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Comment by silencio | Hacker News Reader

I honestly feel like hospitals (and other similar facilities) need to be designed to encourage this. Get dressed, and then what? You’re wandering the floor and it’s only long boring corridors and other patients resting.

My dad frequents a newer hospital that has wider sunlit corridors and a nice greenery-filled common area, as well as a lounge-y area on every floor, and it’s a big difference from other hospitals and even short term nursing facilities he’s been in.

I also wonder if the culture of any particular type of care encourages this more than others. Postpartum, many on my floor that gave birth were wearing their own clothing soon afterwards. There’s a whole market for personal gowns for labor and postpartum. And given how terrible breastfeeding is in those maternity gowns, that’s also not a surprise...

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Supposedly†, smokers recover faster in hospital -- because they're very motivated to stand up and go outside several times a day, as soon as they possibly can.

† i.e. I've repeatedly heard it as folk wisdom, but never looked for statistics

> I honestly feel like hospitals (and other similar facilities) need to be designed to encourage this.

I agree. But hospitals are also ridiculously expensive on a per-sq-foot basis. Outside of very high-end hospitals that can try to make some of that money back from cash patients and very well insured patients, most hospitals simply don't carry the funds for that, even if they wanted to.

Discussions about healthcare are always rich in "hospitals need" or "hospitals should," and people never stop and ask "why don't they?"

The answer is usually "because we don't pay for it." Most of our healthcare dollars don't end up in the hands of hospitals or doctors, though a good chunk go through the hospitals. Most dollars ultimately end up with insurers, device manufacturers, or pharmaceutical companies. What money does go to the hospitals, doesn't go towards the things people say they want.

Unsurprisingly, as with every entrepreneurial discussion on HN, there's a difference between what customers say they want and what they're willing to pay for.

> Most of our healthcare dollars don't end up in the hands of hospitals [..]. Most dollars ultimately end up with insurers, device manufacturers, or pharmaceutical companies.

Do you have some evidence for that? I am pretty dubious that insurers are walking around with more than typical margin.

Also, it seems nebulous when talking about device manufacturers. That money went to the hospital in a very real way.

It is difficult to change the environment of a hospital that may have been built 30-40 years, with planning likely taking place in the decade prior, when treatment-for-cure one-size-fits-all type of care was the design objective.

There’s also realities of laundry. Many families often bring in 2 or 3 days of clothes and launder them in between visits. Patients tend to go back into gowns when nursing staff try to find a balance between having family come in frequently (because of laundry soiled by incontinence), versus patients having available clothing to wear the next day for at least part of the day.

On a tangent, consider admissions where next-of-kin live in a rural community and don’t drive due to personal health problems. The determinants of health that likely contributed to the admitting condition are perpetuated in acute care in very subtle ways.

The issue is much more complex than “just don’t wear gowns”. There’s definitely solutions in changing workflows, but this needs the convincing of administrators to provide funding for additional staff.

> Get dressed, and then what?

Then you go talk with your neighbor.

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