Interior design: Not ‘just colors' anymore
The biggest trends in healthcare are the biggest trends in healthcare interior design: patient safety, wireless technology, and hospitality. They all rely on interior design solutions early in the process to be successful. If you're a hospital stakeholder working on a major healthcare project, expect to see an interior designer long before floor plans are approved. We interior designers play a key role in modifying healthcare environments in line with the latest trends and movements.
Factors such as rising construction costs and tight project schedules mix with trends such as patient safety, and put new pressures on interior designers. For instance, as construction costs increase, the hospital design must be more flexible than ever to minimize the impact of future changes on the flow of patients and services. One design response is to provide flexible, multiuse spaces such as observation/short-stay/exam rooms. Casework and lighting must also be flexible; casework today offers movable file pedestals and flexible wire storage in place of built-in storage, and area lighting offers direct and indirect options with separate switching.
Patient Safety and Design
Patient safety affects everything, from technology and communication planning to the design of patient care areas, all of which are focused on reducing medical errors. Demonstrating the prominence of this issue, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has established its 2005 National Patient Safety Goals to promote specific improvements in patient safety (http://www.jcaho.org).
Patient safety affects interior design in two major ways:
An emphasis on standardization. Standardization in hospitals results in a universal room design: Every room, from an intensive care unit to a labor and delivery room, shares important design features. For example, all wall-mounted outlets, gasses, and equipment are in the exact same location. Rooms are not mirrored but are laid out identically side by side. Interior designers must also standardize the location of key equipment and furnishings. This promotes safety in that it leads to environmental familiarity during day-to-day operations and in emergent situations.
The need to address infection control. Designers must be ever mindful of issues such as placement of sinks and waterless handwash equipment, as well as gown and glove storage. Most infection-control protocol personnel would like to see a gown and glove rack on every patient door. Designers are challenged to incorporate equipment such as this into the environment in a way that doesn't detract from a room's comforting atmosphere.
Because of an increased awareness of infection control and lack of substantial research supporting alternatives, carpeting is being used less and less in place of hard surface materials. Carpet remains a good option as long as the facility commits to a regular maintenance program. Key issues with hard surfaces are acoustics, maintenance, and durability. To deal with acoustics, we've incorporated higher-quality ceiling tiles to moderate noise. Vendors have kept up with the changes nicely, even providing customized ceiling panels for different departments, such as neonatal, emergency, admissions, and labor and delivery.
The patient room has shifted to nonslip flooring, such as rubber flooring or low-pile carpet like Lees' NeoFloor™ to prevent falls. Rubber flooring, extensively used in European markets, is getting more attention in the United States because it requires lower maintenance, has high durability, and is slip-resistant. Epoxy terrazzo also is becoming more popular because of its long-term durability and low-cost maintenance. Lower maintenance means lower life-cycle costs for a facility and potentially fewer full-time cleaning staff—even if the initial cost of the material is much higher than other flooring, such as vinyl composition tile, that was used in the past.
Guidelines from the Centers for Disease Control and Prevention published in 2002 state that “handwashing is the single most important procedure to prevent nosocomial infection.” Concern within hospitals is so heightened that, in one user meeting, the staff asked if a sink could be placed in the room so that the caregiver would be forced to go around it to get to the patient. Another idea that has surfaced is putting a detector at the door that makes the sink swing out in front of the caregiver as he or she enters the room.
Kicking and Screaming Into Wireless
Wireless technology, including PDAs, has expanded staff's access to patient information. The equipment is smaller and less invasive in the environment, and this means greater flexibility in where and how nurses chart. For interior designers, this means that storage spaces and casework must become more flexible.
If your hospital has a shortage of storage space, you're not alone. On some of the principal author's (J.K.) recent projects, it was difficult to convince clients who were moving toward wireless to surrender alcove space traditionally reserved for computer workstations. It is true that laptops on rolling stands (aka “computers on wheels,” or COWs) still need storage space, but much less than a traditional workstation requires. Perhaps medical equipment, long ago displaced to create room for those workstations, can now return home.
Some cautionary words about those COWs: Not long ago a client purchased some of these units during construction but had not considered space or power connections for them. Those COWs have now, unfortunately, joined the ranks of homeless medical equipment lining the hospital's corridors and reducing usable space. On a more recent project we were able to anticipate the presence of COWs early in the design and were able to dock them conveniently in alcoves hidden behind the central nurses' station.
Putting the “Hospital” Back in “Hospitality”
“Hospitality” was the biggest buzzword in healthcare design a few years ago. Designers took cues from the hotel industry in hopes of creating a better care environment. Today, we're happy to report, we've taken hospitality further than a few chandeliers and a concierge stand in the lobby.
For example, we now see the efficiency value—not just the aesthetics—of the location and design of the hotel front desk. The functional beauty of a hotel's front desk is that it's easy to find. And whether you're there to stay the night or just going to a banquet lunch, the front desk will guide you in the right direction. Does the same model work for hospitals? For the most part, it does.
The old hospital information desk has been redefined (figure 1). Hospitality used to be about making an information desk look like you should be picking up your keys and scheduling a wake-up call. Now we care less about fancy granite finishes and pay more attention to environmental cues that lead all patients to what is now called the patient intake center—a central location where all types of patients are greeted and then distributed appropriately. The result: improved wayfinding, faster treatment access, and shorter patient throughput time. That's responsive healthcare interior design.
Hospital information desk redefi ned—Aventura Hospital and Medical Center, Aventura, Florida.
Does this mean no more room service? Not exactly. The hospitality trend is still going strong, partly because of vicious competition among hospitals and community demand for upgraded environments in these facilities. Giving patients more dignity and choices in their healthcare is as much a marketing tool for the hospital as it is a response to the healing environment movement. And that means amenities are becoming the standard in healthcare facilities (figures 2 andfigures 3).
Amenities—Sky Ridge Medical Center, Lone Tree, Colorado.
Amenities—Sky Ridge Medical Center, Lone Tree, Colorado.
There's still an upward trend, for example, in valet parking, menus with meal choices, and 24-hour room service. We're also designing patient “amenity suites,” with extras such as 24-hour chef service, whirlpools, built-in hair dryers, bathrobes, and Internet access.
Higher-quality design through the use of finishes, colors, patterns, and architectural features is reflecting the quality of design used in hotels (figure 4 and figure 5). “The general public has a much greater awareness of good design, and this is being translated in the design of their health facilities,” says Lisa Snowden, IIDA, principal of Snowden Design in Fullerton, California. Louise Nicholson Carter, IIDA, AAHID, principal of Carter Design Associates in Houston, adds, “There is also an emphasis toward a spa environment. Soothing spaces that support people's inner selves are important, as is the increased emphasis on alternative medicine.”
Hospitality-level design 1—Virginia Hospital Center—Arlington, Arlington, Virginia.
Hospitality-level design 2—Virginia Hospital Center—Arlington, Arlington, Virginia.
Even non-amenity patient rooms are extending hospitality to family. Daybeds are now standard in patient rooms to provide much-needed family seating and accommodate overnight stays. Manufacturers are providing designers more choices for durable, residential-style patient room furniture.
Envisioning the Future
Healthcare interior designers must address the future of healthcare in their designs, going beyond color palettes and finish selection. Our designs must last up to 20 years, considering it might be that long before an organization decides to do another major renovation or new construction. Flexibility is important, but we must also strive to select timeless, classic designs; incorporate durable, long-life materials (in a neutral palette, where possible); and use more natural materials. We must understand current trends and likely future trends to make informed decisions today. And to maximize our impact, we must be involved early in the design process.
We would also note that when value engineering occurs, as it does on almost every project, it is a shame that interior finishes still get scrutinized solely on the basis of cost when they are so important to the overall aesthetics and effectiveness of the interior environment. You get what you pay for, and much more. HD