The Leaflet Archive
FLEXIBLE GROWTH & PATIENT EXPERIENCE New patient tower for Baptist Health of Northeast Florida supports demand
BY STEPHAN K. GARTMAN | PHOTOS BY RANDY VAN DUINEN
In 2005, Baptist Health of Northeast Florida's new hospital, Baptist Medical Center South, opened its doors to patients. As part of this undertaking, a cohesive, long-term campus master plan was created to guide growth. Located in Jacksonville, Florida, when Tower C opened in spring 2018, one of the final pieces of the master plan was realized. The new eight-story, 138- bed, 155,200-square-foot patient tower gives Baptist Medical Center South the space to better serve a rapidly growing community - especially in surgery and labor and delivery.
In with Skin: 6 trends to watch in healthcare exterior design
BY DAVID STACZEK
Around the country, hospital and health systems are investing in expansions and new construction. When it comes to designing the exterior of a new facility, owners are making a renewed investment in sustainable, high-quality materials that improve facility performance and lifespan. Technology advancements in areas such as prefabrication and computational design are expanding design options and accelerating construction timelines. The following are a few of the healthcare exterior design trends anticipated in 2019 and beyond.
RE-IMAGINING CARE 6: tips for taking an empathy & experiential approach to pediatric behavioral health spaces
BY PAT MALICK | PHOTOS BY HALKIN MASON
Across the U.S., the demand for inpatient mental and behavioral health services continues to surge, particularly within the child and adolescent demographic. According to a CDC/NCHS study, six percent of youth ages 12-19 are being treated with psychotropic medication for a psychiatric disorder or condition.
Entry to Care: Exploring door hardware & access solution trends in healthcare facilities
BY STEPHEN JOUFLAS
Multiple influences are driving today’s trends of hardware and access control solutions in healthcare facilities, including increased security needs, evolving technologies and changes to healthcare delivery impacting movement through spaces. There is an increased demand on architects and designers to correctly specify door hardware in a healthcare environment undergoing constant change. The following trends represent a small portion of these needs and responses.
HEALTHY ALIGNMENT: Embracing cultural shift to consolidation, standardization drives positive design & operations outcomes
BY CINDY BECKHAM & STEPHEN PARKER
Each year, more community hospitals are absorbed into larger systems. By the end of 2018, the number of community hospitals in a system will approach 70 percent nationally, according to the American Hospital Association. Why are hospitals becoming systemized? The premise of systemization is simple: reduce cost by leveraging size for enhanced purchasing power, contract negotiation strength, consistent data reporting and reduced variation through standardization.
Timeless Design:Tips for saving money on interiors while maintaining a competitive edge
BY REBECCA DONNER
The average cost of constructing a new hospital comes out to roughly $400 per square foot. When this kind of money is at stake, owners are naturally looking for ways to save money without sacrificing quality — and interior design is often one of the first places they look for savings.
Healing the Healers: The sound and well-being connection in hospitals
BY TAMA DUFFY DAY & BONNY SLATER | PHOTOS BY WENDY STECK MERRIMAN
Did you know that stroke patients working with a music therapist can learn to express themselves through singing, or that music with a beat can make walking easier for those suffering from Parkinson’s disease?
Standing Ready: Lightning protection for hospital rooftop gardens, terraces
BY MICHAEL CHUSID & JENNIFER MORGAN
From the ground, it can be difficult to see slender air terminals (lightning rods) mounted on a roof. Locating air terminals out of reach from the ground also helps protect them against damage or vandalism. If, instead, a person is on a rooftop terrace or landscaped garden, only inches away from the air terminals, it is appropriate to consider both the appearance and damage resistance of air terminals.
WATER WISE: What U.S. hospitals can learn from Cape Town, South Africa’s water crisis
BY KELSIE WHITTINGTON
The world was shocked to learn that Cape Town, South Africa’s second largest city, was forced to reconcile with the fact that its water supply wasn’t a lifetime guarantee. In January 2018, the mayor of Cape Town, Patricia de Lille, announced that “Day Zero” would occur in April of that year. Day Zero was a term used to describe the crisis at hand when the dams that feed the city its water supply would dry up and all city-supplied water would cease to exist. The city asked residents to drastically cut back on their water usage, warning they might be forced to wait in lines for water rations if trends continued.
CONSTRUCTION CONTAINMENT & PROTECTION: Today's best practices keep infection control top of mind
BY RACHAEL FARR
All construction logistics are challenging, but perhaps one of the more difficult aspects rests in managing construction containment methods on healthcare projects. While the staples of infection control procedures and mitigating risks remain similar to years past, the way teams are working to improve each facility’s construction experience is rapidly evolving.
Designing from Cultural Cues: A Stigma-free model of care for "sidelined" adults
BY CHRISTIE ADAMS, LIBBY LAGUTA & DAMON LAMBERT
Whether it’s the opioid crisis, homelessness, depression or any of the other diagnoses heard about on a regular basis, behavioral healthcare is an increasingly visible component in the spectrum of care across the United States. On average, 1 in 5 adults battle mental health issues, with roughly 41 percent receiving care. In examining the typical architectural and interior design process for behavioral health facilities, it frequently focuses on a single project, an isolated part of the sum of treatment and care options.
EMERGING SOLUTIONS FOR EMERGING DISEASES: Designing for resilience in the face of infectious diseases
BY ERIN PEAVEY & DAN THOMAS
When the Ebola epidemic caught the world by surprise and exposed potential weak points in readiness for certain types of infectious diseases. These events, often thought of as once-in-a-lifetime, are on the rise as the world becomes more connected and the changing climate is shifting and expanding disease zones. Although outbreaks often come from unintentional harm, such as travel-borne illnesses and lack of childhood vaccination, the threat of intentional harm (e.g., bioterrorism, anthrax) is also a reality we must prepare for.
Design Thinking: Reimagining the healthcare design process
BY KURT SPIERING & AMIN MOJTAHEDI
There is no question the healthcare industry is transforming at a rate faster than ever. To address the speed of this transformation, healthcare providers are faced with balancing the implementation of cutting-edge technologies and forward-thinking processes with the financial impact of each decision.
CONSUMERISM ELEVATES HEALTHCARE FLOORING: Flooring integral to creating ‘wow’ moments, calm patient spaces
BY JEN ANKERSON & HEATHER ROBBINS
Consumerism is changing the business of healthcare, and brand loyalty is the Holy Grail. As patients take more control over their health spending, providers can influence buying decisions by offering a patient experience that is pleasant, convenient and seamless across digital platforms and physical locations.
TRANSPARENCY IN HEALTHCARE: Bring down those walls with glass
BY NATHAN MURRAY
The physiology of the medical campus and its edifices has experienced a dramatic change in permeability, transparency and accessibility. Glass — the most vulnerable of all building elements — has multiplied from being a treasured 10-15 percent of a building’s cladding to, in many cases, 50 percent or more today. What has driven this movement to more clearly expose and reveal the inner workings of the healthcare machine with increasingly transparent and invisible membranes? We are truly seeing evidence of the shift in attitude toward healthcare as a more knowable and accessible aspect in modern society — intelligence and control over health in all its facets is a power we’ve gained almost exponentially of late.
COMMUNITY CONNECTIONS: Taking the next step with enhanced family care delivery
BY JENNIFER HOSKINS
A tremendous amount of research in facility design and care implementation has been provided in the field of healthcare in the last two decades. Hospital administration, developers and designers often sift through copious white papers to understand what is still considered best practices and what features translate to the most impact for dollar value.
Sound Advice: Designing for speech privacy, controlling noise to enhance care
BY NIKLAS MOELLER
The Facility Guidelines Institute’s Guidelines for Design and Construction of Hospitals and Outpatient Facilities are broadly accepted as best practice in healthcare facility design and construction, and its recommendations are incorporated into building codes in many U.S. states.
SUICIDE PREVENTION IN BEHAVIORAL HEALTHCARE SPACES : Updated The Joint Commission guidance clarifies issues on anti-ligature scores
BY SCOTT HOLMES
Between 2010 and 2014, The Joint Commission received almost 1,100 reports of suicides occurring in healthcare settings. The reports paralleled a trend that now puts suicide as the 10th leading cause of death in the United States, according to the Centers for Disease Control and Prevention
DESIGNING FOR TOMORROW: Making room for more personalized care experience at Park Nicollet Methodist Hospital
BY MATTHEW D. SANDERS & CHRISTINE HESTER DEVENS
To meet the needs of a growing community and an aging population, Park Nicollet Methodist Hospital is engaged in a transformative modernization program on its Methodist Hospital campus in St. Louis Park, Minnesota — the largest facility improvement since the hospital opened more than 50 years ago. When complete in 2019, the four-year expansion and renovation program will enhance the experience of care, safety and outcomes with a sustainable solution that will position Park Nicollet for continued leadership in healthcare.
MONITORING TECH: Trends in healthcare TV, digital technology
BY GARY BUSS
TV viewing preferences and digital technology in the U.S. have changed rapidly over the last few years. More people are going mobile and streaming self-curated content to their smartphone or tablet. The hospitality industry has embraced mobile technology to meet consumer demand for on-demand content. Hotels now provide input panels with power, USB, VGA and HDMI ports, allowing guests to use their personal mobile devices as receivers for audio and video content. Airlines, restaurants and other entertainment venues offer free Wi-Fi, mobile check-in and other amenities onsite and on demand.
Necessity & Opportunity: How strategic partnerships can benefit outpatient healthcare facilities
BY STEPHEN WINIKOFF & STEVEN STAFFORD
As U.S. healthcare continues its evolution toward a value-based and consumer-centric model, health systems are growing more responsible for population health management and rethinking care delivery strategies. One emerging strategy health systems are testing across the country is a growing focus and reliance on strategic partnerships. When leveraged appropriately, strategic partnerships can help health systems better manage population health by addressing the social determinants of health, strengthen their continuum of care and achieve improved health outcomes.
CHILD-READY: Envisioning pediatric spaces of the future
BY LISA LIPSCHUTZ
Healthcare design requires careful thought, consideration and attention to detail, especially when designing for a pediatric population. While routine pediatric care is typically community based in medical office, ambulatory, urgent care, emergency and even community acute care hospitals, specialized, complex care is routinely sought out at pediatric centers of excellence.
Planning Perfection: Facility activation = coordinated approach to occupying a new healthcare facility
BY JAY HORNUNG
Moving into a new or renovated space is the most highly anticipated part of bringing a new project online. Even a tiny oversight can have a huge impact, causing delays that can result in significant lost revenue. And yet two services are often overlooked when bringing a new project to completion: transition planning and move management.
State of Healthcare HVAC: Trends, challenges and HVAC’s role in infection control in large hospitals
BY GREGORY HUDSON
Hospital HVAC systems are not only used for thermal comfort, but are a critical component of infection control and patient safety. HVAC systems help prevent the spread of infection within the hospital, along with helping to promote patient healing. Recent trends in healthcare projects (such as increased energy efficiency, increased budget constraints and compressed project schedules) have shifted the focus of HVAC systems away from their primary purpose of promoting patient safety, in an effort to help achieve other project goals.
ENGINEERING GREEN: Top emerging strategies to reduce hospital operating costs, utility expenditures
BY MICHAEL PULASKI & BILL REPICHOWSKYJ
As the economics of healthcare undergo increasing pressure and uncertainty, hospitals are facing a greater-than-ever imperative to manage costs. Although energy represents a small portion of a hospital’s overall yearly operating costs, reducing utility expenditures can be a low-risk, high-yield and stable investment for the future.
FIRST DEFENSE: Protecting medical facilities from vehicle threats
BY ROB REITER
We’re in a new era of healthcare delivery — modern healthcare architecture has become more focused on strategically designed projects that accommodate the latest advancements in both construction techniques and medical technologies. This evolution has resulted in innovative state-of-the-art facilities that are as beautiful as they are functional.
Rethinking Design: Incorporating new trends, technologies in healthcare restrooms
BY JASON COSTELLO
Restrooms are universally used spaces, but their design in healthcare settings can vary widely based on patient population, room location and layout and safety concerns. For designers, patient restrooms in hospitals pose the greatest design challenges to ensure that spaces support healing, comfort and calm for patients and provide ease of maintenance, infection control and safety features for facility managers
Beyond the Intercom: Today’s nurse call, communication systems deliver improved patient care
BY JOHN KACPERSKI
Today’s nurse call systems are no longer simply an intercom for patients to contact the nurses’ station. Modern nurse call systems are now an integrated part of the ever evolving patient care solutions that interface with patient electronic medical records and provide real-time patient status to improve patient safety. Safety improvements such as “out-of-bed” alerts help prevent slip and fall incidents that sometimes are cause for extending a patient’s stay.
How Sterile is Too Sterile? Balancing form and function in a healthcare environment
BY LISA BONNET
Whether as a patient or a visitor, everyone can relate to being in a healthcare facility that feels institutional and overly sterile. Typically, sterility in a hospital is a great attribute and one that should be encouraged. Patients have many choices when it comes to providers and — historically when asked for input on the interior environment — often express a desire for warm and engaging attributes that promote a healing environment.
SAVVY PLANNING: Navigating growth, change with integrated planning and flexible spaces
BY THOMAS GUNN & PHIL L’ESPERANCE
To respond to changing dynamics and forces driving healthcare, industry leaders study the paths of growth and change in an effort to match forecasts to hospital building plans. And to plan with a longer and yet even more precise perspective, healthcare leaders, using clinical engineering principles, need to evaluate metrics and appropriate analytics to develop customized flexible solutions and decisively allocate resources.
Fringe Benefits: Lighting design to improve staff health, wellness, productivity
BY KEVIN TURNER
Whenever we interview hospital staff on lighting design improvements, their instinctive response is to brainstorm with us on the best possible design for their patients. This says a lot about their dedication and priorities. When choosing — for example — where to provide more natural light or views to the outside, nursing professionals will insist on upgrading patient spaces over their own every time.
Healing By Mother Nature: Past, present and future of incorporating biophilic patterns in healthcare projects
BY SONJA BOCHART
Biophilic design incorporates our innate connection to nature into the built environment to improve health and well-being. The science is relatively young, but new studies and research results continue to support the importance of integrating natural elements and so-called biophilic design patterns into new projects and renovations. Nowhere is this more important than healthcare settings.
SAFETY, MAINTENANCE & LOOKS: Factors driving today’s trends in healthcare flooring
BY DAWN FREDRICK-SEIBERT
The intended use of a healthcare space defines the type of flooring selected, and many factors must be considered. Attention to factors that make sustainable environments conducive to safety, cleanliness, wellness and healing have created the best results. These factors include the selection of everything from ceiling to flooring that can contribute to the healing process.
‘A PLACE TO FLOURISH’: Research gathered from 1,000 women guided the design intent of the Women’s College Hospital in Toronto
BY SUSAN BLACK & HEATHER MCPHERSON
Women’s College Hospital, designed by Perkins Eastman Black/IBI Group Architects, in Toronto, is the recipient of the 2016 Generative Space Award, presented at the Health Facilities Symposium and Exhibition. Women’s is the largest academic ambulatory care center and research institute in Canada, dedicated to improving the lives of women and their families.
Acoustical Ceilings & Fire Safety: Suspended ceiling systems play important role in controlling growth of fire in facilities
BY PAUL A. HOUGH
A suspended acoustical ceiling represents a significant percentage of a room’s surfaces. As such, it is critical to controlling the noise level in a room and between rooms. It is also critical to controlling the growth of a fire in a room by providing a separation between the room and the space above the ceiling. Because of this separation, a suspended ceiling can delay a fire that starts in an occupied space from reaching potentially combustible materials in other areas of the building.
Safe Haven: Designing comfort, safety into behavioral health spaces in EDs
BY REGAN HENRY
The rate of mental health-related emergency department visits is increasing. According to a 2010 study by the Agency for Healthcare Research and Quality, mental disorders and substance abuse are related to one of every eight ED cases in the U.S. or nearly 12 million visits to EDs yearly. As the baby boomer population grows older, more seniors with dementia and mental illness are presenting at EDs across the United States; patients aged ≥65 years have the highest rate of mental health-related ED visits and the highest risk ratio for hospital admission.
EMERGENCY CARE FOR AN AGING POPULATION: Best practices in geriatric emergency department design
U.S. Census data indicates that in the near future, 1 in 5 medical patients will be over 65 years old. Will our emergency departments be ready to respond? As 79 million baby boomers age into the 65-andolder geriatric bracket and increase their utilization of healthcare resources, it is imperative that EDs are designed to accommodate this growing market segment.
FIVE-STAR HEALING: Specialty facilities bring in comforts of home via hotel-like features
WILLIAM H. SCOTT III
The design and construction of hospitality healthcare facilities are as profound and complex as for a full-service hospital. Like any construction or renovation project, specialty projects require resources, experience, communication and collaboration that span between design and construction phases.
PICTURE PERFECT: Illuminate health and wellness with digital signage
As the industry transitions into a more preventive- and wellness-oriented industry, the expectation to do more than just treat sickness and disease is prevalent — to not only heal, but to inform and promote wellness and quality of life
Enhanced Flow: Benefits of using 3-D modeling, coordination drawings on HVAC projects
BY GREG HUDSON
Three-dimensional building information modeling is revolutionizing the way medical facilities are planning and managing their projects. It has made a specific impact on heating, ventilation and air conditioning work, a component of healthcare projects that affects every other design and construction aspect.
HARNESSING POWER OF PLACE: Creating flexible spaces built for technology, fostering patient-provider relationships
BY MICHELLE OSSMANN
“I’m going to see my doctor today.” There are two immediate intentions in this statement — the patient plans to both visualize and directly encounter a doctor in person or, increasingly, via telemedicine. Whether technology is a help or a hindrance, however, is based on both the physical environment and the associated user behaviors. Moreover, technology constantly evolves, necessitating flexible environments and ongoing user learning
More Power, Please: Factors behind a growing demand for emergency backup power in healthcare facilities
BY SEAN WILLIAMS
Among the many currents of change buffeting the healthcare industry, the issue of emergency backup power can be added to the list. Building codes, relative to emergency backup power in hospitals, are basically consistent from code cycle to code cycle. Each new edition of the National Electrical Code and National Fire Protection Act (NFPA) 99 makes minor tweaks, but the overall concept of the code remains consistent.
CONTINUOUS CARE: Top patient, design considerations for today’s bariatric spaces
BY SANDY FAUROT
One of the intended outcomes of the healthcare law was to improve overall community health, rather than just treat patients when they become sick. This has led to the development of facilities that offer comprehensive care for patients with chronic conditions or long-term diseases such as cancer, diabetes and morbid obesity.
Lifting the Lid on Restrooms: Rethinking patient bathroom design, creating clean spaces
BY BILL REPICHOWSKYJ
One crucial area in which the built environment has direct impact on care delivery is in the effective management of infection control. From structural and interior space design to the technologies and materials used within it, the built environment can significantly help reduce the spread of infection.
REPURPOSE, REUSE: Turning old facilities into new assets to benefit communities
BY KATE MORRIS & VINCE FEMIANO
Due to the healthcare law and other forces, hospital systems and other healthcare providers are employing new strategies to serve patients. Traditionally most services were centered on hospital campuses, but just like retailers have known for a long time, healthcare providers are realizing the benefits of being close to the communities they serve.
A Model Performance: OPTIMIZING HEALTHCARE CONSTRUCTION, OPERATIONS WITH BIM
BY CHUCK RICHMOND
Building Information Modeling is an integral part of providing construction services for healthcare facilities. Whether during design, estimating or construction, the process lends itself to building virtually by demonstrating its true value. Whether saving labor through improved fabrication techniques, reducing risk by engineering a hazard out of the equation or operating a building more efficiently with a data-rich model — the use of BIM should always be where it makes the most sense. To do so requires an equal amount of commitment and coordination from clients, design teams and subcontractors.
Healthcare Facility Commissioning: CLOSING THE GAP BETWEEN DESIRED BUILDING PERFORMANCE AND CODE REQUIREMENTS
BY MIKE SHEN
Building commissioning requirements for commercial buildings are slowly being accepted throughout the country. This progression is occurring through the adoption of energy and green codes, such as the International Energy Conservation Code and the International Green Construction Code. The Joint Commission uses these guidelines, where applicable, to determine the accreditation of hospitals.
Keeping Up With Fire Safety: NEW CODES, MATERIALS GUIDE DESIGN AND CONSTRUCTION OF TODAY’S HEALTHCARE FACILITIES
BY JOSEPH DE LUCA
According to the latest numbers from the NFPA’s Fire Analysis & Research Division, U.S. fire departments respond to an average of 6,240 structure fires in healthcare properties per year. These fires can cause an average of $52 million in property damage annually.
5 Elements: INTERIOR ESSENTIALS FOR CREATING HEALTHCARE SPACES IN HARMONY WITH FACILITY OCCUPANTS
DORI MOMMERS & THERESA WOOD
Healthcare systems are focusing on the “best patient experience” as one of their top priorities when designing facilities. This focus on the patient is applied in healthcare environments in order to satisfy the needs of patients away from the comfort and convenience of their own homes, and to provide a higher quality of care.
Balancing Act: Healthcare flooring trends that support needs of staff, visitors
Finding the perfect flooring solution in healthcare environments these days can seem almost impossible. With manufacturers providing solutions for designers to create unlimited design options and pattern capabilities, the performance and maintenance criteria is more crucial than ever. Fortunately, Evidence- Based Design criteria has been gathered in recent years around the flooring materials and their contribution to improved outcomes. These tools can help designers prioritize the best solution for a particular facility’s needs.
BEYOND THE CARD: The importance of prudent cyber security for healthcare facility control systems
COLEMAN L. WOLF
While construction of new healthcare facilities has skyrocketed in the last decade, most campuses consist of a combination of new and legacy buildings that have grown piecemeal over time to accommodate the needs of a growing care population. As a result, the control systems that manage building functions are often cobbled together without the latest security challenges in mind.
Embrace the Dark Side: Dimming hospital lighting to save money
RICHARD J. MANNING
I admit I’m the parent who walks around the house shutting off lights, and I tell my children the money that doesn’t go to the power company is our vacation money. Okay, there is other money budgeted for vacations, but it’s a great incentive to conserve energy and save money for activities the whole family enjoys.
MEASURING UP: METHODS TO RISE UP TO CHALLENGES, NEEDS OF URBAN HEALTHCARE
DAVID WATKINS & BHARGAV GOSWAMI
An overarching problem with U.S. healthcare is the uneven distribution of care, especially high-quality care. Urban centers, with the highest concentrations of population, are also most likely to have the highest concentrations of top quality of healthcare capability. However, demographics are just the beginning of the story
The Right Ingredients: Today’s developments in healthcare dining facilities
As healthcare evolves, and as healthcare institutions set the stage for an increased emphasis on wellness, healthier dietary choices are becoming key in leading hospitals into new advancements in food service. Rather than just providing standard dietary options for its patients, hospitals have begun to align dietary and nutritional selections with their principles for patient care. Patient satisfaction has become a priority for healthcare systems. HCAHPS, the Patients’ Perspectives of Care Survey, focuses specifically on the individualized care of the patient; however, an unsatisfactory meal experience may lead to an unsavory ranking on the overall experience. Improving the experience for the patient has included customized menus and dining-on-demand
AGE OF THE ACA: RISE OF THE EMPOWERED HEALTHCARE CONSUMER
The healthcare industry continues to experience significant change in the effort to reduce costs and improve efficiency, much of which has been influenced by the healthcare law and other incremental regulatory changes. For example, the recent enactment of the U.S. Bipartisan Act of 2015 added distance parameters for provider-based, off-campus outpatient departments, which will change reimbursement and reconsideration of some outpatient program strategies.
Prevention Through Design: Process provides enhanced plan for safety
Much like patient safety, employee safety is paramount to the professionals that design, install and operate healthcare facilities. But despite the highest caution and control, hospitals can be some of the most hazardous places for workers, including the building teams operating around or within the facilities. In many instances, considerations for safety within healthcare facilities are isolated. Architects are concerned with code compliance and other design considerations; engineers primarily focus on maintenance and service access of equipment; the constructor executes on building the given design and the owner aims to operate the healthcare facility as safely as possible. What if all involved parties collaborated on safety, ensuring that all key stakeholders share and build upon valuable input for the entire building lifecycle? Enter prevention through design.
RETAIL, CORPORATE WORKPLACES, SCIENCE: LOOKING TO OTHER INDUSTRIES FOR INNOVATION
For decades, healthcare has been able to innovate within itself. Leading providers and systems could look to peers for new ideas to modify their services and facilities and these changes kept organizations achieving financial and care-delivery goals. That reality changed with the introduction of the healthcare law, landmark health reform that essentially asks providers to do more with less.
ENERGY OPTIMIZATION: Making it work for long-term savings
MICHAEL DELLA BARBA
The industry is often tasked to build and maintain an infrastructure that provides high-level, sustained performance with little or no additional financial resources. Asset optimization, in all aspects of a healthcare institution’s operations, has become a significant driving force for efficiency, allowing the institution to maintain a high level of service within a value-based revenue model.
Lessons from Clinic 20XX: HOW TO DESIGN FOR AN EVER-CHANGING PRESENT
BY PATRICK SCHULTZ
Healthcare is at a crossroads, shifting significantly from inpatient to outpatient care. Given this change, how do we design outpatient facilities, not for a faceless future, but for a dynamic present? Researchers recently set out to find answers to better prepare for the healthcare industry of tomorrow. The result is a report by the Center for Advanced Design Research and Evaluation, Clinic 20XX, Designing for an Ever-Changing Present, which delves into the drivers of change, the trends in response and principles for clinical design. The findings of this report are summarized here, along with some additional case studies and insights on how principles outlined in this report have been implemented in practice.
Orchestrating the User Experience: Trends in healthcare facility signage and wayfinding draw competitive edge
As consolidation and competition accelerate and payment-for- satisfaction takes hold, health systems must carefully orchestrate the user experience that visitors, patients and providers have when encountering healthcare facilities. Getting lost remains a primary patient complaint and risk factor for many hospitals. As a result, signage and wayfinding have moved from after-thought to competitive advantage.
Recover, Rethink, Thrive: Responding in the Wake of Natural Disaster
Every time a major storm capable of widespread damage and destruction occurs, organizations and their facilities are severely impacted. For healthcare organizations, this can lead to levels of damage that render key spaces or entire medical centers inoperable for extended periods of time. There is very little healthcare organizations can do to predict when these natural disasters will occur, but there is a great deal they can do to prepare and respond.
Reducing Risks: A Joint Commission Fire and Life Safety Code Update
John D. Maurer
Knowing what guidelines dictate the design of healthcare facilities can sometimes be bewildering. This confusion often stems from the multiple sets of potentially applicable codes and guidelines that architects, designers and facility professionals must adhere to.
Top 4: Strategies For Minimizing Renovation
The combination of the Affordable Care Act’s passage, an aging demographic and changes in technology are all fueling a healthcare building boom across the U.S. As facility owners race to align with these shifts from volume-based to value-based care models, the number of expansion and renovation projects on existing campuses is outnumbering new, stand-alone facilities. This means more construction work is being performed on active medical campuses which, if not planned and executed properly, can be disruptive to staff operations or patient care.
Under The Evidence-Based Lens
Successful interior design installations respond to the industries they serve. In healthcare, the most important responsibility of an interior designer is to create environments that facilitate the delivery of quality care. In this complex and evolving field, it is crucial to keep up with policy and operational trends and anticipate how interior design interventions most impact performance.
Safe, working restrooms are a critical part of any building, but in a healthcare environment, sound restroom plumbing design is even more important. Special attention must be given to reducing the risk of hospital-acquired infections, while also ensuring reliable access to water, even in times of emergency.
The Accessibility Experience
Life has become increasingly difficult for me over the past 23 years, as different parts of my body have stopped functioning. I live with a progressive neuromuscular disease, which has forced me to use braces, a cane, a manual wheelchair and, most recently, a power chair for mobility.
From the approach to a hospital entrance, to winding one's way through the interior spaces to facing an examination or sitting in a waiting room, patients and visitors would rather be anywhere else than a hospital. The perception of hospitals is hard to shake - a place of crisis, scary beeping machines, bland decor and cold fluorescent lighting. But the hospital experience today can be dramatically different than even five years ago in healthcare facilities embracing designs that inspire hope, comfort and confidence while accentuating the hospital's mission. And lighting is an essential design element influencing the staff, patient and visitor's perception of the hospital experience.
Providing Solid Foundations
There are many moving parts to activating new facilities. While building preparation is paramount, consideration must also be given to the function and flow of the new space. In addition, plans will be significantly altered depending on whether services and employees are relocating to the new space or if the facility will require all new users, furniture, fixtures and equipment.
Urgent Care Centers
The phenomenon of the urgent care center is here to stay. While many people have great affection for their primary care provider, and those PCPs serve an invaluable role in the health and well-being of their patients, they cannot be available 24 hours, seven days a week. The UCC, in any number of incarnations, offers a level of availability at hours beyond that of most PCPs and at a fraction of the cost of equivalent services at an emergency department. These are all established facts, and support the growing number and popularity of the plethora of new urgent care providers.
Biocontainment Patient Care Units
Doctors and nurses who treat highly-infectious diseases do so at great personal risk. These are deadly illnesses for which there is no vaccine, and whether they are transmitted via bodily fluids, in the case of Ebola, or through the air, in the case of SARS, they pose a serious threat to the men and women who provide care.
Path to Harmony
According to the American Cancer Society, it's estimated that there were over 1.6 million new cancer diagnoses in the U.S. in 2014, with the number increasing globally each year. With this number of cases, it is reasonable to assume that regional health centers will be expanding facilities to provide services to accommodate these patients. A community-based approach to the delivery of healthcare also suggests the best way to treat these patients is by providing service in their own areas — minimizing the expense and stress of going to a larger, perhaps unfamiliar, metropolitan location for care.
Laura Morris & Phil Carey
One of the largest and sometimes most controversial investments healthcare clients make on the interior design of their facilities is flooring. Many facilities have maintenance protocols or are used to making do with what they have because of miles and miles of existing flooring.
eye ON LIGHTING
The replacement of fluorescent and incandescent lighting with LED technology in the healthcare industry has led to substantial energy cost savings. While the focus on squeezing out additional savings increases, many unique capabilities of this exciting technology remain locked away waiting to be unleashed.
There's an old joke about a man who goes to the doctor complaining that he sees spots. The receptionist asks, "Have you ever seen a doctor?" And the patient replies, "No. Just the spots." Like much humor, this one-liner actually mirrors a truth: men are much less likely than women to see a physician and look for ways to enhance their wellness.
Voice of Ventilation
Christopher P. Rousseau
As the only ASHRAE/ASHE jointly sponsored ASHRAE standard, and based on its close relationship to the Facility Guidelines Institute, Standard 170, Ventilation of Health Care Facilities, is in a unique position to be the premier voice in ventilation requirements.
Creating positive distractions
In today's healthcare market, hospitals are designed with a contemporary way of thinking and state-ofthe-art technology. Facilities are reaching beyond the ordinary to create soothing, healing environments for patients, families and staff. Artwork can help create that impact and provide a sense of wellness and comfort. In the past, artwork in a hospital seemed to be an afterthought and not considered a priority in the overall design. This has significantly changed over the last decade. Today, more hospitals are realizing artwork has an immeasurable impact on the healing process.
PULSE of activity
Bhargav Goswami & Mark Vaughan
"It's about time for an emergency department that understands patients better." That quote came from Dean Q. Lin, FACHE, president of Ocean Medical Center in Brick, New Jersey. Lin was announcing the opening of the new Hirair and Anna Hovnanian Emergency Care Center last March but he could easily have been talking about any number of the newest emergency department models. Medical planners and architects are working with administrators and clinicians to develop EDs that are not only more responsive to the needs of patients and their families, but also provide flexible, efficient facilities that allow emergency department staff to deliver the highest quality of care in high stress environments.
Alfred I. duPont believed "It is the duty of everyone in the world to do what is in his power to alleviate human suffering." The charitable trust established through his will became the Nemours Foundation, an internationally recognized children's health system that owns and operates the Alfred I. duPont Hospital for Children in Wilmington, Delaware and the Nemours Children's Hospital in Orlando, Florida, along with major pediatric specialty clinics in Delaware, Florida, Pennsylvania and New Jersey. His philosophy was one of kindness, fairness and responsibility.
Striking a BALANCE
John Klopsch & David Vollmer
Begin with the end in mind, as recommended by Stephen R. Covey in his book on personal development, "The 7 Habits of Highly Effective People." This concept also applies to the capital facility planning process. Aligning the guiding principles of design with the implementation of construction and the long-term effectiveness of operations will produce a highly effective facility. By defining the broad parameters and measurable metrics for success at the inception of the project, the owner can better control the end product.
The main artery of every hospital is the essential power system, which is always in a state of change due to remodels, equipment obsolescence, new codes and growth. Here are eight trends to consider as essential power systems evolve: 100 hours? Air quality regulatory agencies require limiting the use of emergency/standby power non road stationary compression ignition internal combustion engines to 100 hours or less per year for testing. Some agencies may evaluate the 100 hours based on operation of a plant, and not of the individual generators. If so, it may be difficult to individually cycle through generators and load each one up long enough to reveal heat-based flaws. Consider testing for the minimum time required each month, but once a year run each generator at 90 percent load for a minimum of four hours or longer - if staying under the 100 hour limit.
We Did Everything Right, Right?
Trish Martinec K
Norio Tsuchiya, senior designer at HKS, was proud of the design of Texas Health Flower Mound Hospital. He thought he and his team did everything right. They designed with healthcare urbanism, wellness, operational efficiency, staff and patient satisfaction and wayfinding in mind. The project won many accolades including the IIDA Design Excellence Award and the Symposium Distinction Award. In 2013, the project received Modern Healthcare's Best Place to Work award. On a celebratory note, Tsuchiya - who was working on another project with Texas Health - talked to the current president and CEO, Spencer Turner, to congratulate him.
Comfort by design
Tracy A. Randall & Christine Guzzo Vickery
Once known for sterile aesthetics, today's healthcare facilities are trading vinyl-lined corridors and florescent lighting for a more welcoming aesthetic that borrows design cues from the hospitality industry. And while most patients will never mistake a hospital or clinic for a hotel, healthcare facilities nonetheless are projecting a stronger welcoming image with natural finishes, more intuitive wayfinding and a stronger connection to natural light and exterior views. The image makeover is driven partly by competition as healthcare organizations jockey for market share and partly by consumer demands for quality service.
Leveling the Playing Field
Societal shifts, technology developments and the political landscape have greatly changed the way we live and the way we work within the past five years alone, and it's often difficult to keep up with this ever-evolving nature - especially in the healthcare industry. Healthcare organizations are tasked with catering to the multiple and diverse needs of patients while delivering quality care amidst these constant shifts. In effect, much of the consideration is put on the patient, which has left hospital employee needs largely out of the mix.
Anton Lama & Mary Ann Hay
The challenge in designing effective lighting for healthcare facilities lies in the ability to meet the multiple needs of each space. From the patients and their families to the medical staff and the owner's operational and energy savings requirements, it must be the lighting designer's mission to streamline all the facility's needs into a single, multi-faceted lighting program.
Casework has been a viable component of healthcare environments for decades, providing a multitude of functions in a variety of locations from public to clinical areas. A significant portion of a project's design process is focused on the configuration, size and functionality of casework within each space. It can contribute to the operational efficiency of workflow and performance while at the same time serve as an aesthetic element, bringing warmth and comfort into a space.
Maximizing value, maximizing resources
The challenges of developing modern medical facilities are immense. Hospitals large and small must continually consider changing patient needs, innovations in the practice of medicine and myriad differing economic factors before investing financial resources in facility improvements. To best understand the multitude of variables associated with design and construction, medical facility managers often engage in an integrated development process to achieve better spatial efficiency and cost-effective facilities.
Prefab in motion
With the unclear landscape in healthcare, organizations are looking inward to control costs. Operating margins continue to constrict due to changes in reimbursement and the looming implementation of the Affordable Care Act. This constriction decreases the overall ability to fund capital investments, making decisions on the use of the available funds critical. As investments in new or renovated facilities can become a significant portion of the expenditures, it is critical that each investment is carefully implemented.
L. Kent Doss
The term "biophilia," which literally translates as "love of life or living systems," is used to describe the theory that suggests there is an instinctive bond between human beings and other living systems and that this bond is essential to good physical and mental health. 1. We have a natural attraction to all that is alive and vital — all humans have "the urge to affiliate with other forms of life." 2. This premise helps explain why many spend time and energy caring for plants and flowers in their homes…in other words, our natural love for life helps us sustain life.
Healthcare leader PREDICTIONS
Compiled By Constance Nestor
The Health Care Institute recently embarked on finding out healthcare leaders' prescriptions for healthcare environments during the next 10 years. Thoughts on these challenges were found while conducting the HCI 2013 Healthcare Leaders Survey. The survey included healthcare institutions of various sizes and types from a range of geographic regions. Healthcare c-suite leader predictions were presented in the November/December issue of MCD. The following is an account of what facilities leaders have to say:
A hybrid OR is on the wish list for many facilities, as a way to attract physicians, expand services and provide hope for patients. Whether the hybrid project is a renovation or part of a larger replacement or addition project, facilities doing a hybrid for the first time are in for a challenging new experience. The perfect recipe for a successful hybrid OR project includes involving the right clinical stakeholders, determining actual procedures to be provided, coordinating multiple vendors and integrating timely decision-making into the design.
With the unclear landscape in healthcare, organizations are looking inward to control costs. Operating margins continue to constrict due to changes in reimbursement and the looming implementation of the Affordable Care Act. This constriction decreases the overall ability to fund capital investments, making decisions on the use of the available funds critical. As investments in new or renovated facilities can become a significant portion of the expenditures, it is critical that each investment is carefully implemented.
Prescription for SUCCESS
WITH ITS NEW 72-BED ADDITION, DELL CHILDREN'S MEDICAL CENTER OF CENTRAL TEXAS HAS ACHIEVED what no other hospital has: becoming the first to earn LEED Platinum certification twice — first for the original structure completed in 2008 and now being the first in the world to achieve LEED-HC Platinum for its 2013 expansion, the W.H. and Elaine McCarty South Tower.
RETURNING TO EARTH
Greg Gore & Clay Seckman
The geothermal heat pump system powering HVAC operations at the new Methodist Olive Branch Hospital in Olive Branch, Miss. is certainly innovative — MOBH is one of a handful of hospitals in the country to incorporate such technology. It is also green — reducing fossil fuel usage and supporting overall sustainability efforts at MOBH, which is tracking LEED Gold and predicting an Energy Star rating of 93. However, these are not the only reasons the project team selected this particular HVAC system.
In recent years there has been a consistent trend to create easily accessible and efficiently planned ambulatory surgery facilities for healthcare systems. Following this development is the emergence of new alternatives to provide care for more specialized emergency, surgery and oncology patients within the parameters of an expanded outpatient setting.
RELIABLE condensate drainage
Hospital facility managers are continually plagued by preventable building damage and health-threatening conditions caused by the failure to drain condensate from air conditioning systems. When condensate is not successfully removed, one or more of the following conditions develop: 1) condensate stands in the drain pan, 2) condensate overflows the drain pan and/or 3) condensate is blown onto internal components where it causes damage and creates fertile growth places for pathogenic organisms.
J. Patrick Schultz
The design of the hospital pharmacy can play an important role in streamlining patient care, improving workflow and reducing errors in medication dispensing. And good design makes it easier to provide the right prescription efficiently and free the pharmacist to ensure medication instructions are understood — thereby eliminating one of the primary reasons for patient readmission.
How big is 'big enough'?
Many people take the continued operation of hospitals for granted during a power outage, but electrical engineers must plan the details necessary to maintain continuous power. During an outage, an essential power supply system, or EPSS, is necessary for every hospital to provide backup power in case of loss of the normal power supply. It is these backup systems that ensure a continuous power supply for medical equipment, lighting, communication, ventilation and other critical systems that patients are dependent upon.
Silence is golden
Healthcare costs are rising, and the federal government is trying to rein in costs and get better results for the money it is spending on Medicare. With the passage of The Affordable Care Act, insurance coverage expansion received most of the media attention, but part of the act covered improvement of quality and reduction of costs in Medicare. Under the ACA, the Department of Health and Human Services and its Centers for Medicare and Medicaid Services are tasked with implementing these quality and cost measures. CMS already had some cost and quality improvement measures in place, such as reducing hospital-acquired conditions and the inpatient quality reporting system.
Miguel Burbano De Lara
Challenge and innovation are two sides of the same coin. The Affordable Care Act underscored many of the existing challenges confronted by healthcare organizations - in particular, safety, quality, access, efficiency and cost - to which leaders have responded with innovations that began transforming the delivery of healthcare. Yet these existing challenges persist as new ones have emerged, including: capacity limitations, a shortage of qualified healthcare workers and the ineffective distribution of healthcare facilities and services. Leading healthcare organizations and their partners are demonstrating that ground-breaking methodologies can be used to design or redesign and build facilities to become an integral component in accelerating the positive transformation of healthcare.
Sheila J. Bosch & Elisa A. Worden-Kirouac
At first glance, the application of Evidence-Based Design seems like a simple equation for flooring selection — if choosing X flooring, Y outcome will occur. Rubber flooring diminishes noise levels. Anti-microbial flooring decreases healthcare-associated infections. Slip-resistant flooring reduces patient falls.
In today's healthcare environment, budgetary constraints dictate a more prudent use of hospital facility space. Wise designers and administrators are finding solutions in strategically used wall space, which eases tight corridor and floor-space burdens.
To invest or not to invest
Aran A. McCarthy and Jim Rivard
As economic changes continue to challenge the nation's healthcare systems, hospital administrators need to take a hard look at their priorities for capital improvements. Each year, spending budgets must be set, with funds reserved for facilities upgrades, expansions and new clinical models that will help healthcare systems maintain a competitive edge. While balancing these various priorities is always a challenging task, it's even more critical in today's shifting economic and regulatory environment.
CHALLENGE OF VISIONING
Scott Larkin and Michael Ryan
With financing becoming available again and requests for urgently needed healthcare renovations and expansions starting to roll in, now may seem the least likely time to delve into the master-planning process. But being overwhelmed by short-term needs and ignoring long-term planning can be a recipe for failure.
Edward M. Browne
Wayfinding was first described centuries ago as a system of navigation used by people who traveled land and sea by unmarked routes. The indigenous people of Polynesia astounded Western sailors by use of tides, movement of waves and cloud formations to navigate huge distances in open canoes. They did not have maps or charts, relying instead on an innate sense of how to find their way.
THE NEW INTERNATIONAL HOSPITAL
At the same time that construction of healthcare facilities in the United States is experiencing constraint due to an uncertain healthcare delivery system, designers are seeing an international interest in modern, Western-style hospitals that follow U.S. codes, can be accredited by Joint Commission International and have amenities similar to five-star hotels.
'Defend in place'
Hospitals are a vital part of civic infrastructure, and never more so than during natural disasters. When a crisis occurs, people naturally gravitate to hospitals, not only for immediate medical needs, but also because of order and stability, with 24/7 activity and the expertise to deal with emergencies.
Beyond the curve
It has been said that Baby Boomers, when viewed on a graph of U.S. population by age, create a noticeable lump in the curve that, over time, moves across the graph "like a pig in a python." Today, a similar phenomenon is occurring with Building Information Modeling in healthcare design and construction.
MADE TO ORDER
Though not a new concept, prefabrication is a strategy that is taking off in commercial construction.
From oil to gas
Richard Borrelli and Jeff LaPierre
Recent technological innovations have brought natural gas supply levels to record highs and near historic lows in price. For healthcare institutions looking for ways to reduce facility operating costs, the switch to gas is attractive. But how do you decide if it is the right decision?
Michael Kennedy, Kim Williamson and Kris Denevan
Sanford Health is an integrated health system headquartered in the Dakotas, and is now the largest, rural, not-for-profit healthcare system in the nation with locations in 112 communities in seven states. With more than 25,000 employees, Sanford Health is also the largest employer in North and South Dakota.
David A. Bateman Jr., Benjamin Davenny and Jeffrey A. Zapfe
Acoustics, technology and vibration considerations will all affect healthcare facilities of the future, in ways that administrators need to prepare for now. Acoustics and noise control are increasingly important in hospital design, as evidenced by incorporation into healthcare facility guidelines, LEED for Healthcare and other standards.
Barbara Anderson and Elsa Mersereau
Lean principles are regularly employed in healthcare organizations as a process-improvement methodology. Increasingly, Lean thinking is a consideration during the design of healthcare projects in an effort to improve workflow, eliminate waste and enhance patient-centered care.
On the horizon
The recently released 2012 Mortenson Construction Healthcare Industry Study includes several key insights related to the continuing need for innovation in the design of healthcare facilities.
There is no question that, in these economic times, new funding models for infrastructure projects are more important than ever. Capital for these projects, which include upgrading roads and bridges, building schools and constructing new medical facilities, is limited, but the need is great.