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By Design

January 1, 1998
by Terry Monahan
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Executive Summary

Who: Kenneth L. Kaplan
Architect and Principal Research Scientist
Department of Architecture and Planning
Massachusetts Institute of Technology, Cambridge, Mass.

What:Scientific Director of the National Healthcare Project.The project’s research committee conducted its first meeting with industry in September; plans are under way to establish technology test beds within the U.S. military healthcare system later this year.

How:By partnering with civilian test beds and the Department of Defense, which through its Advanced Research Projects Agency has prototyped some of the most sophisticated and practical healthcare technologies in the world, the NHP plans to identify and test practical, available technologies that are ready to deploy in the near future.

Four years ago Kenneth L. Kaplan, an architect and researcher at Harvard and MIT, received a grant from the U.S. Department of Defense Advanced Research Projects Agency to research the surgical room of the future. The project began as an investigation into improving the outcome of front-line battlefield casualties which, because of the difficulty in locating and diagnosing injured soldiers, has not improved significantly since the Civil War. But time spent in mega-hospitals like Massachusetts General in Boston convinced him that if he intended to redo the surgical room, he’d have to take on the whole hospital--and by extension, the whole healthcare environment.

A year later he was asked to testify about his research before the House Science Committee’s subcommittee on technology, which under U.S. House of Representatives Speaker Newt Gingrich was interested in how advanced medical technologies could help improve the population’s health status. From biosensors in diagnostic monitoring to a telemedicine-based home healthcare network, Kaplan cited the cost and quality-of-life advantages of various current technologies--many of them being developed by the Department of Defense, academia and industry. He concluded that advanced healthcare could be delivered to soldiers and citizens alike--anywhere in the world.

With the encouragement of Congress and the technology subcommittee, Kaplan, a former social worker in New York City, has expanded the Surgical Room of the Future Project to an ambitious National Healthcare Project. Under the auspices of the Potomac Institute for Policy Studies, a nonprofit technology and policy research organization in Arlington, Va., the project’s research council held its first industry meeting last fall with representatives from Wang Healthcare Systems, 3M, Honeywell, Inc., Overture Prime Inc., CVS and GE Medical. This year the project intends to develop several advanced concepts for technology application in healthcare delivery--and to test them within the vast and comparatively well integrated U.S. military healthcare system.

How did research into surgical-suite design mushroom into reinventing healthcare?
In looking at using advanced simulation computer tools, I spent a lot of time visiting with doctors, watching surgeries, walking around the hospitals. Mass. General had 45 operating rooms for various surgeries. Why wasn’t there one basic room? Why when a new procedure came along did there have to be a new room built? I walked the hallways, came across rooms and the way people worked in them didn’t make sense--they were even dangerous, with an enormous assortment of wires, cables and stuff everywhere.

The system of healthcare is simply unsystematized compared to other industries. There’s an irrational aggregate of buildings that you have to go to to get treatment. It was a research question: If you started with a blank slate what would you do?

I went from enthusiasm to despair. I’m an architect. Most of the buildings’ designs haven’t changed in 40 to 50 years. And if you’re going to design a building, the facility has to last 40 to 50 years. How can a room of furniture and equipment be integrated better? McDonald’s kitchen has been completely thought through. It’s foolish to design a hospital today based on paradigms of 20 to 30 years ago.

So what’s today’s paradigm?
The focus of investment in healthcare today is not wellness, it’s later-stage disease. It’s on the surgeries. That’s where care is being delivered; that’s where the money is leaking.

Everyone agrees we want optimal care, but the costs are extravagant. How do we integrate high-quality with low-cost delivery--and get wonderful service? If you have your major investment on prevention, nothing’s to say you’re going to lower costs and people are going to live longer. But there’s certainly a lot of evidence now that diseases once restricted to Western culture are expanding to the global culture--heart disease and cancer are growing, and now in the Far East we’re building new hospitals for later-stage disease--literally duplicating what we have here. How do we turn a large ship around toward prevention? That’s really the challenge now.

The model we develop will reverse some of the irritating and disturbing elements that are causing the turbulence in the field. Two major problems are enormous cost and how little you get in value for that cost.

What gives a project this ambitious a chance for success?
The National Healthcare Project brings together designers, engineers, technology developers, doctors and healthcare providers. What we’re doing is concurrent engineering. Traditional engineering is linear: You design something, build it, and then ask people to comment on it. Concurrent engineering came through aerospace design--that’s what healthcare needs. You don’t want to design something and then ask the doctors: Is this what you want?