HEALTHCARE INTERIOR DESIGN

Selected Projects

Bilkent University (FADA) Department of Interior Architecture and Environmental Design IAED 302 Interior Design Studio IV ID Lecturer: Sinisa Prvanov January 2017

Hospitals are the most complex of building types. Each hospital is comprised of a wide range of services and functional units. These include diagnostic and treatment functions, such as clinical laboratories, imaging, emergency rooms, and surgery; hospitality functions, such as food service and housekeeping; and the fundamental inpatient care or bed-related function. This diversity is reflected in the breadth and specificity of regulations, codes, and oversight that govern hospital construction and operations. Each of the wide-ranging and constantly evolving functions of a hospital, including highly complicated mechanical, electrical, and telecommunications systems, requires specialized knowledge and expertise. No one person can reasonably have complete knowledge, which is why specialized consultants play an important role in hospital planning and design. The functional units within the hospital can have competing needs and priorities. Idealized scenarios and strongly-held individual preferences must be balanced against mandatory requirements, actual functional needs (internal traffic and relationship to other departments), and the financial status of the organization. In addition to the wide range of services that must be accommodated, hospitals must serve and support many different users and stakeholders. Ideally, the design process incorporates direct input from the owner and from key hospital staff early on in the process. The designer also has to be an advocate for the patients, visitors, support staff, volunteers, and suppliers who do not generally have direct input into the design. Good hospital design integrates functional requirements with the human needs of its varied users.

The basic form of a hospital is, ideally, based on its functions:

bed-related inpatient functions outpatient-related functions

diagnostic and treatment functions

administrative functions service functions (food, supply)

research and teaching functions Physical relationships between these functions determine the configuration of the hospital. Certain relationships between the various functions are required-as in the following flow diagrams. These flow diagrams show the movement and communication of people, materials, and waste. Thus the physical configuration of a hospital and its transportation and logistic systems are inextricably intertwined. The transportation systems are influenced by the building configuration, and the configuration is heavily dependent on the transportation systems. The hospital configuration is also influenced by site restraints and opportunities, climate, surrounding facilities, budget, and available technology. New alternatives are generated by new medical needs and new technology.

BUILDING ATTRIBUTES Regardless of their location, size, or budget, all hospitals should have certain common attributes. EFFICIENCY AND COST-EFFECTIVENESS An efficient hospital layout should:

Promote staff efficiency by minimizing distance of necessary travel between frequently used spaces

Allow easy visual supervision of patients by limited staff

Include all needed spaces, but no redundant ones. This requires careful pre-design programming.

Provide an efficient logistics system, which might include elevators, pneumatic tubes, box conveyors, manual or automated carts, and gravity or pneumatic chutes, for the efficient handling of food and clean supplies and the removal of waste, recyclables, and soiled material

Make efficient use of space by locating support spaces so that they may be shared by adjacent functional areas, and by making prudent use of multi-purpose spaces

Consolidate outpatient functions for more efficient operation-on first floor, if possible-for direct access by outpatients

Group or combine functional areas with similar system requirements

THERAPEUTIC ENVIRONMENT Hospital patients are often fearful and confused and these feelings may impede recovery. Every effort should be made to make the hospital stay as unthreatening, comfortable, and stress-free as possible. The interior designer plays a major role in this effort to create a therapeutic environment. A hospital's interior design should be based on a comprehensive understanding of the facility's mission and its patient profile. The characteristics of the patient profile will determine the degree to which the interior design should address aging, loss of visual acuity, other physical and mental disabilities, and abusiveness.) Some important aspects of creating a therapeutic interior are:

Using familiar and culturally relevant materials wherever consistent with sanitation and other functional needs

Using cheerful and varied colors and textures, keeping in mind that some colors are inappropriate and can interfere with provider assessments of patients' pallor and skin tones, disorient older or impaired patients, or agitate patients and staff, particularly some psychiatric patients.

Admitting ample natural light wherever feasible and using color-corrected lighting in interior spaces which closely approximates natural daylight

Providing views of the outdoors from every patient bed, and elsewhere wherever possible; photo murals of nature scenes are helpful where outdoor views are not available

Designing a "way-finding" process into every project. Patients, visitors, and staff all need to know where they are, what their destination is, and how to get there and return. A patient's sense of competence is encouraged by making spaces easy to find, identify, and use without asking for help. Building elements, color, texture, and pattern should all give cues, as well as artwork and signage.

ACCESSIBILITY and CONTROLLED CIRCULATION A hospital is a complex system of interrelated functions requiring constant movement of people and goods. Much of this circulation should be controlled.

Outpatients visiting diagnostic and treatment areas should not travel through inpatient functional areas nor encounter severely ill inpatients

Typical outpatient routes should be simple and clearly defined

Visitors should have a simple and direct route to each patient nursing unit without penetrating other functional areas

Separate patients and visitors from industrial/logistical areas or floors Outflow of trash, recyclables, and soiled materials should be separated from

movement of food and clean supplies, and both should be separated from routes of patients and visitors

Transfer of cadavers to and from the morgue should be out of the sight of patients and visitors

Dedicated service elevators for deliveries, food and building maintenance services

AESTHETICS Aesthetics is closely related to creating a therapeutic environment (homelike, attractive.) It is important in enhancing the hospital's public image and is thus an important marketing tool. A better environment also contributes to better staff morale and patient care. Aesthetic considerations include:

Increased use of natural light, natural materials, and textures Use of artwork

Attention to proportions, color, scale, and detail Bright, open, generously-scaled public spaces

Homelike and intimate scale in patient rooms, day rooms, consultation rooms, and offices

Compatibility of exterior design with its physical surroundings. SUSTAINABILITY Hospitals are large public buildings that have a significant impact on the environment and economy of the surrounding community. They are heavy users of energy and water and produce large amounts of waste. Because hospitals place such demands on community resources they are natural candidates for sustainable design.

RELEVANT CODES AND STANDARDS Hospitals are among the most regulated of all building types. Like other buildings, they must follow the local and/or state general building codes. However, federal facilities on federal property generally need not comply with state and local codes, but follow federal regulations. To be licensed by the government law, design must comply with the individual national licensing regulations.

Operational Goals Enhance the quality of the PATIENT and STAFF EXPERIENCE. Maximize FUNCTIONALITY and FLEXIBILITY of the building. Create environments for COLLABORATIVE and MULTIDISCIPLINARY

practices. Support new OPERATIONAL PRINCIPLES. Provide a consistent hospital IMAGE with unique program IDENTITIES. Maintain BUDGET and COST efficiency of the building

St. Joseph’s Health Systems’ Hospital Patterson, N.J, USA 2013 CLIENT St. Joseph’s Regional Medical Center 703 Main St. Patterson, NJ 07503 www.sjhmc.org PROJECT TEAM Francis Cauffman 33 East 33rd St. Suite 1201 New York, NY 10016 (646) 315-7000 www.franciscauffman.com

Natural and artificial light plays a key role in the expansion of St. Joseph’s Health Systems’ medical campus in Patterson, N.J., which serves as a new portal to the highest quality of care in a calming and healing environment.

A 30- by 30-foot feature wall made of acrylic boxes is back-lit with LED lights that adds both a sculptural element to the space, while the constantly changing color scheme offers visual interest, particularly during the nighttime hours. Photographs by Francis Cauffman and Eventscape.

It is an indisputable fact that humans cannot exist without light. Our survival depends upon the source of light and heat around which our planet revolves. But researchers are quickly discovering that our innate need for light is about more than just warmth—it affects everything from our body’s natural rhythms to the speed of our healing. For example, a 2006 study by Dr. Anjali Joseph for the Center for Health Design found that higher light levels are linked with better performance of complex visual tasks, and that light requirements increase with age. By controlling the body’s circadian system, light impacts outcomes in healthcare settings by reducing depression among patients, decreasing length of stay in hospitals, improving sleep cycles, lessening agitation

among dementia patients, easing pain and improving adjustment to night-shift work among staff.

It’s no wonder then that access to plenty of natural and artificial light played such a critical role in the recent expansion of St. Joseph’s Health System’s (SJHS) medical center in Patterson, N.J. After extensive community research, New York-based firm Francis Cauffman created a master plan for SJHS that reorganized and expanded the entire medical campus to meet the needs of the surrounding population, with a state-of-the-art Critical Care Building (CCB), and a two-story lobby connecting the CCB and the children’s hospital, as its centerpiece. Francis Cauffman designed the CCB as two intersecting ellipses, an unusual shape for a healthcare facility. The layout allows nurses to be closer to patients (nurses are no more than 15 feet away) but also presents a unique challenge in terms of daylighting.

“I think the biggest challenge was how to bring natural light into the core of the lobby, because the floor plan was more of a linear than a square format,” explains Architectural Designer Kasia N. Zielonka. “Throughout most of the projects—the lobby and the critical care building—the use of natural light coming through the building was the major design key that we worked out, [because] from a patient point of view, a lot of the healing power comes from the natural daylight.” Floor-to-ceiling glass in every patient room ensures that daylight penetrates deep into the space, to the point that “we noticed there’s so much natural daylight coming in that the staff and patients don’t use as much artificial light as a result,” Zielonka says. Patient-controlled roller shades on the interior and fritted glass glazing on the exterior of the CCB help to reduce heat gain, as well as ensure patient privacy. Entrance to an outdoor courtyard from the main lobby was also a central factor in the design, according to Jennifer K. Kenson, IIDA, EDAC, associate at Francis Cauffman. “Based on the infill project, we created access to an interior courtyard that wasn’t accessible before. That was another key element we wanted to provide the patient—access to nature without leaving the hospital grounds,” she says. The core of the project, in many respects, is the main lobby, which became “the new front door of the hospital—the new branding effort that [the client was] going through—and a big transformation in terms of how people view the facility,” says Kenson. Connecting the CCB with the children’s hospital, the lobby doubles as a multipurpose room for community outreach and educational programs. The focal point of the main lobby is a giant LED-lit wall of white acrylic boxes that changes color and interacts with natural daylight coming from the clerestory windows. The kaleidoscopic wall is synced with music and streams video art, providing a calming distraction for visitors and a fun feature for younger patients.

“The feature wall was one of those elements where the client had asked us to design an architectural component that would provoke movement and light, and some kind of a focal point,” Zielonka explains. “What we came up with was a 30- by 30-foot wall that was more of an architectural piece than an art piece, so we tiled the whole wall in these acrylic boxes. The idea was that they would be reliefed [sic] in different depths, so they would give you the sculptural aspect of movement, and the whole layering of LED lights behind each one of those boxes was to create this pixelated image.” Kenson adds that because of the unique layout of the floor plan, every patient has a view to the color-changing light, which cycles throughout the day. Complementing the LED feature wall is a large, custom-designed globe fixture made up of color cubes that continuously reflect light. Both the globe and feature wall play off the natural light flooding the space, with the globe reflecting most of the light during the day and the LEDs acting as a backdrop to the lobby. As nighttime approaches, however, the interplay of light is reversed—the LED feature wall takes center stage as its colors constantly change to help create a soothing atmosphere, while the globe becomes a more subtle design element. The main lobby sets the standard for the rest of the hospital and acts as a “portal” to its services, which includes a 729-bed tertiary medical center and a 120-bed full service children’s hospital. The resulting facility shines brightly as a beacon of light to the Patterson community, as well as to the growing segment of the population in need of better and more accessible health services.

RUSH UNIVERSITY MEDICAL CENTER

Chicago, IL 2015

This hospital is part of a campus-wide transformation project, which also includes an orthopedic building, parking structure and new loading and delivery systems. The 800,000-square-foot hospital consists of 386 patient beds along with diagnostic and treatment facilities, such as surgery, radiology and emergency departments. The hospital is sited adjacent to the Eisenhower Expressway (a major arterial feeding the central area of Chicago) on the north, Ashland Avenue on the east and Harrison Street, the major internal street for the Rush Campus, on the south.

The organizational concept consists of a rectangular seven-story base, containing new diagnostic and treatment facilities, topped by a five- story curvilinear bed tower. The base connects to existing diagnostic treatment

facilities to create a new continuous interventionalplatform. Part of the ground level of this base contains an emergency department, which has been designed to be an advanced emergency response center for the City of Chicago. The geometry of the bed tower maximizes views and natural light for patient rooms while also creating an environment for efficient and safe health care.

The massing and architectural expression of the north, south and east respond to the differing surrounding conditions. The north elevation is simple and large in scale, similiar to the adjacent freeway. The east elevation works in tandem with the orthopedics building to create and reinforce the new entry boulevard from Ashland. The south elevation weaves the rectilinear and curvilinear geometry of base and bed tower together to scale the building down to relate to the environment of the entry boulevard. The difference in north and south elevation also responds to the internal organizations of the base. The simpler north elevation expresses the back of house staff connection corridors. The more layered and scaled down south façade contains the public elements of the base, such as lounges and waiting areas.

At the junction of new and old hospital is a multi-story entry pavilion whose roof is landscaped to provide a patient staff garden at level four that connects by bridge to the existing parking structure and has upper level patient check-in facilities. Skylights act as roof garden sculptural elements and provide natural light for the entry pavilion below. The walls of one of these skylights project down to the floor. Of the entry pavilion to introduce an exterior landscaped space without compromising internal contamination issues associated with plantings.

Skylight System

A highly unusual – and strikingly immediate – unification of the natural and built worlds, our landscape component for the Edward A. Brennan Entry Pavilion brings light, weather, and flora directly into Perkins + Will’s architecture. The forty-foot-high glass terrarium features native woodland plantings that mark the changes in the seasons, and connects to a therapeutic rooftop garden directly above – further uniting interior and exterior.