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The Power to Restore

By Eileen Jones, AIGA

"Successful healthcare design entails helping the people delivering care understand the circumstances surrounding the people coming in for care to ensure the environment is a healing, relaxing and comforting place in times of crisis or stress."
—Eileen Jones

Innovative medicine and groundbreaking treatments are only part of the path to health, well-being and comfort. Design also plays a significant role in helping people stay healthy and happy, whether in a hospital setting, a doctor’s office or even the workplace. Perspective spoke with Eileen Jones, AIGA, who leads strategic research and design of brand integration at Perkins + Will, to learn what elements of design can improve health and wellness in both healthcare and corporate environments. She discusses Perkins + Will’s work on the Children’s Hospital and Critical Care Pavilion in Santa Fe, N.M., as one example of the power of design to restore.

How do healthcare designers make a significant societal contribution?
As a basic concept, the purpose of a healthcare facility is to deliver care to those who need it. So while the space needs to reflect the concept of healthcare, the design also should be about care — the care and respect of the people that come through that facility. Therefore, a key goal in healthcare design is identifying and resolving issues that create confusion or intensify emotions of unease or anxiety. Making the space as comfortable and easy to navigate as possible can help to allay these feelings.

Every design element became a reference for a local artist's interpretation, including regional plants and animals, water and the integration of healing medicines into the space.

An element of comfort can be delivered through the environment’s feel. For example, patients feel very differently when walking into the lobby of a hospital when it’s clean, friendly, and there is someone there to greet them, versus when there are wheelchairs lined up or a gurney in the hallway.

“Change management” also is important in helping ease stress for both patients and staff. When a facility is undergoing a major renovation or relocation, it can’t be done without expectations of changing procedure or methodologies, and the staff needs to know how to care for patients while keeping the level of care consistent.

How can healthcare designers help patients feel a connection with their surroundings?
Each project presents unique challenges in this regard. For example, the work we did for the Children’s Hospital and Critical Care Pavilion in New Mexico presented some issues we had to address specific to that patient population. Because the population in New Mexico primarily is Native American and Hispanic, it was a big leap to expect them to come to an organized Western medical facility. Therefore, we knew the design had to deliver a feeling of safety, comfort and wellness to the people there in order for them to visit the facility for treatment.

We tried to find a way to blend traditional local customs with modern medical practices. In order to accomplish this, we had to acknowledge the local people’s beliefs about things like the healing properties of the land and all that grows on the land, and how they interpret those ideas through their own series of religions. Once we did that, we could begin to work on building a bridge between their beliefs and modern medical practices.

First, we gathered information from focus groups we conducted with hospital staff, families of patients and some cultural consulting groups. We asked ourselves, “How can we extend the story of the landscape with the healing nature of the Earth and the environment?” In pursuit of that goal, we looked at the strata of the Earth up to the sky, plus the plant and animal life in that region that had healing properties and were important to the people there. With that concept, our design theme became “The Healing Power of the Land.”

We looked at bringing in natural materials from the environment to create a connection between the outside and the inside. It was clear the sense and delivery of water were critical to the people living in the area, so we patterned insets on the floor and placed them at key critical decision-making points throughout the hospital based on our interpretation of the motion and flow of the Rio Grande.

In order to facilitate communication with multiple languages and dialects, we implemented color-coded visual markers and cues instead of verbal signage on each floor to direct people where to go. We learned that in the Hispanic and Native American cultures, when a family member is ill, it is considered the illness of the family, not just the individual. So when these patients visit a medical facility, they generally come in large family groups. To accommodate this, we made the waiting areas larger than usual and created a sense of separation so that other family groups would not be disturbed.

How can designers address healthcare workers’ comfort and well-being?
It is the nature of the nursing profession, for example, to have a general lack of downtime. In fact, nurses barely have enough time to sit down and eat lunch in most cases, and this aspect of the job has caused obesity, stress and workplace burn-out. Designers can try to assist in resolving these issues, and the approach has a lot to do with providing an oasis inside the healthcare environment to allow the nursing staff
to decompress — even if it’s just for 20 minutes.

Depictions of native healing plants in the hospital's lobby help to form a sculptural and graphic backdrop that can be used as a teaching tool.

A good solution to this problem might be finding space for a separate restroom or lunchroom for nurses in order to create a level of disconnection. We would hope this separation would give them some privacy, but also mental health time to get away from the unrelenting demands.

How can the outside world — such as the corporate environment — benefit from the tenets of healthcare design?
There is more discussion lately about workplace and how to provide alternative work areas to break up the tremendous pressure most people are under in a traditional corporate environment today. Workers are totally accessible through modern technology, and as a result, it is important to try to create a sense of restoration in the workplace. We always look to create an underlying sense of sustainability and user comfort. We build combined notions of work and restoration into the office environment. When we have looked into people’s perception of their work space, we have found that workers appreciate some connection to the outside. We can create this feeling via window accessibility, daylight, views or through a water feature in the environment.

People want to be able to control the amount of light and the temperature in their work space. If we can’t accommodate daylight and views for all employees, then perhaps we can make the space brighter as you move into the environment, or integrate reflective components within the space. Modular flooring systems can resolve the temperature problem. Removing these kinds of distressing physical distractions helps to improve employee productivity and comfort.

Designers also are exploring new ideas for added space where people can gather for social conversation, like a staff commons or “teaming stations” that can provide a change of environment that’s different from a traditional conference room where business meetings are held.

Proof Positive

Evidence-based design is the process of making design decisions based on the best available data. In the best-case scenario, that data includes current research studies and evaluations of completed projects. In the area of healthcare design, recent analysis of such evidence has identified critical connections between a hospital’s physical setting, patient outcomes and staff satisfaction.

Improved hospital design can help decrease staff stress and fatigue, and increase effectiveness in delivering care. It can reduce patient and family stress levels, improve patient safety and enhance overall healthcare quality, according to “The Role of the Physical Environment in the Hospital of the 21st Century: A Once-in-a-Lifetime Opportunity,” a 2004 Center for Health Design (CHD) report.

To address these issues, the CHD recommends hospitals implement evidence-based design principles, such as single-bed rooms, sound-absorbent ceilings, access to natural and full-spectrum lighting, and effective navigational systems. Bronson Methodist Hospital in Kalamazoo, Mich., executed many of these principles in its $181 million campus redevelopment. The redesign included private rooms; shorter walking distances; innovative use of light, artwork, music and nature to create a more pleasant space; and information kiosks near every main entrance. Among the reported results:

  • An 11-percent reduction in nosocomial (hospital-acquired) infections
  • Nursing turnover rates of just 6.5 percent (the national average is 20 percent)
  • An overall patient satisfaction rate of 95.7 percent
  • Improved staff satisfaction
  • A 6-percent increase in market share