SUPER GREEN - the International Academy of Design and Health

effi ciency, reduce errors and injury, build in fl exibility, and improve thecontribution of architecture to a healing environment. “Throughout thisprocess, we needed to remind ourselves repeatedly that we are notbuilding with today’s technology in mind or even for the innovations of10 years from now,” Covert said. 2PPH’s process includes evaluations of cutting-edge technologies,including operating suite robotics, remote medical presence via rovingconsultation robots, personal RFID tracking devices, high-tech patientbeds and automated systems that monitor patient health status andmovement, LCD image and information panels in each patient room,and patient rooms that can be quickly reconfi gured to support rapidlychanging patient needs and advances in medical procedures.Shed burdensomeheritage...comefrom nowhere;change the game;innovate; and actThe innovation challengeA confl ict arises when selecting information and high-technology solutions for healthcare environments. Technological innovationsand developments occur at a pace that is more rapid than the architectural process. By the time a healthcare facility has beenplanned, approved, and built, several new generations of technologies may have been tried and tested.To meet this challenge, Orlando Portale, PPH’s chief technology and innovation offi cer, uses an approach borrowed from systemsdesign philosophy: “Shed burdensome heritage; put everything on the table; come from nowhere; fail early and small; embraceconstructive dissatisfaction; change the game; innovate; and act.”This approach considers not only products readily available today, but also looks to future systems at the ‘bleeding edge’ oftechnological innovation. This process builds a view of the future that can be used to formulate more informed and educatedguesses about changes in architectural infrastructure. Finally, the PPH strategy may include a delay of technology purchases untilthe last practical moment, so that innovations can beincorporated when the hospital opens in three years.The nature and risk of healthcare provision posesadditional challenges that arise when choosingtechnologies. The margin of error for medical technologiesmust be extremely low. An error rate of one may resultin one death or multiple injuries. However, old systemsimpose their own risks. Portale suggests that they canbe ineffi cient; at worst, deadly, including errors in surgicalorders, medication dosage or follow-up care.Testing technologiesUpdated information technologies and operationalsystems are thus being sought to reduce the vast amountsof information permanently lost because of outdated orpoorly conceived information transfer and managementsystems. Critical to the successful implementation ofany new system in a complex, high risk environmentsuch as healthcare, is the testing of technologies byinterdisciplinary planning and care teams in clinical unitsduring real-time, real-world healthcare operations or inmock-up conditions.PPH chief nursing executive, Lorie Shoemaker, recruitedstaff from across the hospital to participate in a userassessment of design concepts and to test some of thetechnologies on its units. For example, remote telepresenceis being explored in Pomerado’s intensive careunits, using internet and video conferencing via the InTouchHealth Kodak camera to review patient results from scansand images.A novel mobile robot is being tested as a means toprovide remote medical presence in several clinical areas.The terrace at the Palomar Pomerado Health’s ‘Hospital of the Future’WORLD HEALTH DESIGN | October 2008 35