The Center for Health Design Blog

Healthcare Going for the Gold in Sustainability

In the past week, I’ve received emails about three healthcare facilities that have achieved a LEED rating:

Laguna Honda Hospital & Rehabilitation Center, San Francisco, designed by Anshen+Allen Architects and Stantec Architecture (LEED Silver).

Jersey Shore University Medical Center, Neptune, NJ, designed by WHR Architects (LEED Gold).

Arlington Free Clinic, VA, designed by Perkins+Will (LEED Gold)

I proud to say that two of these organizations — Laguna Honda and Jersey Shore — are members of The Center for Health Design’s Pebble Project research initiative.

It’s good to see that more healthcare organizations are realizing that health outcomes and sustainability are compatible. And that many evidence-based design strategies support designing a facility to meet LEED criteria — including reducing toxins and energy use through materials, air-handling systems, water processing systems, and lighting.

But, the LEED for Healthcare rating system hasn’t been without it’s critics. Gary Cohen, President of Health Care Without Harm(HCWH), wrote a commentary in Modern Healthcare last month criticizing the U.S. Green Buildings Council for removing all language about persistent bioaccumulative toxic (PBT) chemicals (including dioxin and halogenated materials) from LEED for Healthcare credits.

“Without these material credits, LEED for Healthcare falls short of providing guidance and credits to the healthcare sector for reducing toxic materials in healthcare buildings,” he wrote, stating that there remains “fundamental” differences between LEED for Healthcare and the Green Guide for Healthcare that was developed under HCWH’s guidance.

Whatever the shortfalls of LEED, healthcare is moving in the right direction toward a more sustainable future.

Details Do Matter

It only takes a hospital experience to remind me of the significance of the work that we do at The Center for Health Design. Last weekend, my husband went to the ER for severe back pain and was eventually admitted for an overnight stay in our local hospital in Evanston, IL.

Judging from the furnishings, finishes, and unit layouts, this hospital was renovated about 10 years ago. I was struck by two things while in the ER and later on the patient unit — noise and smell.

We were in the ER on a Sunday morning, when it wasn’t too busy. The hospital still uses overhead paging, so several times, we were subjected to the droning, “Will doctor so-and-do please call radiology? Will doctor so-and-so please call radiology?” Or something like that.

Also, the attending ER physician’s computer station was right outside the exam room where my husband and I waited for six hours. At one point, I heard him talking on the phone to another patient’s family member, explaining all the details of her illness.

When I went to get a cup of water in a small kitchenette adjacent to the nurse station, I used the ice machine. It was so loud that I cringed and wondered if any of the ER patients could hear it.

As we got my husband settled into his private room (thank goodness) on the patient unit, I checked out the bathroom and was overpowered by the smell of urine. Admittedly, I do have a more sensitive nose than most, but it was bad.

The room had a large window overlooking a courtyard with a green roof. It was small — and there wasn’t really a family zone, but it did have a flat screen television on the wall. Trouble is, whoever installed the TV, completely missed the fact that the ugly black wires were hanging down from the back. I tucked them up out of the way — something the facility department should have thought of to do.

My husband got excellent care in this hospital — although I did notice in the ER that the blood pressure monitor that he was wearing on his finger was replaced four times because they had to take it off for whatever reason and it couldn’t be reused. Talk about waste in healthcare. I’m sure we’ll pay for the cost of that little item.

In the end, it’s really the details that matter. You can use the best evidence available to design a healing environment, but if staff doesn’t take care of the details — like the smell or wires hanging down from the TV — it will fall short. Noise, which causes stress for both patients and staff, is an issue that should be addressed in the design of every unit and department in a hospital, and dealt with from a cultural perspective as well.

Most people wouldn’t have noticed the things that I did. But that does not make it okay. Because the goal is to motivate and inspire hospitals to do better. And it doesn’t stop when you open the doors to a new or renovated building.

Wellness, Anyone?

One of the current trends in healthcare is wellness programs offering complimentary and alternative therapies and preventative screenings. A recent survey by the American Hospital Association indicates that 37% percent of hospitals are offering such programs, which can be used by people in the community as well as hospital patients and staff.

Last week, I participated in a workgroup to look at the design guidelines for residential care facilities (i.e., nursing homes and assisted living). The assignment of my sub-group was to see if there was a place to insert something about wellness centers.

We concluded that residents in long-term care and assisted living facilities also have access to wellness programs, but that it is not something unique to residential care.

After doing a quick search on the Internet, we also came up with this definition of a wellness center: A place where there is access to programs that support the integration of the physical, psychological, social and spiritual components of wellness to help people of all ages and fitness levels live healthy lifestyles.

These programs may be offered in freestanding wellness center facilities that are adjacent to or affiliated with a private company, community hospital, or long-term care/assisted living facility. They may also be offered in spaces that are within the companies, hospitals, or residential care facilities themselves.

Some, like outgoing Center for Health Design board member Leonard Berry, think that employers are going to lead the way in reinventing healthcare in the U.S. Besides complimentary and alternative therapies, companies are also providing onsite primary care, which Berry claims is a very fast moving trend in this country.

I think he’s right…and it won’t end when people retire from working. They will continue to embrace the concept of wellness and want access to those services in their communities. So, it makes sense to at least acknowledge in the design guidelines that this is a trend and begin to think about what types of facilities are being designed to support wellness programs.

The Best HC Products at NeoCon

NeoCon — the annual commercial furnishings exhibition at The Merchandise Mart in Chicago that is attended by 30,000-40,000 design professionals, facility managers, product manufacturers, students, and others related to the design industry , concludes today.

Healthcare products definitely grabbed more of the spotlight this year at NeoCon. In the Best of NeoCon product design competition sponsored by Contract magazine, Merchandise Mart Properties, Inc., McMorrowReport.com, the International Interior Design Association (IIDA), and the International Facility Management Association (IFMA), 36 products were entered in the four healthcare categories.

Eight of those products won awards — including gold awards for Herman Miller’s Compass modular system, Wieland’s Allay Sleep Sofa, Pallas Textiles’ Entwined Collection, and Momentum Textiles’ Silica. Compass is clean and uncluttered — and offers many configuration options. Allay has a nice look to it and a fold down back that becomes the bed.

Contract has uploaded a nifty slide show on its website where you can view all the healthcare winners.

I saw a lot of other interesting healthcare products while walking the halls of The Mart with Rosalyn Cama, The Center for Health Design’s board chair and head of her own healthcare design firm, Cama, Inc., in CT. We liked the smaller scale and clean lines of the Gatesby Lounger from IoA (part of a collection that won a Best of NeoCon silver award).

Nurture’s new Tava seating collection and the complimentary concept casegoods they were featuring made of Corian with wood legs also looked fresh — and yet a little retro. And while we’d like to get away from computers on wheels, Nurture’s Pocket cart shows how good design can really improve a standard product.

Carolina was also showing a modular headwall system with very clean lines and Roz and I really liked the contemporary design aesthetic of its showroom and other healthcare seating collections.

So, the healthcare furniture industry is maturing. NeoCon used to be a handful of specialty manufacturers who had pretty standard healthcare products and a bunch of office furniture manufacturers who were trying to adapt their products to healthcare. But the bar has been raised, and the success of conferences such as HEALTHCARE DESIGN has helped bring this market segment to the forefront at trade shows like NeoCon.

Healthcare Grabs the Spotlight at NeoCon

The focus of NeoCon, the annual contract furniture exhibition happening this week at The Merchandise Mart in Chicago has always been office furniture and furnishings, but in recent years healthcare has grabbed some of the spotlight.

Steelcase raised the bar a few years ago when it launched Nurture and opened a dedicated showroom in The Mart to display its new line of healthcare products. This year Herman Miller finally took healthcare out of the corner of its expansive third floor showroom and showcased its Brandrud, Nemschoff, and Herman Miller lines in a separate showroom on the same floor.

KI has substantial space in its 11th floor showroom for its healthcare products and Carolina was front and center in OFS Brands redesigned showroom on the same floor. Spec opened its first Mart showroom this year — also on the 11th floor.

Flooring companies such as The Mohawk Group, Tandus, Interface/Flor, and Mannington have always had showrooms in The Mart, and for NeoCon, they don’t necessarily separate out their healthcare product lines. But if you walk in the showroom and ask about healthcare, you can be sure there is someone there to talk about it and show you the goods.

Finally, The Mart management made a smart decision this year by putting all the temporary healthcare product exhibitors into one “Healthcare Pavilion” on the 8th floor. Before, you’d have to make your way through the endless corridors of the 7th and 8th floor to find them. It makes a lot of sense for them to be all together.

More to come on notable products seen at NeoCon.

Another Credential? Here’s Five Reasons Why

For those who think there are too many credentialing programs for architects and designers and question the value of adding EDAC (Evidence-based Design Accreditation and Certification) to your name, here are five good reasons to do it:

1. EDAC is a learning opportunity that educates individuals on the evidence-based design (EBD) process. It is very different from certification offered by the American College of Healthcare Architects or the American Academy of Healthcare Interior Designers. As best as I can tell, those programs refer to EBD, but are focused more on evaluating design experience and are specific to design professionals. EDAC is open to anyone.

2. EDAC is also different than LEED, which accredits individuals on their knowledge of sustainable design practices. I’m told by those who have taken the LEED exam that it involves more recall of facts, while EDAC, again, is testing knowledge of a process. And, while I haven’t studied for and taken the LEED exam, the two programs seem to be complimentary, because there are clear intersections between evidence-based design, safety, and sustainability.

3. Healthcare organizations are asking for proof of evidence-based design knowledge in their project RFPs. EDAC is a way of qualifying that knowledge to clients.

4. The cost to study for and take the EDAC exam is relatively low — $160 for three study guides and $285 to take the test. After that, there is a $60 maintenance fee every two years. Discounts on these fees are also available to Center for Health Design Affiliate members, EDAC Advocate Firms, and special offers. An additional value is that the material in the study guides is a useful reference tool for any design library.

5. Maintaining EDAC accreditation only requires 3 hours of continuing education units per year. There is cross-over with CEUs required for other accreditation programs, and many opportunities to easily log 3 hours at industry conferences, webinars, and more recently, the HERD Journal.

In this economy when dollars are tight, I understand that design firm principals and owners need to justify the costs for their employees to pursue any type of certification. But if they start to think about it as employee education, it becomes a relatively low-cost way to support further growth and development. What do you think?

Evolving Innovation

Yesterday, I attended, as an observer, the judging for Healthcare Design magazine’s 2010 Architectural Showcase issue, which is published by Vendome Group in association with The Center for Health Design.

Approximately 130 projects were reviewed by a panel of 20 architects, interior designers, facility executives, and others who served as jurors.

The jury spent most of the day reviewing 20 projects that had been deemed worthy to be considered for a Citation of Merit. Here are some of the design features that stood out for me while looking at these projects:

1. The signature stair in the lobby hasn’t gone away — even though most patients can’t or don’t walk up or down them.

2. Green space and gardens, whether on the roof, in a courtyard, or a “Healing Mall” (love this term!) as described by one, are everywhere.

3. Good to see many projects pursuing and achieving LEED certification.

4. Disturbing still to see sterile, stark interiors — particularly in clinical spaces. Less is not more when it comes to healthcare spaces.

5. Canopies, curves, round atria, and LOTS of windows.

6. Fascinating to see the “nursing neighborhood” concept and love the fact that we’ll soon see evidence-based design research on how it worked.

We also looked at some of the Citation of Merit projects from the last 10 years and it was interesting to see when innovative design features, such as decentralized nursing, single patient rooms, family zones, etc., started appearing in projects. One juror asked if there was anything innovative in the projects we saw today. The consensus was that innovation is evolving - we’re seeing new things, but they are not necessarily new ideas.

Projects selected for publication will be showcased in Healthcare Design’s September issue and the four earning Citations of Merit will be presented at the Healthcare Design conference in November.

An Inspired Student

Earlier this week, I had lunch with young man who is a recent graduate of the Health Design masters program at the School of Architecture at the University of Illinois-Chicago (UIC). I first met him when I was a guest lecturer for the program two years ago. He’s also attended our Environments for Aging and HEALTHCARE DESIGN conferences.

Anyway, he’s starting a job in June in Switzerland (he’s from Austria) with a planning firm that does mostly long-term care. He’s also involved with the organizers of a new university in Switzerland, who he’s convinced to offer coursework on evidence-based design.

He also shared with me a set of four interesting “mini-books” that he’d self-published. One was a comparison of 30 different long-term care facilities that he had visited in the Midwest. Another was a history of nursing homes. Another was about empathy for elders. Really cool stuff — with pictures and illustrations and his own unique perspective.

What’s really neat about this young man, though, is how the work of The Center for Health Design and his studies at UIC have influenced him and inspired him to write these books, be involved in a start-up university, and spread the word about evidence-based design in Europe. And it also shows how important it is for all of us in the healthcare and design industry to reach out to students and get them engaged early in their careers.

Pebble at 10

Last week, partners in The Center for Health Design’s Pebble Project research initiative met in Philadelphia. Ten years after the program began, more than 70 healthcare organizations and corporations have participated in Pebble. Currently, there are about 50 active partners.

The idea for the Pebble Project came during a joint meeting of The Center’s Board and Research Council in 1999. The minutes from that meeting state that Derek Parker, Blair Sadler, Roger Ulrich, and Bob Horsburgh described the project in detail, explaining that the idea was to engage “other organizations on research projects of common interest. The highest priority objective in this multi-organizational approach is to better understand how the planning and design process affects behavioral and cultural change in healthcare organizations that are striving to create a healing environment. A specific project – the organizational behavior or ‘pebble’ project – has been identified to address this objective.”

It is hard to determine from these meeting minutes whose idea it was for the Pebble Project, but I believe it was mostly Derek Parker’s, and that Blair Sadler’s commitment for his hospital (San Diego Children’s) to be the first pebble was really what launched it. And of course, the term “evidence-based design” had yet to be coined and the research focus soon turned to patient and staff outcomes instead of the more broad “behavioral and cultural change.”

Unfortunately, because of market changes and other factors, San Diego Children’s Hospital never completed its Pebble Project. But it helped lay the groundwork for others to develop and test research hypotheses.

And now, 10 years later, several organizations that joined the Pebble program as they were starting their projects have completed their buildings and are starting to research and document the results of their design decisions. Last week at the Pebble meeting in Philly, we toured the new Paoli Hospital and heard its management team talk about the importance of evidence-based design to the success of the project and the organization.

There are lots of lessons to be learned from 10 years of Pebble. We hope to be able to synthesize them and share them with everyone soon.