In An Introduction to Inclusive Healthcare Design, Denise M. Linton and Kiwana T. McClung compile insights exploring how healthcare settings and services can be made more inclusive, focusing on equity, sustainability and accessibility. Although the multi-author, interdisciplinary nature of the book creates some inconsistencies in its methodology and structure, it will nonetheless be a valuable resource for those looking to comprehend the social drivers that produce health disparities and how to counteract them, writes Cathy Lazarus.
An Introduction to Inclusive Healthcare Design, a new book of collected contributions by a diverse group of authors from across the healthcare and design fields, is intended as a comprehensive guide to design and facilitation of safe, healthy, equitable, and inclusive healthcare settings across a variety of scales. This is a timely volume that adds to the background and knowledge about social drivers of health and the contributions to health disparities, which have been widely recognised in the US particularly.
The COVID-19 pandemic brought health inequality to the forefront across the globe: the unevenly distributed impact of the disease and its toll on healthcare systems was glaring as poor and marginalised communities faced higher risks and worse outcomes. The impact of environment, education, income, geography, adverse childhood experiences, disability, race, socio economic status are all examples of areas where inequality has been shown to have significant health impacts. The built environment, addressed in this volume, and the organisation of health services within it and within the community can enforce or mitigate those impacts. The editors and authors of this new volume offer insights into, and potential solutions to, this wide scope of issues across the chapters.
The underlying and consistent theme of the book is the focus on equity, sustainability, accessibility and the need for patient- and community-centred healthcare spaces, systems and practices.
The underlying and consistent theme of the book is the focus on equity, sustainability, accessibility and the need for patient- and community-centred healthcare spaces, systems and practices. The two editors represent the spaces of healthcare (Dr Linton) and design (Professor McClung) and they have recruited experts from nursing, emergency medicine (EMTs), architecture, industrial design, education, counselling, psychology, healthcare executives, university administration, DEI (diversity, equity and inclusion), and community planning to contribute chapters to the book. The result is a wide-ranging summary of inclusive practices in different settings, with a varied approach.
The book is organised into three parts: Part One: Overview of the Variety of Scales, Locations, and Types of Healthcare Settings; Part Two: General Principles for the Design of Equitable, Inclusive Healthcare Settings and Innovations in the Design of Healthcare Spaces; Part Three: The Future of Healthcare and Alternative Healthcare Situations. Part One has five chapters covering regional healthcare systems, health sciences centres and academic medicine, healthcare in hospitals, neighbourhood and ambulatory settings, and healthcare in the home. Part Two has seven chapters organised around the healthcare setting including healthcare environmental control systems and settings, the healthcare experience, planning and design for regional and neighbourhood settings, design for hospitals and health science campuses, for the ambulatory setting, for the patient room, and for residential spaces. Part Three has two chapters covering renewable energy and resilience and innovations in the design of devices.
The needs of this next generation of healthcare providers, particularly resident physicians’ need for places to eat, sleep, work, and gather, are integral to facility design in academic medical centres.
The chapters vary in length, detail, focus, organisation, and application. While all chapters include a conclusion and a list of references, only some include application exercises such as case studies, analytical exercises, definitions or glossary, “alerts” which are an application description by a community engagement expert, discussion questions, or key points and takeaways. For example, Chapter One on Regional Healthcare Systems (by Garold Hamilton) has an analytical exercise and a case study around team design of a hypothetical health system, challenging readers to apply the principles introduced in the chapter. Chapter Seven on The Healthcare Experience (by Kristi Anderson) includes a case study on the role of learners in the healthcare environment. While not all health facilities or systems include learners, when they do, the needs of this next generation of healthcare providers, particularly resident physicians’ need for places to eat, sleep, work, and gather are integral to facility design in academic medical centres. Chapter Eight on Planning and Design Principles for Healthcare Settings at the Regional, City or Town, and Neighbourhood Scales includes a helpful table of key concepts and a glossary. Chapter Nine has an example written by Alexander Lazard that adds a welcome community perspective in the context of the Americans with Disabilities Act (ADA). The Chapters with application exercises are more effective than those that are merely descriptive. Some chapters take an international perspective while others are more locally focused. The inconsistency in the chapters was distracting if the intention is to use the entire book for teaching rather than selected excerpts or sections.
There is considerable redundancy in the content of the chapters. Reinforcement of the importance of applying universal design principles, of social drivers of health, of community engagement, and of patient centeredness is critical, but it seems to happen circumstantially rather than deliberately. Rather than being used consistently as a theme to link the chapters, it appears to have been left up to the individual contributors to determine what content to emphasise. There is unevenness in what and how topics are covered by each author, with some choosing multiple examples without a clear organising theme. Chapter Nine on considerations for ambulatory settings has content spanning inclusive design, the need for more diverse EMT workforce, and the needs of special populations with aging and autism spectrum disorders as the two examples. All of this content is important, but its lack of a clear structure and focus made it difficult to follow the flow of the chapter. Conversely, some chapters adopt a more cohesive structure with clearly articulated points and examples. Chapter Twelve, The Design of Residential Spaces for Healthcare by Kiwana McClung is a well-organised chapter with clearly identified key concepts, accompanied by a case example. Each chapter is extensively referenced, which is good, but there is no cross-referencing between chapters which could have made the book more coherently organised.
The book is a tool to spark thoughtful and critical engagement, particularly if taught by faculty from different disciplines.
The book is a useful one for academic spaces that seek to teach interdisciplinary coursework relating to health and design. It could be useful to bring students from pre- health and health- related, architecture, engineering, human systems, environmental and urban planning, health care administration, international development, health policy, disability studies, to name only some of the many fields with an interest in and an important role to play in the future of health and healthcare regionally, nationally and globally. It is a tool to spark thoughtful and critical engagement, particularly if taught by faculty from different disciplines. Health is a universal interest for the future of individuals and the planet, and we desperately need to bring the best minds together to solve complex and existential threats. This book is a contribution to that effort.
- This review first appeared at LSE Review of Books.
- Image credit: PongMoji on Shutterstock.
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- Note: This article gives the views of the reviewer, and not the position of USAPP – American Politics and Policy, nor of the London School of Economics.
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