Mary Lindeman, a project manager for CDH Partners, Inc., was recently interviewed for a PBS special that will air in 2014. The documentary is titled “Coming of Age in Aging America” and features segments depicting different phases of our aging society. Lindeman, project manager for the WellStar Paulding Hospital opening in April 2014, talked about the facility from an architectural perspective and how it will address the various needs of the community and staff inclusive of those who are aging.
“People are living and working longer than ever before,” she notes. “During our integrated design sessions with the WellStar Paulding team we were motivated to think differently about each aspect of the facility tailoring the design around the healthcare that will be provided while maximizing flexibility and usability for not only aging patients but aging staff as well. The WellStar and the CDH team wanted to create a healing environment that fits well into the community and that is safe and accommodating for patients, family, and staff.”
A primary focus of the PBS special is on communities and how they are addressing the needs of our expanding and aging society. “There is a growing realization”, said Lindeman, “whether out of choice or necessity we are staying active and continuing to work longer during our lifetimes. An important component in improving the quality of our longevity is to have the places where we live and work provide appropriate environments that proactively help us to stay safe, to stay strong, and to thrive as we age.”
Mary Lindeman, EDAC, LEED AP BD+C, joined CDH Partners in 2004, with 10 years of previous architectural experience. She works with some of our largest healthcare clients.
When a space is designed, we usually assume that the lighting will properly illuminate the area evenly. However, have you ever thought about what type of light source should actually be used? What the color temperature (Kelvin) rating of the bulbs is? Or what is the color-rendering index (CRI) that determines if colors in a room are truly the colors your eye thinks it sees?
Look up at the lighting in your surrounding space. See anything that looks strange?
• Different colored lamps.
• Lamps that are burned out.
• Bugs, dust, and debris in the lenses.
• Reflectors that aren’t clean.
• Fixtures that are switched on when no one is around.
Each one of these factors contributes to an environment where the lighting is not ideal. Not only can these eventually put a strain on your eyes, they can also affect the mood of an employee.So where do you start in regards to providing a good lighting design? The basics. Know your options in regards to what types of lighting fixtures and lamp sources are available. By planning your design for illumination up front, you’ll have a better understanding of what the space is going to look like when the design progresses.
Lumen output, color temperatures, CRI ratings, beam spread, lamp life depreciation, and rated lamp life can all dramatically affect your design. However, with the help of photometric software, you can visualize what a proposed design will look like even before it’s started.
• Lumen – Is the total amount of visible light emitted from a source in a particular direction. The higher the lumens are, the brighter the light source will be. Typically one lumen equals one candela (or foot-candle). A candela is equivalent to the light emitted from a single candle burning.
• Color Temperature (Kelvin) – Determines the “warmness” or “coolness” of a particular lamp measured in Kelvin’s. The lower Kelvin ratings give a warmer appearance of a lamp. The higher Kelvin ratings give a cooler appearance of a lamp. Warmer colors typically emit a more orange to yellow appearance while cooler colors typically emit a more blue to pink appearance. Daylight is a mixture of both cool and warm colors.
• Color Rendering Index (CRI) – The ability of a lamp to render the color of an object in a normal and natural way. Typically measured from 0-100. The higher the rating, the better the color appearance of an object. Lower ratings may give an object a false color appearance (a beige wall may look gray under certain lighting, for example)
• Beam Spread – The total angle of a projected beam of light.
• Lamp Life Depreciation – Measures the overall lumen depreciation level over the life of a particular lamp.
• Rated Lamp Life – The actual number of hours a particular lamp will burn before failing
• Photometrics – Actual candela (foot-candle) plots that can be placed on a floor plan for a particular light fixture. There are thousands of different types of photometric files that are specific to a particular fixture. These files are called .IES files, which are certified by the Illuminating Engineering Society of North America (IESNA) and are entered into lighting calculation software.
Types of Light Sources
There are a wide variety of light sources available to illuminate a particular space. However, there is no “one size fits all” category. Some sources are better suited for certain environments rather than others.
• Fluorescent – The most commonly and widely used light source available today. They can be found in a wide variety of different types of fixtures: 2×2, 1×4, 2×4, 4×4, 4’ strips, downlighting, undercabinet and decorative lighting.
• Incandescent – Commonly found in floor and table lamps, downlighting, and flood lighting. Very inefficient in regards to power consumption. This particular light source is being phased out.
• Halogen – Commonly found in small, decorative fixtures, smaller downlights, landscape lighting, house lighting for theaters and sanctuaries and some floor lamps.
• High Intensity Discharge (HID) – Commonly found in exterior fixtures consisting of Metal Halide, Low Pressure Sodium or High Pressure Sodium light sources.
• Light Emitting Diode (LED) Have become a viable alternative to fluorescent light sources as the technology continues to improve and prices drop. Commonly found in a wide variety of interior and exterior fixtures due to the best “bang for the buck” in regards to energy consumption versus lumen output.
• Induction – This source is similar to fluorescent lamp, except it doesn’t have electrodes as part of the fixture. Therefore, these sources have a much longer lamp life than any other source available. However, they’re cost prohibitive and limited in applications and lamp wattage.
You don’t have to be limited to just on/off switching to control light levels in a space. Dimming or dual level switching is a common practice to control different light levels. Daylight harvesting can be used to switch off or dim lighting near windows. When they’re not in use, occupancy/vacancy sensors switch off lights. And Building Automation Systems (BAS) can be tied into lighting systems for seamless building wide control, even remotely!
Providing control to automatically switch off lighting when it isn’t needed saves the owner money on their energy bill. Control devices are also eligible for incentives and rebates from many different power companies from around the country.
One of the best and most abundant sources of illumination is daylight. Bringing more daylight into a space will reduce the amount of artificial illumination needed. Roof penetrating “Solar Tubes” with internal mirrors and lensed reflectors bring in a surprising amount of daylight from such a small footprint. Skylights and large windows are another great way to bring in large amounts of daylight. Building orientation and landscaping are also an important factor in regards to the amount of daylight that can be brought into a space.
Picking the right illumination source early in the design process is only part of the solution. Coordinating with the architect and interior designer in regards to the space design is critical. Determine who is going to use the space and what they’re going to use it for. Will it be occupied continuously or periodically? Will it be used during the day, at night, or both?
There is some up front research that must be completed before a lighting design takes place. But this is necessary in order to get a good idea of what the space is going to look like before the design is even started. This will help the architect, interior designer, and owner choose the proper design approach for the space.
Sarah Hepler, an Interior Designer for CDH Partners, was recently named to the board of directors for the International Interior Design Association (IIDA). She will be a Healthcare Forum representative with responsibilities that include developing educational ideas for IIDA’s specialty Forum in association with the Forums director.
In particular, the Healthcare Forum provides a venue for discussions on the latest trends and design concepts. It supports design professionals in the challenging and rewarding field of healthcare design and acts as a source for exploring methods of design and innovated, which create positive, effective healing environments.
IIDA Forums offer a venue for discussion with professionals in similar fields and dissemination of information on trends, problem-solving strategies and perspectives on current or developing areas of design practice within specific markets. Tapping into this network of exclusive contacts puts people in touch with the expertise of design industry leaders.
In accepting this position, Sarah said, “I’m excited to be involved with IIDA. My personal goal for this position is to encourage an exchange of information centered on the quality of care and positive patient outcomes, especially where design is directly related to these issues.
“I’ll focus on current trends and design methodologies for healthcare. I’ll also emphasize the practice of Evidence Based Design and EDAC and seek active participation in local and regional conferences and events to gather and to share good industry practices. The Forum’s main line of communication will be a blog site that will reach both our Atlanta chapter members as well as our CDH intranet. IIDA members and CDH peers will be encouraged to participate in open discussion about the practice of healthcare design.”
Sara Hepler is an Interior Designer for CDH Partners, Inc., in Marietta, Georgia. Her extensive experience positions her to work with many of the firm’s largest healthcare clients.
Over the past decade, we’ve seen a tremendous push to rethink hospital design and safety. This is mainly because Evidence Based Design (EBD) proves a strong relationship between the physical design of hospitals and key patient outcomes which include patient safety, hospital acquired infections (HAI), medical errors, and injuries. Furthermore, there’s a deep need to reduce stress on hospital staff while increasing effectiveness in patient care. For our clients one of the true marks of success rests on providing positive patient outcomes and improving the overall quality of healthcare.
Actually, there are many parts to the healthcare equation. Some are basic and if implemented correctly can reduce the rate of Hospital Acquired Infections (HAI). Over the last five to ten years, we have seen a tremendous rise in HAI. The fact is: ten years ago diseases were not as smart as they are today. They responded well to treatment with antibiotics, but this is not the case today.
Many of today’s viruses and bacteria have become resistant to treatments—this type of treatment—something that once worked well. Because of this, the healthcare industry seems to have taken an “all-hands-on-deck” approach, especially when it comes to fighting new strands of bacteria. According to the Centers for Disease Control and Prevention (CDC), a large number of patients die each year from nosocomial infections. This is alarming, especially given the advances we have in the area of patient care. As a interior designer, I found myself asking: “What can we do even if it is on a basic level to address this situation in the medical facilities that we design?”
When it comes to hospital design, I believe we need to —
• Think differently —We continually evolve and broaden our design approach to ensure we meet the challenge of thinking strategically, efficiently, and effectively when creating a built environment to reduce HAIs. Our projects utilize state-of-the-art heating and cooling systems to improve air quality, reduce pathogens, and help to prevent the spread of infectious diseases. Recent studies have shown a link between the increase of infectious diseases such as C-diff, MRSA and VRE and something as simple as proper hand washing and sanitizing. While that may seem shocking, it is understandable when we realize the pressure and workload that is placed on healthcare providers. (A Review of the Research Literature on Evidence Based Healthcare Design by Ulrich.)
Even though hand washing is a part of the clinical processes and culture of a facility, the built environment can play a positive role with high impact. For example, our team was challenged to increase hand washing compliance for nurses and physicians while designing the Paulding Replacement Hospital in Hiram, Georgia. The design team rose to the challenge with specially designed hand washing and sanitizing stations located inside and outside of the patient rooms throughout the hospital to increase the opportunity for hand washing.
We designed the patient rooms to operate on a smarter platform. First, the room layout and spatial design of the support spaces allows nurses and the doctors to be closer to the patients for excellent “bedside care.” Plus, we’ve incorporated technology that tracks nurses and caregiver’s proximity to hand washing sinks, encouraging them to wash their hands. Each care provider is tagged with a small device that allows the hospital to track opportunities for hand washing compliance. This device can also monitor how many times a care provider enters and exits a patient’s room. This isolated example proves how serious hospitals are about stopping the spread of bacteria and disease.
• Promote and use surfaces that help to prevent diseases— Surface materials make a tremendous difference in patient outcomes, especially when dealing with hospital acquired infections. When appropriate, this is why we make a concentrated effort to specify materials that are anti-microbial and anti-bacterial. In the past, hospitals have used plastic laminate countertops, which are basically compressed paper with wood substrates. These materials are porous and over time they absorb moisture and bacteria. Wet wood harbors bacteria. Therefore, we recommend non-porous surfaces such as Corian solid surfacing or solid acrylic surfaces in high-risk areas. This material is nonporous, inert like stainless steel. It also is more hygienic and easier to clean, which aids in fighting diseases. Plus, it can help eliminate the spread of infections and cross contamination of things like Staph, Hepatitis B and C, and HIV.
Once surfaces are installed, they must be maintained correctly. Just because a surface is white and shiny does not mean it is clean. The truth is that we can design a warm, welcoming, and inviting space, but if the surfaces are not maintained properly, viruses and germs will grow. We also can install great products, but the success of these depends on proper cleaning and maintenance.
• Use bacteria and moisture resistant fabrics— Our particular design process also takes into consideration the daily use and lifespan of materials. Fabric companies are always researching and creating fabrics that will fight against cross contamination and HAI’s. NanoTEX and Crypton fabrics are non-porous and were designed to be easy to clean. They are also resistant to stains, which can help to reduce the spread of infections. However, certain cleaners can actually shorten the life of surfaces and fabrics and damage the overall effectiveness of the material. Therefore, we often use hospital approved vinyl, which are scrubbable, antimicrobial, antibacterial, and moisture resistant.
• Include light and spaciousness — I truly believe healing is directly connected to the quality of patient care delivered and the ability of the built environment to support care delivery processes. Therefore, we design healthcare facilities to be warm and welcoming, to reduce stress for patients and staff. We design specific family zones inside and outside of patient rooms for families and loved ones to meet, rest, and regroup. Window walls in patient rooms allow natural light to penetrate into the structure and provide views to the outside. Natural distractions along with lighting, art , and neutral colors create a calm, warm and safe healing environment.
Advantages of LEAN design
As a final note, we also take advantages of the principles of LEAN design. More than ever before, our healthcare design practice focuses on efficiency and patient safety. We utilize a holistic view of the design concept and implement the best practice approach that will lead to a successful outcome while eliminating redundancies and reducing waste. For example, visual and physical access to patient rooms has become increasingly important to many of our clients. Historically, nursing stations were centrally located, which often removed the caregiver from the patient’s bedside.
Today, many of our clients want caregivers at the bedside and have implemented a six-second rule to prevent extended time hunting and gathering. Meaning, nurses should not have to travel more than six seconds to reach common supplies. Additionally, nurses may be equipped with mobile devices that connect to landing and perching stations. These areas permit doctors, therapists, and technicians to collaborate and simultaneously monitor patient progress. The perching stations allow them to record data quickly and remain focused on patient care. Hospitals monitor many aspects of patient/nurse interaction for process improvements in order to be more effective and efficient.
Healthcare design has a broad and bold scope, but when we address this changing industry, we still must begin with the basics. But with such high stakes, we cannot afford to simply create pretty spaces that flow from a set of great drawings. We must create efficient and effective healing environments where patients are confident that they will receive the best and most advanced care possible.
Paulla Shetterly is an associate principal and director of Interior Design at CDH. Her broad experience includes working with major healthcare clients and complex projects. She has been interviewed and published in Healthcare Facilities Management Magazine. She is a graduate of Kansas State University where she received a B.S. in Interior Design. To learn more about this subject or to contact Paulla Shetterly, you can email her at: email@example.com.