured architectural team, engineers, and healthcare practitioners. It is important to understand the indigenous cul- ture tightly knit to the community, the natural environment of the facility, the disease epi- demiology, and the frequent medical encoun- ters in that area, as well as many other met- rics that only medical staff would advocate for a shaped design solution, thus improving the patients’ experience and the staff’s post- occupancy adeptness. Such a blend of expertise would con- tribute to a flexible archetype, a sustainable economic and practical design that resembles the area and fits its essentials. Before moving to aesthetically compelling designs, the com- plex healthcare typology will be subdivided according to data collection and architectural requirements, so hospitals in low-resource or developing countries will not mimic their Western counterparts. In other words, designs should capture the local and national dynamics rather than being a duplicate of standard layouts implemented abroad. This rule also applies to other scenarios such as the renovation of a health institution or its expansion due to demographic factors or the occurrence of a new pandemic, as in COVID-19 case. This interdisciplinary atten- tion would avoid redundancy and obsolete layouts, moving forward. A healthy design will rely on environ- mental analysis, collected through inter- views and on-ground assessment. It can be surprising to see how much input doctors, nurses, and the rest of the medical staff can provide, sometimes showing little sketches to back up their ideas. Small interferences like that can summarize years of practice or mirror a patient-centered experience. The concluded design will be an active under- standing of the sociocultural norms and par- ticular medical needs, thereby a solution that enhances these attributes. A certain infrastructure may limit the implementation of a standard design and this is common in developing countries. For example, it would be difficult to maintain an energy-intensive air-conditioned facility where frequent power outages will cause a monetary setback for generator usage. The solution is a customized design typology that includes climate analysis and alternative ventilation strategies. Natural wind aeration, ceiling fans, window distributions, or open- ward layouts are used to accommodate that challenge, and here comes the importance of the hybrid integration of medical practition- ers in such decisions. Airborne transmitted diseases have different epidemiology as compared to Western countries; for example, Tuberculosis prevalence and spread are more common, as are many other viral-related ill- nesses, such as COVID-19 or Ebola. That feedback will better adapt the ward planning before building the hospital or expanding a specific space, moving toward a more decen- tralized layout with partial or completely iso- lated rooms and individualized ventilation.1 When pandemic infections are not a major concern, as in some specialized centers that only get precise referrals, for example, women’s health and wellbeing centers, other variables account for the care delivery. With skyrocketing birthrates, the healthcare sys- tem in developing countries is focusing more on delivery and pediatric services, which is lowering mother and infant mortality. This should be done along with an increase in the medical staff-to-patient ratio and amenities to accommodate that, which is a serious chal- lenge in rural areas. Patient-centered care and well- being: natural light, noise reduc- tion, mobility spaces The input of the medical practitioners will also help when it comes to building a facility in a highly prevalent area for traffic accidents and major injuries. This feedback will shape the emergency department layout Healthcare in Low-resource Settings 2023; volume 11:11183 Correspondence: Carlos Machhour Noujeim, Chief Medical Director, Port Harcourt Government House Clinic, Old GRA, Port Harcourt-500241, Nigeria. E-mail: carlosnjeim@hotmail.com Key words: hospital design, developing coun- tries, medical caregivers, health outcome. Conflict of interest: the author declares no potential conflict of interest. Availability of data and materials: data and materials are available from the corresponding author upon request. Received for publication: 20 January 2023. Accepted for publication: 24 May 2023. This work is licensed under a Creative Commons Attribution 4.0 License (by-nc 4.0). ©Copyright: the Author(s), 2023 Licensee PAGEPress, Italy Healthcare in Low-resource Settings 2023; 11:11183 doi:10.4081/hls.2023.11183 Publisher's note: all claims expressed in this article are solely those of the authors and do not necessarily represent those of their affili- ated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guar- anteed or endorsed by the publisher. No n- co mm er cia l u se on ly [Healthcare in Low-resource Settings 2023; 11:11183] [page 21] into an easily accessible area that facilitates the unloading of major casualties and includes wider aisles and a larger storage shelf area, in addition to a triage room that helps in a better allocation based on the severity of each case. When it comes to the patient’s comfort and quality of life, both for inpatient and ambulatory care, storytelling is countless. Especially when evidence-based medicine backs up the input of the medical practition- er. By providing access to natural light, through abundant windows in closed criti- cal areas or regular wards, an overall agree- able healing environment will pay for a bet- ter well-being and outcome. As part of a non-pharmacological approach for hospital- related delirium or mental status fluctua- tions, a controllable lighting feature or the use of daylight shading devices will also help to regain a physiologic circadian rhythm.2 This condition is a real challenge for medical caregivers, and it is through their feedback and experience that design- ers can optimize the layout. Many other metrics can be better understood when such collaboration occurs; this positively impacts patient-centered care. Noise reduction especially in critical care units is essential. It can be achieved by minor technical fitments related to the patient’s room and surrounding space, but also by redesigning the staff working areas and break room access. A watchful decen- tralized working station can be considered in line with the standard guidelines for hos- pital design. It is also very important to communicate with the practitioners con- cerning the choice of the medical equip- ment in the pre-commissioning phase, as some have a threshold for beeping and buzzing and should be fixed according to the on-ground team.3 Additional scientific data has proven the need for the early mobilization of high- risk patients, whether in critical care units, regular medical floors, or post-operative care units.4 This will minimize the muscle wasting in their catabolic state and also reduce the occurrence of delirium, which will improve their outcome and shorten their hospital stay. The medical staff along with physiotherapy personnel are best posi- tioned to advocate for dedicated spaces and hallway changes to reach that purpose. A standard design where the bed is the focal point and the room is built around it will be modified to accommodate minor rehabilita- tion activities or a small porch can be added to the room where the patient will have space for movement. Some efficient modifi- cations were also pledged for in medical lit- erature, such as adding measurement signs and walking aids along corridors, which will assist the patients during their activity. Customized furniture and pallia- tive care regulations Also, medical practitioners can be directly engaged in furniture and amenity selection. For example, in units that care for lung diseases, a practical input is about hav- ing a splash-free sink and a sputum basin right next to it, this is in line with infection control directives. Another input would be having chairs with adequate reclining angle, so patients can breathe better. This also con- cerns the examination room where elderly people with limited functional status can be evaluated on these recliners. Doctors will also determine the exact position of the examination couch and the wall-mounted diagnostic sets in a specific consultation room to ease the physical examination of the patient. In developing countries, nursing homes or chronic care facilities are scarce. With the growing geriatric population, the philosophy and need for palliative care are becoming prevalent. According to studies, unfortunately, the risk of falls is not only limited to the patient’s room: one-fifth of falls occur in diverse spatial areas.5 To create a safer environment for the patients, special consideration and insight call for collabora- tion between the healthcare designer and the caregivers. It also positively develops com- prehensive hospital signage, whether direc- tional or informational, as part of the wayfinding system that will assist the geri- atric population in seeking medical care. Staff-centered modifications to cut burnouts A big neglected topic concerns staff- centered care where designs prioritize the patient’s comfort and discretion. Multiple published medical data reviewed the burnout of hospital staff, which may affect the care delivery and overall outcome. With increased stress due to work overload, infectious pandemic constraints during COVID-19, or scarce hospital amenities, staff members are more vulnerable to phys- ical, mental, and emotional exhaustion.6 This leads to job discontent and poor pro- ductivity. Some healthcare designers have moved to a decentralized model where smaller work areas are dispersed throughout the ward, individual care is better provided, and nurse stations are on wheels, with less noise and within walking distance. This model is supported by easy access to break rooms or even the inclusion of small alcoves that have reclining chairs and smartphone chargers, enough to revitalize the nursing staff. With the current medical practice, the need for computer access is crucial, and it can be attained in large multi- disciplinary workspaces or lounges where medical staff can also interact and rest. Future trends in healthcare set-up A better understanding of the medical trends over the years will leave a lot of unsolved challenges for the healthcare sys- tem in developing countries, as it will be even more difficult to cope with the rapid pace of technology and visionary develop- ment process. The provided medical care can be shifted to a more flexible universal design where patients of different ages and abilities can be better served. Another path to improve wellness and health would focus on a strong infrastructure for medical home care, keeping the hospital setting only for acute critical cases. References 1. Stiller A, Salm F, Bischoff P, et al. Relationship between hospital ward design and healthcare-associated infec- tion rates: a systematic review and meta-analysis. Antimicrob Resist Infect Control 2016;5:51. 2. Lee HJ, Bae E, Lee HY, et al. Association of natural light exposure and delirium according to the presence or absence of windows in the intensive care unit. Acute Crit Care 2021;36:332- 41. 3. De Lima AE, Silva DCDC, de Lima EA, et al. Environmental noise in hospi- tals: a systematic review. Environ Sci Pollut Res 2021;28:19629-42. 4. Zang K, Chen B, Wang M, et al. The effect of early mobilization in critically ill patients: a meta-analysis. Nurs Crit Care 2020;25:360-7. 5. Anderson DC, Postler TS, Dam TT. Epidemiology of hospital system patient falls: a retrospective analysis. Am J Med Qual 2016;31:423-8. 6. Mollica RF, Fricchione GL. Mental and physical exhaustion of health-care prac- titioners. Lancet 2021;398:2243-4. Short Report No n- co mm er cia l u se on ly