Designer Forum - March 2012

By Paul Cooper

Excellence in design comes from a designer’s dedication to enhancing the built environment through design solutions that celebrate the human spirit and contribute to people’s lives. Never is this mission more apt than when you’re designing a hospital. At Mease Dunedin Hospital, a BayCare Health System facility, the owner’s initial statement—“We want: Chill-out”—was the overriding concept that inspired the design to promote healing and wellness.

While it can be hard to achieve a balance between function and aesthetics in these environments, there is a trend in the Florida market, especially for healthcare facilities, to specify materials like sheet vinyl and luxury vinyl tile that provide for easy cleaning and low maintenance yet still provide a level of aesthetics reminiscent of more familiar environments.

BayCare Health System is a leading community-based health system in the Tampa Bay area. Composed of a network of ten not-for-profit hospitals, outpatient facilities and services such as imaging, lab, behavioral health and home healthcare, BayCare prides itself on providing expert medical care throughout a patient’s lifetime. With more than 200 locations, BayCare connects patients to a complete range of preventive, diagnostic and treatment services for any healthcare need.

In an effort to provide the new standard for high performance healthcare at Mease Dunedin Hospital, the 16,657 square foot, 20-bed critical care unit is designed to exceed existing code requirements and to improve staff mobility and visual access to patients. TRO Jung Brannen was commissioned to solve existing fundamental programmatic issues while promoting a healing and stress reducing environment.

The existing conditions were not conducive for the staff to provide the most effective care and often saw compounding levels of stress in the work environment due to lack of space, poor traffic flow and outdated equipment. This inefficiency and confusion created the perception that the level of care was disorganized. Our challenge was to design within a limited existing cruciform footprint with low floor to floor heights and little plenum space to implement a rigorous program that required disciplined coordination and communication with the owner, contractor and various trades.

We are committed to creative outcomes for our clients and our users that generate exceptional results, optimize opportunity, exceed expectations and sustain our firm. In an effort to balance both function and aesthetics and increase the performance of the space, attention to detail was critical to the success of the new state-of-the-art intensive care unit (ICU)/critical care unit (CCU). The suite boasts, among other functional components, two isolation rooms and bariatric rooms with lifts. All patient rooms include the latest headwall technology, which allows doctors 360º access to the patient’s head without interfering with wires and plugs. The central nurse station allows visual access to each of four wings and is connected to each room through a high tech patient monitoring system. Family amenities include a coffee bar and family lounge with wireless Internet access and a faux water feature and rock wall with soothing nature sounds. Natural light and views to the outside establish a connection to nature reflected in the creative selection of warm finishes and soft colors promoting a holistic approach to quality healthcare.

Design’s Impact on Patient Outcomes
Although the patients may not always be in a position to appreciate the effort that goes into the final design and the process that leads to a successful outcome, the families and loved ones who arrive under duress and the staff who work the many tireless shifts certainly will. The ICU/CCU is the primary arrival point for patients who need to be stabilized prior to surgery. These patients typically suffer from head trauma, strokes or organ failure, and the fight for life is in its most crucial moments. At this point, color and pattern don’t matter, and it is the function of the environment that prevails. However, when the family is called in to celebrate a hard won fight or pay their last respects, the quality of the aesthetic environment serves that purpose as well.

Dark wood sheet vinyl flooring was selected both to add a level of formality and because it could be strategically placed beneath the gurney to help disguise potential stains caused by Betadine. Flexibility in lighting provides required illumination for surgical procedures while, at the same time, incorporating a variety of lighting scenes for a patient to read or a family to rest inside the room with their loved one. Allowing patients and family members control over their lighting environment with options to reduce glare also gives them a sense of dignity and ownership, thus improving recovery times.

Manufacturers are developing methods that make their products more impact resistant, introducing nano-technologies that reduce the spread of germs and bacteria, and increasing the life of the product while improving upon the look and flexibility of the material. There are other unique performance characteristics related to flooring that must be taken into consideration, such as the PSI rating, coefficient of friction, warranties and anti-bacterial/anti-fungal treatments. These factors need to be addressed and resolved before a floor product is selected. Only then can a design or pattern be implemented which, in the end, may affect or be limited by the product itself. In this case, and in homage to Louis Sullivan, form really does follow function. When functional needs are met or exceeded, the form that the final design takes is almost limitless.

The inspiration for color, texture, and pattern are principles of design used to reinforce an idea both physically and metaphorically yet still play a functional role in the overall scheme. Deciding whether the floor, for example, should be part of the accent or a neutral component to complement the design is determined by the nature of the space and where it fits into the hierarchy of the design. These origins lie in the design concept. The purpose of a floor pattern and accent is to foster and promote effective wayfinding and to reinforce the order of the space.

More complex designs are typically located at areas of importance such as entryways, family zones or areas of significant or specialized activities. This hierarchy creates contrast and a visual way for individuals to move through the space without relying entirely on signage, and creating a sense of destination and arrival.

Critical Concerns
Sheet products generally give the most creative design latitude because the designer is not limited by the material plank or tile dimension. These products also allow for welded seams that mitigate dirt from collecting in joints. The drawback is that complex design patterns can also generate more waste than dimensional tiles, and the cost associated with installation generally increases as well. The point is to make the design strategic, not complicated or confusing. Although visual confusion can be associated with poor planning or unpredictable existing conditions, it is noise that can be one of the most confounding aspects of design to manage.

Acoustics are a major factor in the design of public spaces and areas of high stress, and play a major role in other parts of the hospital such as labor/delivery/recovery areas and in neonatal intensive care units. In fact, healthcare environments are most notorious for dinging bells, pumps, generators and overhead paging systems. Hard surfaces are often unavoidable in these types of environments and proper planning in the ICU/CCU has gone a long way in helping to deflect some of these high frequency intrusions by angling walls or providing setbacks to patient rooms. Acoustical ceilings with high noise reduction coefficient (NRC) ratings and varying ceiling heights are one of the most effective ways to reduce the transfer of noise.

TRO Jung Brannen puts itself in the shoes of the client in an evolving effort to best address the issues and concerns facing the healthcare industry today and in the future. Infection control is one of the most profound concerns facing hospitals today, adding to the liability and maintenance costs of healthcare delivery systems. It goes without saying that flooring is a considerable factor in how well a space performs for its intended use, especially in the medical arena. “Bullet-proof and indestructible” is often what we hear our clients ask us to specify for flooring, since it is one of the most abused and heavily cleaned surfaces in a hospital. In the past and even today, hospitals have to train staff in a myriad of equipment and cleaning solutions which, if used improperly, can end up destroying the product they are intended to protect. The flooring selection for the ICU/CCU takes into consideration these factors and other staff concerns.

There is a challenge ahead of us not only in terms of how to balance function and aesthetics but also how to better merge durability with sustainability. This is often an inverse ratio or correlation: as one value increases the other value decreases. Designers are demanding more sustainable products and manufacturers are fighting to keep up with the demand to compete in the environment of LEED projects. TRO Jung Brannen takes very seriously the position that 21st century high performance design utilize sustainable materials wherever appropriate, but it is still difficult to find high performance products that meet or exceed environmental requirements. Performance and cost still rank as the primary considerations in final flooring selection, often with cost prevailing.

There is a misconception that the quality of interior design is determined by the application of color, material finishes or furniture alone. The design staff at TRO Jung Brannen believes differently. We would assert that it is in fact the other way around, where excellence in design arises out of rigorous planning and programming that result in functional adjacencies that maximize efficiency, reduce travel distances and eliminate redundancies. Early planning can also lead to opportunities where staff can identify how they need to communicate more effectively in high stress collaborative environments. These planning exercises allow clients and their staff to differentiate their wants versus their needs and evaluate associated costs that ultimately continue into the detailing of how the physical environment is shaped.

The interior design process and material and lighting selection is where the critical dimension and scale of each space is then honed. Good design comes from good planning and organization of space. Designers who recognize and anticipate the need to accommodate future technologies also need to be aware that the future technology of flooring is already upon us.

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