Health care Facilities

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Classification Health care facilities enco mpass a wide range o f types, fro m Major Resources small and relatively simple medical clinics to large, co mplex, and co stly, teaching and research ho spitals. Large ho spitals centers may include all the vario us subsidiary health care types that are o ften independent facilities. The o ld expressio n, "Yo u never get a seco nd chance to make a go o d first impressio n" applies to health care facilities. The facility co nveys a message to patients, visito rs, vo lunteers, vendo rs, and staff. The facility also co mmunicates a to rrent o f clues abo ut the o rganizatio n and the medical care being pro vided there. The clues start at the appro ach to the facility, the dro p-o ff area, the parking lo ts, and the street signs. Ideally, that message is o ne that co nveys welco ming, caring, co mfo rt, and co mpassio n, co mmitment to patient well-being and safety, where stress is relieved, refuge is pro vided, respect is recipro cated, co mpetence is symbo lized, way-finding is facilitated, and families are acco mmo dated. The facility also influences emplo yee service attitudes and behavio rs. Finishes, signage, and artwo rk must be carefully selected, well co o rdinated, and integrated. Security can be balanced with so me features apparent to patients/visito rs, while co nveying a message o f safety. Tho ughtful design can help ensure the pro per first impressio n is created and sustained.

SPAC E T YPES

The design o f health care facilities is go verned by many regulatio ns and technical requirements. It is also affected by many less defined needs and pressures. The mo st pressing o f these are wo rkfo rce sho rtages, reimbursements, malpractice insurance, physician-ho spital relatio ns, capacity, care fo r the uninsured, patient safety, advances in techno lo gy, and patient satisfactio n per a recent American Co llege o f Healthcare Executives survey o f ho spital CEOs.

D ESIG N D ISC IPLIN ES

The entire health care system is under great

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BO O KMARK AND SHARE

by Robert F. Carr Revised by the WBDG Health Care Subcommittee Last updated: 12-30-2010

We shape our buildings and afterwards our buildings shape us...

Winston Churchill (May 10, 1941)

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Health Care Facilities

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The entire health care system is under great pressure to reduce co sts, and at the same time, be mo re respo nsive to "custo mers". The aging are the heaviest users o f health care services, and the percentage o f the aging in o ur po pulatio n is increasing significantly. At the same time, rapid techno lo gical advances, o ften invo lving very so phisticated techniques and equipment, make mo re diagno stic and treatment pro cedures available. The co nsequent increase in health care co sts is no t easily acco mmo dated. Designers find increasing fo cus o n limiting bo th co nstructio n co sts and the co sts o f their design services, while co mpressing co nstructio n schedules and still meeting the highest quality standards.

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As co st pressures increase, health care facilities find themselves in increasing co mpetitio n fo r bo th patients and staff. Architecture is o ften reco gnized as an impo rtant to o l in attracting and retaining the best do cto rs and nurses, the mo st successful HMOs and insurance plans, and the mo st patients. Co nsumer decisio ns are based o n co st, accessibility, quality o f service, and quality o f medical care. An aesthetically pleasing facility is a key aspect o f the perceived quality o f care.

Health care is a labo r-intensive industry, and much o f that labo r is highly skilled and highly paid.

Since 6 0 to 75% o f ho spital expenses are labo r co sts, a design that increases o peratio nal pro ductivity o r efficiency and reduces staffing needs can have a majo r impact o n the bo tto m line.

(Do n Blair, then at Perkins + Will, estimated that the co st o f o ne full-time staff perso n is equivalent to the debt service o n $1 millio n o f bo rro wing per Architectural Record o f May 19 9 7.)

Likewise, o peratio ns and maintenance co sts o ver the typical 50 -year life cycle o f a ho spital co ntribute up to 8 0 % to the equatio n, so anything designers can do to facilitate maintenance and reduce to tal life-cycle co st will have tremendo us returns o n a relatively small up-fro nt investment.

(So urce: Federal Facilities Co uncil.)

Flexibility must be a basic feature o f any new health care facility to keep it fro m rapid o bso lescence in the face o f changing needs and techno lo gies. Health care facility needs are evo lving rapidly, and the directio n o f that evo lutio n is difficult to fo recast with any certainty. New equipment techno lo gies, new treatment metho do lo gies, changes in diseases, and changes in the patient po pulatio n base all impact the facilities that ho use them. Inpatient care is steadily being reduced while o utpatient services are gro wing. There is increasing emphasis o n specialcare units and smaller satellite facilities rather than large, centralized facilities.

In the past, co mmunicable diseases were the majo r health pro blem, and sanitatio n o r cleanliness was the main characteristic o f a healing o r therapeutic enviro nment. Cleanliness remains extremely impo rtant, but there is increasing reco gnitio n o f the value o f a pleasant, easily-understo o d, and no n-threatening enviro nment fo r patient reco very. Fo r example, the Planetree Ho spital philo so phy o f "demystifying medicine" emphasizes such a physical PDFmyURL.com

enviro nment as part o f its appro ach. Go o d design in the health care setting starts by reco gnizing the basic functio nal needs, but do es no t end there—it must also meet the emo tio nal needs o f tho se who use such facilities at times o f uncertainty, dependency, and stress.

The HIPAA (Health Insurance Po rtability and Accessibility Act o f 19 9 6 ) regulatio ns address security and privacy o f "pro tected health info rmatio n" (PHI). These regulatio ns put emphasis o n aco ustic and visual privacy. While HIPAA do es no t regulate facilities design, its implicatio ns fo r healthcare facilities may affect lo catio n and layo ut o f wo rkstatio ns that handle medical reco rds and o ther patient info rmatio n, paper and electro nic, as well as patient acco mmo datio ns.

There is a no ticeable mo vement fro m ho spital-based acute care to o utpatient care, and to ward a mo re ho listic, preventative, and co ntinuo us care o f health and wellness.

Sustainability must be a co nsideratio n fo r the design o f all health care facilities. Many sustainable design features can be inco rpo rated into health care facility design, including daylighting, energy and water co nservatio n, no nto xic materials and finishes, and sustainable o peratio ns and maintenance. Health care facility energy and water co nservatio n standards must meet EPAct 20 0 5 (PDF 1.3 MB, 550 p g s ) and Executive Order 13423 requirements. The Energy Independence and Security Act o f 20 0 7 (EISA) (PDF 740 KB, 310 p g s ) pro vides additio nal requirements fo r energy co nservatio n.

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EMERGING ISSUES There is an increasing emphasis o n security, especially in large public facilities, and the need to balance this with the desired o penness to patients and visito rs.

Evidence-based design. Acco rding to the Center fo r Health Design, "Evidence-Based Design is the pro cess o f basing decisio ns abo ut the built enviro nment o n credible research to achieve the best po ssible o utco mes. Evidence-based health-care architecture creates safe and therapeutic enviro nments fo r patient care and enco urages family invo lvement. It pro mo tes efficient staff perfo rmance and is resto rative fo r wo rkers under stress. These designs ultimately sho uld impro ve the o rganizatio n's clinical, eco no mic, pro ductivity, satisfactio n, and cultural measures."

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CLASSIFICAT ION A trend to wards specializatio n has resulted in a gro wing number o f health care types. Amo ng them are ho spitals, nursing ho mes, o utpatient facilities, psychiatric facilities, rehabilitatio n facilities, ho spices, assisted living facilities, co ngregate ho using, adult day care facilities, and vario us specialized o utpatient facilities. The WBDG currently includes sectio ns o n the fo llo wing fo ur specific building types: Ho spital Nursing Ho me, including Alzheimer's Related Dementia (ARD) units PDFmyURL.com

Outpatient Clinic , including the specialized diagno stic and treatment areas which may be stand-alo ne facilities Psychiatric Facility, including psychiatric ho spitals BACK TO TO P

MAJOR RESOURCES WBDG Federal Mandate Executive Order 13514 Technical Guidance Products and Systems Building Envelo pe Design Guide

Websit es AIA Academy o f Architecture fo r Health (AAH) —Co ntains AAH newsletters, repo rts, and o ther do cuments related to health care design.

American Ho spital Asso ciatio n —Info rmatio n generally fo cused o n financial and o rganizatio nal issues, but includes go o d data o n health care statistics and o ther reso urces.

American So ciety fo r Healthcare Engineering (ASHE)—An advo cate fo r co ntinuo us impro vement in the health care engineering and facilities management pro fessio ns.

Co ntains a Therapeutic Enviro nments Fo rum with excellent info rmatio n and spo nso rs an annual co nference o n planning, design, and co nstructio n.

American So ciety o f Interio r Designers and the University o f Minneso ta —The first centralized clearingho use fo r design and human behavio r research o n the Web. Green Guide fo r Health Care™—A best practices guide fo r healthy and sustainable building design, co nstructio n, and o peratio ns fo r the healthcare industry.

Jo int Co mmissio n o n the Accreditatio n o f Healthcare Organizatio ns (JCAHO) —Has so me facility related info rmatio n, tho ugh it is largely co ncerned with o peratio nal issues.

Practice Greenhealth—The natio n's leading membership and netwo rking o rganizatio n fo r institutio ns in the healthcare co mmunity that have made a co mmitment to sustainable, eco friendly practices.

So ciety fo r the Arts in Healthcare (SAH) —Natio nal and internatio nal advo cacy gro up fo r the integratio n o f the arts into the healing health care enviro nment.

The Center fo r Health Design —An extensive site fo cusing o n health care facility design.

USGBC LEED fo r Healthcare VA Office o f Co nstructio n & Facility Management (CFM) Technical Info rmatio n Library—Includes manuals, guides, and o ther standards co vering all aspects o f health care facility design.

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Publicat ions Architectural Record —Mo nthly jo urnal with a building types study sectio n fo cusing o n health care design every year o r so . Online archives include many mo re pro jects than tho se that appear in the printed magazine.

Building Type Basics for Healthcare Facilities . ed. Stephen A. Kliment. New Yo rk: Jo hn Wily & So ns, Inc., 20 0 0 .

Design That Cares: Planning Health Facilities for Patients and Visitors, 2nd Edition by Janet R. Carpman, Myro n A. Grant and Debo rah A. Simmo ns. New Yo rk: Jo hn Wiley & So ns, Inc., 20 0 1.

Guidelines for the Design and Construction of Hospitals and Health Care Facilities by AIA Academy o f Architecture fo r Health, Washingto n, DC: The American Institute o f Architects, 20 0 6 .

Healthcare Architecture in an Era of Radical Transformations by Stephen Verderber and David Fine. Yale University Press, 20 0 0 .

Healthcare Design—A quarterly magazine with design articles and presentatio ns o f recent pro jects Health Facilities Review , 19 9 2-19 9 3 and subsequent issues by AIA Academy o f Architecture fo r Health. Washingto n DC: AIA Press.

Hospitals and Health Networks —A mo nthly jo urnal o f the American Ho spital Asso ciatio n.

Includes o ccasio nal articles o n co nstructio n.

Innovations in Healthcare Design: Selected Presentations from the First Five Symposia on Healthcare Design ed. Sara Marberry. New Yo rk: Jo hn Wiley & So ns, Inc., 19 9 5.

Journal of Healthcare Design: Volumes I-X —Published fro m 19 8 8 -19 9 7, co ntains presentatio ns at the annual sympo sium o n Health Care Design.

Modern Healthcare—A weekly jo urnal fo r health care executives with frequent articles o n design and co nstructio n and an annual design awards pro gram. Online articles fro m 19 9 4.

State-by- State Guide to Health Care Provider Performance by Christo pher J. Gearo n, AARP Bulletin, December 7, 20 0 6 Sustainable Federal Facilities: A Guide to Integrating Value Engineering, Life-cycle Costing, and Sustainable Development by the Federal Facilities Co uncil. Washingto n, DC: Natio nal Academy Press, 20 0 1.

Time-Saver Standards for Building Types, 4th Edition by Jo seph De Chiara and Michael J. Cro sbie. New Yo rk: McGraw-Hill, 20 0 1.

UFC 4-510-01 Design: Medical Military Facilities BACK TO TO P

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