BSA LifeStructure's hospital lobby facelift: Designer Forum

By Melissa Davis

Today’s healthcare landscape is more competitive than ever. Many hospitals boast hotel-like amenities and top of the line finishes. Patients have come to expect a higher degree of quality and cleanliness. The hospital lobby is usually the first place a patient begins to form their initial impressions about the hospital environment. Hospitals have recognized the need to update their lobbies to improve aesthetics and the registration process.

Flooring is an integral part of the lobby, but finding flooring solutions in healthcare settings can be a bit of a challenge. There isn’t one flooring material that will work for every area of a hospital. There are too many variables in healthcare settings for a turnkey solution. Durability and maintenance have always been primary concerns, but there are many other issues that are becoming important. 

Hospitals have overwhelming concerns about infection control. As a result, antimicrobial products are becoming more popular. Achieving high patient survey scores on the Health Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is also a top priority and has a direct effect on improving cleanliness and noise control. Both of these issues impact flooring. Environmental services usually advocates for products that require very little maintenance to lower lifecycle costs and minimize the time it takes to maintain and clean the surface. Safety is also a huge concern. Addressing slips and falls as well as comfort for staff are all top priorities. Then there is the significance of aesthetics. It is a challenge to find a product that has a positive appearance and addresses the above concerns.

A HOSPITAL LOBBY GETS A FACELIFT
A recent project at Major Hospital in Shelbyville, Indiana tasked our design team to create a new public area space plan that would upgrade the existing hospital. The renovation affected the main lobby, registration, surgery waiting, emergency waiting and registration, administration, and the corridors connecting all of these departments. The goal of the project was to improve flow, primarily with the registration process. Over the years, Major Hospital changed processes and did small renovations to update the space. Those changes made the space quite dysfunctional with bottlenecks, tight work areas and the need to correct current HIPAA (Health Insurance Portability and Accountability Act) issues due to the tight spaces. 

Major Hospital viewed the renovation as a necessity to survive in the competitive healthcare landscape. The hospital was evaluating plans to design a new replacement hospital that will be completed in the next five years. Even with a new hospital only a few years away, the hospital decided that a facelift to the existing lobby was essential to deliver quality healthcare services in today’s marketplace.

Flooring had a direct impact on the new plan. The existing flooring was carpet tile in all areas with walk-off mats at the entrances. The design team identified a series of flooring priorities for the project, with slipping, maintenance, durability and sound containment at the top of the list. Subfloor prep would be an issue with any new flooring, especially a vinyl sheet or tile product. Seams and durability in high traffic areas were a great concern, and environmental services was in favor of using a material other than carpet. The renovation is a short-term fix until the hospital’s new replacement facility is complete.

In an effort to evaluate flooring options, the client visited other facilities to examine the performance of flooring materials in different settings. Conversations with environmental services at many of those facilities provided great insight on a variety of flooring materials. 

There are pros and cons to most floors, which vary by the area they are installed in. What might be the perfect flooring in one area might prove to be totally inappropriate in another, especially in healthcare settings. In addition to these evaluations and conversations, we provided a product comparison to the client. This document compares things such as initial material cost, maintenance, lifecycle cost and product benefits.

After this evaluation period, porcelain tile was determined to be the product of choice along with carpet tile in some waiting areas, registration, administration and one corridor area that connects administration to the main lobby. This corridor has medium to high traffic but is away from exterior entrances and has a low potential for the spills or accidents that often occur in healthcare environments. 

SELECTING THE RIGHT FLOORING MATERIAL
With porcelain tile, the client will have the benefit of a durable floor material, which will require little more than vacuuming or mopping. Grout tends to be the only cleaning concern with porcelain, and, in this case, we selected a medium gray tone to match the darkest color in the tile. A medium grout tends to work best because salt and water residue from Indiana winters can give a white appearance to grout. If the grout is too light, it will appear dirty as wear and cleaning occur. Walk-off carpet tile was used generously at each outside entrance to increase the walk-off distance and limit the amount of outside elements that are brought onto the porcelain. 

Chipping edges can also be an issue with porcelain tile in high traffic areas or areas where medical carts are used. To address this concern the design team used a tile with an eased edge. Eased edges take away the harsh corner that is more likely to chip. A tight joint size reduces the amount of grout, therefore there is less grout to show soiling. We specified a 3/8” grout joint, which was the manufacturer’s recommendation for this tile. Due to our budget concerns, we did not use a tile with rectified edges (rectified edges allow for a smaller grout joint because tile edges are perfectly square). The tight grout joint also helps with sound. This area has many carts that travel across the floor, and the noise can be very disrupting to patients. 

Once the first phase was complete in the administration area, the hospital raised a concern that highly sensitive radiology equipment would be pushed on carts across this section of the floor. This equipment is calibrated and cannot tolerate bumps and jarring from grout joints. We tested the carts during installation and determined the 3/8” grout size was not a concern since the cart’s wheels are made of a rubberized material. 

Though tile eliminated many flooring issues, noise was still a great concern to the hospital. To address this, the design team incorporated carpet tile insets in the main lobby waiting area. These insets provide two functions: sound absorption and creating an area rug affect, which helps define the areas and keeps the seating organized. At the registration booths, the design team used a wall system that featured acoustical properties and sliding doors along with carpet to reduce sound creation and transfer to improve patient privacy. 

A CHALLENGE FROM CRACKED TILES
This project presented a tough phasing challenge. The hospital was up and running throughout design and construction, so phasing the renovation had to be strictly coordinated. It was imperative to phase the installation stop/start points to minimize the possibility of the flooring pattern not lining up. Installation started at one end and the construction crews had to work their way to the opposite end of the building. Some work had to be done at night and on weekends to avoid the hospital’s high traffic volume. A quick set mortar bed was used to decrease the amount of time before the tile could be walked on. The project had one area outside radiology that could not be fully shut down, so the floor had to be partially done and covered with plywood while the mortar set. 

Once this area was complete and construction had progressed to the final phase, the design team started noticing some cracked tiles. While the designers determined the radiology equipment was not affected by the tile joints, the tile was affected by the weight of the equipment. Several tiles had to be replaced and more kept cracking. It almost seemed that there was a hollow space between the tile and the mortar. When the heavy equipment crossed over the flooring, it was causing the tiles to depress and crack. The hospital was actively involved during installation and knew that installation was completed properly. So how could this happen? 

The design team met with the tile and mortar manufacturer to identify the problem. It became apparent that the quickset mortar was the issue. Though a quickset mortar can be walked on shortly after installation, it still requires time to completely cure. The time allowed before moving the extremely heavy equipment over the tile needed to be increased to allow for a proper curing period. The remaining tile was covered with plywood for a much longer period and eliminated any cracking issues in the future. Another challenge that occurs in most renovation projects is the subfloor condition. In our case the floor was very uneven, so installation of 12”x24” tile had its challenges even following the partial installation method. 

Overall, the project looks amazing and has been very well received by patients, visitors and staff. Environmental services is able to maintain the floor easily, and it has a clean look. Noise has not been an issue with the addition of the carpet, wall system and higher noise reduction coefficient ceiling tiles. 

There isn’t one flooring material that is appropriate for every project. Being well versed in the available products and listening to the client’s needs will inform and guide a designer in recommending the right product.