Healthcare Design: A Case Study - March 2008

By Darius Helm

In recent years, healthcare construction has been heavily influenced by a new approach that uses architecture and design to augment the healthcare operation. Evidence-based design employs research to make design decisions that enhance the health and well being of patients, staff and visitors—and quantifiably improve patient outcomes. St. Mary’s Medical Center North in Knoxville, Tennessee, completed last summer, is replete with examples of this new approach.

Evidence-based design is gaining recognition as a fundamental tool for delivering healthcare. Statistical studies show that, in acute care facilities, elements not directly involved in the administering of medical care can play a measurable role in the health and recovery of patients. Sunlight, color palettes on floors and walls, artwork, background noise and a host of other seemingly benign factors all have an impact on the health of patients.

However, evidence-based design doesn’t stop there, because it also affects the health and well being of staff. Subtle details like how patient rooms are laid out can reduce staff errors, increase efficiency and even ease interaction between patient and staff. Cushioned flooring can ease stress levels, and the right patterns and colors can make the difference between a hectic, jarring workplace and an environment that is calm and focused.

St. Mary’s Health System opperates a number of Catholic medical centers in and around Knoxville, and its latest addition is St. Mary’s Medical Center North, a facility the leadership team wanted to be “the hospital of tomorrow, today.” HDR, the nation’s leading healthcare design firm, was brought in to create the new facility, and it was designed, built and completed in less than three years, opening last August at a cost of $67 million.

The goal was to create a facility that enhanced the healing process through innovative design, state of the art information and communication systems, family involvement, and St. Mary’s core values of compassion, human dignity and sacredness of life. As a Catholic institution, it was essential to enhance the healing ambiance with religious art and iconography. Also influencing design were the nearby Smoky Mountains, with their powerful imagery and calming presence.

St. Mary’s Medical Center North looks less like a hospital and more like a hotel or resort lodge. The dominant impressions are of light and wood. Many of the walls have wood paneling, and the exterior walls have an abundance of glass, where possible, flooding the interior with natural light.

There’s also plenty of artwork throughout the hospital, from soothing landscapes to religious art. Noticeably absent are abstract paintings, which are more likely to cause anxiety than are representations of nature. Religious artwork includes bronze and glass sculptures, watercolors and oil paintings. There’s a cross above every bed and a chapel with stained glass windows.

Flooring at St. Mary’s
The lobby features a natural stone installation using four types of marble in a variety of large-scale square and rectangular formats, tempering the sleek lobby design with a subtle randomness. The marble has a honed finish for slip resistance, though the design of the floor is further randomized with the occasional high gloss tile, and the cross design centered on the reception desk is also high gloss.

The seating areas on either side of the lobby entrance are inset with broadloom in a symmetrical, highly stylized botanical pattern colored in warm rich earthtones. Significantly, the manufacturer HDR selected for the lobby broadloom was Templeton, a hospitality carpet mill.

Beyond the lobby, much of the flooring appears to be oak in medium and dark finishes with elegant scrolling borders and other custom touches. In fact, it’s sheet vinyl by Teknoflor, a commercial division of Halstead International, which manufactures product in South Korea and also sells residential vinyl under its Metroflor division.

Teknoflor targets the healthcare and retail markets with its high performance heterogeneous product. It’s appropriate for both acute care and assisted living, with slip resistance—conferred by tiny grooves—that meets ADA safety flooring standards. In addition, Teknoflor is antibacterial and antifungal, using nano silver sterilization technology, plus it offers antistatic properties. Another key consideration is maintenance, and Teknoflor requires no waxing and no buffing. And its low gloss finish helps hide scuff marks and other signs of wear.

Teknoflor is the main flooring in the hospital, and it is in patient rooms, reception areas, the cafeteria, and lounges, functioning as a central element in the overall design.

Carpet tile from Mannington and Tandus was installed wherever possible in patient corridors, offices, conference rooms and lounges. Evidence-based design research indicates that carpet offers numerous advantages in healthcare environments. Mostly, it’s a softer, quieter flooring, which in turn encourages a quiet, more restful atmosphere. Carpet absorbs a significant amount of noise, and its comfort underfoot has a significant impact on the physical and emotional well being of both patients and staff.

Interestingly, research suggests that nurses are quieter around carpet than they are around hard surface flooring. Patients sleep better, patient outcomes improve, extended care is minimized, success rates climb. In this manner, evidence-based design can help a hospital provide both better healthcare and a better work environment, and ultimately, a more successful healthcare model.

HDR also used VCT by Mannington and Azrock in various non-sterile settings. A dark-neutral and off-white checkerboard tile from Azrock was installed in a corridor regularly used by staff going back and forth from the main hospital in downtown Knoxville. The pattern, designed to echo a dominant pattern at the Knoxville facility, both serves as a transitional space and conveys a subtle sense of continuity.

21st century design
St. Mary’s North has 72 beds, each one in a private room with a view of the outdoors. The 206,000 square foot facility, with five floors and one shell floor for further growth, includes a 24/7 emergency room, a surgical department with five operating rooms, and a wide range of medical and surgical services.

Unlike traditional patient rooms, the rooms at St. Mary’s are “same-handed,” which means that all items, from the patient bed to the bathroom to the electrical outlets and medical equipment, are all in the exact same location.

Back in the 20th century, rooms tended to be paired mirror-images, mostly because it reduced the cost of elements like plumbing. But research has shown that medical staff operate more smoothly and efficiently, and with fewer errors, when patient rooms are same-handed. The rooms are also designed to be more patient-safe, with a table alongside the bed that has a handrail which runs all the way to the bathroom, enabling patients to move with much greater ease, especially when groggy or at night.

Evidence-based design acknowledges that patient outcomes are further improved when family members help care for the patient, and to that end, the hospital’s patient rooms are large enough to accommodate a “family zone.” This includes a sleep sofa, Wi-Fi access, and two TVs—one for the patient and one for the family zone. There are also visitor lounges with recliners, a coffee bar, Wi-Fi access, multiple TVs and a view of the Smoky Mountains.

Patient care is further enhanced and optimized by a decentralization of the nursing stations of old. Instead of one large, noisy and chaotic station per floor or wing, there are workstations outside every patient room, enabling medical staff to closely monitor each patient with all the medical information at hand.

Though St. Mary’s North is not a LEED certified building, environmental sustainability is slowly making its way into the healthcare field. The project was conceptualized at the beginning of 2005, and it contains a handful of green elements, like recycled content in its Teknoflor vinyl. However, in the intervening years, HDR has handled an increasing volume of LEED projects. This is particularly true of government projects, like Veteran Administration facilities, which must attain some degree of LEED certification.

Omaha, Nebraska based HDR was founded about 90 years ago but has done most of its growth in the last decade, driven largely by the rapidly growing healthcare market. HDR, which has been wholly employee owned since 1996, is now a top ten design firm, with installed work of around $1.8 billion and interior design fees of $63 million. In 2007, total billings for HDR Architecture were $205 million.

The St. Mary’s project was headed up by: Cyndi McCullough, medical planning; Jeff Getty, AIA, design architect; Tony Cicci, project architect; Barbara Dellinger, IIDA, AAHID, principal interior designer. Also participating in the project was a local architecture firm, Barber McMurry Architects.

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