By Jane Rohde


This month, Sunbrella is bringing to you; All about Guidelines! There are some exciting new resources being completed by the Facility Guidelines Institute that have been introduced in 2018.

What is the Facility Guidelines Institute?

The Facility Guidelines Institute, commonly referred to as the FGI, is an independent, nonprofit organization dedicated to developing guidance for the planning, design, and construction of hospitals, outpatient facilities, and residential health, care, and support facilities. The FGI oversees the revision process and publication of guidelines, funds research, and offers resources that support the development of safe, effective health and residential care built environments.

What is the Health Guidelines Revision Committee?

The Health Guidelines Revision Committee, referred to as the HGRC, is the guidelines revision multidisciplinary consensus body of the FGI that includes all types of expertise as it relates to hospitals, outpatient facilities, and residential health, care, and support facilities. Expertise includes design professionals, clinical and care providers, authorities having jurisdiction, researchers, and specific experts in specialties; including but not limited to gerontology, critical care, acoustics, lighting, telemedicine, and IT. Further HGRC liaisons partner with ANSI/ASHE/ASHRAE Standard 170€“ Ventilation of Health Care Facilities committee members to promote a seamless connection between the Guidelines and the Standard content for Hospitals and Outpatient settings.

For the 2018 revision cycle, there were three document groups of experts assembled, focusing on hospitals, outpatient facilities, and residential health, care and support facilities€“ specifically of note is the brand-new book, Guidelines for Design and Construction of Outpatient Facilities. The trends indicate, despite potential changes to Obamacare by the current administration, that care services will predominantly be occurring in outpatient settings or within the home. In 2014, a separate book was developed for residential settings entitled Guidelines for Design and Construction of Residential Health, Care, and Support Facilities, which has been updated in the 2018 cycle to include two new chapters; one for residential settings for residents with developmental and/or intellectual disabilities and the other for residential substance abuse treatment settingsThe hospital of the future is trending toward providing intensive and critical care services and has been coordinated closely with the new outpatient book to evaluate common types of spaces that impact both types of settings. The Guidelines for Design and Construction of Hospitals rounds out the set of books for the 2018 cycle publication.


Who Uses the Guidelines and Who Adopts the Guidelines?

The Guidelines are used by designers, providers, and regulators (commonly called authorities having jurisdiction). The Guidelines are adopted in 42 states in some form.  Some states adopt the entire document or only a portion of one of the documents. In some states, as the new edition is published, the state licensing code automatically updates to the new edition. The Hospital Part (and subsequently the 2018 separate Hospital Guidelines book) has the highest use as both a reference and for code in various states. With the introduction of the new and updated 2014 Residential Care Guidelines, there is an educational opportunity to raise awareness with senior living and long-term care providers that this resource exists and it can assist in supporting resident-centered care models. When adopted, the Guidelines for Design and Construction of Residential Health, Care, and Support Facilities can assist with the review and approval of various care models by authorities having jurisdiction (AHJs)€“ as the book provides minimum criteria that can be used to review models other than traditional/institutional models; such as clusters/neighborhoods and household models, which are models of care focused on person-centered philosophy and decentralized services. By providing AHJs with current criteria for these newer models, this assists them in being able to review clusters/neighborhoods and households more easily for approval. To date, the following chart shows states that have adopted the Residential Guidelines, are in the process of adopting, or have adopted a version prior to 2014 for Adult Day Care, Assisted Living, Hospice, and Nursing Homes. In many states Nursing Homes are regulated by the same agency that reviews and approves Hospitals. This is reflected in the higher number of states that have adopted or are in the process of adopting the Nursing Homes section of the Residential Care Guidelines.


What is included in the Guidelines?

Each book includes minimum criteria for guidance and/or compliance. In addition to this main body text, there is explanatory Appendix information referenced from the minimum criteria to assist the user with meeting the minimums and/or further defining a concept or example to illustrate the meaning of the minimum criteria. There are also helpful resources and references available on the FGI website ( to assist the design professional and the provider through the design of a hospital, outpatient facility, or residential health, care, or support facility. Ultimately the goal is to streamline the review process with the regulator by meeting the minimum criteria€“ and in some states, that have not adopted the Guidelines as code, designers will use the state codes, which can often be lagging behind the current marketplace, and compare them with the FGI requirements€“ choosing to comply with the more rigorous requirements to achieve the highest quality standard possible for healthcare building design.

AuthorLauren Erickson

By Jane Rohde


This month, Sunbrella is bringing to you; Wayfinding: Not Just about Signage!  Designing a complete wayfinding system improves a healthcare experience for patients, residents, visitors and families, and visiting physicians and care givers. In some cases, it may be a temporary stay or a first time visit to a complicated healthcare campus.  At other times, a consistent wayfinding system may reinforce or cue residents with memory care issues that live in a smaller residentially-scaled community.  Regardless of the setting, clear and easy to find spaces and locations, reduces stress for the person who is confused, potentially upset, or someone already worried about a procedure or a loved one.  

Simplification and Focus

Too much information places an already stressed person into overload.  Overload can be exacerbated not only by a confusing or inadequate wayfinding system, but also poor acoustics and lighting.  A person doesn’t know where they are going, they can’t see well as they seek out signage or a person to assist them, and a noisy environment adds to the overall chaos for an individual, who simply wants to know how to get to their destination or loved one. There is a term, progressive disclosure[1] that is often referenced in the computer and tech world, but has good application to wayfinding;  “maintain the focus of a user’s attention by reducing clutter, confusion, and cognitive workload – only presenting the minimum data required {effective wayfinding} for the task at hand {finding destination}”.[2]

Users and Wayfinding

Because people do not process information in the same way; some do better with a map or GPS, which can be both visual and auditory.  Some facilities provide kiosks or apps that are used on their phones to help people find where they are going within complex healthcare settings.  Designing a wayfinding system includes a global approach for a community or campus, requiring an evaluation of the arrival approach and evaluating all circulation paths (vehicular and pedestrian), including the departure or discharge process (where applicable).  For residents living in an established community, the evaluation starts with “a day in the life of a resident” to better understand the sequence of life events and where a question would occur as a decision point; such as four intersecting corridors.  No matter the setting, looking at each point in a circulation path and identifying where a decision has to be made is critical.  Followed by prioritization of the location in the overall context of the setting. Choosing specific landmarks, artwork, accessories, color, music, or other types of cues can be beneficial for most users when provided in conjunction with signage; including directional signs, “named” rooms or spaces, and systematic numbering of spaces.

Garden Spot Village located in New Holland, PA is a continuing care retirement community that has an exceptional landmark within their community entry.  There is a metal tree sculpture in the entry lobby that connects four major pathways – is visible from a staircase, and is accessible to a coffee bar, water station, fish tank, and reception desk.  When the sculptor asked Steve Lindsey, the Executive Director, the significance of the sculpture prior to completing the design, Steve explained how the community supports a person-centered model of care – embracing everyday life down to the details.  The sculptor came back with not only the exquisite tree as the center landmark and focal point, but also added Patina and Sparky – two movable squirrels.  One-day Steve arrived in his office to find a tiny paper bag on his desk.  Inside were two small scarfs, two of many that reflected the season and time of year for Patina and Sparky.  Not only does the tree act as a landmark, but also a conversation starter and allows residents to participate in the sculpture on a seasonal basis!


[2] Huelat, B. J., Position Paper for The Center for Health Design’s Environmental Standards Council, 2007 1.0. (


Garden Spot Entry. Architect: RLPS. Photographer: Nicole Lowder, JSR Associates, Inc.


Garden Spot Entry. Architect: RLPS. Photographer: Nicole Lowder, JSR Associates, Inc.



Sometimes branding does not align with the wayfinding within a healthcare campus or continuing care retirement community – which is a missed opportunity.  If consistency is achieved, all components reinforce a positive experience as a person moves through interior and exterior space. All social media, websites, and other internet presence gives the user or consumer the opportunity to already be familiar with an organization before they even reach the arrival entry.  Seeing something familiar, provides an initial comfort level that they are entering the right place as a first step in finding their final destination.  This additional reinforcement supports recall by the user in anticipation of a visit.  For examples and additional information about branding and wayfinding, see the Society for Environmental Graphic Design (SEGD), which is a multidisciplinary community creating experiences that connect people to place (

AuthorLauren Erickson