Most architects and interior designers would agree that the broader the perspective one brings to a project, the smoother the process should be-simply anticipating multiple viewpoints and objectives should help avoid unnecessary interruptions and conflict. Perkins+Will's (P+W's) Brenda Smith goes that one better-she has actually had career experience as a healthcare provider for seven years, a high-end interior designer for 15 years, and an owner's representative for a children's hospital, responsible for 1 million square feet of renovation and construction, for five years. As Team Leader for Health Care Interiors for P+W's Atlanta office since August 2008, she is expected to bring all three perspectives to the working-out of interior designs appealing to everyone. Recently, Brenda discussed with HEALTHCARE DESIGN Editor Richard L. Peck how she got to this point and how it's working out so far.



Richard L. Peck: How did nursing get you started in this direction?

Brenda Smith, RID, IIDA, LEED AP: I was always interested in the sciences and, growing up in the Midwest, nursing seemed to be a logical way to express this interest. After becoming a general med/surg nurse, though, I found I was unsatisfied with such short-term exposure to patients, and I moved to a more specialized clinical setting where I first worked with physical rehabilitation patients and later served as a liaison for oncology patients, physicians, and insurance carriers for a radiology group. I enjoyed getting to know patients and their families in more depth. But there was a piece missing-a creative outlet. After some academic exploration, I decided to go to school for interior design.

Peck: During your first experiences with interior design, did healthcare design appeal to you?

Smith: Not initially. This was in the mid-1980s-government regulations in healthcare and insurance were changing and the healthcare environment was uncertain. I didn't think healthcare design would allow the kind of full expression I was interested in. I gravitated to high-end corporate/commercial design, and I worked on executive offices and corporate headquarters for companies such as Coca Cola, Georgia Pacific, and the Bank of Boston. The economic downturn around the year 2000, though, made me rethink my path. I ended up moving to a position that I felt was a perfect blend of my skill sets: interior design manager for the master planning project at Children's Hospital of Atlanta. I provided owner representation in working with interior designers, graphic designers, art consultants, and FF&E procurement.

Peck: Did you find healthcare design to be more satisfying then?

Smith: Yes, there's been a dramatic shift since the mid-1980s. Healthcare design has responded to principles from evidence-based design, such as design solutions for creating patient distraction and staff retention through environmental design. Healthcare institutions are now seen more as civic amenities in our communities, much more so than 20 years ago. Now we are using aesthetic principles to set people at ease and create a welcoming environment, one that is engaging and comfortable. We are combining the visual aesthetic with clinical requirements in a way that's unique.

Peck: What is your take on how hospitality intersects with clinical requirements in these environments? Is there a built-in conflict here?

Smith: It is a challenge for designers to provide the materials required for healthcare and detail things in a way that aids in infection control, and yet be as welcoming as possible. In this office, for example, we're always looking for ways to design and detail patient rooms so that they will include amenities similar to home. We are providing options for patients, giving them some control of their environment, such as adjustable or colored lighting and choice of information sources, and providing spaces for families and care partners, such as work areas and sleep surfaces, where families can spend not just days, but weeks.

Peck: What did you learn, as a designer, from experiencing the owner's representation perspective?

Smith: I straddle both worlds-I am able to think like a nurse and see like a designer. As a designer, I've learned to be much more pragmatic. From an operational standpoint, owners want something that will look great not only at the photo shoot, but five years down the road. Owners care about these spaces, and there is an emotional commitment as well as a financial reality in keeping them looking nice for as long as possible. Owners also have a direct link to their customers with customer satisfaction surveys and are sensitive to any perception of their environments as being unclean or unpleasant. Owners are also much more cognizant these days of evidence-based design principles, and want to apply proven research results to patient safety, outcomes, quality of care, esthetics of the surroundings, and more.

As a nurse, I've learned that quality of patient care and staff experience can be greatly influenced by the care environment. Successful healthcare design involves partnering with care providers to examine and improve operational flow and practice, as well as to create beautiful surroundings.

Peck: From a designer's perspective, isn't this broad involvement by owners a little nervous-making?

Smith: No, it is welcomed. The best project outcomes occur when the end-users and operational team participate in the solutions. Sometimes the owner's concerns have to be redirected a bit-for example, one project at Children's Hospital used color theory to design a cardiac unit with bright reds, oranges, and hot pink, with the concept that this would help increase circulation. One physician was outraged by this and thought all colors should be subdued. But the chief cardiologist was delighted-it helped him identify when the patient was blue from hypo-oxygenation. The point is, evidence-based design gave us a tool to use in color selection, as opposed to personal preference.

Peck: What about the ultimate in evidence-based design: the post-occupancy evaluation (POE)? Does that make you nervous as a designer, if things don't work out as planned?

Smith: A POE is, of course, always concerning, but as a designer you use best practices and rely on historical information and your own experiences to make the best decisions possible. And you have to anticipate knowing what to do if results are contradictory to the expected outcomes. Evidence-based design research is always a partnership between the owner and the design firm, with assume projections as to outcomes.

Peck: Would you say that owners today are pushing designers in the direction of evidence-based and longer-term planning?

Smith: Yes, and in fact we are hired these days to work with owners in this way. And, for our part, we designers strive to be savvy in terms of best design practices and healthcare trends to meet owners halfway. HD

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Healthcare Design 2009 November;9(11):92-94