COVER ARTICLE, SEPTEMBER 2011

BIGGER IS BETTER
Healthcare design trends expand with paying and insured customers in mind.
Saul Jabbawy

While the recession may have caused commercial real estate to go into cardiac arrest in the past 5 years, healthcare real estate and building design has continued to develop in surprising yet logical directions. Though not quite recession-proof, the healthcare market has expanded in response to competition, innovation, changes to the building codes and legislation, causing four big trends to emerge in healthcare facilities: these facilities are growing larger, greener, smarter and cleaner.

Big, Beautiful Buildings

Despite concerns over healthcare reform’s effect on the marketplace, the trend in both hospital and medical office building design is toward larger overall facilities as well as larger exam rooms, treatment rooms, imaging centers, labs, patient rooms and visitor amenities. Institutions are increasingly concerned about attracting the paying and insured segments of the population; hence, they entice potential clients with a more refined patient experience as well as a hospitality-like environment.

Studies indicate that patients connect finer facilities with caring, skilled treatment. Patients will gravitate toward the hospital with the beautiful lobby, comfortable waiting area, serene chapel, multi-computer resource center, counseling center, accessible garden, restaurant-like cafeteria, Starbucks, gift shops and patient rooms that look and feel like a four-star hotel. These amenities require additional space, an increased investment that healthcare providers know will come back to them in time.

The shift toward larger facilities is paralleled by an increased emphasis on the investment spent on the building skin, often moving from traditional masonry wall with punched windows to a more designed image of glazed curtain wall and metal panels. This is often driven by the goal of interior day lighting, achieving more views to the outdoors, and being associated with a cutting edge, modern look.

The trend towards larger facilities has been facilitated in the past several years by the plummeting price of construction. Institutions that do have resources can buy more with their dollars, hence, construction cost overages are no longer an integral part of the design process, and do not create the zero sum environment and financial pressures that have forced more modest facilities in the past.

Green Machine

Another factor in the recent trend to dedicate more resources to new or renovated facilities is LEED registration. While facilities do not have to spend additional funds to achieve the lesser levels of LEED, more and more institutions are choosing to aim at Silver, Gold, or Platinum, often spending additional resources in order to achieve these goals.

Becoming more energy efficient allows healthcare institutions to reduce expenses, while improving the care environment for patients, family, and staff. Sustainability has become the industry standard in the design of new buildings; but older buildings can be renovated inexpensively to minimize energy usage. Exterior building materials, lighting, and mechanical systems are often adjusted to net lower utility bills.

In their desire to create a healthy building from materials to methods, more and more healthcare providers are using native landscape, energy from the sun, and nature-inspired, sustainable interior finishes. Large windows with views of natural settings are important, as are art and design motifs inspired by nature.

Viewing images of nature reduces stress, blood pressure levels, and diminishes reliance on pain medication, studies show. By designing and building a welcoming, tranquil place, we create a healing environment that reflects an institution’s commitment to human-centered care, an approach that appeals to patients.

Pebble in a Lake

With wave-like influence, the National Center for Health Design’s Pebble Project initiative is encouraging institutions to commit additional funds in order to achieve the image and function of the ideal hospital. Also known as Evidence-based Design, healthcare Pebble Projects incorporate methods and data collected from hospitals around the world to influence design and:

 • Promote the healing process.

 • Enhance patient safety.

 • Enable nurses to focus more time and attention on patients.

 • Increase comfort and lessen patient and family anxiety.

 • Minimize the spread of infection.

 • Significantly improve patient satisfaction.

 • Create a better work environment for doctors, nurses and staff.

EwingCole Architects has worked on several Pebble Projects, most recently at Paoli Hospital in Pennsylvania. The new Pavilion at Paoli nearly doubles the size of the hospital to almost half a million square feet. Functional areas in the hospital have all been expanded and equipped with state-of-the-art technology — all with one purpose: to foster the best possible care in a warm, supportive environment. The new Pavilion is an innovative patient care facility designed to be smarter from the ground up.

As a Pebble Project, Paoli Hospital is participating in ongoing research to make future hospitals safer, more efficient, more healing environments. Evidence-based Design is a blueprint that can aid healthcare providers and real estate professionals in determining how much space they will need to serve their clients.

Separate and Safe

Hospitals should be healthy places. Often, they are not. Public perception is growing that U.S. hospitals are error-prone and that hospital-acquired infections are on the rise. Designing the hospital toward the goal of zero tolerance for healthcare associated infections has become a major trend. Protection from infection can be designed into a hospital even before it is constructed. Apply the principle of separation and the chances for cross-contamination can be reduced. Examples of this include:

 • Separate clean goods and soiled goods while transporting or when stored.

• Separate food service traffic from all other traffic.

• Separate zones within patient care spaces like the operating room or the inpatient bedroom.

• Separate service path from patient path.

An effective way to divide the hospital’s pedestrian circulation is by providing separate elevators while the facility is still in design. Infection control considerations need to be written into a project’s goals so that such decisions can be made at the outset and costs properly apportioned.

Decentralization

Lastly, a design trend we’ve seen in the past few years is due to the reimbursement structure to the hospitals from both the insurers as well as the U.S. government. As reimbursements for inpatient care decline, hospitals are trying to decentralize all but the most invasive and critical functions and services away from the inpatient hospitals. For instance, functions such as the back of house registration, outpatient radiology services, as well as certain invasive procedures and treatments are being sent to satellite facilities. In fact, even emergency departments are now being built free-standing and away from the larger hospitals. The need for more real estate, not necessarily contiguous, is something that hospitals still can’t cure.

Saul Jabbawy is the director of design for EwingCole Architects. Based in Philadelphia, the firm has offices in Irvine, California, and Washington, D.C.

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