Realistic design prototypes have become standard decision-making tools for healthcare leaders who understand their value in an environment in which every design decision impacts the facility's ultimate success in fulfilling the institution's mission and goals.

Increasing use of prototypes has been driven by a number of factors, including escalating construction costs, highly competitive markets, rapidly changing medical and communication technology, and implementation of new treatment models, such as private patient rooms. Decision makers at leading institutions have found that prototypes are cost-effective tools to enhance stakeholders' understanding of architectural and interior design. Because they give users a hands-on feel for the space, they can be used to develop staff consensus and validate decisions.

When presented to construction professionals, prototypes can enhance the accuracy of construction estimates and reduce the number of change orders. Authentic prototypes also create excitement among staff, patients, and potential donors.

Matching the tool to the project phase

Prototypes, ranging from three-dimensional renderings to animated videos to full-scale mock-ups, vary in level of detail, depending on the audience and goals. Generally, the level of detail is related to the project phase, evolving along with the design. As design progresses, architects and interior designers refine both the virtual and physical models to reflect increasing levels of detail. The first step may be a sketch or rendering that is simply colored. The next may involve development of 3-D drawings from design documents.

As the design progresses, an animated video might be developed to give user groups a virtual tour of the proposed facility. Following extensive programming and user input, a full-scale interactive mock-up can be built to allow staff, patients, and family focus groups to test the design, equipment, furnishings, and finishes under simulated or actual conditions. On the other hand, prototypes created for development or community marketing purposes typically focus more on the overall aesthetics of the site, building, or interior spaces than on the technical details.

Envisioning a master plan

In the form of a three-dimensional site plan, a prototype is useful in helping constituents within the organization or in the community understand the vision and the scope of a master plan and assuage concerns. In particular, it can help people who are not experienced in reading and interpreting two-dimensional site plans to visualize the built environment and its impact on the surrounding community.

For example, University Hospitals (UH) in Cleveland, Ohio, occupies a mature campus in a congested urban environment. With several service lines that have ranked in U.S. News and World Report's top 10, UH is in the midst of upgrading and expanding its facilities. Part of the designer's task in developing the master plan was to identify opportunities for growth, including identification of several buildings that had reached the end of their useful life spans, for demolition and replacement. At the same time, the surrounding community had concerns about the impact of campus development on landmark buildings.

UH needed a cost-effective way to address these issues and communicate their vision to the community, so the designers developed a series of computer-generated 3-D site models that showed the proposed pattern of growth on the UH campus (figure 1). These prototypes effectively clarified the master plan, allayed community concerns, and helped spark what has become “Vision 2010,” which UH has embraced for branding, recruiting and fundraising.

Array developed a facilities master plan at UH Case Medical Center in Cleveland, Ohio, that outlines system-wide growth to retain its world-class reputation over the next decade. The facilities master planning exercises pinpointed areas for strategic growth, identified obsolete systems and buildings, as well as developed a feasible phasing and implementation scenario that aligned with the Health System's long-term growth goals. Array used advanced computer prototyping to ensure that the new projects, developed in tandem by different architectural teams, would work well together. These projects include a new Cancer Hospital (far left, in association with Cannon Design), structured parking (center, designed by Array HFS), and Center for Emergency Medicine (right foreground, in association with OWP/P)

Facilitating board acceptance

Similarly, development of appropriate project prototypes can be used in board meetings to support the financial analysis associated with a recommended project approach. For example, for Jupiter Medical Center in Jupiter, Florida, designers created a 10-minute animated video depicting the next generation of campus development. This was used by the medical center to communicate to the board of directors the recommended master plan and quality of the future campus.

Enlivening fundraising efforts

Various types of project prototypes can also be used to enliven fundraising efforts. For example, the Jupiter Medical Center video will be included in a custom-designed presentation binder, with additional collateral materials in support of the medical center's community relations and fundraising efforts. A realistic watercolor rendering, 3-D drawing, or video can even be modeled with potential donors' names on key elements of the building façade or unit entrance portal.

Gaining staff consensus

Early in the design process, Array has used “gaming sessions” to allow users to participate in the layout of complex diagnostic and treatment spaces. For example, in the process of designing the layout of a complex imaging department, designers created scale representations of the various diagnostic rooms, and allowed the imaging staff to arrange and discuss different layouts on a to-scale schematic background.

Extensive mock-ups, both virtual and physical, are a must when developing layouts of treatment areas in which patient and staff flow and/or sophisticated medical and communication technology are critical to optimal patient outcomes. They are also valuable in reducing the number of costly change orders that typically result when staff see these spaces for the first time while under construction.

For example, in designing the new Emergency Department at Saint Barnabas Health Care System's Community Medical Center, in Toms River, New Jersey-which is among the largest EDs in the state-designers developed computer renderings and a 3-D animation that provided staff with a virtual walk-through of the department. Designers also worked with the construction manager to facilitate the construction of full scale mock-ups of several exam spaces and adjacent nurse station so staff could evaluate sight lines and layouts down to the last detail, including locations of medical gases, hand-washing stations, even the glove boxes (figure 2).

Array and consultants constructed the mock ED patient room at Community Medical Center in Toms River, New Jersey, to simulate for staff and physicians the size and layout of a typical patient room. The hospital project manager estimated that the alterations made through the staff input of the mock-up saved $75,000 in change orders

Although these locations had been carefully determined through the course of several programming meetings with staff, the mock-ups provided additional insight. In fact, meaningful changes were made that improved the spaces for staff and helped develop consensus and validation of the final design.

Increasing patient satisfaction

Use of a prototype can also be used to test the impact of a facility upgrade or a new treatment model on patient and staff retention. For example, the single-patient rooms at Indian River Medical Center, just north of Miami, had begun to show their age, but the Medical Center was reluctant to implement a hospital-wide upgrade without evidence that the upgrade would impact patient satisfaction and staff retention.

The designers developed an updated interior refurbishment plan, including new equipment and upgraded furnishings and finishes. The new design was implemented in one nursing unit to test its impact on patients, families, and staff. Just 60 days after the prototype unit re-opened, the hospital's Press Ganey satisfaction scores increased to 92%. The staff is also satisfied with the redesign, which includes a more open nurses' station with access to natural light, improved sight lines, and more durable and easily maintained finishes (figure 3). Based on these positive responses, the hospital is moving forward with plans to renovate all nursing units.

The Orthopedic Unit at Indian River Medical Center in Vero Beach, Florida, was designed to reinvent the traditional nursing unit within the existing configuration of bed floors, including decentralized nursing; patient-centered, calming design; reduced travel distances for staff; and improved workflow. Press Ganey patient satisfaction rates average 92% on this Unit since renovated

Increasing accuracy of construction estimating

Development of detailed prototypes also improves the accuracy of construction estimating. Given today's high cost and rapid pace of healthcare construction, hospitals and other healthcare organizations are well-advised to have their designers begin the mock-up process well before the construction drawings are complete.

When construction managers have a thorough understanding of what will be involved, their estimators are able to reach a more accurate construction cost estimate. They may also be able to identify ways to value engineer and build the same high-quality facility for less.

For example, in designing a recent Planetree prototype unit (figure 4), Array developed a mock-up of an entire patient bedroom and bathroom, including a custom headwall unit, and the CM identified strategies to reduce the cost to a level comparable to a standard headwall system.

From the moment a person enters this prototype patient room at Lankenau Hospital in Wynnewood, Pennsylvania, warm colors, rich wood textures, and soft lighting evoke a sense of soothing calm, promoting the essence of a modern resort destination. The hospitality theme is further explored through the tiled bathroom, automated room controls, and modern entertainment and communication amenities

Proving desirability of new finishes

In a new or existing facility, prototypes that include samples of proposed materials and finishes enable nursing and environmental services staff to evaluate their pros and cons, especially when these materials differ from the institution's existing standards.

Many institutions are accustomed to the waxed-and-buffed high gloss of traditional floor coverings, and they need an opportunity to experience the aesthetic, safety, maintenance, and environmental benefits associated with the newer no-wax vinyl floor coverings. For example, Cleveland's UH staff recently evaluated the increased comfort and reduced odor and noise generated by a no-wax, cushioned floor product in its neonatal intensive care units. Similarly, staff at Alfred I. duPont Hospital for Children, in Wilmington, Delaware, evaluated several types of flooring materials before making a final selection for their neonatal intensive care unit.

Case studies

Owners also benefit when experienced healthcare designers can share prototypes of other projects, at various stages of design and construction, as examples of current design trends. Similarly, a visit to other healthcare institutions in the country allows clinicians and owners to learn from the experience of their colleagues and apply these lessons to the design of their own facilities.

Investing in development of appropriate, realistic prototypes at every stage of design is a wise use of a healthcare institution's resources. Today, there is a prototyping tool to match every design stage and every budget. These cost-effective tools have been demonstrated to improve architectural and interior design solutions, enhance user understanding, develop consensus, improve accuracy of construction estimates, reduce change orders, validate decisions, and create excitement among staff, patients, and donors.

In fact, given the cost of construction associated with healthcare facilities, and the critical relationship between design and the ultimate success of the facility in fulfilling the institution's mission and goals, healthcare decision-makers find that they can't afford not to use these tools. A prototype may not be quite “the real thing,” but it is as close to reality as possible before the ribbon-cutting ceremony. HD

Lisa Naide Lipschutz, AIA, ACHA, is Principal, Practice Area Leader, Planning Design, of Array Healthcare Facilities Solutions, based in King of Prussia, Pennsylvania. Patricia D. Malick, AAHID, IIDA, is Principal and Practice Area Leader, Interior Design, brings over 25 years of healthcare experience to Array. Lipschutz and Malick can be reached at 610.270.0599 or through

http://www.arrayhfs.com. Healthcare Design 2009 May;9(5):42-51