Patient-centred and technological-centred approaches : patient room adaptability solutions

If the progressive process of humanization of the hospital and of the socio-health structures has led to the transition from the biomedical approach to the bio-psycho-social one, shifting the attention from the disease to the individual as a whole, technological advances (IoT, AI, robotics) are leading to a further reorganization of hospital structures and the birth of new highly original and relevant forms of interaction aimed at the “medicalization of life”. The paper addresses one of the main challenges that all of us – technicians, health professionals, scholars – are called to face which is to combine the dualism between “Technical Progress” and “Humanization” through a dialogue/comparison between patient-centered vision and vision centered on the bio-technology of care spaces. The prospect of convergence between the two approaches, within hospitals, can be expressed in the hospital room, which represents the place the patient interacts with most and the one in which activities related to personal and private life are conducted; at the same time it constitutes the space in which patients are given treatment and their state of health is monitored. In particular, the field of biomedical technologies allows us to configure the Patient Room as a real Bedside Point of Care, that is a care model that reduces the patient’s movements so as to reach interventional and imaging technologies, making each room the hospital’s spatial and clinical ‘centre of gravity’. Bibliographic research (120 selected papers) has shown that patient room models that adapt to the complexity level of the disease – known as Intensive Care Patient Rooms, Acuity Adaptable Rooms, and Universal Bed Care Delivery Models – are the main trends in patient room design and involve considerations on the layout of the entire functional area of the hospital. Starting from an analysis of the main critical issues concerning the traditional spatial/organizational solutions of hospitalization from which the first reflections on people-centred models (patient-centred, family-centred, medical-staff-centred) have been derived, the paper identifies three main thematic axes with respect to which different organizational/spatial/technological solutions are analysed to optimize the ‘flexible room’ model: 1) adapting the hospital room to the level of complexity of the pathology; 2) balancing the technological complexity with the human dimension; 3) improving the organization of staff work through decentralized nursing stations. For each strategic axis, case studies have been identified, representative of the design trends, analysed in their criticalities and peculiarities with respect to the possible users (patient, visitors and medical/assistance staff). Evaluation/verification of the solutions of the three thematic axes with respect to the points of view of the different users constitutes the element of originality of the contribution, which does not aim to define the characteristics of an absolute spatial/organizational model but, to provide a framework of design alternatives that can be selected based on the priorities and specificities of the hospital’s economic, social and environmental contexts. The solutions and alternatives analysed to improve the patient’s room show that the physical environment can lead to positive results in terms of well-being (for users and operators); staff productivity (workflow); clinical safety (prevention of medical errors, incorrect application of therapy, contraction of nosocomial in fection), psychological and physical safety, (prevention of medical errors, application of therapy, contraction of nosocomial infection and reduction of stress factors). However, the future research spaces in this field are ample, and the possible scenarios of use concern the development of tools for ‘verifying’ the adaptability of existing hospital structures; for ‘guidelines’, useful for public administrations in drafting innovative tenders for the construction of new hospitals; for ‘support’, for hospital strategic management and professionals to orientate actions towards new or existing structures, also through the use of simulation systems (Digital Twin) capable of verifying the possible transformation scenarios with the impacts on staff productivity, on the clinical safety/well-being of the patient and on accessibility to treatment.