Interiors & Sources: Fashion Forward

How is Healthcare Design Impacted?

By Jane Rohde, AIA, FIIDA, ACHA, AAHID, LEED AP, Green Globes CIEB Assessor

Fashion Week” is upon many folks around the world—and it is no longer the hubs of NYC, Paris, London, and Milan—but happening in other countries, such as Mercedes-Benz Fashion Week in Australia and Mercedes Benz Stylo Asian Fashion Week in Malaysia, Indonesia, Japan, and other Asian countries. According to a recent NPR segment, it used to be when fashion was seen for the first time on the runways, it would impact the clothing racks in six to 12 months, including the brand name originals. However with the “instantaneous gratification” movement, a tweet or Instagram of the most popular new fashion is old news within six months. So the fashion industry is looking at introductions that are ready within mere weeks—keeping the interest of the consumer and reducing the potential for fashion knock-offs.

Thinking through the immediate need and desire for changeability and updates, social media and technology are also impacting healthcare from both an immediate access to information and a documentation perspective. Technology is used operationally to meet requirements established through the Patient Protection and Affordable Care Act (PPACA), aka Obamacare, by reducing readmissions to hospitals from home as well as long term care settings, resident and patient satisfaction and facility ratings, and reduction of infection rates. Reminders and follow-up information are available in patient portals, and texts and emails are reinforcing appointment times and follow-up needs. At some point soon, it is possible that all of our information will be on a smart card similar to a credit card that will allow any practitioner anywhere to have the exact same information. One of the current challenges is uniformity across the continuum of care and all practitioners being able to see consistent information. Consistency is a driver for positive outcomes.  

What is “fashion forward” for patients and residents in relationship to healthcare facilities and related care models? In order to have individuals take on personal responsibility in the healthcare sector, is it necessary to spark interest in health and wellness through the same means as gamification? To gain interest, the “hook” would have to span all ages and have to be on equal footing with games such as the Legend of Zelda: Ocarina of Time for the younger set, as well as appeal to the older Candy Crush Saga addicts. To encourage participation in health and wellness, a program has to be dynamic, interesting, educational, and fun! Compliance with recommendations for healthcare is one of the most difficult parts of maintaining a continuum of care.

Design Implications

In attending Design Connections in Ponte Verde in January, 2016, acute care designers are looking for product durability, long building service life, and ability to clean product while maintaining aesthetic over time. These are tall orders for product manufacturers. As the aesthetic needs to be more than trendy, it has to be enduring—no more 1980’s “mauve and teal” flashes in the pan that end up haunting healthcare designers, clients, patients, and residents for well over two decades. If long service life is key, then how do designers become “fashion forward”—to allow a fresh appeal and look to healthcare spaces and remove dated aesthetics?

• Products that are flexible—modularity, movability, and adjustability are key. Products manufacturers like DIRTT and Herman Miller are no longer just looking at modularity, but are also evaluating the ease of change that includes moveable furniture on tracks, walls, and door openings that can slide and adjust to the need, and overall flexibility within the building environment. We are seeing this with equipment and products that at one time were considered fixed components, and are now adding movement options, such as PressalitCare grab bar systems and Adjust-a-sink products.

• Another approach for designers is utilizing a somewhat neutral palette of finishes that supports changing accent colors and finishes which can be updated or changed through regular maintenance to freshen the space—allowing for updates, but supporting longevity of the base products. This approach could allow designers to have a flexible section of standards that allows for regular updates that are keyed to the facilities department, work order system, and regular required work that would be within an operational budget.
• Technology used for wayfinding provides opportunities to update images and provide information in a real time format that adds interest, but can also be interactive. Now that wearables are fashion forward, the “wander guard” bracelet could have an entirely new meaning, as it not only tracks a resident’s or patient’s GPS coordinates, but also can check vitals, provide medication reminders, and quantify the amount of exercise and movement an individual is completing. This is also a game changer for providing more freedom of safe movement for residents that have dementia.
• In the resilient flooring sector, the advance of manufacturing, digital technologies, and capabilities is expanding the standard vinyl stone and wood patterns, and creating beautiful textile looks—some resembling a linen finish and texture and other replicating tonal carpet patterns with coordinates that provide an interesting aesthetic and appeal to break up the usage of the luxury vinyl stone and wood grains that have become a staple within the healthcare industry. New introductions are being made by Teknoflor®, Mannington, and Metroflor that are taking resilient floorings to the next level of “fashion forward” thinking.

Conclusion

The future comes upon us every second—the demand is not “what’s next?” but “what’s now?” as in the next second there is an anticipation for something new and fresh—an immediacy that we have never experienced before in the design industry. In the built environment this creates a dichotomy between a fixed building and an interior that can evolve, grow, and change—to meet operational needs, technological needs, and user needs and desires. The term of the day is dynamic—thinking of design as never final takes on the meaning of the future!

This article can be found on the Interiors & Sources website.

Interiors & Sources: What Can Healthcare Design Learn from Airlines?

Jane Rohde discusses the commonalities.

By Jane Rohde, AIA, FIIDA, ACHA, AAHID, LEED AP, Green Globes CIEB Assessor

Traveling from BWI to LAX on United…

A delightful flight attendant was concerned because he had “stashed” extra water and blankets on the plane for back-up, and another team had used “his” plane and the extra stores were gone!  He said that he is always concerned that he doesn’t have everything or enough supplies that he needs to make his guests comfortable.

This sounded like outcomes from recent focus groups that I’ve completed with hands-on care givers in long term care settings. Their comments included, “We have to ‘stash’ extra supplies in resident rooms to make sure that we have what we need to make residents and patients more comfortable.” On the surface these may appear to be operational issues, but in many ways, these are also environmental design issues.  Storage spaces are rarely considered during the programming and design phase, yet contribute substantially to the quality of life and potential independence of a resident.  For example, if storage was located at point of service and supplied according to operational needs, supplies, materials, snacks, and more could all be located and accessible for staff, family, residents and patients when needed.

A few years ago, I was walking through a nursing home of a prospective client that had recently renovated his existing community – it took staff 25 minutes to change a catheter. How could this be possible? The discomfort and potential pain that a resident may endure while waiting to have this minor procedure completed seemed so unnecessary. In speaking with the front line staff, the core of the issues was that the storage of supplies versus nursing areas and the location of the residents were completely disconnected. One storage space next to an elevator opened up inside a dining room, making it inaccessible when the room was in-use for a meal or activity.  After further review, all of the storage spaces throughout the building were located in all the wrong places. In this case, it was the gathering of supplies that took too long—partially because of the environmental layout and partially because of reimbursement—leading to potential (and needless) suffering.

The programming process clearly did not include the operational overlay and circulation patterns that are part of operating a nursing home. This can impact types and locations of spaces, as well as the materials that are specified for areas. I’ve seen this not only in long term care, but also in hospital settings. After presenting at the AHE (Association for the Healthcare Environment), I heard a half dozen stories just during the lunch hour on how facility design was not reflective of operational needs. For example, a hospital design included lack of storage and separation between clean materials management and existing trash from the building – circulation required for the trash to be driven straight through clean materials management area.  A materials example included within a Labor Delivery Room, vinyl plank was used as the flooring. At first I thought that was the right solution, however the designer selected a ‘V’ groove detail between the planks instead of a flush detail. A flush vinyl plank or continuous sheet vinyl would have been the correct flooring choice, but because of the groove, the terminal cleaning required housekeepers to get down on their hands and knees to verify all bodily fluids were cleaned to prevent the spread of infection. Typically, a set number of minutes are allowed for a terminal cleaning so that another patient can be admitted into a room. If this process takes longer, it not only impacts how much harder it is on the environmental services worker to clean the floor, but also the revenue impact of being able to turn a room for the next patient. 

As a designer working in long term care, it is a cliché, but true that we spend most of our time designing bathrooms. This is because we are always looking for a better, more compact solution that meets not only ADA requirements, but also the actual circulation needed within a resident room for care givers and mobility devices. The other item almost always missing in bathroom designs in healthcare is storage. If a caregiver has to leave a resident in a precarious position to get extra towels, Depends, or any other supply, fall risk increases. With appropriate storage spaces, these types of situations could be avoided.   

I think we can take some lessons from the airlines play book of designs that include compact bathrooms that are well designed with full amenities. Per the Jennifer Aniston commercials for Emirates Airlines, full showers and a designed “spa” experience awaits travelers. This approach to the design of bathrooms in healthcare could actually reduce square footages to please developers and financial folks, but more importantly establish a positive, safe outcome for residents, patients, family members, and staff. 

In looking at the full bathrooms from Emirates, there are grab bars in several locations, assistive mirrors that are well lit, full length mirror for dressing, and well-marked storage compartments that contain supplies.  Most notable is the access to countertop space that provides a place for bathing and other personal products and towels.  Often in shower configurations in healthcare settings, there will be unattractive grab bars and tiled or fiberglass walls, but no place for personal products to be stored during the bathing process. 

An opportunity to have a seating area to support dressing is another plus in the well-designed bathrooms. In healthcare settings, this would support independence and those with mobility difficulties. It may be that the TV wouldn’t be needed, but in more and more hospitality settings, flat screens within the bathroom are becoming common place.  There was a time when I was told that “flat screens will never become common in long term care, because of cost.” That thinking went by the wayside along with the person who thought that the personal computer would never happen.

Because of the nature of the design, all of the surfaces are curved or rounded.  Appropriate edge details are often overlooked within the design of bathrooms for healthcare – eased edges provide easier movement within a space and reduce the opportunities for bruising or being hurt from falling on to a sharp corner or edge.

The vanity area with excellent indirect edge lighting on the mirror is a detail that could be beneficial for patients and residents in healthcare and long term care design. For anyone who wears glasses, has difficulty seeing, or needs more magnification, lighting is key to making this successful. The two level mirror also provides another option for those who need further magnification to see. The soft indirect light that washes the “view” provides additional ambient lighting in a critical task area.    

In conclusion, designing healthcare and long-term care settings, competition is becoming more aggressive. Looking for opportunities to be set apart from other provider’s settings has grown in importance. The users of healthcare are better informed consumers – seeking the best available healthcare solution, no matter what the setting – acute care, outpatient care or long term care. Evaluation of other industries like air travel seeking improvements (from Southwest and their “transfarency” to the higher end Emirates with a flying ‘spa’ experience) could positively impact the design of healthcare settings. Next time you are traveling, be keen to the “transformation of time zones” with the use of LED lighting and smart detailing, instead of focusing only on the leg room (or lack thereof). Bon Voyage!

The article can be found on the Interiors & Sources website.