"Designing for Health" is a monthly, web-exclusive series from healthcare interior  design leaders at Perkins+Will that focuses on the issues, trends, challenges, and research involved in crafting today's healing environments. This month's topic:

Shifting Culture, Shifting Service Lines: Is Tiger Woods the New "Grandmother"?

By Tama Duffy Day and Carrie Rich

When a knee injury ended Tiger Woods' 2008 golf season, doctors ordered surgery followed by rehabilitation. Woods likely had a private entourage of medical experts to monitor his recovery, but the rest of us, after suffering a similar injury, would be transferred from the hospital to a rehabilitation facility where a team of skilled clinicians would guide our recovery. Preferably, our stay would be as brief as possible and complimented by modern amenities—private rooms and bathrooms, flat-screen televisions, Internet, gracious dining facilities serving healthy foods, and other hotel-like features. As a younger, less severely ill patient population infiltrates formerly acute care facilities, nursing and rehabilitation centers are adopting a progressive design to remain competitive. As morphing service lines change from acute to sub-acute services, a culture shift is not only occurring in patient cohorts and the care provided, but also in the facilities supporting this care.



Shady Grove Nursing and Rehabilitation Center, a 120-bed facility located in Montgomery County, Md., is one example of how design influences economic imperatives. Once focused on providing of long-term care for elderly patients, Shady Grove now confronts the challenge of supporting younger, more active patients and shorter lengths of stay. Today, a growing number of sub-acute rehabilitation patients utilize the facility. They are a younger population suffering from illnesses that are less abrupt than acute diseases, with symptoms less severe and of shorter duration than chronic illness. This growing patient mix has different needs, preferences, and reimbursement patterns than older counterparts who once filled the facility, and so, as the culture shifts, so too does the service line. For Silvana Dill, the director of business development & market strategy for Adventist Senior Living Services, service line shifts create an opportunity for strategically pursuing younger patients. To that end, Shady Grove hired Perkins+Will and North Point to redesign an existing patient wing specifically focusing on this baby boomer short-term patient.

To attract and care for younger, more active clientele, Shady Grove converted double rooms to singles, improved existing private bathrooms, created a separate upscale dining room, developed new guest services/nursing station, and relocated the rehabilitation gymnasium into an existing two-story space that has abundant natural daylight and garden access. The newly placed guest services/nursing station allows staff to increase the availability of personalized care. This station, along with new offices and work areas, also help staff adapt to the cultural shift underway. According to The Advisory Board Company, a Washington, DC-based firm with the mission of researching best practices in the healthcare industry, packaging services can enhance employee satisfaction while offering "incremental value to the consumer," ultimately "delivering an unparalleled patient experience" and differentiated product.

"If the guest wants a Starbucks coffee or ice cream at 9 pm, then our staff will respond to those requests," even if the current culture does not provide those services, says Michelle Mahn, M.A., the administrator at Shady Grove, in explaining how both the physical environment and model of care must shift. Mahn refers to patients as "guests" and is developing a director of guest relations position that will ensure that incoming persons obtain the care and comfort they seek during their 20- to 23-day stay. With the ultimate goal of creating a healing environment that provides care in the most efficient manner possible, Shady Grove is rethinking traditional methods to meet shifting population needs. In particular, customer service goals were carefully incorporated in the new facility design, as Mahn recognizes that design is an integral part of providing care. Patient-driven design elements include private rooms with flat-screen cable televisions, wireless Internet accessibility, accommodations for family visits, and increased access to natural light and gardens. Some facilities are even including Wii Sports in rooms. Faced with specialty competition and heightened consumer expectations, the facility also enhanced the work environment for clinical staff, allowing them to function more effectively while creating opportunities for streamlined operations in the context of patient care delivery.

The big picture: As the U.S. population ages and healthcare service line delivery consequently changes, shifting cultures and service lines transform healthcare delivery. Facilities once designed for chronically ill Alzheimer patients are being renovated for baby boomers with minimal injuries in need of short-term rehabilitation; design expectations for an active 50-year-old are very different from those for an elderly grandmother permanently taking residence. Taking a moment to reflect in the midst of constructing this new rehabilitation-focused unit, administrators at Shady Grove confirm that design and planning services are best incorporated from the outset so that the strategic plan is integrated into the budget, planning, and design. Perhaps even more importantly, well-designed environments facilitate current service line shifts as well as cultural shifts, potentially playing a key role in future patient morale, employee attitudes, and overall organizational culture.

|c|

Tama Duffy Day, FASID, IIDA, LEED AP, is a principal at Perkins+Will, an international architectural and interior design firm. She is the national interior design healthcare practice leader, formulating research and design initiatives throughout the firm's 19 offices. She can be reached at Tama.DuffyDay@perkinswill.com.

Carrie Rich is a graduate student of Health Systems Administration at Georgetown University and a healthcare research analyst at Perkins+Will. She can be reached at DCResearch@perkinswill.com

Data and content for this article was developed from the following sources:

The Advisory Board Company (2008). Achieving Service Line Excellence: Creating Competitive Advantage in a Value-Driven Marketplace.

The Advisory Board Company (2008). Re-Envisioning the Acute Care Enterprise.

Mallak, Larry A.; Lyth, David M.; Olson, Suzan D.; Ulshafer, Susan M. and Sardone, Frank J. (2003). Culture, the built environment and healthcare organizational performance. Managing Service Quality.

Pyne, Mel (2008). Transformers: New facilities, a new culture, and new processes. Health Executive.