advertisement
advertisement

Hospitals can make racial disparities even worse. It’s time to change how they’re built

Black and brown Americans’ mistrust of healthcare is rooted in decades of discrimination and neglect. Can inclusive design make a difference?

Hospitals can make racial disparities even worse. It’s time to change how they’re built
[Source Photo: peterspiro/iStock]

For healthcare organizations, a new architectural project is more than just a building update. It’s a fresh start, an opportunity to address both spatial shortfalls and operational shortcomings. It’s also a time to improve performance and, more importantly, to correct ongoing failures in patient care.

advertisement
advertisement

But all too often these buildings themselves become sources of distrust and impediments to care. Inclusive design could begin to remedy that if designers and health systems bring in more voices from the outset—and are willing to implement the suggested design changes.

This is critically important as the U.S. continues to battle a pandemic that has revealed stark and persistent racial disparities in health coverage, chronic health conditions, mental health, and mortality. These gaps in health delivery and outcomes reflect larger, society-wide inequalities in income, wealth, employment, and education. Building facilities that are truly community oriented can be a step to bridging these gaps.

A cycle of mistrust

Surveys conducted by the Kaiser Family Foundation have documented racial and ethnic trust gap for decades, which is particularly harmful as it erodes the public trust required to fight disease. One-fifth of Black respondents to Kaiser’s most recent poll reported personally experiencing race-based discrimination in healthcare within the past year.

advertisement
advertisement

Distrust feeds into underutilization of services, which leads to worse health outcomes and further suspicion. The cycle continues. Hospitals and outpatient centers play a role in this cycle through their physical, operational, and psychological positioning.

When we design a healthcare facility, we do so with the goal that it will function effectively for the full lifespan of the building: typically 50 years or more. To accomplish this, designers and healthcare organizations assemble a range of design contributors and healthcare professionals to work “on behalf” of the ultimate-end users: the patients and their families, and, by extension, the wider community.

Unfortunately, something is often lost in translation, as new or renovated health facilities engender neither confidence nor enthusiasm in their communities. The result is that people with the most at stake in the outcome of a design often have the least amount of say in its process. Too often, things like donor recognition—in the form of a feature wall, inscription, or signage—are prioritized over communal context, creating public spaces that don’t engage with the larger cultural site.

advertisement

I’ve witnessed this in my largely Black and Hispanic neighborhood in Brooklyn, as large architectural projects tend to appear out of the blue with little input from the community. People in minority neighborhoods grow accustomed to—and jaded about—living among building projects foisted upon them by uncaring institutions. This disconnect is one thing when it is condos or office towers, but it’s a whole other problem when it’s healthcare. A healthcare facility that doesn’t connect with the minority community it serves only exacerbates the existing problems within the system.

[Image: ismagilov/iStock]

How to break the cycle

Both public and private healthcare systems update their campuses as a form of viability and survival. Across the nation, we’ve seen what happens to systems that cannot innovate enough to compete. They close their doors for good, which impacts more than just community health.

By relying on siloed and limited project teams to inform design, healthcare organizations can miss opportunities to make systemic changes within their communities. In building out or up, they can do more than just bolster their branding, extend market reach, and draw more privately insured (i.e. better paying) patients. They can enable real change.

advertisement

But this requires a sustained commitment to trust-building, particularly at moments when the objectives of the project and the community may seem to diverge. There is no one-size-fits-all solution, so creative problem-solving is essential. Design teams, including architects, engineers, and urban planners, can start by approaching projects with a wider lens. What does the socioeconomic data say of the neighborhood’s existing public health shortcomings? What do we know about people’s diet, language, and culture? Beyond existing information, what can the people themselves tell us about their physical and mental health and needs? In other words, how can we involve the community in a way that establishes trust and ensures the success of the hospital for the decades that follow its ribbon cutting?

We can broaden the definition of “consultant” to include local arts, environmental, educational, political, ethnic, and religious organizations. Members of these groups have a wealth of local, specified knowledge and history that can inform and elevate our collective design work.

Patient and family focus groups also can expand to include more than just the small subset of go-to people who administrators tap for periodic input. Survivors, support groups for chronic conditions, therapy groups, and formal and informal wellness groups are trusted, established patient resources that already connect the health organization to the community. Through their contributions, healthcare projects can be improved and better linked to the community living just beyond the hospital walls.

advertisement

Effecting change

Today, as the U.S. recovers from its biggest health crisis in modern times, we stand at a crossroads. We can continue with the same formula—the one that sows doubt and misgivings by providing one population with quality healthcare and another with substandard care.

Or we can make the tough, yet simple, decision to rebalance our priorities. Instead of focusing exclusively on the finished product of the healthcare facility, we can take a deeper look at the process and whether that process builds trust by aligning itself with the needs of the community.

Nsenga Bansfield is a healthcare architect for HOK in New York. Her design work over the past two decades has helped shape private and public healthcare institutions across the country.

advertisement
advertisement
advertisement