Addressing the requirements of healthcare regulatory agencies is increasingly becoming a driving factor in healthcare interior design. In the past, key factors in interior design success encompassed meeting the expectations of the owner, the local community, the vision of the organization, and the architect. Today's healthcare interior designers must also weave in the realities of the regulatory and business environment.

Designing for Safety

In 2005, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) stated that its primary goal for 2006 was to address the issue of patient safety in relation to clinical practice. This has significant implications for physical design, construction budgets, and interior finishes of healthcare projects, both present and future (figure 1).

South Jersey Healthcare Regional Medical Center, Vineland, New Jersey. Providing work areas adjacent to the patient decreases the opportunity for distractions and promotes patient visibility to caregivers, decreasing patient falls. Appropriate sound attenuation is provided with carpet and high-NRC (noise reduction coeffiecient)-rated ceiling panels in the corridors

We are learning, for example, that ambient noise in hospitals affects patients' perception of receiving a good night's sleep and affects caregivers' ability to provide excellent care; nurses who experience excessive noise in the work environment have a tendency to make more errors. Healthcare designers need to be mindful of the implications of this when eliminating higher-end ceiling and wall materials during value engineering. They must push for construction budgets that are adequate to accommodate costs that will allow healthcare interior designers to use best practices.

Healthcare designers must also work closely with architects regarding the many other environmental factors contributing to patient safety, specifically, using research-based interior-finish material specifications. Issues such as slip and fall, glaring floor finishes, and high-contrast materials that can disorient elderly patients have been addressed by healthcare interior designers since the 1980s. Flooring specifications and the coefficient of friction of materials will continue to be major considerations in interior design as long as safety remains a high priority for clients.

Infection Control

Healthcare interior designers are familiar with the rigorous interior-finish guidelines they must follow to meet local and state health code requirements for treatment and procedural areas in health facilities. It is also prudent that designers familiarize themselves with the regulations and guidelines from the Centers for Disease Control and Prevention (CDC), as infection control measures need to be planned and implemented throughout the majority of spaces in acute care facilities today. This is a continuing challenge because airborne pathogens and persistently antibiotic-resistant microorganisms plague the infection control departments of today's hospitals.

Decisions regarding specifications for finish materials require healthcare interior designers to look closer at materials once used routinely. Textiles such as those used in upholstery, cubicle curtains, and flooring have come under intense scrutiny by owners during interior finish selection and approval because of their increased sensitivity to infection control. Through informed interior-finish specification, owners can be assured that the selections will be viewed favorably by their facilities' in-house infection control departments. Coordination with and integration of environmental services and in-house infection control officers in design development will increase the likelihood of success.

Because some infection control measures—such as today's hand sanitation implements and required personal protective equipment—are so readily visible to hospital visitors, these must be dealt with and integrated into hospital interior designs in a creative way (figure 2).

Parker Adventist Hospital, Parker, Colorado. Providing multiple means of hand sanitation in prominent locations is now common as health facilities attempt to decrease nosocomial infections. Proactive incorporation into the interior design eliminates awkward sight lines in public spaces

Design Promoting Privacy

When implemented conscientiously, the Health Insurance Portability and Accountability Act (HIPAA) has been very effective in accentuating the importance of patient privacy and, from the design standpoint, the need for sound attenuation in interior materials specification. Material selection for floors, walls, and ceilings must take sound attenuation into account as a factor in meeting HIPAA requirements. From a space planning standpoint, many facilities are reconsidering the use of private offices rather than open carrels for any discussions involving patient histories (figure 3).

Emory Crawford Long Hospital, Atlanta. Accommodation of the privacy of the patient is key in areas where the patient's history is spoken between individuals. Furnishings placement must be provided at an appropriate distance to avoid the range of audible speech of individuals in the adjacent admission area

Healthcare designers are also noting a cascade effect from programming and space planning for the required square footage to provide more private spaces during the patient's hospitalization. This affects construction costs, and budgeting is again an issue. Construction costs must cover the increase in requests for sound attenuation measures, white noise sound-damping systems, and music systems used to meet HIPAA requirements.


Once considered a concern addressed only in corporate settings, ergonomics is an issue for the healthcare designer, not only in planning private offices but also for all millwork and casework designs throughout the healthcare facility. For example, nurses charting for prolonged periods need work surfaces that meet the ergonomic recommendations from the Occupational Safety and Health Administration (OSHA) and the International Standards Organization (ISO).

In addition to addressing the physical needs of today's aging caregivers, interior designers must take into consideration tasks performed by ancillary providers (figure 4). Factors include providing work surfaces at the recommended height adjacent to pneumatic tube stations, proper clearances within housekeeping closets and equipment storage rooms, and safe clearances for staff approaching linen chutes. Selection of flooring materials is often finalized from the standpoint of caring for the caregiver in terms of reducing leg fatigue and avoiding occupational strains.

Abbott Northwestern Heart Hospital, Minneapolis. Various work-surface heights were provided to accommodate the specific tasks performed. An adjustable work surface was provided in the work space of the unit clerk, where prolonged computer use occurs. The work surface can be adjusted at shift change to prevent occupational strains for the next user

Furniture selection is no longer evaluated simply for the longevity of its mechanisms, the warranty, or ease of maintenance. Attention is given more prevalently to ease of operation and avoidance of injuries. A driving factor behind this is the fact that aging caregivers or family members are often operating the furnishings rather than the patients themselves.

Nonregulatory Design Issues

Dealing with personnel shortages and physician/hospital relationships is a major issue for today's healthcare executive. Creating an environment that is clinically efficient, supports the work process, and is safe for the staff, while at the same time is beautiful, calming, and easy to maintain, will continue to be on the list of responsibilities for healthcare interior designers (figure 5). Designing spaces that accommodate multiple clinical purposes and address the professional needs of the physician and staff will continue to be a priority. Patient satisfaction is another important issue for healthcare executives. Healthcare interior designers will continue to be challenged to enhance the patient journey in creative, maintenance-friendly, and cost-effective ways (figure 6).

McKay-Dee Hospital Center, Ogden, Utah. Providing an organized caregiver station with immediate views to nature and an adjacent space for consulting with the patient's family and fellow staff members is an asset for nurse recruitment and staff satisfaction and retention

Parker Adventist Hospital, Parker Colorado. Designing the experience is a high priority for today's healthcare executives to ensure patient and family satisfaction

The Future: A Balancing Act

As more healthcare executives ask architectural firms and healthcare interior designers to incorporate design elements from the hospitality sector, designs must be reengineered to meet the always rigorous parameters and guidelines of healthcare facility design. More and more technology—including information technology—is being added to the environment as, all the while, the quest for calm, soothing, hotel-inspired healing environments continues.

Balancing these demands will continue to be a challenge for the healthcare interior designer. In general, while most technology should be “hidden,” it should also be easily accessible and incorporate ergonomics in its design, creating a clinically efficient yet beautiful interior environment. In meeting challenges such as these, it is up to the healthcare interior designer to understand them and strike the appropriate balance for the modern healthcare facility. HD

Laurie Waggener, RRT, IIDA, AAHID, is Vice-President of HKS, Inc., and a founding member of the American Academy of Healthcare Interior Designers. Contact her at 214.969.5599.

To send comments to the author and editors, e-mail


What is AAHID?

Designing safe, functional, and welcoming interiors within all types of healthcare facilities requires special accreditation in healthcare interiors. Given the complexity of care within this interior design segment, AAHID (American Academy of Healthcare Interior Designers) was formed in 2004 to elevate rigorous standards for the design and specification of healthcare interiors. For more information on AAHID, please contact:

American Academy of Healthcare Interior Designers

6213 Skyline Drive, Suite 100; Houston, TX 77057

Phone: 713.266.0531



Healthcare Design 2006 May;6(3):64-70