In looking at the interior design of a space, what says “hospital”? And what can we do about it if we don't want to hear it anymore? Recently HEALTHCARE DESIGN spoke with three interior designers who have helped lead the charge away from that institutional look so beloved by Hill-Burton-era builders. We asked, what have they seen of late that contributes to the new look in healthcare design, and how have the bright ideas of the recent past continued to evolve? Responding were:

Linda M. Gabel, IIDA

Senior Associate and Director of Interior Design, Karlsberger Companies

Julie Smith, IIDA

Director of Healthcare Design, Rowland Design

Heather Monroe, Associate IIDA

Facilities Planning and Development, Texas Children's Hospital

What follows are excerpts from recent phone interviews:

Linda M. Gabel: “An overall recent trend is toward designs intended to support family needs and to enhance comfort. In-room recliners are out, for example, and moveable daybeds are in. With furniture, the use of woven fabrics continues, but with high-tech finishes going even beyond the state of the art. There is a considerable problem with staining these days. With our approach to a more homelike environment, people feel inclined to make themselves more comfortable in hospital rooms and waiting areas. The result is more contact of body oils, lotions, and hair care products with the furniture and wallcoverings. Aside from using specially treated fabric, chairs and sofas are often specified with polyurethane or wood arm caps to avoid stains, splitting, and softening from these oils. Vinyl wallcoverings, too, have special, Teflon-like coatings to protect against staining and other damage from these oils and from water-free hand-sanitizer gels.

“The perception of cleanliness and maintenance issues is also affecting the choice of floorcoverings. I see a move toward more use of rubber flooring, which can provide a nonglare surface. Rubber flooring requires no waxing, absorbs sound, and reduces foot fatigue. With smoother surfaces, we can help to reduce back strain from staff pushing heavy carts and mobile equipment. We see these floorcoverings used more and more in ERs, ORs, and trauma and intensive care areas. Their initial cost is higher, but they pay for themselves in 5 to 10 years through the reduction in housekeeping and maintenance costs.

“Getting back to furniture, we're getting away from that modular look and toward comfortable sofas and side chairs that are highly cleanable. Because there is more space for family in modern patient rooms, there is more space for additional furniture, such as lighter-weight glider-rockers and mobile desks; in fact, everything is easily moved about. Rather than replace furniture, hospitals often plan to reupholster every three or four years, so there is a trend away from the use of expensive, removable upholstery covers. The added longevity also means that chair frames need to be more substantial than they often were in the past.

“With children's furniture, there are a lot of new products that look good and are easy for kids to move about. Of course, we're seeing a lot more interactive technologies, including LED artwork and use of computer-driven animation for positive distraction elements in waiting areas and child-life rooms. We also see the creation of storytelling artwork for exam and treatment areas that appeal to kids of all ages.”

Julie Smith: “It's more and more about comfort. Waiting rooms used to include lots of four-legged chairs, and now there are sofas and loveseats. Hospitals want better sleeping conditions for visiting parents and spouses, so now recliners have given way to fold-out cot-chairs. A big factor in all this has been specially treated fabric that looks like woven fabric and holds up very well against wear and tear, spills, and incontinence. We're seeing a lot more choice in child-sized tables, chairs, and game tables-more items, in general, for small children. Teens are still pretty much left to fend for themselves.

“With floorcoverings, linoleum is growing in popularity, with lots of great colors and patterns, and with seamless installation, if desired, to enhance safety and maintenance. Today's tile floors are becoming inherently more slip-resistant, so that you don't have to add a special coating for this.

“Wallcoverings are tending to be more heavily embossed these days; this looks homey and stands up relatively well to being battered by carts and so forth if used on the lower half of walls. On the other hand, many facilities that don't have the budgets for upkeep or for replacing out-of-stock wallcoverings every few years are opting for paint; at least it's easier to repaint an area than to reapply wallpaper. Also, painted walls are allowing designers to create imaginative patterns on them that bring rooms to life for kids.

“Infection control is, of course, always a big issue, and it's good to see facilities getting infection-control personnel involved in the design process early on. They keep designers focused on the need for easy cleaning and avoiding mildew.”

Heather Monroe: “We're trying to make our hospital family focused; it's not just a place to drop kids off for treatment and visits. To accommodate the entire family, we have furniture of all sizes throughout the hospital.

“There is a problem here, though-not so much with adult furniture, but with children's furniture: It's been difficult to find pieces that are sufficiently durable and, at the same time, meet the right price point. This is of particular concern to us because we are also responsible for several satellite pediatric clinics that don't have anything near the budget the hospital does for purchasing furniture. We've had to make quite a few things ourselves and rely pretty heavily on manufacturers to accommodate our needs as they arise. We also have a local upholsterer who did a wonderful job for us making new daybeds that were not as hard and narrow as the old ones but still looked neat when folded up.

“On the good news side, I think the message is starting to get through to manufacturers-that is, why does hospital furniture have to be so ugly? There's starting to be a big improvement. The color palette for wallcoverings, for example, has evolved toward hot magenta, bright turquoise, bright yellow, bright teal, and the like; it used to be difficult finding wallcoverings in those colors that met code, but not so much anymore. Sleeper beds, too, are starting to look a bit more stylish, although they'll always be somewhat boxy because of their structural and maintenance requirements. In waiting areas, we're seeing more wood-trimmed detail and not so much plastic laminate.

“Things in the hospital environment don't always have to say ‘healthcare.’ People in the hospital know where they are; we don't have to identify that for them with our products. One result is that we're starting to treat our patient rooms almost as houses. They have their own mailboxes, and even small arrangements reflective of outdoor furniture immediately outside the rooms where families can relax. It's not really outdoor furniture, of course, but it has a patio feel to it.

“The search for appropriate and affordable furniture that is attractive yet still meets code is always difficult. Recently a manufacturer discontinued a line of rocker-recliners that our nursing staff liked a great deal. We looked at NeoCon but didn't find anything sturdy or comfortable enough to replace them (although we did ask one manufacturer if they could just go a step further and make their rocker-recliners adaptable to healthcare). We finally had to go back to the original manufacturer and special-order several rocker-recliners from the old line. This was expensive, but you want to keep your nurses happy!” HD

For further information, phone Linda M. Gabel, IIDA, Karlsberger Companies, at (614) 461-9500 or e-mail; phone Julie Smith, IIDA, Rowland Design, at (502) 585-1232 or e-mail; or phone Heather Monroe, Associate IIDA, Texas Children's Hospital, at (832) 824-2185 or e-mail

Healthcare Design 2003 May;3(2):31-32