from the Article Sunny Disposition

Day-lit Operating Rooms, Commitment Rules and a Case Study

from the Article Sunny Disposition
from the Article Sunny Disposition

A few articles on healthcare caught my attention this week.Two are about architecture and one is about the policies surrounding commitment for mental illnesses.

Sunny Disposition by Green Health Magazine 

In one of my LinkedIn groups, someone asked whether or not having naturally lit Operation Rooms was beneficial. It sparked a whole series of comments from various designers, including one who pointed to the article Sunny Disposition, by Nancy E. Berry. (The first photo of an 1800’s OR suite is stunning for its simplicity and how effective natural light is.) She illustrates a number of points, highlighting a

“a survey conducted at a new medical center incorporating many daylight-enhancing features (such as atriums and windows in patient rooms and operating rooms) that examined the impact of natural light on staff satisfaction. The study found that 43 percent of the staff rated the increased natural light in the new facility as having a very positive impact on their work life, and 27 percent rated it as having a positive impact (Mroczek, Mikitarian, Vieira, & Rotarius, 2005).” (Berry, Sunny Disposition)

The members of the group illustrated a number of issues that affect operations in lit environments.

  • Does the architecture accommodate the change in climate with changes in the natural light?
  • Is there visual privacy when required (such as blinds within the glazing)? Is the glazing thick enough (3 layers of glass) to adequately temper the environment both for climate and for bacteria?

In my first work term (more than a decade ago) I updated drawings for a hospital in the maintenance and cleaning staff department. We were constantly fed phone calls from the OR asking for the room temperatures to be turned up or down a degree or two.

  • Can the temperature be controlled by the OR staff members, so they can customize it directly from the room itself?

Changi General Hospital Case Study by EDAC

The Center for Health Design (EDAC) released a new case study this past week on the Changi General Hospital (pdf). The new project deals with the “Silver Tsunami – the rapidly growing population of elderly patients”.

Among other changes, the project took 8 and 12-bed patient rooms and restructured them into 5 patient rooms with common spaces, family areas and outdoor terraces. The new units are very interesting, considering the hospital’s mandate to help patients live normally, like they would at home. Would patients live in 5 bedroom suites at home? Here in North America, it might be considered too densely packed by our standards, but I hope there’s more information on how EBD led to this design.

Committing a mentally ill adult is complex by USA Today

I’ve seen articles similar to this in Toronto, dealing with teenagers who have mental health issues and the parents who can’t get the support they need due to funding cuts, but this is the first article I’ve seen asking for general changes to civil commitment laws.

I didn’t know until reading the article that:

“All states generally require (someone) provide clear and convincing evidence that someone is imminently dangerous to themselves or others,” Gold says. And “imminent” is typically interpreted to mean the past 24 to 72 hours.

So under certain circumstances, a person who threatens to stab his mother often may not be committed against his will, even if he has stabbed her in the past, Gold says, if the most recent threats occurred more than a few days ago. “You can’t commit them. You can’t get them into treatment. You can’t even hold them for observation; it’s considered a violation of their civil liberty.” (Liz Szabo, USA Today)

Is this also true in Canada?

It’s a sensitive topic for a number of people. Often the patients don’t think they need nor want help, and as an adult, no one can commit them unless they have power-of-attorney. And it affects everyone from seriously disturbed people, teenagers with no control, and seniors with dementia.

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I’d love to hear from you. What are your thoughts on the articles I’ve linked here?

2 thoughts on “Day-lit Operating Rooms, Commitment Rules and a Case Study

  1. Hi Heather.
    This is a great and relatable post. 🙂

    Both my parents are/were surgeons and mom is still a practicing anesthetist. Her hospital OR rooms don’t have any natural sunlight because modern digital instruments are sensitive and carry a risk of complications if the conditions they are used in aren’t controlled and sun light is a highly uncontrollable factor. There can’t be any chances taken with a patient’s life. I can see the privacy issue and the good health from natural light issue as well though. It’s a bit of a two sided coin, isn’t it?

    The second issue…Canadian laws suck! I have a dangerous, clinically diagnosed, psychotic cousin off meds. She’s a menace and a threat, and my children and family have learned to fly very low under her radar. Her response to police intervention has been to set a fire in the house, has done this 3 times, and no amount of court proceedings will institutionalise her because she is functioning in a normal manner , keeping her rent payments on welfare and with her late mother’s money and keeping her dogs responsibly, so for the most part, functioning. Never mind that she sees angels walking beside her or thinks the radio is talking to her.

    There are no easy answers here.

    1. Thanks for your insights Veronica. I think designers should see those instruments in use so they can understand their intricacies and how the internal OR climate affects them. Though I’m not sure how many architects have the stomach for surgery.

      As for your cousin that is a very difficult situation. It’s a fine line between taking anyone’s rights and ensuring they don’t hurt themselves or anyone else. I wonder if there is a way to modify the laws especially for the families involved. I can completely empathize with you as I’ve had my own experiences that way.

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