Does this sound like a familiar scenario? Your new healthcare facility has a beautiful architectural design, construction documents are close to completion, and construction is imminent or well under way. Now for the interior design/FF&E (furniture, fixtures, and equipment) package. The traditional FF&E process begins: design, selection, specification and then, finally, a bid package that goes out to numerous office furniture dealers. Those dealers then come back with their bids, substituting products and pricing what they deem marketable. The owner finds himself or herself caught in a painful cycle of intangible design fees, bids, and value engineering, and all the while the construction clock is ticking.

End result: The most important areas of the facility— in terms of what they “say” to patients and families—have been considered too late in the process, without the intense scrutiny of realistic budgets. The project ends up being modified and diluted so many times that the original intent to create a “healing environment” is lost. Worse yet, the owner has lost precious time and dollars and has received furnishings that are better suited to a corporate office environment.

Oh, and artwork, the feature that contributes most directly to creating a healing environment? That was value-engineered out long ago.

This frustrating and reactive sequence of events is too often business as usual for healthcare projects—which is why so often we see an environment that looks applied to the architecture rather than integrated seamlessly with it.

This doesn't have to be. I would submit, as an example, the process that was used recently for the 67,000-sq.-ft. Oncology Hematology Associates of Central Illinois (OHACI) facility, an outpatient cancer care practice located in Peoria. OHACI is a growing practice that covers an area with one million people. This highly regarded group is one of the largest private-practice entities in the country, employing 12 physicians, 5 nurse practitioners, 39 registered nurses, and a total of 130 full-time employees.

Working intensively with a multidisciplinary planning team for 12 months, OHACI successfully created a truly patient-friendly environment that responds to body, mind, and spirit while addressing bottom-line financial considerations. OHACI secured a relationship with a developer, began preliminary financial modeling, developed a site-specific review plan, went on oncology practice site visits, developed contracts, and selected an architect, contractor, and interior designer. The practice solicited feedback from physicians and staff, as well as from patients—key information during the design phase involving the Peoria-based architectural firm Phillips Swager Associates.

Another key team member was Design Build Associates in Peoria. The owners also engaged our firm, Spellman Brady & Company, to collaborate closely with all parties. And the project was spearheaded by OHACI Director of Operations Peggy Ramsey, who was instrumental early in the process in creating open communication between all team members.

In our design/procure model, we position ourselves as an owner's representative, working parallel with the architects to facilitate all aspects of the interior design, FF&E selections, procurement, and installation. Because it is critical to stay ahead of the contractors to ensure that the FF&E package works with the facility and is not applied to it, we prefer early involvement in the project, preferably in the schematic planning phase.

Developing with the owners a range of FF&E budgets that include the project's hard and soft costs, we're able to develop realistic criteria upon which to base educated decisions. Once the owner approves the budgets, only those items that fit into the budget are shown. We have accountability for every dollar spent and eliminate the duplication of work seen with the traditional design/bid process. We find that negotiating directly with manufacturers strengthens our communications with the factories about the owners' specific needs and budgetary goals by eliminating a layer of possible miscommunications. Discounts are further enhanced by the manufacturers' knowledge that we are negotiating with numerous competitors. By integrating all services and products, we were able to reduce OHACI's cost for the overall interior package, including design and product costs, by 25%.

The owners then have the option of applying these savings to the features that really speak to the patients—for example, comprehensive artwork. Again, we give the owners a range of choices with developed budgets, and we work directly with the artists to meet owners' needs. To create a successful end result, the content and style of the artwork must interface with the interior design. This is determined by the demographics, lifestyles, and natural environment of the facility's market base.

For the OHACI project, Peoria's surrounding lush landscape with its large vistas of sky influenced our interior design theme (figure 1). Specifically, our design colorways were influenced by semirural Illinois prairie and sky. We used lots of color against neutral backdrops, and these “pops” of color were blue (sky and water), greens (prairie grasses), and clay red (earth). As a further nod toward nature, the treatment room recliners face outward toward windows, providing an overview of the beautiful surrounding landscape (figure 2), which creates a peaceful, Zen-like place.

Also, working closely with the owners and architect, we consulted on the materials for the exterior of the building (figure 3). We helped to select the colors of the brick and even the window glass color (recommending a more restful, inviting sage green rather than the blue-gray originally specified for the latter).

In general, we worked with the owners, architect, and contractor to integrate our visions and coordinate all design elements, resulting in overall consistency of appearance from the outside in (figures 4-6). This type of collaboration and the integrated result represent a growing trend in healthcare design.

We believe that OHACI achieved its goal of creating an embracing, comforting environment for patients and families. The building has a wonderful, consistent flow throughout. You do not see where the architecture stops and the furniture begins—it's seamless. Accomplishing all this within budget means that we really did meet the bottom line of healthcare design. HD

Diana Spellman is President of Spellman Brady & Company, an interior design firm based in St. Louis. For more information, phone 314.862.0070 or visit