2006 AIA Guideline Revisions Usher in New Era of Healthcare Design

The American Institute of Architects (AIA) National Committee Review Board just passed the 2006 Revision to its Guidelines at the annual meeting held this year in Irvine, California, ushering in a new era in healthcare design. This latest revision includes a major new change to the Guidelines for the Design and Construction of Hospital and Health Care Facilities (Chapter 7)--hospitals are now required to create single-bedded rooms for all new construction projects. The key factor in this decision was the need to uniformly provide private and comfortable healing environments for patients. 

"Single-bedded rooms have advantages for hospitals, in terms of creating a private and dignified therapeutic environment, as well as from an occupancy perspective because there does not need to be any bed loss due to segregation of the sexes," said William Selan, AIA, Principal of RBSD Architects, who serves on the Review Board responsible for revising and updating these Guidelines.  

This was not the first time that the Review Board had deliberated on making all-private patient rooms the standard for new hospital construction. In 2001, the requirement for single-bedded rooms was championed by J. Armand Burgun, AIA, Chairman Emeritus of RBSD, based upon the belief that it is unnatural to force patients to lie side-by-side with complete strangers during a time when they are feeling the most pain, anxiety, and stress. As Parlaimentarian of the Revision Committee during the 2001 Revision Cycle for the Guidelines, Mr. Burgun authored the proposal for all-private rooms, arguing that the patient experience within the standard double-bedded room was not conducive to the healing process and patient dignity.

In 2001, the Guidelines Committee did not adopt the resolution for single-bedded rooms, fearing that requiring all-private rooms in hospitals would make new construction and major modernization projects cost-prohibitive. Since that time, however, the healthcare industry has embraced evidence-based design, which maintains that patients' health can be improved by the environment, especially through such factors as privacy, lighting, and connection to the outdoors. Recently, major hospitals in the Midwest and Western U.S. have been leaders in implementing evidence-based design and all-private rooms, demonstrating that Mr. Burgun's once radical suggestion to make private rooms the standard is both desirable and practical. It is only fitting that the guidelines that Mr. Burgun suggested several years ago were finally implemented this year, his last year before retiring from  his role on the Guidelines Committee.

The new guidelines will pose interesting challenges for architects in terms of designing facilities that take up more floor space, but are still efficient to operate. "Single-bedded rooms increase privacy and comfort for patients, but right now increasing the number of rooms also increases the travel distances for medical personnel as well as the potential to make their jobs more difficult," said Mr. Selan. Now that the Guidelines mandate single-bedded rooms, the challenge for architects is to create a nursing unit configuration that makes sense and mitigates travel distances for staff. By incorporating new technology such as wireless charting, as well as nursing sub-stations, we can achieve some of these goals. But architects will be challenged to find innovative ways to design efficient patient floor layouts for the new generation of hospitals that will be constructed using the latest Guidelines."

Although private rooms have already been adopted by many hospitals across the U.S., in urban areas, cost and space restraints may seem to pose an insurmountable burden to building new facilities with private rooms. The Guidelines Committee recognized this potential hardship, and has included in the 2006 Revision the potential to waive this requirement if a facility can prove that the cost is inordinately burdensome.

"Building all-private rooms might not be practical in urban areas where available land is scarce and at a premium," acknowledged Mr. Selan. "If a hospital can prove hardship, such as excessive cost and/or lack of space availability, and obtain the approval of the local authority having jurisdiction, then the hospital will be allowed to find alternate means to provide privacy and a healing environment within a double-bedded room configuration."

Another accomplishment of the 2006 Revision to the Guidelines was that the Sub-Committee responsible for Guidelines for Long Term Care Facilities wrote three new chapters to address Assisted Living Facilities, Adult Day Health Care, and Hospice Facilities. "These new chapters provide national standards that had not previously existed for these specific types of facilities, which are becoming increasingly important components of healthcare," said Mr. Selan, who worked on this sub-committee to develop the new standards for these areas.