Culture Creep: How Your Best-Laid Design Plans Get Hijacked Over Time
Last week, Healthcare Design assembled the team of jurors for our annual Architectural and Interior Design Showcase, where we huddled in a room at the IIDA headquarters in Chicago for a full day. As the jurors presented their recommendations for Citation of Merit winners (which will be presented at the Healthcare Design Conference in November), a couple of times they made remarks like, “Well, of course, it’s hard to tell if that carpet is going to wear well over time,” or “I bet those nurses’ stations aren’t going to look that uncluttered for long!”
Lots of nodding around the room. The best-laid plans and designs can only go so far once a space really gets put through its paces, and as the years go by, corners get bumped, walls get scuffed, and the staff makes changes to its surroundings to better fit the day-to-day routine.
When we write about healthcare projects, we always want to know about the process: What were the facility’s goals? What research informed the layouts? What materials were chosen, and why? The answers are invariably detailed and well thought out. And the photos of the space prove the points, with gleaming surfaces, balanced design elements, waiting room chairs perfectly aligned, and absolutely everything in its place.
It’s not often we get to see photos of the “lived-in” space. And so I was surprised, and delighted, when I moderated a recent Healthcare Design webinar titled, “Five Years of Use: Interior Environment Review of an Acute Care Hospital.” The speakers from Ankrom Moisan (Portland, Ore.) were refreshingly honest about how, five years after implementation, some of their design elements and finish choices didn’t end up being realistic—while others, despite sound thinking and planning, were just neglected by staff as the years progressed. There were design successes, to be sure, but as the speakers walked us through before and after photos, choosing to focus on the elements that didn’t work, the lessons were immediately apparent.
“Life changes at a facility once you walk away,” said Karen Bowery, head of the interiors department for Ankrom Moison. Shifts in facility leadership over the life of a project, deficiencies in training staff on using the new facility, a design team’s limited involvement in determining the signage strategy—all these issues play a role after the design team “walks away.” And, added senior healthcare architect Erin Couch, “no matter how carefully you plan a space, it’s difficult to fight inbred culture.” Equipment meant to reside in a strategically located storage area ends up in the hallway instead; specially designed family areas remain empty because the families just don’t want to leave the patient’s side. Stained wood surfaces—which look elegant and rich at the grand opening—end up dinged, chipped, and unsightly before too long, because it requires too much effort/expense to touch up the damage.
Though I couldn’t see the audience’s faces during the webinar, I knew there was lots of nodding going on, just as there was in Chicago last week among our jurors. (The feedback during the Q+A portion of the event confirmed it.) All healthcare projects could benefit from a revisit several years later, and, more important, from really getting to the bottom of why some things changed, why others didn’t, and which finishes and design strategies really stood the test of time. We all learn from those stories, yet few firms and facilities are willing to share them. Is it pride? Fear of admitting mistakes? No one’s perfect or omniscient, and the better we all understand the true culture of a facility, the better we can extrapolate best practices that will effectively serve that culture—industry-wide—going forward.
So what about you? Design firms, architects, providers: I know you have your own post-occupancy stories to share. We’d love to hear them.