Healthcare

FGI Guidelines Part 2: Imaging Department Updates

by Emily Wagner

AIA

Project Architect

While many items have shifted and updated, three progressive topics have surfaced in 2022. Common to these topics is the relationship between departments and how care is delivered, and the needs of clinical staff vs vendors and code requirements. This three-part series will highlight the key areas of changes for 2022 and their impact on design.

Imaging Department Updates

The imaging department is often the first step in patient care. So it’s critical for hospitals to provide an experience that’s focused on their comfort – and that of their medical providers. When the 2022 FGI guidelines are rolled out in the first quarter of the new year, changes to the imaging department seek to improve patient and staff needs alike. Changes will include clearance requirement modifications and reductions to the required patient care station counts.

At DesignGroup we know that these guidelines aren’t the only factors considered in the development of new imaging rooms. We understand how to balance the often-competing needs of patients and staff with the regulatory requirements and equipment vendors needed for a successful project. The changes coming to FGI 2022 are steps toward making that delicate balance easier to achieve.

Modified Clearances

The shift of clearances focuses on providing additional space on the patient transfer side – where space really counts. Previously, clearances were a seemingly arbitrary zone around the device. Moving forward, these clarified definitions provide black-and-white requirements to make the design and construction process more straightforward and significantly reduce issues in the field.

Venn diagram of imaging equipment requirements

Patient Care Stations

In 2022, the guidelines recognize that not all hospital programs are the same – and thus will reduce the required counts of holding bays for Class 2 procedures. The result will give hospitals more flexibility and grant additional space back to other critical care areas in the facility.

Other Space Planning Considerations

Early engagement with the hospital’s equipment vendor is critical for ensuring that all clearances are met beyond basic regulatory mandates.
Thorough conversation with departmental staff is critical in understanding additional mobile equipment rooms to provide increased efficiencies in staff flow and function of the room.

Emily Wagner

AIA

Project Architect

More about Emily

Education, Community

Concrete Exposed!

by Robert Stroup

AIA, WELL AP, CDT, NCARB, LEED AP

Project Architect

When establishing the groundwork for impressionism, Claude Monet famously said “my garden is my most beautiful masterpiece.” Monet recognized that humans are drawn to what is naturally cultivated. In the architectural study of wellness, this relationship to the healing power of nature is known as biophilia.

As architects, we often aspire to design interior spaces that feel almost organic, born from necessity. The same should be true for the exteriors, as well. The cladding of a building can achieve some of the same biophilic appeal.

The genius loci (the pervading “spirit of place”) should not be lost when building in any environment. To achieve harmonious integration into the broader landscape, architects and owners often seek cladding materials that are functional and regional. Here in the Midwest, this typically means the use of brick, metal, concrete, or wood. Brick and metal are safe bets because of established standards laid out by manufacturers. The use of wood is less common; limited to fire retardant treated lumber for healthcare occupancies, it is rarely employed as cladding for larger scale projects. Concrete is mostly misunderstood as a cladding material, and that’s a shame because it offers real possibilities.

Throughout the 20th century, reinforced concrete was generally seen as utilitarian “man-made rock” and employed mainly for structural integrity in parking garages, foundations, and elevated building construction. Yet the aesthetic potential of concrete has largely been missed in commercial construction until recently. Owners looking to distinguish their brands with exterior cladding should consider the possibilities of concrete beyond typical assumptions about the material.

More Than Pure Function — Indoors and Out

Concrete has a unique duality: while functional for weatherproofing and support, it also offers a natural aesthetic with comparable prices to interior and exterior products. Though it’s often concealed, concrete that’s architecturally exposed can create highly refined, minimalist interior spaces. When properly executed, poured concrete countertops and millwork offer endless possibilities. With advances in formwork and construction techniques, architecturally exposed concrete can also bring a humble aesthetic to building facades and reduce the need for additional trades.

Two methods are typically employed to achieve a heightened level of design with exterior concrete: pre-cast and cast-in-place construction. Pre-cast concrete panels, which are molded and then cured in a controlled environment, are durable, clean, noncombustible and can be unitized, eliminating the need for onsite formwork. Panels can be designed as either structural tilt-up walls or as cladding. Cast-in-place concrete, conversely, is constructed on site and is mostly structural in nature; this form of construction has advantages where strength and higher levels or insulation are required.

It’s important to engage a construction manager who understands the nuances of the material. The workforce, unfortunately, has limited tradesmen with the necessary expertise, so it is vital for architects to provide insights as early in preconstruction phases of design as possible while setting reasonable benchmarks for the material. Providing intuitive performance specifications can better address appropriate concrete mixes, aggregates, and enhanced sustainability targets while achieving the envisioned form.

Architectural considerations for formed concrete include:

Method of construction (concrete is built twice, once as formwork/mold and once as concrete)
Construction and site-related logistics
Color and texture of concrete
Treatment of joint locations
Chemical composition of concrete

Most critically, if cast-in-place, the formwork itself should be well understood by the contractor. Architects have multiple design choices: using the form itself to imprint into the concrete or casting it through the removal of the cement paste skin. These options are more commonly known as board-formed concrete and exposed aggregate concrete. A third option in precast panels presents itself when more versatility, quality-control and time-efficiency is sought on a project.

Board-Formed Concrete

Board-forming concrete is a cast-in-place process of imprinting that leaves a wood grain pattern on the finished face of concrete. It can visually soften and warm concrete’s somewhat cooler appearance while still allowing concrete to express construction technique. Prior to casting, formwork is built on site to hold wet concrete in place until it hardens. A layer of selected wood is added to the inside face of the plywood formwork, which allows the cast concrete to take on the pattern of wood’s surface. The wet concrete will take on the grain structure of the dimensional lumber. The contractor responsible for pouring should keep dendrochronology in mind; the difference between winter and summer tree rings will show in the patterning on board-formed concrete.

In DesignGroup’s collaboration with Allied Works Architecture on the National Veterans’ Memorial and Museum in Franklinton, Ohio, during the construction administration phase, two wood-imprint options were explored: a board-formed finish or a smooth as-cast finish (in which form liners are placed on plywood to secure a sought texture). For the board-formed finish, a narrow 4” width for boards was specified. Reveal lines, tie holes, and joints were located per architectural drawings and approved in shop drawings. For the smooth as-cast finish, joints were spaced to reflect the actual panels of plywood, which were sloped to address the required exterior wall curvature. Form material was specified as either MDO, HDO or phenolic surface film plywood. In both forming techniques, a uniform high quality of finish was sought to obtain a consistent surface texture, color, and porosity. Boards were tightly connected, and precautions were employed to stop grout loss between boards. Most importantly, objectives were clearly stated to meet concrete surface category CSC4 as defined in ACI 347.3R-13, meeting industry-wide standard expectations for exposed concrete in museum construction. Ultimately, after reviewing mockups, the smooth as-cast finish was chosen as it proved more capable of addressing overall design needs while addressing the project’s budgetary and scheduling parameters.

nighttime exterior view of Veterans Memorial

This is a caveat to board-forming: if a project is not rectilinear in design or has a highly irregular exterior surface, a smooth as-cast finish may prove a more economical and effective option. While the cost to detail varies by region, on average the process of board-formed concrete is around $30 to $50 per square foot. In addition to the cost of the concrete there will also be the expense of securing wood, ripping it in half, sandblasting the surface to enhance texture, and then applying it to the interior faces of the plywood formwork.

Exposed-Aggregate Concrete

Exposing aggregate is another method to enhance concrete’s visual appeal. This technique is akin to polishing marble or granite; an unremarkable skin is stripped away to expose the underlying beauty of the utilitarian material. This beauty comes in the form of a decorative aggregate.

This process has been around since the early 1900s, before stenciling, stamping and overlays became popular. Because of its innate durability and traction, exposed aggregate concrete can be used for sidewalks, driveways, patios, plazas, and other walking surfaces. It can also be used where rougher appearances are desired, such as in retaining walls or building facades, and can be a feature of either pre-cast or cast-in-place construction. It is also typically used in conjunction with regularly placed concrete to achieve a desired aesthetic, and little maintenance is required other than sealing and periodic cleaning.

Pre-Cast Panels

With an old-world meets new-world appeal, pre-cast concrete panels can elevate both classical and contemporary designs. Offering a wide variety of finishes and sizes, pre-cast construction offers the client a traditional aesthetic that is best employed either throughout a façade or at the lower levels of a building.

Typical rules of thumb for precast construction:

Textured surfaces provide more uniformity than smooth surfaces due to the natural variations in aggregates
The maximum height of loads is typically around 13’ 6” (including trailer and shipping frame height)
The maximum width without permit is roughly 8’ 6” and the maximum load without permit is 48,000 lbs
Ensure proper crane access and swing space from truck to building placement
In general, work to avoid precast placement under soffits

At the Columbus Spanish Immersion K-8 School, DesignGroup worked with Integrated Precast Solutions in the design of a precast sandwich panel exterior that provided a durable exterior with peak thermal performance. Panels were 12” thick overall, with a 3” thick exterior panel and 6” interior panel sandwiching a 3” rigid insulation panel.

Children playing on the playground outside the Columbus Spanish Immersion Academy — Columbus City Schools Spanish Immersion Academy

Caps were provided at exposed ends matching the exterior finish with steel plates and studs welded to the interior panels allowing for easy anchorage to the building’s primary structure. Thicker panels and an attention to detail in avoiding tight and mitered corners mitigated the potential for chipping. This direction in design led to a flexible panelized solution which met the aesthetic and sustainable needs for the project simultaneously, resulting in LEED Silver certification.

Revealing Concrete's Inner Beauty

When casting in place, there are generally three ways to achieve compelling architecturally exposed concrete aesthetics.

Brushing/washing is the oldest method and the easiest because no chemical retarders are involved. The thin layer of surface mortar covering the aggregate is simply washed away by spraying water and scrubbing the surface with a broom to the desired depth. Timing is critical for this approach, so it is typically used for smaller jobs where there is more control over the final product.
A surface retarder can also be used immediately after placing and finishing. This application delays setting and allows for flexibility in removing cement paste 24 to 48 hours after placement. Scrubbing and pressure washing are two effective means to remove the paste. This application is typically used for larger projects with summer-long project schedules.
Finally, abrasive blasting is most often achieved by sandblasting or shot blasting. The primary disadvantage to this approach is that it can fracture aggregate and dull the surface quality of the concrete. This approach should be avoided, if possible, when the best possible aesthetic for a concrete wall is desired.

Other Options

In addition to pouring and exposure methods, other ways to alter the appearance of architecturally exposed concrete include the following:

Use contrasting aggregate (sizes, textures)
Color the concrete in a shade that complements the aggregate
Use chemical stains to highlight patterns
Place exposed aggregate in bands/fields separated by joints or divider strips
Vary the degree of aggregate exposure from light to heavy; contrasting different exposure levels next to one another can add a unique effect and highlight certain areas of concrete

Sustainability Considerations

A typical mistake in concrete construction is to add unnecessary prescriptive requirements that may contradict provisions from the American Concrete Institute’s Specifications for Concrete (ACI 301). Limits on supplementary cementitious materials, maximum water to cementitious materials ratios, and grading of aggregates can severely impact the carbon footprints inherent in concrete, regardless of form. Instead, designers and providers should seek to specify performance requirements outlined in ASTM 595 (for blended cements) and ASTM C1157 (for performance cements). These standards will result in concrete construction with Type IL and pozzolan-blended low-alkali cements that reduce the use of natural resources while meeting strength performance targets for the project overall.

Code Considerations

To ensure the best outcome for concrete construction, a design must also consider all structural and code-related implications. The American Concrete Institute (ACI) publishes standards for cover, shrinkage, temperature reinforcement, and typical deflection limitations; for cast-in-place construction, the structural engineer-of-record should be aware that these guidelines are not conservative enough for the demands of exposed concrete. Serviceability issues should also be considered; joints should be placed properly to prevent cracking in undesirable locations. Developed mock-ups and repair details can help control the cost and finish before moving forward with construction. If provided in pre-construction phases, long-term costs can be offset by assuring limited defects will occur in concrete placement.

The ideal convergence of architectural and structural considerations can be found in one document: ACI 303R-12. This reference, provided by the American Concrete Institute, is a guide to cast-in-place concrete that provides helpful tools for understanding the intricacies in finishing concrete. With a thorough understanding, proper reinforcement, time and temperature for placement and crack control can be properly specified. All qualified professionals should address this provision when designing architecturally exposed concrete for commercial construction.

Precast structural walls conversely are required to meet Chapter 14, Section 2 of ASCE 7-16 for loading and serviceability requirements. When architectural finishes are provided for walls, the Precast Concrete Institute offers specifications to achieve desired finishes. Similarly, to achieve the proper finish, it is recommended for non-load bearing precast panels used for cladding to meet the Precast Concrete Institute’s architectural certifications (the PCI has released specifications for 5 levels of surface quality).

Choose Wisely

It should be noted that architecturally exposed concrete is not for every project. Certain processes, such as board-formed concrete, come with a higher premium upfront for the formwork alone. Exposing aggregate can cost up to $2.50 per square foot and decorative touches can roughly add $0.50 per square foot (without considering taxes or fees associated for purchase). Precast panels also have higher upfront costs associated with them and, although versatile, require consistency in exterior wall assembly construction throughout the building perimeter to prove cost effective. Material choice, erection details, and access conditions additionally can impact a cladding budget as well. Yet, while exposed concrete is often costlier at the start of construction, it can provide significant return on investment thanks to the requirements for its design and better durability. It requires lower maintenance, is easily cleaned, and is structurally resilient and aesthetically pleasing. When thoroughly understood, concrete can be elevated from stolid to striking.

Robert Stroup

AIA, WELL AP, CDT, NCARB, LEED AP

Project Architect

With a diverse technical background, Bob has contributed to a vast array of large-scale projects from design through construction. Having worked as an engineer and being a Registered Architect, Bob brings a strong technical skillset and has earned an understanding of what clients and consultants look for from an architect. He excels in product selection, understanding constructibility, implementing sustainable practices and most importantly, working with the client and consultants to deliver the best building possible.

Healthcare

Current Trends in NICU Design

by Jane Peters

Senior Healthcare Planner

Neonatal Intensive Care Units are a relatively recent phenomenon in the development of modern healthcare spaces, with the first typically recognized as opening at Yale New Haven Medical Center in 1967. This unit, as with most units prior to 1990, consisted of rooms with multiple infant stations with as many as 20 infants per room. Since the mid 1990’s a greater focus on and understanding of developmental care for neonates has led to smaller groups and ultimately in 1997 to the first NICU with a large proportion of single family rooms.

Creating a Place for Family

The move to single family NICU rooms followed a similar shift in other cohorts of ICU care for adults and pediatrics. The recognition of parent involvement as care partners along with relaxed visiting restrictions has led to a focus on family accommodations within the NICU.

This, coupled with the equipment required to care for high acuity neonates, is continuing to suggest that NICU patient rooms are deserving of the same space allocation and amenities found in other patient rooms within the hospital. The first forays toward individualized spaces resulted in pinwheel configurations that afforded more space and privacy at each bed but still clung to the open room scenario. As the benefits of providing additional area and family accommodation at the bedside become clear NICU’s introduced pods of three-walled bays which helped to balance space requirements with budget. Finally, the leap was made to creating a completely private room environment. This was made possible by new communication and monitoring technology as well as mounting evidence on the benefits of a controlled environment.

NICU rooms are typically equipped with lockable storage for family belongings, sleeping accommodations for one, if not both, parents, breast milk refrigerators and warmers. Some units are also providing private family toilet rooms for each NICU room, although care must be taken to attenuate noise and enhance infection control. Space for parents and siblings needs to be provided outside the patient room areas to support the entire family unit and the transition to home and respite.

The overall unit is intrinsically changed with the advent of single family room NICU’s. Larger room areas inherently increase travel distances. Therefore, strategies need to be developed to decentralize work areas for nursing staff and the many specialty subconsultants that are involved in the collaborative care of patients in the NICU. Technology has also answered the call with alarm management solutions that eliminate the audio alarms within the unit and notify staff directly when attention is needed. This has extended to adaptations for fire alarm system alternatives that eliminate the need for audio alarms and flashing strobe lights. Many staffing changes studies conclude that nursing ratios can remain similar to those of open units. However, the number of staff needed to support biomedical engineering, environmental services and supply control often increase given the reliance on communications technology, monitors and increase in physical area.

The environment should balance the needs of the family with those of the staff. Staff need ergonomic work spaces at the infant care station with supplies, charting, medication and nourishment resources close at hand. When possible, service personnel should be able to access linen and trash without entering the patient room. Task and room lighting (artificial and natural) can be controlled for each individual patient in the single family room setting and tailored for their developmental needs.

Materials for a Healthy Environment

As designers, we advocate for sensitivity in maintaining a healthy built environment. Sustainable practices are a focus for the NICU for the finishes selection and supplies that are used to support infant care. Materials should be selected that reduce exposure to toxins when looking at anything from IV administration, cleaning products used in the NICU and composition of building materials. Similarly maintenance of heavy rolling equipment such as portable x-ray units can reduce noise by 30 dB by lubricating parts. While organizational and behavioral interventions can be successful, building in noise reduction into the design can be most effective. The design should keep these criteria in mind to allow the transformation of existing environments to state of the art facilities to support the highest level of patient care, family considerations and staff engagement.

Jane Peters

Senior Healthcare Planner

Healthcare, Education, Community, Science & Technology, Commercial

The Beauty of Renovation

by Elliot Bonnie

AIA, LEED AP, BD+C

Principal, Designer

I felt compelled to share my thoughts on Hugh Hardy’s new book, The Theater of Architecture, as he discusses buildings in relation to what they do, how they do it, and how their context inevitably influences the results. This is not a cut and dry architecture book with explanations of design solutions, it’s about all the elements and people that affected the building examples. His stories are supported by commentary from the project’s prime clients. I particularly enjoyed the Brooklyn Academy of Music’s Harvey Theater in Brooklyn, New York. Formally known as the Majestic Theater, it had long since closed its doors and sat in ruin. The theater was chosen as the stage for the production of the “Mahabharata”, a nine-hour epic, creating the need to renovate the space.

During the course of construction, the designers made an unusual discovery – that they preferred the way it looked in this semi-unfinished state. While a theater with a somewhat natural character had been desired, it was never intended to be this radical. It wasn’t an easy sell to the city fathers and the code officials, but the producers prevailed. “Such a premise was completely unheard of in New York, where restoration was long assumed to mean returning a building to a simulation of its original appearance as close as physically possible”. The results are extraordinary! Hugh takes the reader on a journey along the spectrum of renovation from the recreation of the original design for Radio City Music Hall to the rebirth of New York City’s 42nd Street and Broadway Theater District in the 1980’s. All are noteworthy examples of the social and political forces influencing their design solutions. In Hugh’s words, “The assumption that restoration involves reproducing the original does not always apply. Interpreting the past is sometimes preferable to attempting to re-create it”.

When a building has a valued, historical past, it is not an easy decision to alter its original appearance. But for a building to remain relevant, it must serve its function properly and accommodate today’s new technologies. As natural resources diminish, and our energy sources are at a premium, we are learning to recycle and reuse much of our existing products, including our buildings. An inevitable question that surfaces during a building renovation is, do we restore a building to its original state, or alter it somewhat, or maybe repurpose it to something different, or all the above? Knowledge of theater can help inform creation of buildings – not through imitating the illusions of painted scenery, but through understanding how buildings are discovered and experienced by the public. What excites me about my profession is that architecture is defined by the human spirit. And all of us, as individuals, affect our built environment more than we realize.

Elliot Bonnie

AIA, LEED AP, BD+C

Principal, Designer

Healthcare

Resiliency in Healthcare: Look to Nature. A Q-and-A with Judith Heerwagen

by Chris Haedt

AIA, ACHA, NCARB, LEED AP BD+C

Principal, Columbus Healthcare Practice Group Leader

Healthcare institutions have a responsibility to be social and environmental leaders. To do this, there needs to be a bigger idea that helps guide this rallying cry. I believe the natural world can be that driver. It can anchor the thinking in a bigger-picture context of healthy living through connection to the natural world.

Within that environment, hospitals can focus on three areas:

To be resilient in healthcare, we truly need to consider biophilic principles into design. This concept aligns with the Hippocratic Oath and the very reason for medicine: Primum non nocere – first do no harm. And it can seat these institutions as the bedrock of their communities.

To help illustrate this, we contacted industry thought leader Dr. Judith Heerwagen. Judith’s background in ecology and biology has enhanced her work in studying the psychology of why humans behave the way they do. She strongly advocates for biophilic design, the integration of nature and built environments. After all, the natural world has been part of our genetic make up for millions of years. Driving it out of places as important as hospitals is simply counterintuitive.

We spoke with Judith from her home office in Seattle, where smoke from the Oregon wildfires had drifted into her area and created haze and breathing difficulty, a situation she described as grim. Our conversation, fortunately, was much more optimistic.

DesignGroup: Do we, as humans, need interaction with nature?

Judith Heerwagen: The truth is, people can survive without it. The better question is, perhaps, what helps people thrive? We lived in the natural environment for millions of years. The built environment is very young in comparison. We have adapted, for our survival, to recognize the parts of nature that are helpful and those that are harmful. We’ve seen the harmful side magnified in the recent natural disasters. But we’ve also evolved to seek out the positive sides of nature: flora, fauna, water, and sunlight. There is a strong need ingrained in us to seek out the positive attributes. Satisfying that urge promotes mental and emotional well-being. It helps us to thrive by affiliating with nature.

It is important to note that biophilic design is not a cure all. It is a process of integrating back with nature that we know is beneficial to our emotional and physical well being. Why wouldn’t we do it? We have an innate desire to associate with nature, to satisfy the nature module in our brain. Whether it’s for physical health or our social and emotional well-being, we understand the benefits associated with being connected to the natural environment. Rodger Ulrich’s breakthrough article in the journal Science years ago started a serious, long-lasting assessment of how nature really does help our health. His study showed that hospital patients whose window view was nature-dominant (mainly trees) stayed in the hospital fewer days than those who had a window view without natural elements. The study opened up a whole new way of thinking about hospitals and patients.

Interior of Building with plants on walls

How does the natural world impact our health and well-being?

Stress reduction is a really powerful impact, but there's also the experience of more positive moods, which affect our physical and social health as well as our general sense of well-being. These are powerful and consistent results across studies. And we know that many aspects of nature that can elicit these responses.

Flowers are one. There's been some really interesting work done in psychology on this. In one study, researchers would hand a person entering an elevator either a flower, a piece of fruit, or a pen. Two were natural things, the flower and the fruit, then a pen that had nothing to do with nature at all. Researchers studied how people responded to the gift, and only the flower elicited what is called a true smile. You can't fake a true smile, the way it changes your cheeks and your eyes. It was a clever experiment. Another study, by a landscape student of mine, looked at how children play outdoors. She carefully observed young kids at recess in two areas — one a very natural area, the other a more traditional climbing structure. She found that the children attracted to the natural space engaged in much more imaginative play. They would explore the overgrown hedges and pretend they were houses or spaceships — a very different type of play than the children on the playground who would run and jump and climb. Both kinds of play are important to development, but imaginative play is considered extremely valuable to child development. Pretend play enhances their ability to imagine things — a high-value skill, especially in problem solving. We’re an imaginative species and facilitating that imagination is important.

A final anecdote: when my student went back to the school for her final day of gathering data, she discovered that all of that nature, the hedges and stuff, had been pulled out over the weekend. She asked the staff, "Why did you do this?" And they said that they were concerned because they couldn't see the children. They had no idea whatsoever of the play value of that space.

How can nature be incorporated into the physical healthcare environment to promote healing?

That's a great question and health care is surprisingly behind the curve on this. There are so many opportunities here for looking at how to reimagine the hospital setting — focusing not on getting people over illness but helping them get well in a very positive way. And that includes the doctors, the nurses, the people who work there. This isn't just about patients. It's for the entire population. The visitors as well, because it's a very high-stress environment.

When you walk into a hospital, it often doesn't feel like a place for healing. To begin with, it's colorless. Nothing says “healing” other than the presence of white walls and people in white coats. There's so much possibility. Think about how you treat the spaces surrounding the hospital. If you've got land you can put natural features in. Trees are particularly valuable, and flowers. As you walk toward the hospital it would seem more welcoming, because you see right away that the hospital is in a natural, biological environment.

Medical offices frequently use a fish tank to enhance space, but people often aren't paying any attention to it. They're absorbed with their phones. So how do you actually design the environment in a way that enhances visual engagement and psychological comfort? For instance, how do you begin to use color more effectively? We have color vision, for heaven’s sake.

You can also use nature murals and photographs when you can't put in real plants or other nature elements. Colors like blues and pinks and peaches can really enliven a space. If the only thing you do is color in the furnishings and the walls, that alone can make a big impact. Even if it’s as simple as colored blankets. Our homes aren’t all beige and gray. Color helps make hospitals more home-like.

Have studies been done to validate these ideas?

Yes. In one study of a hospital in England, they added color in different ways and the improvement in patient outcomes was significantly higher than having kept it a neutral palette.

I think it's just wide open for thinking about biophilia as a healing component of a health care setting. Making it more of a people space than shrubbing it up to make the building look good. Water, for example, is inherently soothing to people. Research shows that stress is relieved by the sound of gently flowing water. Water features in the exterior environment are being used to counteract the sounds of traffic. This is one of the natural elements that would be really interesting to integrate more effectively into the hospital environment.

Biophilia is not a fad. That’s the thing that needs to be really understood. We've got some really important research [about] things you can do that aren't going to cost a lot of money. Other solutions are more expensive, but look at the impact on not just patients, but the doctors, nurses, and the people who visit them. Anything you can do to make their lives more pleasant in the hospital, reduce their stress, or improve their emotional functioning, is valuable, because hospitals are stressful. There's a whole slew of people who benefit from this.

How do we ensure that these principles are equitably distributed?

This is a really, really important issue and I’m glad you raised it. It should be equitable. It needs to be democratized. It needs to be looked at as something that’s good for everybody. There are different ways to do this. Some will be policy, some can be design. Recent studies have suggested that, with the advent of the pandemic and working from home, dollars can be saved on real estate by incorporating work-from-home strategies in a more permanent way. Healthcare leaders may be able to shift these dollars long-term so that they can be used to help push healing spaces into communities, especially areas that are currently underserved.

Regardless, we need to think about these things as an ecosystem of connected parts. We tend to put things in boxes, whether it's professions or buildings or neighborhoods. We need to get out of the boxes and think more holistically. That's why I like ecology — it is not in a box. Species aren't in a box. They interact. They interact with the environment and I think it's that sense of an ecosystem, which I always go back to. That's what nature builds on.

Species exist together in a space and they have to get along. They might use the space differently, but it's the same space. My backyard must have 15 species of birds and they all use the environment differently. We need to think like that — a hospital can be an ecosystem.

Chris Haedt

AIA, ACHA, NCARB, LEED AP BD+C

Principal, Columbus Healthcare Practice Group Leader

Chris began his career at DesignGroup in 2007. With over 20 years of experience, he has earned a reputation for design excellence. He leads the Columbus Healthcare Practice Group and has worked extensively with key clients such as OhioHealth and Norton Healthcare. Chris is a leader within the AIA Columbus Healthcare Committee, has spoken nationally and is an Advisory Board member for Healthcare Facilities Symposium & Expo. In 2023, Chris received the AIA Young Architects Award, an honor bestowed to individuals who have demonstrated exceptional leadership and made significant contributions to the architecture profession early in their careers.

Healthcare

The Power of BIM Partnership: A Conversation with the BIM Managers of the New OSUWMC Tower Project

by Joshua Hostetler

BIM Manager

The Ohio State University Wexner Medical Center (OSU WMC) is one of the largest university health systems in the world. It comprises multiple specialty hospitals on its main campus in Columbus, Ohio, including the University Hospital, the Brain and Spine Hospital, the Richard M. Ross Heart Hospital, and, most recently, the James Cancer Hospital and Solove Research Institute.

In 2017, the Medical Center’s executive leadership turned to a partnership between HDR and DesignGroup to help determine how to add a substantial new University Hospital inpatient and surgical tower into its existing dense campus.

The two firms relied on advanced, and in some cases original, BIM methodologies and collaboration to manage it all. In all, 230 team members and 15 multi-disciplinary firms created 40 Revit models representing 1.5 million square feet of facility design.

In this interview, DesignGroup’s Joshua Hostetler and David Moore of HDR describe how the project came together and what it took to create such an ambitious and complex BIM implementation.

How did the HDR/DesignGroup partnership begin? When were you brought into the project?

Joshua (JH): I was brought on early, based on my experience with Ohio State projects and the advanced BIM standards they have. From the beginning, I understood the importance of heavy BIM oversight on a project of this size. My role as overall BIM Manager was to help guide the Architectural team as well as all consultants in a successful and collaborative effort.

When Dave joined the team we expanded our BIM efforts — coordinating daily and working to provide the best processes and workflows. As time went on, my role shifted to support Dave in the daily efforts to resolve issues quickly.

David (DM): I joined the OSU project during the Design Development phase. My role as Architectural BIM manager included supporting the team’s daily modeling questions and issues, building super families, mentoring users on proper documentation processes, and other roles. Joshua and I divided up the BIM Management tasks to cover all aspects, from MEP to architectural, to verify all modeling efforts were coordinated. With HDR as the design lead, it was our job to set the standards in terms of workflow, content, and clarity.

On a project of this size and scale, how did you help it all come together?

JH: There were a lot of complexities: breaking out and managing models, sharing content across so many teams, streamlining communication between all team members, and more. We knew from the start that communication and organization were an absolute must. Ohio State’s required BIM standards helped us easily define our deliverables and set a clear understanding of how we would use BIM throughout the project.

We knew the team was going to be large, involving many firms. To streamline collaboration, we did the entire project on BIM 360, an Autodesk cloud-based platform for organizing, distributing, and sharing files all on a single system. This workflow allowed for real-time collaboration between all the firms, which streamlined our ability to coordinate, communicate more effectively, and make informed decisions.

We also assigned a designated Model Coordinator to each model, both Architecturally as well as in each consultant model . This provided a point person to help maintain the integrity of their model and assure standards were being followed. This also allowed for all questions and other needs for that specific model to be filtered through one person. Dave and I met with the Architectural Model Coordinators weekly and the consultant Model Coordinators bi-weekly. These meetings allowed for regular communication on design changes, BIM needs, model issues, and more.

DM: Larger-scale projects like this one, 500,000 square feet or more, present unique challenges for the Project BIM Manager and Project Model Coordinators. Preparing a strategy for model break-up is vitally important — your models need to be set up in the most efficient way possible.

We break up models so that opening, closing, and saving times can be as fast as possible. We also do this so that each model is more manageable for the team members to work with. The more efficient the team can work results in less down time. Those time savings directly equate to budget savings.

We implemented a central location for all correspondence relating to graphic standards, approved content, and proper workflows. This was a way for us to have documented standards that each team member could refer to. We used the General Administration (GENAD) Model as a container file for standard walls, doors, view templates, and more. This allowed for easy distribution of project standards to all models and teams. And we also created a modeling process through Worksets within Revit that allowed for more control over all model elements. This allowed users to only work with what they needed leading to faster models, opening and saving times, and increased productivity.

Hospital Blocking Diagram — The Ohio State University Wexner Medical Center Blocking & Stacking Diagram

What are some issues you experienced that good BIM oversight helped resolve?

JH: Working with 18 Architectural models on a project of this size, we knew early on an issue would be keeping these models light, efficient, and problem free. Slow, inefficient models can quickly lead to massive time loss as well as major rework if proper modeling practices are not followed. From the start, we implemented a tool I created called the Model Health Check, which helped improve the performance of our Revit models and processes. This tool made us aware of our major problem areas as well as helped assist our teams in identifying and correcting inefficient modeling habits. The weekly Model Health Check reports we ran helped us optimize model performance, increase productivity, and reduce team frustration.

After a few months of using this tool, we worked with HDR’s digital team to implement a live report embedded directly into the Revit models. This allowed our teams to view a Health Report for their model in real time, updated every four hours. We used it to stay on top of most issues and help keep every model manageable for the team.

DM: One of toughest jobs as a BIM Manager is producing the most coordinated and efficient models for both team use and eventual model hand off to the owners. As team members enter the modeling environment, each individual brings their own strengths, weaknesses, and ingrained bad habits. Bad modeling habits present a unique challenge as there are a few key workflows that are frowned upon and can significantly impact the efficiency and health of the project. To alleviate modeling issues, and to keep the entire team productive, we employed an automated monitoring program that prevented bad Revit practices by tracking when certain tools and workflows were used. This tool also made it possible for us to make just-in-time suggestions to the team so they were aware of alternative solutions.

On a project this size, spaces or layouts can be highly repetitive. It is not uncommon in these situations to model that area once, group everything together, and copy that layout around. We went a different route and implemented the concept of super families (combining multiple families in a nested environment to create a full layout). This was done for several reasons: Groups are inefficient, add additional weight, and are often unstable. Taking this approach was the best solution for revising multiple spaces quickly.

Hospital Podium Model — DesignGroup's Model Health Check created by BIM Manager, Joshua Hostetler

How did the partnership between DesignGroup and HDR improve the BIM process?

JH: Having the two of us together allowed us to explore all options or potential solutions to issues in a very powerful way. Dave and I pulled from our experiences and looked for better ways to do things. We combined resources and implemented newly created tools to push the boundaries.

One example was a unique workflow solution called Sandbox Models. This process let designers work in detached models for design studies and client requests without having to constantly make changes in the live model. Once the studies were finalized, we could then swap the geometry in the live model with relative ease. This also made the live models more efficient.

DM: Through our combined efforts, our partnership often improved workflows and processes resulting in time savings and reduced rework. One example I enjoyed was how we shared and distributed our model content. We used BIM 360 and its central location to make all standard families easily accessible and consistent across all models and drawings. Storing this information in BIM 360 also allowed us to consolidate our Project Library making it clear to all users how to best access the correct content.

What lessons did you learn? How can you further improve BIM in the future?

DM: To be successful on large scale projects like OSU, you need to get out in front of potential pitfalls. This includes having a clear and concise understanding of owner’s expectations. It’s the best way to avoid tons of rework later in the documentation process.

JH: One area I feel we did better on in this project, but can always improve upon, is the amount of BIM oversight and when that oversight is brought in. BIM Managers or Project BIM leads need to be brought on board early to help plan, strategize, and set up efficient workflows that can be used throughout the rest of the project. The better your BIM plan, the more successful the project team will be.

With today’s aggressive project schedules, it is vitally important to use our tools in the most effective manner possible. BIM allows us to streamline this process and maximize our use of 3D models. We’ve found that there are significantly fewer RFIs when BIM is used correctly in all phases of a project. In addition, it allows the owner to see what he/she is getting with the aid of walkthroughs and accurate renderings. BIM has created a solid connection between design and construction that has never been felt before. Instead of asking how we can get architects, engineers, and construction managers to collaborate efficiently, we are now asking how we can use BIM to make the process even faster and more efficient.

This project plans to start construction Q1 of 2021 and open in Q4 of 2025.

Joshua Hostetler

BIM Manager

Healthcare

AI, Neurodiversity, and the Future of Healthcare: Insights from DesignGroup’s Advisory Board Event

by Kristina Bertocchi, Nicole DeFazio, Mike Forejt, Daniel Mathur

For over a decade, DesignGroup has partnered with Advisory Board, a national think tank committed to improving the healthcare industry through research, strategies, and practical tools for execution. Advisory Board participates in our annual Future of Healthcare event where DesignGroup architects present trends and possibilities in healthcare facility design and operations. Guests from across the healthcare industry gather to learn about and discuss these issues and how they might impact their systems.

This year, four DesignGroup architects spoke to an audience of 50 professionals about our core values, the use of AI in the industry, and the importance of inclusive design. Here’s what they had to say.

AI in Healthcare

By Kristina Bertocchi, Designer

Last year, Kristina attended the AAH/ACHA Summer Leadership Summit to learn from experts about the realities of current AI technology and possibilities for its use in the future. She shared what she learned.

The kind of AI we use, and that experts predict we will be using for the foreseeable future, is called Artificial Narrow Intelligence. This is AI that uses a specific set of data, runs it through an algorithm, and performs tasks that the algorithm is programmed to do.
Artificial General Intelligence is AI with similar capabilities to a human and Artificial Super Intelligence is AI that is more intelligent than a human. These types of AI do not yet exist.
The use of AI has become very prevalent in the healthcare industry, but it is not without its challenges. In one instance, hospitals and insurance companies used algorithms that failed to identify Black populations for high-risk care management programs.
“AI Hallucination” is a phenomenon where an AI will perceive things that don’t exist, creating outputs that are nonsensical or entirely inaccurate. Over time this issue will diminish, but it continues to challenge full faith in AI content.
Cassie Holmes, PhD, Professor at UCLA’s Anderson School of Management, encourages us to prioritize our time on things that bring us joy. Time saving tasks, such as a meal service plan, have been proven to increase happiness, regardless of an individual’s social or economic status. So let's let AI do the stuff we don’t want to do so that we can spend time doing what we love.

Inclusive Design for Our Neurodiverse Communities

By Nicole DeFazio, Interior Designer

Nicole is a big proponent of inclusive design. In her presentation, she addressed a growing area of architectural interest: design that accommodates the increasing number of patients considered neurodiverse. Highlights of her talk:

Neurodiversity does not mean disability, but simply refers to the spectrum of how our brains process information and react to external stimuli.
Historically, most interior spaces are designed for the “neuro-typical” person, instead of creating comfort for those who may fall along different places of the neurodiversity spectrum.
Inclusive design elements, such as flexible furnishings and incorporating spaces for both focus and respite, give staff flexibility to determine what is most accommodating for their patients and families who support them. When users have control over their environments, it can reduce stress and lead to increased satisfaction and innovation.

Sherm-isms and The 6 Things (and 1 other thing)

By Mike Forejt, Principal, Project Manager, and Daniel Mathur, Designer

Pioneering the future of healthcare requires sound, fundamental business and management practices. And no one at DesignGroup knows more about that than our CEO, Sherm Moreland. (Also, Sherm loves lists.) So Mike and Daniel explored what Sherm calls “The 6 Things” that are important to project success, and added one of their own to the list.

“The 6 Things” (Business Plan, Budget, Site, Program, Concept Plan, Schedule) serve as a checklist to ensure that we have all the necessary elements in place before beginning the design process. When all “6 Things” are followed, projects move forward smoothly, with less risk of setbacks or rework.
Mike and Daniel added Human Experience to the checklist to bring DesignGroup back to the core purpose of our work: creating spaces for the people who will use them. While the first 6 Things address logistical aspects of each project, the new Human Experience element reflects the values that underpin all the work that we do.
This updated checklist demonstrates that, from the earliest stages of a project, design can and should keep the needs and wellbeing of building occupants at the forefront.

DesignGroup is proud to partner with the Advisory Board to discuss the many ways architecture can support and improve the healthcare profession. To learn more, please explore our healthcare capabilities or connect with us to discuss your needs and interest.

Kristina Bertocchi

AIA, NCARB

Designer

More about Kristina

Nicole DeFazio

NCIDQ

Interior Designer

More about Nicole

Mike Forejt

AIA, NCARB

Principal, Project Manager

More about Mike

Daniel Mathur

AIA

Designer

More about Daniel

Jenna Glover

Project Architect

Healthcare

Part 3 | Addiction Recovery Design: An Example of Success

by Kristina Bertocchi

AIA, NCARB

Designer

Note: This article is the third and last in a series focused on substance-use disorder care. Our writer, DesignGroup Designer Kristina Bertocchi, looks at a substance-use center that includes a welcoming architectural face, an integrated structure, a consistent brand image, and a community partnership. We’re proud of her work designing for a more compassionate and equitable future. Please also see Part 1 and Part 2.

Part 1 in the series explored the social stigma that can be attached to addiction and, therefore, addiction treatment centers. As architectural designers, we can contribute to positive change by rethinking our own approach to the design of addiction centers.

Part 2 in this series examined four architectural potentials for addiction treatment centers to reduce the social stigma around addiction and to create a welcoming, community-based atmosphere.

When I began writing this series, I reached the end of part 2 and believed it was complete. The previous segment ends with an open call for us to design more accepting substance-abuse centers. But the problem remained: I had never encountered an example of a facility fulfilling the four potentials. That was until I found OneFifteen, an addiction-care organization in Dayton, OH thoughtfully realized by Champlin Architecture / EOP Architects-led design team.

As an architect, what drew me to OneFifteen was the welcoming image the building presents to its occupants and the community. But when I entered it, what struck me was the passion and care that every individual who is part of the organization exudes. I was given a tour of OneFifteen by their president and CEO Marti Taylor and let me tell you – it checked all the boxes from part 2 of this series. Here’s a closer look at why.

1. A positive face to the community

When you approach the building, its exterior is up to date, stylish, and comforting. There are two free-standing buildings at this location, the Outpatient Treatment Center and OneFifteen Living. Between them sits a park-like enclosure that is full of life. It holds a community garden, walking paths, and recreation areas.

Inside both buildings is a thoughtful interior palette that Marti said was created through the lenses of trauma-informed spatial components. The design includes wood slat ceilings, green walls, and carefully selected color palettes, all contributing to an overall sense of tranquility and acceptance.

When I asked Marti how patients reacted to the physical space – and whether they commented on its caliber – she replied, “Always. And more as a thank you.”

2. Integration in whole health

I was particularly interested in the third part of the system, the Crisis Stabilization Unit. This unit is embedded in a vacated emergency department and is a short walk from the other two buildings.

“This is where we get a lot of drop-offs from EMS, police, family members, self-referrals, and people in crisis,” Marti told me. They can stay there for up to 23 hours like an ED, and then a decision is made: Will they go upstairs to the third floor (which has a slightly higher intensity level of care than OneFifteen Living) or will they head down to OneFifteen Living and then go to outpatient? “With this model,” Marti said, “all levels of care are on one campus.”

Because of their connected buildings and centers, OneFifteen allows patients to go through different stages of recovery without having to leave the system or their found community. The easily accessible and highly visible crisis center has helped Emergency Departments in the area more efficiently provide their care. By physically placing different levels of care side-by-side and using unifying brand aspects across the buildings, OneFifteen has created a successful integration that both patients and staff appreciate.

contemporary building exterior with wood paneling

3. Consistency and superior product

In the last blog post, I used Starbucks as an example of consistency. Thanks to the stability and quality of the products at Starbucks, it has become a staple for people from various walks of life. The facilities at OneFifteen feel the same to me. They are open and accessible to people from all financial backgrounds who need services. They provide a sense of space and community that makes anyone feel welcome.

Marti Taylor was rightfully proud to tell me that the average demographics of the facility’s patients closely mimic the demographics of Dayton as a whole. When walking through OneFifteen, patients would pull Marti and me aside to tell us how much of an impact the organization has made on them.

Because of their space, staff, and systems, OneFifteen has a Net Promoter Score to be proud of. “We're better than Starbucks,” Marti said with a laugh.

4. Community integration

When OneFifteen was initially announced, the surrounding community expressed some unease. Because of the present stigma of substance-use disorders, this is a common issue for new centers. But OneFifteen leadership was determined to get the community on board. Through collaboration and open communication, OneFifteen convinced the community it was a smart move – and had data to back it up.

To ease the community’s concerns when it opened, OneFifteen added architectural accommodations to enclose the area without it feeling restrictive. Four hundred trees were planted along the boundary of the facility to give a natural feel while also creating a boundary. The exterior space is so inviting that after construction, the same community asked if they could have access to the park space for recreation and walks.

It was through cultural sensitivity and active listening that the organization was able to not only break through barriers but also bring the community together.

Now, OneFifteen meets with the Dayton Police Department every quarter to look at statistics. And interestingly enough, over the last three years since OneFifteen’s founding, crime rates in this community have gone down.

After my tour of OneFifteen, it became even more clear that the services they provide are the way through the addiction crisis. “I'll never forget it because of all the places I went, this one made me see the light. I say that from the bottom of my heart,” one patient told us.

To join the cause, architects must begin to think of the spatial components that can be brought to substance-use care, such as trauma-informed architectural practices, the exterior image of a building, and the connection to existing services through visible characteristics. But we know that there’s more to reducing stigma and providing care than just architecture. These centers need funding, staffing, leadership, and partnerships. In addition, how we fundamentally think about substance-use disorders is at the core of providing exceptional care.

By taking a moment to review motivating factors, potentials, and this story of success, I hope you feel more informed. My goal is to spark thoughtful conversation and encourage action in your respective fields and lives. If we all spread awareness and contribute just a little, we can make big leaps toward ending this crisis.