Rebecca Donner. Credit: Inner Design Studio
When it comes to designing hospitals, the majority of the focus is understandably on the clinical side. Rebecca Donner, the founder and owner of Inner Design Studio, a healthcare interior design firm, has designed everything from ambulatory surgical centers to full-blown acute care hospitals, medical office buildings and cancer centers.
In the early 2000s, she said hospital competition ramped up as expectant mothers began shopping around more for where they would give birth, and so the focus honed in on labor and delivery units and how they could make them as welcoming and comfortable as possible.Then the trend moved to physician recruitment and so areas like physician lounges were in the spotlight.
The aim for physicians was to design their work areas in a way that made their jobs easier. For instance, in a surgery center they designed comfortable lounges and dictation centers amd in areas where on call doctors sleep, they made sure there were plugs for all their devices and internet access.
Today, medical systems are paying far more attention to design when building new facilities, catering to the wave of consumerism that has been steadily sweeping through the industry, especially in the last few years.
Healthcare Finance spoke with Donner about the increasing attention on patient experience and implementing design features that increase comfort, decrease stress and accommodate visiting family.
Q: With hospitals, the focus in usually on the clinical side. Why are the aesthetics important?
A: We are learning so much more about the stressors on the patients. We have learned that the environment plays such an active role in the patient's recovery as well as their comfort level. With that we try to focus on patient experience. Back in the day we just went with whatever came out of the c-suite. It was very driven by budget. Now, we are all focusing on the patient. We are all trying to make it a better experience, and that's for the staff as well.
Q: HCAHPS scores are huge for hospitals. What are the measures most affected by facility design?
A: We concentrate on areas that are under the hospital environment. So we are doing things especially on the acoustic side. We are beefing up ceilings and adding acoustical tile to make sure they are absorbing as much of the sound as possible. We are also trying to change out the flooring. There are some hard surface products that have a cushion back that also help with sound absorption and acoustics. We are also adding acoustical panels to patient rooms, again just trying to keep things quiet. We also are doing similar things in the corridors like the acoustical ceiling tiles and panels. When you look back in the day we used to use a lot of carpet in the corridors and then infectious control got in and we went to the hard surfaces, which brought us back to the loudness. So we continue to try to find items to keep that decibel as low as we can get it. We also work with the lighting quite a bit, trying to keep it at a higher level during the day and then usually around 8pm the lights in the corridor will dim down a little bit. For the patient rooms, we are adding blackout shades so there are actually two shades on the window: the blackout and then another one that is perforated so if they pull up the blackout they can still see outside and it takes the glare out. Ideally, we'd like to have those motorized at the patient bed. Also small things like putting night lights in. Some of the beds we are using actually have a nightlight underneath it so it illuminates the floor but keeps the lighting level low. We put towel hooks closer to the shower for safety and are trying to make sure all patient rooms and bathrooms are private. That is 90 percent of our work. There is a huge call for privacy, including acoustical privacy so you can't hear what is going on next door. Also, lots of docking stations in the rooms for patients and visitors and making sure patients rooms have room for the family. We are trying to take good care of the family so everyone' experience is positive. I think the hospitals are seeing a better recovery for the patient and a better experience if the family is there.
Q: What are some of the other changes you're seeing a big call for?
A: We are also seeing a big push for the patient wanting to know what their day is going to look like. So we will either have a place on the whiteboard or we would put it on the television. We have some IT people who have worked it so you can go to a certain channel and then it gives the list of what's going to happen for that patient that day. I think that takes a lot of the stress off the patient knowing what their day looks like.The ability to clean surfaces easily. We are using a lot of patterned vinyls for the upholstery so you can clean them with a bleach solution. They can be wiped down and it keeps the stains off. Same thing with the flooring and countertops. We are trying to go to a solid surface all around, including areas where there is a sink. I think we can all picture what it looks like when that surface starts to bubble when near water. We are using less grout and more larger scale tiles with the showers.
Q: So often the ideals of cutting costs and improving quality are at odds. Let's talk about the cost of some of these upgrades.
A: Infectious control actual sits with us when we are meeting at the design tables when we meet with the hospitals and talk about cleanability. We are trying to find opportunities to make things less hard to clean. Some of these items may be more expensive, but it's saving them time on cleaning. It also goes back to the ACA and infections. If you leave with a little extra infection, that goes back on the hospital's dime. We're trying to eliminate any opportunity where something could harbor bacteria. Yes some of the items are probably a little bit more expensive but the investment outweighs the risk. On the items for the patient's comfort, we have have to put some type of window shade. Probably motorizing the window shade is an upgrade but there would be some type of window shade there, and I don't believe we are putting them throughout a hospital. The night lights, towel hooks, and acoustics, those are things that are really not that expensive. The typical tile is running about 1.25 a foot and you add little extra to it. Your probably adding 10 to 5 cents per square foot. If you were to do a horizontal blind on a window that would typically be about $200 a window. For motorized shade would probably be about $300. But going back to infection control and cleaning, the horizontal blind is a nightmare for hospital staff. By doing the roller shade, there's no dust that collects.
Q: How can a hospital that is on a really stringent budget make some of these improvements?
A: Beefing up acoustics in the ceiling and adding these acoustical panels, adding dimmers to lights so patients can control the lighting are small things, and probably not as fancy as your private facilities. But acoustics are huge and even just the visual of bringing the light levels down in keeping with their sleep cycles, that makes a big difference. One acoustical panel is under $100, probably in the $70 range. Sometimes we use a combination of them to make it like art. We are able to put images on the fabrics. You could use money from your art budget and instead of buying art for $250 you can change it up, not frame it and make it look like it's a piece of art and it actually has acoustical properties.
Q: Any other tips for struggling hospitals on how to make patient-centric improvements?
A: It's just about being smart in selecting items based on cleanability. Not everyone can go to higher end solid surfaces, but finding one that can fit your budget but serve the same function helps. When you use the vinyl products on upholstery you get more wear out of is as well as boosting cleanability. It's also about studying the lifecycle cost of things. The generic, common grocery store type tile, called VCT tile, installs for under $2 a foot. Then there's a product called luxury vinyl tile which gives you the wood look or the stone look. Yes it it a little more expensive. It installs for around $3 a foot, but there is no maintenance to it. The VCT or vinyl composition tile, that we put down, that has to be stripped and waxed several times a year. For some hospitals that can mean a $20,000 annual budget for stripping and waxing floors. So we are finding things that have a better life cycle.
Q: What should hospitals look for in the next three to five years?
A: We talk a lot about healthy buildings these days. We talk about off-gassing and no VOC paints. You can renovate your hospital in the middle of the day and not worry about fumes for patients. Everything is about a healthy environment and how things affect patients.