Voices of Veterans, Staff Shape New VA Hospital
An illuminated three-story departmental seal creates a dramatic entry focal point.
Circular settees outside a bank of elevators provide an informal place to sit and socialize.
All stairs are straight and don’t have switchbacks, to improve wayfinding, clarity, and legibility.
In 2008, NBBJ began designing a new medical center for the Department of Veterans Affairs (VA) in New Orleans, with goals to create an environment that would serve as a model of patient-centered healthcare and respect surrounding neighborhoods. But it was also critically important that the project deliver a comfortable, dignified environment that honored service members and their families and supported the nuances of veteran care.
After Hurricane Katrina devastated New Orleans and destroyed the previous VA medical center there, NBBJ collaborated on the Southeast Louisiana Veterans Health Care System Replacement Medical Center with two local New Orleans firms, Eskew+Dumez+Ripple and Rozas Ward Architects. Together, the team set out to design a new four-story, 1.6-million-square-foot campus housing 200 beds for critical care, acute care, mental health, and transitional living, as well as an emergency department (ED), intervention center, and comprehensive outpatient services to serve more than 70,000 veterans in 23 parishes throughout the region.
To begin figuring out this specialized patient population and its healthcare needs, the design team engaged experts in other domains, including a quantitative psychologist/industrial designer with a focus in disability studies and a clinical psychologist. The VA also recruited veterans as research participants, including men and women of different age groups and backgrounds, such as homeless veterans, those who lived through the trauma of Hurricane Katrina, 20-somethings who had served in Iraq and Afghanistan, and 80 year olds who fought in World War II.
For nearly three years, a range of research initiatives were conducted with participants, including workshops, interviews, and design charrettes, taking the team from the heart of New Orleans to rural neighborhoods in southeast Louisiana. The process was both generative and evaluative, and started with empathy- and experience-based workshops alongside early programming and schematic design sessions that allowed the team to better understand veteran culture. Concept testing was conducted and color, interior finish, and furniture suggestions collected, while the VA developed its workflow and processes.
Overall, the research effort included more than 100 veterans, 180 VA hospital staff from Louisiana (many of whom are veterans themselves), 70 hours of observation, and 600 pages of notes. From these immersive and interactive activities, the design team distilled several major insights that informed the design priorities of the project, which continued through the end of 2011.
• Veteran care is different
The VA treats the veteran patient for a lifetime, focusing on maintaining overall health and wellness, rather than just treating episodic illness. Additionally, there’s a feeling of family, service, and welcoming that patients and their families experience as soon as they step inside a VA facility.
As a result, one of the core design drivers for this project was to create a sense of belonging and allow space for connection and interaction. Many veterans find that sharing their story or listening to other veterans is not only satisfying but helps heal emotional wounds. VA hospitals can facilitate that healing process by providing spaces where face-to-face interactions can occur. At the New Orleans facility, flexible furniture arrangements enable all veterans, including those in wheelchairs, to easily join conversations and feel included. Some seating is arranged in circles for larger groups, while other areas are designed for smaller or quieter discussions or alone time.
• Mental health is more than a department
Post-traumatic stress disorder (PTSD) affects as many as 30 percent of veterans, compared to 8 percent of the general population. “I have wounds that nobody can see,” one veteran told the team, describing the difficulty that he and many veterans face in their daily lives. Their sharpened reflexes are constantly assessing potential threats within the environment and can be hard to switch off in a non-combat setting. Many southeast Louisiana veterans are also coping with the trauma of surviving Hurricane Katrina. Even veterans not officially diagnosed with PTSD can find themselves dealing with feelings of anxiety, depression, and social isolation.
In response to these findings, the team worked to design spaces and bring in elements that put patients at ease. Wayfinding was simplified with a central concourse that connects to every department in the facility. There are no blind corners, and the staircases are straight, without switchbacks, to increase visibility. The inpatient rooms are arranged around an open staff workspace that feels more like a large, open office environment than a hallway in an inpatient unit. The result is a space that provides an enhanced degree of cognitive legibility and helps reduce anxiety.
• Veteran needs are amplified in unique ways
Veterans and VA staff consistently told us how veterans’ physical, emotional, social, and psychological needs influence the way they interact with their environment. For instance, while incontinence affects nearly 17 percent of men over age 60, it’s an even bigger issue among the veteran population, with roughly 45 percent of veterans enrolled in the Veterans Health Administration (VHA) diagnosed with the condition. More than 35,000 veterans visiting the New Orleans hospital are anticipated to travel an hour or more, many making the trip from their homes in rural areas. Therefore, bathrooms were located near all entrances and in the parking garages, in accessible locations marked with large signs and bright colors.
Furthermore, higher rates of mobility issues and obesity among veterans were also addressed by incorporating specific design features. For example, furniture for the facility was chosen for simplicity and sturdiness. All chairs have armrests to aid veterans in sitting down and standing up, and many chairs are 50 percent wider than standard size to accommodate bariatric patients without standing out as special seating. Contrast between finishes and furnishings, especially at entry points and waiting areas where veterans have to find their way on their own, was also increased to make navigation easier for veterans with visual impairments.
• Veterans deserve more than they expect
Although veterans deserve a superlative facility, they weren’t interested in grandeur or luxury. When shown some waiting room chair options, the veterans didn’t want ornamentation or decoration. Instead, they wanted simple spaces, materials, and furnishings that were characterized by utility rather than extravagance.
Veterans also prioritized places for rest and contemplation on campus. To address this preference, the design team borrowed from the traditional urban design typology in New Orleans—the courtyard—and incorporated eight major and several smaller courtyards on the site, from a civic-scaled ceremonial entry to places for quiet contemplation. Research also highlighted the importance of a chapel as a place of hope and spirituality, so a nondenominational space was added in a courtyard located between the two patient room wings. This freestanding building has windows to bring in natural light and incorporates stained-glass panels from the original VA medical center. Art also plays a prominent role at the new medical center, with an integrated program that includes paintings, sculptures, music, art-making activities, and creative events programming. One example of this is a three-story VA departmental seal located in the concourse near the main entrance, serving as a visual focal point on campus.
This robust research and veteran engagement provided meaningful and deeper insights that may not have been discovered through a more typical design process. The participatory approach also allowed the client and customers the opportunity to connect in a more direct, insightful way throughout the design process. For the design team, it was an exercise in building empathy and created a clearer understanding of the end users—including the VA leadership, veterans, and their families. NBBJ is now incorporating this research-intensive process into all of the firm’s healthcare work, particularly in areas with specialized patient populations, such as behavioral health, neuroscience, oncology, and pediatrics.