Acute Care Update: A robust healthcare design industry continues to evolve with the times - October 2022
By Ruth Simon McRae
During the height of the pandemic, when it seemed that all hospitals could do was keep their heads above water, healthcare organizations continued to be concerned about improving operations by upgrading their facilities. After an initial moment to regroup, these organizations proceeded with plans to build and renovate. Design of healthcare spaces could not stop, yet they did need to massively evolve to accommodate the changing environment. At the same time, this retooling process was-and continues to be-complicated greatly by supply chain issues and rising costs for flooring and other interior elements.
According to Jocelyn Stroupe, co-director of interiors practice at Cannon Design, “Initially, there was a period of time at the start of the pandemic when everything went on hold, and then, when it came back, everyone was very impatient to get their work moving. And they wanted it done quickly.”
Barbara Dellinger of Dellinger Consulting sees the effect of the pandemic on projects as belonging to three buckets. “Projects that were just starting at the beginning of Covid were often scaled back but were started quickly-sometimes with impossible deadlines,” she says. “Some projects that were initially sidelined were taken off the project lists altogether due to rising costs and market availability. And many of the projects started later in the pandemic had to be re-scoped/programmed and rebudgeted because most were significantly more expensive than previously budgeted due to rising costs of goods and labor-some 30% to 50% more.”
With so much change, flexibility and adaptability have become defining principles of healthcare design. Throughout the pandemic, many spaces have had to be used for purposes for which they weren’t intended; now, designers need to make changeability an inherent part of the design process.
DESIGNING FOR CONTINUAL CHANGE
According to Cindy Flinchum, senior project manager, interiors, for UW Health, the pandemic pushed healthcare systems to do things they had been considering or were just beginning to initiate. “The focus has always been on patient experience,” she says, noting that the pandemic has added even more focus on flexibility, technology and scalability.
This included a review of research into the best use of teleheath to communicate and deliver patient services, encompassing issues as subtle yet impactful as lighting, views of the provider and the background, and a sense of privacy.
“In addition,” she continues, “healthcare facilities have always focused on infection control. Other industries are catching up on this issue. However, the current environment is [impacting] products. We are seeing longer lead times and often have to reselect materials.”
Many types of projects are being built-hospitals, outpatient facilities, medical office buildings, clinics. A few years ago, healthcare delivery was making a dramatic shift to ambulatory as opposed to inpatient facilities. Now, new bed towers are again being constructed. Many of the inpatient spaces are ICU units to address the shortage of ICU spaces amid the pandemic and also accommodate for greater numbers of higher acuity and surgery patients.
Cannon’s healthcare team is designing almost every room to have the capability of being easily converted into an ICU room. ICU rooms are a larger size than a typical hospital single and may require different mechanical systems, have isolation spaces and integrate the availability of personal protection equipment (PPE). The rooms are also designed so that staff can see into a room from the corridor, so the care provider doesn’t have to don PPE in order to check on the patient.
Stroupe is seeing an increase in the number of projects for cancer centers. “The pandemic was a negative experience for many cancer patients,” she notes. “They weren’t able to get their diagnoses and were uncomfortable going to a facility for treatment. Incidences of cancer are up; another factor may be that the population is aging. The good news about cancer treatment is that it is managed as a chronic disease, and there are many new treatment protocols.”
Providing supportive accommodations for staff has also become a high priority. Frontline workers were deeply affected by the pandemic. Stroupe adds, “Staff needs places where they can go for respite. Recognition of staff needs has amped up to a much higher level of attention,” In addition to privacy and a sense of comfort, many of these spaces have access to the outdoors, allowing providers to access the healing quality of nature.
Flooring selection is key to making all these spaces functional and appropriate. One example is the functionality of resilient sheet. Unless dictated by code requirements, a typical room does not need to have seamless flooring. On the other hand, in order to make a room ICU-ready, seamless flooring with integral cove base is required. The cost implication may make this a financial decision on whether a facility is able to use this flooring for purposes of adaptability.
In theory, carpet would seem to be appropriate for supportive staff spaces due to its cushion, warmth and acoustic comfort. Yet designers are finding pushback from clients to the use of carpet in many facilities. “This often has to do with the facility’s ability to clean multiple types of flooring efficiently,” Stroupe notes. “They don’t want to do one more surface, with different protocols. Infection control has also come up as a reason to not use carpet. It is often a perceptual issue, though.” For these reasons, Cannon Design typically uses resilient flooring in staff lounges and offices in acute care facilities.
Dellinger, formerly director of design and design research at Adventist HealthCare, concurs that carpet is being used less often, and some hospitals are not using it at all. “The intention to use carpet has to come from the top,” she says. “Upper management needs to be committed and willing to pay for the extra maintenance.” Waiting areas and offices are the place she might use carpet tiles.
Designers see that resilient-product designers have risen to the occasion. “Fortunately, in the field of resilient, there has been a great deal of advancement in pattern and colors, and we have the opportunity to use materials that feel a bit more like a natural or softer material, so that does help,” observes Stroupe.
As Flinchum describes, UW Health has standardized tiers for acute care spaces with outlined finishes for each-from terrazzo at the highest level in main public entries to sealed concrete at the tier for some back-of-house spaces. Due to maintenance, the organization prefers not to use VCT, which many other facilities do use as a value option. In order to find the optimal use for a product, UW Health’s design team extensively tests products in mockups, followed by test installations in multiple locations, environments and types of spaces. This ensures the best product for a given area and function, with the ability to be cleaned and maintained.
Looking to the future, waiting spaces also present an opportunity for new design solutions. “There is a lot of conversation around how we address waiting spaces,” Stroupe explains. “Facilities want to make the waiting process more efficient and not devote too much square footage to waiting areas. So, how do you change this?
“One idea is to create some type of lounge-where staff can find a patient when needed-that has various amenities and possibly workspaces for waiting patients. To use an analogy from the airline industry, it could function like a United or Ambassador Club. What amenities could the person waiting take advantage of? There will be more work done in this area. Many changes would have to occur operationally and culturally for this to take place.”
Two different facilities show the vastly varied approaches that may be taken in today’s healthcare environment. One is a transplant center within a large hospital; the second is a free-standing cancer center.
PLEASANT T. ROWLAND TRANSPLANT CLINIC, UNIVERSITY OF WISCONSIN HOSPITAL & CLINICS, MADISON, WISCONSIN
The Pleasant T. Rowland Transplant Clinic is a world-renowned organ transplant center at UW Health. As described by UW Health, “The clinic serves adult patients who are being evaluated for or who have received an organ transplant, as well as those who give the gift of life through living organ donation.” The new 10,000-square-foot clinic is located just inside the University Hospital and Clinics’ entrance.
The clinic is named after local philanthropist and transplant recipient Pleasant T. Rowland, best known as the founder of the Pleasant Company (now American Girl), whose $10 million gift helped make the new clinic a reality.
University Hospital and Clinics’ main hospital building was constructed in the 1970s. Although initially located on the first floor, the transplant center was moved to near the second-floor main entry for this project. In addition to providing the full range of adult patient services in one location, goals of the project included ease of patient access, improved clinic flows and increased patient-centered care. Moving the unit inspired the additional remodel of the main clinic’s entry, which then extended into an upgrade of the adjacent lobby.
Walking into the main clinic’s entry, a visitor first sees the new technology wall. The dramatic ten-foot-high wall provides electronic information on seamless monitors along with a touchscreen for the visitor to find specific information, in order to assist with wayfinding. The hospital supplements the technology wall with a staffed greeter’s desk.
Right inside the clinic is the interactive living-donor wall, a glass and electronic art exhibit that honors and celebrates the names and stories of people who have donated organs.
The transplant center utilizes hard surface and resilient flooring. Terrazzo was selected for the clinic entry area for aesthetics, durability and ease of maintenance. The terrazzo flooring also helps the space feel unified and uncluttered and adds a bit of visual texture.
The front area of the clinic has a 12”x24” stone-look LVT that flows seamlessly into the terrazzo. Ease of maintenance is one reason that LVT was selected in lieu of sheet goods, as a single tile can be replaced if damaged.
The transplant center features LVT in the large reception area and carpet tile in the seating areas. UW Health typically uses resilient flooring, either heterogenous or homogenous, in team stations, exam rooms and recovery rooms. One type used is a cushion-backed resilient, with backing
from recycled tires. For UW Health, the best use for this type of product is inpatient areas, patient gyms and some pharmacy areas.
SAUL AND JOYCE BRANDMAN BREAST CENTER, CEDARS-SINAI, LOS ANGELES, CALIFORNIA
The Saul and Joyce Brandman Breast Center at Cedars-Sinai is a freestanding three-story, 36,000-square-foot facility dedicated to breast health services for both women and men.
Cedars-Sinai chose to build the space away from the main campus in order to create an environment that felt separate and private, with an upscale, spa-like atmosphere and without the emotional reference of a hospital setting. The architecture and interior design were intended to enhance the privacy aspects as much as possible.
In order to support the desired ambience, designers incorporated materials that felt comfortable and nature-inspired. Garden spaces are connected to the lobby. Stroupe says, “All of it feels very natural with wood materials, curving glass walls, organic forms and a rather neutral palette for walls and floors. Daylight was introduced in the space wherever possible.”
Based around warm and cool neutrals, the color palette is calming. Stronger color is incorporated in the interior though furniture and artwork from Cedars-Sinai’s museum-quality collection. The space feels open and airy with light-colored wood and with wall materials and patterned glass providing texture.
There was also a focus on sustainable materials, with a client preference for PVC-free products. Ultimately, the main flooring selected for clinical areas and corridors of the Breast Center was Noraplan Sentica rubber sheet from Interface’s Nora, with an integral cove base in near-solid colors that have a little bit of fleck. Exam rooms have a warm off-white flooring; staff spaces have a warm grey.
Supporting the calming and open space, the lobby and reception area feature 12”x24” ceramic flooring from Transceramica’s Brush Stroke collection.
Driven by a focus on patient comfort and a desire to make the space feel warm and inviting, a large amount of carpet was incorporated into the Breast Center design. The carpet is located primarily in corridors and office areas, as well as in some waiting spaces.
“It’s unusual to see carpet used in patient care areas,” says Stroupe. “The floor where all the exams take place is designed with the concept of ‘onstage/offstage,’ where the exam rooms themselves have one entry off of a more public hallway that is for patients. There is a central work core for the staff, and the staff enters from a different place. On that ring around the exam rooms-going all the way around the exterior wall-there is a seating area that is all carpeted, so it has a nice feel to it. We have a wood-like material on the outer walls of the exam rooms and heavily frosted glass sliding barn doors at the entrance.”
Corridors, office space and conference rooms, in addition to waiting areas and changing facilities, are all carpeted. Bentley’s Shapeshifter carpet tile is installed in the offices, and its Manifesto carpet tile is in the registration area and patient education rooms. Alchemy Tile from Shaw Contract is installed in a boutique on the first floor that provides specialized services, such as prosthetics and wigs. The interior space feels quiet inside, although it is actually in a busy location.
With its natural color palette and the blues and soft greens of the upholstered furniture, the interior of the Cedars-Sinai Breast Center reflects the lovely outside scenery. One feature of the building is its beautiful views from all directions, including one of the iconic Hollywood sign.
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