The healthcare building industry is unique from other commercial building industries. According to the Department of Energy, Energy Information Administration statistics, the healthcare industry is the second fastest growing sector in the economy. On average, healthcare buildings are over twice as large as any other commercial building type. Current trends for larger healthcare systems have multiple buildings housed on a single campus, encompassing a variety of functions, sizes, ages, and conditions. Many of these buildings have 24/7 operations that require uninterrupted coordination and services at all times. Among the major concerns facing facility directors in healthcare organizations are the need for better indoor environmental quality, improved patient safety, more efficient and flexible facilities, and the need for higher patient and staff satisfaction. Since the costs and life cycle implications of construction choices are borne by the building owners, they have a vested interest in efficient, long-term, maintainable buildings. The current building climate dictates highly regulated design and operations in health facilities including intense economic, health, and life safety oversight.

Components of an interior design master plan

The interior design master plan document is frequently a set of binders that include finish recommendations and specifications for construction and renovation projects including flooring, ceiling, wall finish, millwork, and architectural accent materials; and a separate set of binders that include the selection and specifications for furnishings, finishes/fabrics, and window coverings. Often, these are accompanied by a series of presentation boards showing the various materials set in finish schemes.

Several steps are normally taken in order to develop these standards. The first step includes appointing a committee to meet at least once a month to give input, review, and finally approve the master plan. The committee is usually made up of the interior design consultant and representatives of a variety of areas to provide balance in the facilities department, patient and family areas, clinical areas, purchasing, infection control, and the executive administration. Typically, participants will range from a director level and above. Once the committee is in place, a meeting calendar is established to allow for preplanning and good attendance. Roles and responsibilities are established and then a series of defined steps sets the process in motion. The interior design consultant guides the process with the committee input and establishes specific goals and timelines. The following graphic illustrates the steps in the basic phases, which take several weeks/months to accomplish based on the frequency and timeline for meetings. The phases are described below.

Phase 1: Definition of needs. This initial step includes a site walk. It is typically conducted by the facility representative and the interior designer together. This entails a comprehensive review of the existing facility or buildings in order to have an understanding of the existing condition and needs, and allow for documentation of the priority of needs. This assessment includes the current ceilings, walls, floor finish materials, casework, and furniture to determine the existing age and condition. Comments may include documentation regarding appropriate materials or furnishings in clinical or patient areas, appropriate ceiling finishes, areas showing extreme wear or not being maintained properly, as well as areas that have been recently renovated. A facility assessment document is produced by the interior design consultant and turned over to the facility representative. This document is a useful tool for the facility director when identifying and prioritizing needs. After the assessment, a meeting or series of meetings outlines the final priority statement.
A public lobby in the Memorial Health System North Hospital in Colorado Springs, Colorado

A public lobby in the Memorial Health System North Hospital in Colorado Springs, Colorado

Phase 2: Visioning session. The visioning session is a collaborative and crucial step in the master planning process. It is important to align the process outcome with the health facility's mission and vision. This process helps to identify and confirm the manner in which the physical facility will support the branding of the health system. This collaborative exercise includes all members of the master planning committee. It establishes the guiding principles for the entire master planning process. The guiding principles become the roadmap to keeping the process on track and in focus.

Phase 3: Design direction. This process may be accomplished in a single session or may take multiple sessions. These meetings define the amount of detail expected for the master plan documents, as they can be fairly broad or very specific. Goals need to be established for aesthetics, budget, indoor air quality, sustainability, patient safety, and maintenance issues as they relate to various areas of the hospital or health facility. Discussions regarding the impact of existing finish materials and furnishings on the new branding direction occur during this session. An established set of priorities helps to guide the process and indicate where one priority should take precedence over another, based on the function and area type.

Phase 4: Materials selection. During the development meetings for finish standards, the initial discussions should be focused on product. A schedule of appropriate materials is assessed to determine the products that most closely align with the criteria established in the program goals. These products are scrutinized for compliance with the goals relating to budget, patient safety, durability, flexibility, sustainability, VOC emissions, maintenance, and alignment with branding as established in the visioning process. Aesthetic goals impact the visual branding and must be able to meet the budget constraints in order to be an ongoing achievable process. Sustainability and maintenance goals are related. Products that are more regional, have a long lifecycle, are durable, require less chemical maintenance, and fit the sustainability and the maintenance goals. Indoor air quality goals are closely connected to patient safety. VOC emissions can have a very detrimental impact on patient and staff health, an important consideration with both the finishes and furnishings selection process.

Other patient safety issues include understanding the implications of infection control, fire ratings and ADA concerns for various areas within a health facility, and selecting appropriate products for the various clinical uses. Products that are suitable for a public lobby may not be suitable for a patient or clinical area. A matrix should be developed to identify appropriate materials to use in various areas of the health facility. This allows the facility project manager to make appropriate decisions when selecting products for in-house renovations. Once a suitability matrix is established, this list of specific products becomes the materials legend.

Phase 5: Finish palette review. In this phase the interior design consultant presents multiple concept options to the committee for review based on general alignment with the branding goals set out in the visioning process. The concepts are adjusted and developed based on committee feedback. Product and schemes may vary based on the type of area in focus (public versus staff, patient versus clinical). The end result is a set of finish boards that may include ceiling, wall, millwork, accents, fabrics, and flooring materials that represent the branding concept and color direction established for the health system. Once the final approval has been received, a set of interior finish master plan binders is compiled and provided for the facility representatives/project managers.

Phase 6: Interior furnishings selection. In a similar manner to the finish standards process, the interior furnishings discussions focus on product attributes, color, and fabric. In the initial meeting, the interior design consultant generally reviews product images that fit the basic goals for furniture. Consideration must be given to existing product. During the refinement process, the committee may choose to set up a series of product evaluations either in-house at the health facility or at an off-site location such as a furniture showroom.
The PACU at the Memorial Health System North Hospital

The PACU at the Memorial Health System North Hospital

Family waiting room at the Memorial Health System North Hospital

Family waiting room at the Memorial Health System North Hospital

Basic product categories include public, patient/family, staff/administrative, and clinical. Different sets of criteria are given priority based on the category. Along with the furniture, selection of fabrics, cubicle curtains, and window coverings are generally included in the furnishings standards process. These products also go through a scrutiny of compliance with the goals related to durability, aesthetics, patient safety, budget, ergonomics, sustainability, and VOC emissions. Once the final selections and approvals are made, a set of interior furnishings master binders are compiled for the facility representatives and purchasing managers.

Phase 7: Warranty and maintenance binders. As in a construction project, it is important to include a binder of product maintenance, technical, and warranty information. These product sheets include the specification information regarding warranty, fire ratings, maintenance procedures, durability, slip resistance, and other pertinent information that may be requested by the joint commission and local regulatory agencies. Ease of access to this technical information provides a benefit to facility managers during routine visits by regulatory agencies. This information is included for both the finish and furnishings products.
A CT scan imaging room in the Memorial Health System North Hospital

A CT scan imaging room in the Memorial Health System North Hospital

Benefits of an interior design master plan

An effective interior design master plan can address both the regulatory and branding concerns of CEOs and facility managers by focusing on problem-solving strategies and methods. These may include an enhanced facility image and identity, better controls over short- and long-range planning and costs, enhanced control over patient safety, and more efficient processes in selection of finishes and furnishings. A well thought out and documented interior design master plan allows administrators to anticipate costs related to interior expansion or remodel projects and respond in ways that permit flexible, cost-effective solutions. This can be beneficial whether the project is a small maintenance and remodel project or a planned expansion. By having an organized and structured set of reference materials for both interior finishes and furnishings, the interiors master plan can be a valuable tool to help control project budgets and schedules, maintain tighter controls over patient safety and regulatory issues regarding finishes, and maintain quality standards within a facility. The interior design master plan is intended to be a living document that allows the health facility to maintain quality and safety standards within, assist with the branding effort, and ensure a consistent patient experience throughout the organization. HD

Margie Snow, AAHID, ASID, IIDA, LEED AP, is a cofounder of Gallun Snow Associates, Inc., a Denver-based independent interior design firm. For further information, visit

http://www.gallunsnow.com. Healthcare Design 2009 April;9(4):10-14