Surveys, sessions, and solutions steered the
discussions at Design Connections.
This year’s Design Connections conference was full of dialogue around the continuum of care. It addressed care population needs and extended into the material selections required for successful health- care settings for all ages. I encourage design professionals and
manufacturers to include this venue on their 2016 calendar. The sessions, relationships, and overall knowledge shared is guaranteed to be worth your time!
As part of the three-day programming, Teri Bennett, RN, CHID, IIDA and
Andrea Hyde, CHID, MDCID of Johns Hopkins in Baltimore and I were tasked
with leading two breakout sessions exploring the continuum of care. Teri and
Andrea took half of the attendees for a discussion focused on hospital and
outpatient care, and I led the other half through a discussion of long-term care.
Later in the day we presented our findings across the board, to highlight common-alities between different sectors and identify opportunities for improvement.
Prior to the event, we sent a survey to attendees, and the results provided
some interesting points about the evolution of healthcare environments.
Approximately 10 years ago, the most important measure to designers was
aesthetics, according to a survey sent to the Healthcare Forum Membership.
Now the top two criteria have become durability and cleanability, according
to the Design Connections results. Both findings indicate an increased focus
on adverse events—such as healthcare-acquired infections (HAIs), higher
acuity of patients and residents in healthcare settings, longer time periods
between cycle renovations, and higher traffic from mobility devices, carts,
Unsurprisingly, surface materials were of the most interest to designers surveyed. They seek options that better support the many demands of
healthcare settings. One survey question about acoustics revealed that wall
treatment and flooring are the biggest concerns in this area, while a question
about which product categories required more innovation shows a virtually
equal balance among upholstery, furniture, surface materials, and modular
casework. (See charts at left.)
Survey responses from the acute/outpatient care designers also indicated
that there has been an uptick in design work in outpatient care, which was
anticipated with the ACA and Accountable Care Organizations. As a true
complement to the care continuum, the designers working predominantly in
the long-term care area are seeing a strong repositioning with independent
living settings and community-based services.
Once everyone was gathered into the two breakout groups at the event, we
facilitated discussion around the following scenario:
You have a care setting built in the 1980s or 1990s. What challenges
do you have with older infrastructure? What are current best practices
and how can they accommodate these older settings? What changes
have occurred that have significantly impacted design solutions
supporting person-centered environments?
That seemingly simple prompt unleashed a whirlwind of ideas and sparked
far more conversations than we had time to complete or even fully digest. But
it was thrilling to see so many eager participants, and a
clear sign that we should find more opportunities to keep
the dialogue open in the future. For now, we can recap a
few of the main takeaways.
Renovating concrete block walls—bearing as well
as non-bearing—presents infinite obstacles, specifically with utilization of
advanced technologies. Even with wireless technology, signals are blocked
by the thickness of walls combined with rebar configurations. Therefore,
design professionals are looking for products that work better in older
infrastructure. Discussions included abatement versus replacement or
encapsulation—as asbestos in flooring, ceilings, and insulation still exists
and causes cost concerns in complete renovations.
Another challenge is completing renovations in occupied buildings, particularly
settings where residents or patients have cognitive issues. The lack of compliance with ADA and building codes was an important point in the discussion.
Furthermore, minor improvements for accessibility are often not completed
because bathrooms and other key areas are not completely compliant with
requirements. Unfortunately, most jurisdictions treat this as an all-or-nothing
scenario, so incremental updates are not allowed. This may be a good topic
for the Facility Guidelines Institute and ICC to consider, working closer with the
Federal Access Board to create mutually acceptable resolutions.
There was a good amount of discussion regarding not only the need for
better storage, but also its location at the point of service for equipment and
supplies. Creating a separation between public or community circulation and
service circulation can better accommodate materials management. Plus,
keeping resident, patient, and family spaces separate from the service component
encourages person-centered solutions.
We also discussed care populations being served—including the need for
a shift in culture and mindset to accommodate change not only in the physical
environment, but also from a systematic perspective, starting with operational
culture change and a focus on desired outcomes. Another concern is identifying
bariatric population needs as part of the renovation process: How does a
provider design areas with increased size accommodations that include
doorways, circulation paths, and FF&E?
As a commonality, all healthcare environments are being used predominantly
by people aged 65 or older. The number of older adults utilizing long-term care
or alternative residential care settings is projected to increase from 15 million in
2000 to 27 million in 2015, based simply on the aging population. These numbers
not only represent a larger need for management of chronic diseases, but also
provision of acute care services and outpatient clinics that provide wrap-around
services. Unfortunately, few facilities are designed through “aging lenses,” and
the lack of universal design solutions creates a stigma by not addressing the
needs of older adults. But further, universal design addresses the needs of
By Jane Rohde
LEFT Event attendees
into the issues and