Life has become increasingly difficult for me over the past 23 years, as different parts of my body have stopped functioning. I live with a progressive neuromuscular disease, which has forced me to use braces, a cane, a manual wheelchair and, most recently, a power chair for mobility.
As someone who experiences life from a wheelchair and who relies solely on others for many aspects of daily living, I have developed a keen sensitivity and unique perspective on navigating the day to day.
Everything is more difficult because of the challenges my disability brings. Access to various types of services is something I have become acutely attuned to; access to businesses, access to airlines, access to hotels and, perhaps most importantly, access to healthcare.
Don’t get me wrong, I have access to healthcare services, but access to healthcare facilities often leaves something to be desired.
Individuals with disabilities are the fastest growing minority group in the U.S., with current estimates at 56 million (Disability Statistics, 2014), not to mention the more than 30 million baby boomers set to retire by 2020 (Janger, 2011). Approximately 19 percent of the nation’s population falls into this group (with more to come).
With these numbers, why does access often feel like an afterthought or, in some cases, a burden?
Recently, I was performing some property accessibility assessments for some healthcare organizations and, in my observation, the simplest changes to plans would profoundly impact the patient experience.
During the assessments, I frequently encountered sidewalks/pathways, which I could access on one side, but had no exit point. This required backtracking and looking for another route.
Parking areas offered access to sidewalks via curb cutouts (which is nice) however, these curb cutouts were frequently so off center from the access aisle that they were not navigable in a wheelchair because of being blocked by parked vehicles.
Choice in carpet frequently presented difficulty. Heavy textures or inconsistent grooves make it very hard to travel in a straight line when using a walker, manual chair or power chair.
Another challenge — As I entered one facility through the main lobby, I immediately encountered a flight of stairs with no ramp access. In order for me to access the upper level, I was required to use a tiny lift off to the far side. As it ratcheted and loudly squeaked to the top, heads turned and stared. I felt embarrassed and like a head of cattle. Accessible? Yes, but definitely not optimal.
These are just a few examples of challenges people with disabilities face on a daily basis. I could go on about seemingly endless scenarios where ADA is met but functionality and equal access is executed poorly.
ADA is a godsend when it comes to providing accessibility here in the United States (outside the U.S. is another story) but, in my opinion, ADA is the floor, the minimum level necessary. Who wants to sleep on the floor?
The changing landscape of healthcare
In light of the growing number of Accountable Care Organizations, Medicare Shared Savings Plans, hospital comparisons through Hospital Consumer Assessment of Healthcare Providers and Systems and a growing number of at-risk contracts, hospitals and health systems looking to build new campuses or remodel existing locations have a unique opportunity to gain advantage over their competitors. With everyone being measured by the same tools, everyone is teaching to the same test … but that doesn’t have to be the case.
So how does a hospital, healthcare system or architectural firm gain a unique and significant advantage?
While universal design is nothing new, its being applied to healthcare is. Without going into the details of universal design, I believe there are three principles that, if applied to the design of healthcare facilities, could address many issues hospitals face with regard to patient satisfaction, the overall patient experience and the environment of care. These principles are:
1. Accessibility by design (prioritizing accessibility within the design process)
2. Broad accessibility (accessibility for the greatest number of people)
3. Added value (design that benefits both the disabled and able-bodied)
The key is to approach design from the position of the disabled community and not the perceived position of the disabled community. This means integrating the viewpoints and expertise from a person(s) with a disability within the design environment.
There are no substitutions for real-life experiences — regardless of the books read, the number of buildings built or the number of observations made. Integrating a person(s) representing the opinions of the disabled community within the design process can provide vast insight necessary to make projects successful.
Individuals with disabilities are experts at navigating life with their perceived limitations. Avoiding design flaws that give the perception “you are second class” is a critical step toward success in the ACO environment.
Meeting ADA requirements is often approached as simply a box to check off the list and, in some cases, an afterthought in the overall design execution. Looking at the accessibility of rooms, hallways, care areas and elevators from the perspectives of individuals with all types of disabilities, including limited mobility, vision impairments and hearing impairments, often provides a very different reality and one that should be heeded.
Perception is everything
Healthcare institutions cannot afford to ignore this patient population, and the architects/
architectural firms who embrace this population will be poised to better serve healthcare partners and clients.
Entryways that provide both stairs and ramps in a tasteful design speak volumes. “Whether you walk or roll, we welcome you with open arms and treat you the same.” Design that presents equal access invites both the able-bodied and disabled communities.
Buildings with quietness in mind create better healing environments. Sound is consistently an issue and can be terribly distracting, especially for neurosurgical patients, head injuries and those with auditory sensitivities.
Wide access and entryways used to be synonymous with handicapped accessible rooms, but, in hospitals, they provide better access for the healthcare team when moving patients, navigating bathrooms and dealing with multiple pieces of equipment.
This look at design could avoid unnecessary remodels and retrofits down the road, as well as help capture the millions of dollars up for grabs for healthcare organizations who best serve their patients.
Architects, designers and construction managers have the unique opportunity to impact lives that goes far beyond the physical environment. It is time to be proactive, not reactive. By embracing the accessibility experience, it is easy to go above and beyond ADA requirements, and it typically doesn’t cost anything more. But how you implement it makes a world of difference.
Janger, Michael. (2011). Baby Boomers: The New Disability Market. Retrieved February 28, 2015
Disability Statistics Annual Report. (2014). Rehabilitation Research and Training Center on Disability Statistics and Demographics.