If you asked people how they envision a medical facility, most would respond with an image of large lobbies, endless hallways and patient rooms with a draft. However, ask an architect who specializes in medical design and the answer is quite different.

Healthy Implementation For The Healing Environment — with Medical Design

“For more than a decade, the healthcare industry has been borrowing design concepts as well as ideas regarding amenities from the hospitality market to create an inviting, healing environment,” says Mo Stein, FAIA, principal of HKS Inc. “The idea behind it is simple — hospitality equates to relaxation, comfort and convenience. Today’s sophisticated healthcare subscriber demands all of these elements.”

The first step in creating a healthy environment, says SmithGroup Phoenix’s Vice President Mark Patterson, AIA, is defining the facility’s users.

“We utilize elements of Evidence-Based Design to create environments that are therapeutic, supportive of family involvement, efficient for staff performance and restorative for workers under stress,” he says. “Because healthcare facilities can be stressful environments, it is important to design spaces that are comforting, as well as highly functional.”

Neil Terry, AIA, director of healthcare for Orcutt|Winslow, agrees that seeking and obtaining healthcare is often a stressful and traumatic experience, and that the environment is key to helping create a better patient experience.

“Creating a healing environment can be as simple as using materials and colors that promote a more familiar, home-like experience,” he notes. “It can include the use of elements that are known to be soothing to the human psyche. A healing garden with running water is a very effective approach; providing family space within the patient room, where they become part of the healing process as opposed to an intruder to the care giving.”

Principal Maha Abou-Haidar, AIA, of NTD Architecture adds that every healthcare environment needs access to natural light, the feeling of airiness and uplifting colors in interior schemes.

“Pleasant diversions are included to minimize the stress for those waiting, or for the professional staff who work in a high-stress environment,” she says. “(Additional) space is included to support the family-centered concepts, which provides the social support essential for healing and psychological well-being.”

Medical Design, AZRE May/June 2008

Evidence-Based Design

Terry defines Evidence-based Design (EBD) as using practices in healthcare design that are proven to promote good outcomes in the healing process.

“Often these practices result in higher construction costs,” he says. “EBD was developed as a way of showing that the benefits of EBD outweigh the costs to implement them.”

Stein adds that designing a facility based upon EBD results in improved patient outcomes, staff and visitor satisfaction, and operational efficiency.

“By keeping abreast of current research, we always strive to infuse any healthcare facility with the latest methods for improving outcomes,” says Richard Beach, AIA, managing principal and lead medical planner for Gresham & Beach Architects. “This can be done through the use of appropriate lighting levels, flooring materials that are easier to navigate and not slippery, patient bed positioning for reduced travel distance to bathrooms, conveniently located hand-wash sinks that discourage the spread of infection, etc.”

Abou-Haidar adds that several EBD projects the company has completed have reported a beneficial impact on several organizational and human variables, including incremental changes in market share; satisfaction level of patients, staff and physicians; retention and turnover rates of nursing staff; and labor costs per patient encounters.

Building Information Modeling (BIM)

“We think of research facilities as highly sophisticated machines that are driven by complex mechanical, electrical and plumbing systems,” says Mark Kranz, AIA, principal of SmithGroup Phoenix. “The BIM process allows us to be miles ahead of the curve in terms of coordination and collaboration with contractors and subcontractors.”

Stein adds that new technology is taking the integrated approach to an entirely new level.

“BIM allows architects to explore complex architectural geometry with a realistic and intelligent model, which is seamlessly integrated with construction documents,” he says.

According to Patterson, the BIM process reflects the way architects really work.

“We think graphically in three dimensions and BIM facilitates communication with our clients, helping to express our three dimensional concepts and designs more accurately,” he says.

Terry adds that with BIM’s 3D modeling, a change to the floor plan automatically alters the elevations, enabling designers to see when conflicts occur and correct the design. The design tool also allows architects to see when systems collide with each other, which helps in correcting a problem before the project gets to the construction phase.

“We also use BIM to allow the user to see spaces in virtual reality,” Terry notes. “This is important for having the user help us in determining the proper placement of medical gases and other equipment, so they can be where they are most effective to the care giver.”

Healthcare Design Challenges

Each medical facility type has its own unique challenges, with hospitals being the most challenging because of all the different elements that go into them, Terry says.

“Components range in complexity from the hospital administration to heart transplant surgical suites, each with its own unique requirements,” he explains. “Hospital design can be compared to conducting a 150-piece orchestra as opposed to a medical office suite, which is like leading a musical quartet. The ‘conductor’ must know how to design each specific area, and be able to coordinate all the systems that go into that area, times the number of areas that need to be designed.”

Adding renovations to an existing medical facility creates an even bigger design challenge. Renovations and expansion projects offer major challenges compared to new construction.

“Older systems may need to be connected to new systems, and that offers a unique set of challenges,” Abou-Haidar notes. “Additional issues include the possible presence of asbestos and lead paint, parking deficiencies, dust control, noise, as well as other issues. All of these are causing many institutions to construct replacement facilities with the latest technology systems and consumer-focused amenities.”

In the 25 years Gresham & Beach Architects has been designing healthcare facilities, Beach says it has encountered many “tough” design challenges. Two specific projects Beach remembers involved significant expansions to the existing building, along with extensive renovations and remodeling within occupied space.

“Each required multiple construction phases, maintaining the operations of the hospital during construction and careful planning to maintain infection control,” he says.

Solutions Beach observed through these challenges included documenting and thoroughly understanding the processes used by the medical staff; developing a logical approach to solving space problems; establishing priorities for phasing the design and construction; and empowering a user/facilities/design/builder team to identify issues and resolve conflicts before they became insurmountable.

Another solution, as it relates to upgrading a healthcare facility’s technology, is careful integrated design and early involvement of the contractor through the design assist process, Abou-Haidar says. Taking these steps has allowed her company to turn these types of challenges into opportunities.

Healthy Balance

Collaboration is a key element of project success, Patterson says. It’s important to strive to develop a true understanding of where each stakeholder’s expectations lie and where those expectations originate, he adds.

“For example, when planning a surgery suite, we interview surgeons, nurses, patients, house keeping staff, etc., to understand how they intend to use the facility and how the design of that facility affects their individual function,” Patterson says. “The most fulfilling part of our job is finding that we were in some way able to help implement a more effective or agreeable way for stakeholders to interact with the space and one another.”

Successful projects, Stein says, are the result of a high degree of involvement by the client at each stage of project development.

“We encourage consensus building among the users and other concerned groups in the design process,” he says. “We accomplish this through active discussion and work sessions with owner representatives and most essentially, users.”

Abou-Haidar points out that part of obtaining a healthy balance within the design of healthcare facilities includes incorporating and anticipating the ever-increasing level of computerization within the healthcare industry. Computerized healthcare programs include electronic medical records (EMR); computerized physician order entry (CPOE); point of service electronic documentation with hand-held devices or voice activated systems; digital imaging and archiving systems; wireless medical diagnostic and monitoring devices; nurse call systems that electronically track the nurses’ locations; and robotic systems for material management and distribution.

“All of these systems require a tremendous network fail-safe infrastructure, a data control center for centralized monitoring and multiple communication rooms to manage the structured cabling systems,” Abou-Haidar says.

Trends for Future Healthcare

“We’re seeing the rapid development of changing technology having the most significant impact on the design of research facilities,” Kranz says. “The other significant change we’re seeing is a transformation from the traditional biology or chemistry wet lab environments of the past to much more interdisciplinary and ‘drier’ research environments, where a significant portion of the research is more equipment- and computer-based, not necessarily requiring a wet bench environment. Bioinformatics, for example, is a bright new field that uses computers to store, search and characterize the genetic code of genes, the proteins linked to each gene and their associated functions.”

In terms of future trends, Patterson says one of the most exciting involved the integration of research and healthcare, which is known as translational care.

“This will mean that a patient’s course of treatment will be very customized for their individual genetic composition,” he says.

Another trend Patterson points out is the development of nanotechnologies that will support fewer and fewer invasive procedures.

“This, along with the advances of bio-interface application as seen in the development of smart prosthetics, are allowing individuals to not just live longer, but enjoy more active lives,” he says.

Beach notes that other upcoming trends for the medical field include continued reduction in patient lengths of stay; increased reliance on technology for procedures; and increased patient involvement in treatment alternatives and decision making.

“In the healthcare industry, the only thing safe to assume is that change will occur in the future,” Stein says. “The difficulty is in predicting what exactly it will be and when it will occur.”

Stein incorporates a look at several “megatrends” that are driving the accelerating rate of change in healthcare — rising public expectations, cost containment, advancing technology, computerization, communications, and telemedicine.

“Under this era of technology-intensive healthcare,” Stein says, “facilities must continue to balance high-tech with high-touch. Personal contact, caring service and genuine concern for patients should never be replaced by technology. In this new environment, facility design will become an important marketing tool. The creative architectural firm will be able to contribute to creating an environment that supports the strategic goals of the organization.”





AZRE Magazine May/June 2008