"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:

Designing the Ideal Space

By Paul Chappell, LEED® AP

Described by James Hilton in his novel Lost Horizon, the terms "Shangri-la" is often used to describe a distant and secluded hideaway, usually of great beauty and peacefulness. The term also may be used by clients. For a design firm commissioned to assist in achieving the expected results in a healing environment, communication and creativity are essential to realizing each client's "Shangri-La."

At Perkins+Will, we use the term "assist in achieving" to remind us that as we become involved, we need to recall that we are part of a team. Without the proper communication, creativity and documentation from architects, designers, engineers and their consultants, contractors have a minimal chance of implementing the overriding vision. As architects and designers, our role can be seen as a creative filter in which information from many sources comes in, is analyzed and organized, and creative solutions are delivered. In designing a replacement facility for IASIS Healthcare in Mesa, Ariz., for example, Perkins+Will went through an extensive interviewing process with senior management of IASIS Healthcare and the hospital administrators. Listen first was the rule, and it was only after the vision for the facility was discussed in an interview session with the client, that we presented our thoughts on what was possible, which we communicated with sketches, renderings, and actual samples of colors and materials.

The project, Mountain Vista Hospital, was a replacement facility and had to be designed without many of the staff in place. Early on in the process, team members put themselves in the shoes of all types of facility members, including caregivers, maintenance personnel, and building engineers, among others to understand each team member's perspective. Doing so resulted in spaces reminiscent more of a hospitality environment than what is typically perceived as a healthcare environment. 

Creativity and generating unique ideas can be, at times, the most difficult part of the design process. Inspiration, we all know, comes from many sources, two of which are in-house design charettes and critiques. At Perkins+Will, these reviews occur at several key points throughout any given project, and it is here that we often we discover that the best solution is a procedural solution rather than an architectural one, especially when dealing with existing conditions.

A client's input into design solutions around less-than-optimal existing conditions is a tremendous opportunity to teach, learn and build relationships through frank discussions and open dialogue. Consider this: Perkins+Will was commissioned to redesign the Burn Intensive Care Unit for Parkland Health & Hospital System in Dallas. For Thomas Wilkins, director of design & construction facilities development at Parkland Health & Hospital System, the ideal space "is one that works and is unobtrusively pleasant for the users. The space will have a strikingly good feel about it without having finishes and elements that are blatantly overbearing." From a pragmatic standpoint, there are a number of concerns. In designing for patients with burn injuries, infection control is essential, and as many patients are heavily sedated, design solutions for a BICU must be grounded in the functionally of the space first, followed by aesthetics. The new space had to respect what goes on in a burn unit, work around existing conditions, support new technologies, implement evidence-based design principals, and make for better patient comfort and care.

The design solutions for Parkland Health were a direct result of several charettes with physicians, nurses, administrators, housekeeping personnel, building engineers, acousticians, and lighting consultants. The nurse station, for instance, is the centerpiece of the BICU. A triangular shape, it was planned and designed to meet the many needs of the healthcare professionals. For example, about one-third of a nurse's time on shift is spent walking1—walking not only between the centralized nursing station and patient rooms, but also locating and retrieving supplies. Designing a decentralized nursing station and supplies station brings both the patient care and supplies closer to the patients, reducing wasted time and fatigue. This simple design and planning solution ensures the nurses can work optimally and contribute to an environment of emotional comfort. 



Clearly, an important goal for facility designers should be fulfilling human needs for light by providing a high-quality well-lit environment2. Daylight entering through windows can be extremely beneficial to patients, provided there is no glare and it is possible to control light levels. However, in addition to natural light, electric light is needed in all parts of a hospital, so building interiors are lit by a combination of daylight over electric light.

Communication about the bigger picture or long-term goals also is key. Perkins+Will's relationship with MD Anderson, for example, has always provided for a design process that includes many of the client's personnel who have a vested interest in a particular project, alongside the architects, designers, their consultants and the contractor, when possible. But in facilities as large as some of MD Anderson's, where several design firms are employed at one time, transitions and the use of building standards across a site are important elements. Transitioning of current work with past and future work becomes a design opportunity in and of itself as many projects develop in phases with years of time lapsing between them. For MD Anderson, the problem of "scope creep" was identified in a design charette and as a result, Perkins+Will introduced a concept of color resin portals to allow two projects to potential be underway without increasing the initial project scope.

No matter what the project size or scope, clients don't like surprises—but they do like to be pleasantly surprised. Communication, a source of teaching and relationship building, is the device that can enable this to happen.

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Sources:
1. Hendrich, Chow et al
Guiding Principles for The Development of The Hospital of The Future
http://www.aahid.org/pdf/2008_JCAHO_Hosptal_Future_Guiding_Principles.pdf

2. The Impact of Light on Outcomes in Healthcare Settings
Anjali Joseph, Ph.D., Director of Research, The Center for Health Design
http://www.healthdesign.org/research/reports/documents/CHD Issue Paper2.pdf

Paul Chappell is a senior associate with over 25 years of managing and planning healthcare interior design projects. As senior designer, he is responsible for project design, ensuring  clients' needs are met with flawless management of his interior design studio team. Paul's healthcare experience includes hospitals, ambulatory care facilities, assisted living facilities and medical office buildings.


Past installments of "Designing for Health" include (click on title to access the full article):

• The Importance of Family in Patient Rehabilitation
• Maximizing the Impact of Art in Architecture
• The Benefits of Healthcare Learning Environments
• Making Hospitals More Hospitable for Children and Their Families
• A Seat at the Table
• Healthcare Facilities Want You to Take Notice
• A Prescription to Go Paperless
• Peace and Quiet
• Research Informing Design
• Shifting Culture, Shifting Service Lines