Healthcare

A Personal Diagnosis, a Professional Change of Perspective

by Char Hawkins

IIDA, LEED AP, NCIDQ

Senior Interior Designer

Tragedy and success and other major life events can have a way of transforming you. In a flash, you suddenly realize you now see things from a different perspective and feel differently about things than you once did.

One of those transformations happened to me four years ago, at age 43, when a doctor told me I had breast cancer. Hearing those three words, you have cancer, stopped me in my tracks. I remember feeling frozen in the moment, watching the doctor’s mouth move but not hearing her words as she explained what the mammogram, ultrasound, and biopsy uncovered. As I sat on the couch in her consultation room, the doctor spoke softly and slowly, outlining what was known so far — yet her words barely registered. The multiple pages of the biopsy report were incomprehensible.

I could feel that I should snap out of it and listen intently, but all I wanted to do was run out of there, process this news, and have a good cry. I felt I would be ready to listen and absorb this in a day or two. So in the days after diagnosis, I absorbed the shock and readied myself for the next step — yet had no idea what that next step should be. It was like waking up from a fog and having so many questions but didn’t know what to ask or who to turn to. I became obsessed with Googling everything my doctor mentioned during consultation.

Unfortunately, most of my questions didn’t have a definitive answer. “How bad is it?” That depended on what they found in the upcoming MRI. “What are my next steps?” That depended on a whole host of variables. I honestly thought that, based on the biopsy, the doctors would be able to map out a strategy that would best position me to be free of breast cancer forever. That wasn’t the case. It was frustrating and confusing and terrifying to realize that they didn’t have all the answers. It was the worst feeling. The future was unclear until further scans and genetic testing. At one point the anxiety caused an emotional breakdown.

One morning the anxiety of the diagnosis and unanswered questions simply took over. After dropping off my children at school, I walked back to my car and tears just started flowing. I shut the car door, turned the radio volume up, and just let it out. I bawled and bawled. After several minutes, I looked into the mirror and tried to wipe my eyes and erase the evidence of crying, but just started crying all over again. I called my sister and said through sobs that I just can’t pull it together. I can’t go to work and act normal. Nothing is normal. I have cancer growing inside me, I’m doing nothing but waiting on scans and tests, and I feel like I’m coming apart at the seams.

She calmly told me to call my doctor. Their job was to treat me, as a person, not just my cancer. She was right.

A New Perspective

As a designer, I now have a deeper appreciation for what patients go through when they’re diagnosed and treated for cancer. Of course, everyone has a unique experience that varies a little, or a lot, from my own. But that experience broadened my thinking about how we should define “the ideal” in cancer care, and it changed my approach to design.

Before I was diagnosed, I assumed the most important factor in choosing where to be treated was the doctor's level of expertise and the practice’s capabilities. Having the best oncologists, researchers, surgeons, and equipment to treat cancer in the most advanced methods was at the top of my criteria. And yet, as important as that is, it doesn’t consider the emotional needs of the patients — what they need in the moment of diagnosis, or before and after treatments. I can certainly attest that emotional support is crucially needed.

When designing oncology spaces, clients often use the term comprehensive to define their services, an idea that has a very different meaning to me these days. Rather than thinking in terms of comprehensive treatments, to me it means providing services that support the human beings diagnosed with cancer. Programs and services that provide education, counseling, and wellness services are just as vital to a cancer patient — things that provide comfort, knowledge, and a sense of community.

DesignGroup understands that cancer patients are under great emotional as well as physical stress. This is one reason we incorporate Experience Mapping into our design process. It helps us more fully grasp the patient journey and allows us to work collaboratively with our clients to explore the conceptual framework for delivering ideal cancer care. It’s a unique approach to planning and designing healthcare spaces. We use it to consider a variety of patient types, categorizing them by cancer type, age, gender, and stage of treatment. These and other factors all impact their experience and emotional states.

Then we immerse ourselves in the end-to-end patient experience — what they see and do as they arrive on site, enter the facility, receive care, and then depart. At each key touch point in the patient's journey, we talk through what's happening on-stage (visible to the patient) and what’s behind the scenes to fully understand delivery of care. We talk about the environment at each key touch point, and emotional state of the patient in those moments, all to fully understand and map their journey. It allows us to plan and design cancer facilities that have a dramatic impact on the patient experience.

This is why Experience Mapping is so crucial in decision making. This mapping process gives our clients an awareness of the specific pain points and unmet needs of the patient so they can see the relevance of the interventions proposed by our planners and designers. This process has been instrumental in understanding when and why patients feel emotional stress. We can understand the triggers and suggest innovative improvements to the program or spaces to provide relief and comfort in those specific moments.

By immersing ourselves this way, we consider not only the programmatic requirements of the project, but also the emotional connections that will ensure a positive experience each and every time that the patient returns for treatment. These experiences foster community, reassurance, and even joy, in the midst of a trying encounter.

My own cancer story has given me empathy as well as a passion for designing to the patient’s emotional needs. I’m happy to report that there is no evidence of cancer in my body, and I feel better than ever! I’m grateful that my experience can be used to provide a deeper understanding of the emotional duress cancer causes. It drives me to discover innovative ways to provide a better patient experience in those crucial moments in a patient’s cancer journey.

Char Hawkins

IIDA, LEED AP, NCIDQ

Senior Interior Designer

Char has over 19 years of professional experience as an interior designer specializing in healthcare environments. She believes in a holistic approach to design, blending flow and function with a sense of balance, a feeling for lighting, and an awareness of the latest trends. Clients appreciate Char's approachable style, zest for life, and an enjoyment in shaping their environments.

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Prefab Construction: A Time-Tested Technique with New Innovations

by Jamie Oxier

NCARB

Senior Project Architect

For many architects, our first love of design and building manifested through our childhood play with LEGOs. There is something about the quickness of completion that I still love today. (In fact, I just completed the LEGO London Architecture Skyline set.)

I sometimes wonder if LEGO building systems inspired the increasingly popular use of modular, or prefab, building construction. We’ve seen a rise in these types of applications over multiple market sectors in recent years. While modular and prefab terminology is often used interchangeably, the Modular Building Institute (MBI) defines PMC (permanent modular construction) and RB (relocatable buildings) more as complete “boxes” or pieces that are dropped on site and assembled [3]. Prefabrication is understood more as components either volumetric or panelized that can be installed on site as either interior to the structure or as part of the building enclosure. Both involve the process in which components of a building are manufactured off-site in a controlled facility, then transported to the site for installation.

No matter how these techniques are defined and differentiated, they’ve proven to be a durable solution that can, potentially, speed up construction, lower cost, and reduce waste (among other advantages). Prefabrication is time-tested – you might be surprised how long it’s been in practice. Here’s a closer look at what it is, how it came to be, and how it might help (or not be suitable for) your next project.

Prefabrication is hundreds of years old

In his book Prefab Architecture, Ryan Smith discusses this method of building in the West as far back as British colonization efforts, with the earliest recorded case being a shipment of houses from England in 1624 to the village of Cape Anne, now a city in Massachusetts. It was a way to rapidly extend their influence into regions of unknown building materials, labor, and construction methods [1].

Through the years we’ve seen great design minds reinvent prefabrication, mostly in the housing market. Two noteworthy projects, both of which I’ve visited in person, are Buckminster Fuller’s Dymaxion House (1930) at the Henry Ford in Detroit, Michigan, and Carl Strandlund’s Lustron House (1947) in Columbus, Ohio. Other examples include Moshe Safdie’s Habitat 67 in Montreal, Canada, and The House by Handel Architects Cornell Tech on Roosevelt Island in NY (2017).

Typically, prefabricated components are broken down into two categories: volumetric and panelized [2]. All these assemblies consist of multiple layers of material that are fabricated off site in a factory and then trucked to the construction site.

Ohio State University inpatient tower in process of construction from afar during the day — The new OSU Inpatient Tower in construction

How DesignGroup is using prefab

We’re currently part of the design team working on the Ohio State University Wexner Medical Center’s 820-bed Inpatient Hospital Tower here in Columbus. Developed in collaboration with architecture and engineering firm HDR, this $2.3 billion, 2 million sf, 26-story project is using prefabrication in the design and construction process.

An example of volumetric prefab on the Inpatient Hospital Tower are patient room toilet pods. This application is, essentially a “room in a box” (similar to Habitat 67’s “apartment in a box”). Our temporary office space on the project is in prefab trailers, too, delivered adjacent to the job site. Examples of panelized prefab in the Inpatient Tower are unitized curtain walls and brick-faced precast cladding. This is an increasingly common application for building enclosure (especially for large scale projects like this). There are also panelized prefabricated headwalls for the interior fit out of the patient rooms.

Another important category of prefabrication, which was used on this project, was MEP off-site fabrication. For example, 30-foot sections of plumbing pipe racks/support, sections of duct risers/support, mobile temporary power carts, subgrade conduit runs, and cable-ready electrical assemblies were all delivered to the site manufactured and pre-assembled. Some structural steel, such as the bridge that connects the primary tower to the parking garage, was prefabbed in large, complete sections off site, while others (such as trusses) were fabricated on the ground of the site prior to being lifted into place.

Outdoor during the day of a flatbed truck with patient toilet rooms on the flatbed — Volumetric Prefabrication - Patient Toilet Rooms

Close up of exterior of a building's paneled windows and wall in construction — Panelized Prefabrication - Unitized Curtain Wall

Is this approach right for your project? Key benefits and cautions

There are many factors when considering prefabrication for your next project. At DesignGroup, we start with the project’s scale, size, schedule, and context.

Let’s explore some of the benefits of this approach – and some of the reasons it may not be right for your needs.

Benefits:

Increased productivity
Consistent quality
Schedule certainty
Cost predictability (Research on cost savings is still lacking; cost is very much dependent on the quantity)
Improved safety (controlled environment)
Compensates for lack of on-site labor/skilled trades
More comprehensive warranties on systems, not just components
Improved sustainability by reducing materials and waste
Offsite AHJ inspections

Cautions:

Decisions must be made early (important to understand the manufacturer’s process)
High level of design / construction coordination (especially if the walls are not decoupled)
Tolerances and scheduling become critical
Compliance and inspection processes
Various trades and planning scope of work bidding
Shipping costs, constraints, and logistics
Different costs and site logistics with the different delivery methods (could require a crane and construction loading platform or a palette jack and buck hoist)

Current research confirms the overall benefits in terms of quality and waste reduction. Some analysis shows that for high-rise scale projects, a waste reduction of more than 15% is achievable [4].

There is a lot to discuss and consider in deciding if this approach is right for your project. Learning about the benefits as well as the cautions is critical to success of the owner’s project. Understanding the scope and scale of the project early on is the first step to making the decision.

Woman, Jamie Oxier, on a construction site wearing safety gear — Jamie Oxier on site of the new OSU Inpatient Tower

Sources:

Smith, Ryan E. “Prefab Architecture A guide to modular design and construction: 2010 John Wiley & Sons, Ince, New Jersey
Design for modular construction: An introduction for architects, AIA and NIBS, AIA-NIBS Modular and Off-Site Construction Guide
Modular Building Institute, Research, Whitepapers, & Studies - Modular Building Institute: PrefabModularSmartMarketReport2020.pdf (azureedge.net)
Lu, Lee, Xue, Xu (2021) Revisiting the effects of prefabrication on construction waste minimization, a qualitative study using bigger data.

Jamie Oxier

NCARB

Senior Project Architect

More about Jamie

Healthcare

Rethinking the Patient Experience For Blood and Marrow Transplants | Part 1: The Inpatient Unit

by Sarah Eversman

NCIDQ, Associate IIDA

Senior Interior Designer

Patients aren’t the only ones who struggle with the BMT experience. Families also feel the pain of isolation from their loved ones, and face the same hopes, fears, and frustrations of an unknown outcome. And many hospital staff report that, while their work is deeply fulfilling, it can also be stressful and challenging.

To better understand their needs and potential solutions, DesignGroup took a closer look at typical BMT patients and their treatments – both inpatient and ambulatory – and how design might help lower stress, simplify the experience, and improve outcomes.

In preparation for our work on the OhioHealth Blood and Marrow Transplant Program at OhioHealth Riverside Methodist Hospital and OhioHealth Arthur G.H. Bing, MD, Cancer Center, DesignGroup realized early that all three of these groups — patients, family, and staff — are integral to success, and needed to be factored in design solutions equally. In rethinking the design of a clean healthcare environment, one of our main goals was to shift the patient experience from one that’s cold and clinical to one that provides greater calm, connection, and warmth. In this first of two articles, we focus on the inpatient experience (which can last from 30 to 90 days) and how DesignGroup delivered on this promise. Next month, we’ll look at changes to the ambulatory experience, shorter but crucial visits that happen during recovery.

Mapping the Inpatient Experience

During the design process we met with two individuals, a past BMT patient and a past BMT family member, to understand the patient experience. The discussion was broken down into three parts.

First, we asked about their mental and physical journey through the facility; their likes and dislikes; which flows were and were not working; and what they wished had been available to them during their treatment.
Next, we created an experience map to indicate how they were feeling (low stress, medium stress, or high stress) along the path of arrival to departure. Mapping the stress levels of both individuals revealed joy and pain points throughout their journey on a typical day.
Finally, we were able to share our design visioning, including concepts, goals, color palette, and more with both participants. They were able to confirm that our palette was warm and soothing and that our design concepts followed what they experienced, wanted, and/or expected from a BMT department.

We then concentrated on design solutions to ease the isolation and anxiety that can come with an extended inpatient stay for treatment — often a painful process that can last weeks at a time.

Each person traveling to the BMT inpatient unit at Riverside Hospital, regardless of being a patient or family member, feels fear. Fear of the known and unknown. Fear of the what-ifs, the hows, and the why me. The optimistic thoughts deep inside are often outweighed by the looming diagnosis, treatment, recovery, and their own mortality.

In a perfect world, each new cancer department would be in its own building full of clear wayfinding opportunities, but often the first challenge a patient faces is navigation through an existing facility to the newly renovated space. While we had minimal control over the initial journey from the parking garage to the main entrance to the 6Blue elevators and up to the unit, we could control the journey from the moment the patient stepped off the elevator. This was achieved using three key design strategies incorporated across both BMT projects: calm, connection, and warmth.

Interior day of a family style waiting room with tables and kitchenette — The Family Lounge offers comforts of home and provides areas of respite.

Finding Calm Through Color

The look and feel of a calm space can be subjective. Early in the design process our team agreed the use of color, texture, and lighting, as well as gentle tones and grounding elements, were key to creating a more soothing environment for patients, staff, and family. The goal was providing a greater “softness of space” while also adhering to strict healthcare guidelines and air-flow ratios. The first impression of the department occurs in the elevator lobby, where the wall tile mimics the flow of water and a deep-blue accent paint inherent to the healthcare system indicates that you have arrived at your destination. Corridor finishes are simple and clean with accents emphasizing the threshold at patient rooms, while the wood-look sheet flooring exudes a feeling of home. To counter feelings of isolation, the department layout provides opportunities for patients to walk around the entire floor with the triangular, racetrack floor plan.

Hallway of a hospital with a person walking into an elevator — The visitor's journey begins in the elevator lobby where you first see elements of calm, connection, and warmth.

Connection & Wayfinding

While connection means different things to patients, staff, and families, we drew on commonalities to improve their experiences. Connection to nature is important and has been proven to encourage faster healing. This can be achieved through outdoor views, artwork, and graphics. Another key: providing opportunities for patients to personalize their space, such as dedicated zones to display cards and pictures, and giving them control over lighting. Seeing and talking to friends and family via technology incorporated on the footwall (and easily seen from anywhere in the room), or even a small hand-held device, can go a long way to fighting feelings of isolation. And while each person goes through an individual experience, it is relatable with other patients, so providing opportunities for smaller group connections once the patients have reached a less compromised stage can also help with recovery.

Consistent design and materials for all staff stations help the patient and family recognize “this is where we go for help,” even when they are not aware of the fact. Accent paint used in patient and family zones leads you to a location or marks a threshold and continues inside the space, further connecting patients to their surroundings.

Open and central space featuring a nurse's station with various people working — Staff stations are centrally located to provide sightlines into the rooms and accessibility for patients and their families.

Adding Warmth Through Wood

Incorporating wood elements into a design is the easiest way to bring warmth into a space. We aimed to create a sanctuary for the patient, where they would feel enveloped and safe. Wood wraps the patient from the ceiling and down behind them on the headwall creating a clear patient zone, while a light blue accent paint wraps from the door and around the family seating area. The rich medium blue accent color on soffits above each staff station is further highlighted by the soft glow of a perimeter light fixture. The same accent paint used in patient rooms leads you to the Family Waiting Room with abundant windows and natural light, providing that vital respite needed by all. The kitchenette and island are adjacent to amenities such as a family consult room and laundry room that further provide feelings of home.

Hospital patient room with warm wood paneling on wall and ceiling — Warm wood elements and soft accents paired with daylighting and views promise a comforting experience.

Today and Beyond

Our design journey from visioning to patient mapping to concepts to implementation was successful. The inpatient BMT unit is complete and has achieved what we set out to accomplish. The spaces are calm, warm, bright, and inclusive. They provide intuitive wayfinding elements and surround the patients in a gentle and safe environment. Utilizing all opportunities to uplift patients, family and staff is vital in the design process, and while design elements by themselves do not fully heal patients, they play an essential role in the recovery process.

Sources:

1. Johns Hopkins, Bone Marrow Transplantation | Johns Hopkins Medicine

Sarah Eversman

NCIDQ, Associate IIDA

Senior Interior Designer

More about Sarah

Healthcare

Rethinking the Patient Experience For Blood and Marrow Transplants | Part 2: The Ambulatory Department

by Sarah Eversman

NCIDQ, Associate IIDA

Senior Interior Designer

This piece is focused on the ambulatory experience; you can also read our thoughts on inpatient BMT experience design.

DesignGroup recently worked with the Blood and Marrow Transplant (BMT) Clinic and Infusion departments in the Arthur G.H. Bing, MD, Cancer Center adjacent to OhioHealth Riverside Methodist Hospital in Columbus, Ohio. The overall goal was for both inpatient and ambulatory experiences to feel integrated and cohesive.

We achieved this in part by using similar materials and design elements to create a shared look and feel. We were also asked to design the spaces in ways that help lower anxiety, simplify the experience, and, ideally, improve patient outcomes. Like in our work on the Bing Center’s inpatient department, the design philosophies of calm, connection, and warmth were just as valuable here. The challenge was achieving a light and bright space on a lower level, without windows and natural light.

The patient’s journey begins upon arrival to the building, where they must navigate to the Clinic and Infusion departments in two different ways. The first and perhaps easier travel path is being dropped off at the main entrance. Upon entering, they are immediately welcomed by a smiling face at the reception desk and from there will be instructed to take the nearby stairs or elevators to the lower level and to the subsequent welcome desk. The second travel path consists of parking in the attached garage, entering the building, taking the elevators to the lower level, and continuing to the welcome desk. While the parking option may be confusing for the first-time patient, it will be the preferred method for future visits. Once the patient has arrived, they are escorted by a staff member to the down one of two hallways: to the clinic check-in or to the infusion entrance.

Interior check in desk surrounded by warm wood walls and ceiling — Warm wood beckons the patient down a long corridor, enveloping them as they check-in.

Finding Calm Through Color

The waiting area is open to a large four-story atrium which feels bright and spacious and indicates that the patient journey begins here. Corridors to each department are clean and refined, leading to a wood-wrapped entryway at each entry. While the scale of the atrium and initial travel to the lower level can be a bit overwhelming, the design compresses the patient just enough in the corridors to bring back a soothing and manageable feel.

The deep blue accent paint, signature to this healthcare system, signifies locations for department entry signage and wayfinding elements; while artwork and soothing decorative glass creates a more hospitality-like feel. The same light blue accent that was used in the Inpatient unit can be found highlighting patient zones in both clinic exam rooms and the infusion bays, unifying the facilities as a purposeful whole.

Connection and Wayfinding

The connection component in the outpatient clinic and infusion area is different from the inpatient unit. The duration of the ambulatory stay is much shorter, more catered to the patient and their individual experience, and occurring in a repetitive manner. With guided assistance along the way, patients have the comfort of easier wayfinding from the waiting area to check-in to treatment and back out again.

The clinic patient's path of travel is a more visual experience. The light wood exam room doors have a full frosted glass panel with a large-scale graphic number, with the same light blue accent paint highlighting the entry point. The rich medium blue accent used in the inpatient unit, wraps the clinic staff station from the soffit down to the adjacent wall, once again allowing patients and families to recognize that “this is where we go for help.”

The infusion patient's experience is more solitary. With no cubicle curtains at the bay entrances due to infection control issues, the strategic placement of the frosted glass panels and the patient recliner turns the patient’s view inward to their personal, private space. A wood element wraps the ceiling and wall to envelop the patient and their support person creating a dedicated zone, while a decorative light provides additional glow with personal patient control.

Interior of a room with a nurse and patient, beginning to draw blood — The combination of a frosted glass panel, position of the recliner and wood wrap above creates an inward, personal focus for each patient.

Adding Warmth Through Wood

Bringing warmth into these departments is vital as a calming environment. The public spaces in the building itself, atrium included, incorporate wood elements. The wood in the clinic and infusion areas were intended to ground and comfort the patient, and although these departments are confined to the lower level, they feel bright and open. The Infusion staff stations bring in wood tones with a neutral accent soffit color and are centrally located with an easy visual to all patients. Blue glass tile at the staff station sinks provides a pop of color for everyone in the space and a sense of home. The Infusion bays are encompassed by frosted glass panels at the entrance and in between simulating windows and natural light, while maintaining patient privacy at the same time. Large-scale graphic numbers at each bay tie the Clinic and Infusion departments together with a consistent design language.

Interior of a nurses or staff station with two women interacting at a desk — The centrally located staff station, accented with a deep blue provides an easy visual for all patients, signifying "help" is here.

Today and Beyond

The BMT clinic and infusion departments have been completed and are living up to our original design expectations. The spaces invoke a sense of calm, warmth, and, above all, a brightness to the space that makes you forget you are in the lower level. Beyond the visual finishes, is the sense of pride that the staff feel working in this unit, not only because of the nature of the department itself, but how the space makes everyone feel, staff and patients alike.