Healthcare columnist and expert Jane Rohde speaks to what will make for the safest, most affective healthcare environments in the coming years.
(as featured in Interiors & Sources, July 2015)
By Jane Rohde, AIA, FIIDA, ACHA, AAHID, LEED AP, Green Globes CIEB Assessor
I think everyone in the healthcare industry would like to have a crystal ball – one that allows us to clearly see the future of an industry that is rapidly changing and uncertain. Healthcare Finance Magazine requested illustrator Mark Armstrong to complete a cartoon to embody how we’d utilize that crystal ball to understand where we are going.
From reimbursements to higher acuities of care, to shorter stays in acute care settings, to understand the meaning of the continuum of care, a strategic plan is in order as we approach healthcare spaces in the coming years. No matter what the size or type of healthcare setting, planning and programming for the future—in order to fully identify the strengths and weaknesses of an organization—allow for the development of an understanding on how a provider fits within the continuum of care. And following a product selection process that focuses on exposure and risk can take these environments very safely into the future.
Sustainability, Resilience, and Maximizing Space Utilization
I sit on the GSA Green Building Advisory Committee (GBAC), and one of the key priorities is evaluating the crossover and intersection of sustainability, resilience, and maximizing space utilization.
Sustainability tied to return on investment in healthcare settings is a major consideration – primarily because of the reimbursement climate and impacts of the Affordable Care Act. When budgets and reimbursables are tight, it is often the default, defensive position to evaluate only first costs on a renovation or new project. However, expanding to a lifecycle operational budget model assists with looking at costs over time, as the ongoing operational costs is the most critical from a sustainable operational perspective. For projects that we work on, we look at the value of the products being specified and work with our clients to understand the long term perspective and return on investment (ROI).
The linkage of climate change with planning for resilience to withstand and thrive during major natural and manmade disasters is particularly important in the healthcare sector. Evaluating preparedness at the beginning of the programming process allows for spatial requirements to be appropriately met. There are resources available from the US Department of Health & Human Services; such as the FACT SHEET: Strengthening the Climate Resilience of the Health Care Sector and a toolkit with reference information, case studies, and additional information available in the Primary Protection: Enhancing Health Care Resilience for a Changing Climate.
The healthcare industry, through the utilization and states’ adoption of the Facility Guidelines Institute’s two sets of reference documents -- Guidelines for Design and Construction of Residential Health, Care, and Support Facilities and Guidelines for Design and Construction of Hospital and Outpatient Facilities -- has a primary focus on maximizing space utilization through Part 1 requirements that include completing a Functional Program. Design professionals are used to working with a Physical Space Program that includes square footages and adjacencies and is developed during the planning process or provided by a developer or care provider. However, the Functional Program needs to be completed prior to the Physical Space Program, so that the ultimate built environment can support the occupants utilizing the building, and designers understand the mission goals and nuances of a care model that impact the physical space. From an interior designer’s perspective, it is crucial to be involved in the upfront discussions that clarify the utilization of all types of spaces. Early project involvement results in superior design that supports maximizing physical space utilization. To date, healthcare designs that support occupant desired outcomes – patients, residents, staff, family, and visitors – are successful projects that evaluate all the operational functions, the circulation flows, risk assessment evaluations, and considerations of aspects of the environment of care. These aspects include items such as access to daylight and views, access to nature and the outdoors, and wayfinding that provides clear direction—all of which limit stress and improve outcomes.
Specification of Healthcare Materials
Healthcare materials need to respond to specific issues that impact patient, resident, and staff health and safety within the physical environment. They must be durable and maintainable to support infection control measures, and non-glare and non-slip to reduce falls, fulfill cost constraints, and meet the aesthetic intent. This is not a small charge for designers to specify products to meet all the criteria while withstanding the heavy usage requirements within a newly designed or renovated healthcare environment.
There is a need to evaluate products from a lifecycle and building service life perspective. It is not recommended to specify products using a “red list” philosophy. For some reason, the advent of deselection has become more mainstreamed, often leading to regrettable substitutions. Product failures have become pronounced, which is not a sustainable product selection from a design, operational, or cost perspective.
The Green Building Initiative (GBI) Green Globes’ approach considers multiple attributes including Multiple Attribute Standards (such as UL and NSF product certifications), Environmental Product Declarations (EPDs), and Product Life Cycle certifications. USGBC, GBI and standards organizations are all working to improve their product selection approaches to include not only the evaluation of hazards, but also products and their ingredients in the context of exposure and risk (see Green Suite example: www.chemply.com).
An evaluation of a finished product, production process, and intended use that considers potential hazards based upon exposure may pose little to no risk to the worker, installer, or occupant. This is an appropriate approach for building product selection and specification for healthcare environments.
Implementing a strategic planning process to address sustainability, resilience, and space utilization is essential. Implementation can be completed through workshops, focus groups, surveys, mock-ups, and post-occupant evaluations—all of which lead to building relationships and opening communication channels through provider networks with the planning and design team for a healthcare setting. Once a framework is established, product selections can be made to support the needs of all occupants to meet the desired outcomes of a project.