Healthcare

From Virtual to Real: An Early Architect’s Path to Career Immersion

by Marissa Andrews

RA, LEED AP BD+C

Project Architect

There was a time during graduate school, just a few years ago, when it was hard for me to imagine working side-by-side with a client and fellow architects and planners on a project, let alone one of real significance.

I was halfway through my master’s program at Miami University when the pandemic hit. Many of my classmates lost internships because firms were uncertain how long COVID isolation would last, and whether or not projects would continue – or start at all. I, however, was one of the lucky ones. DesignGroup had offered me a summer position and honored the commitment. It was the opportunity I needed, at a time I thought it might never happen.

This was the summer of 2020, and despite working from home, that internship introduced me to DesignGroup’s largest project ever: the new 2 million square foot Inpatient Hospital at The Ohio State University Wexner Medical Center. Within days, I was working on actual construction drawings. I could hardly believe it was happening.

My internship consisted of many, many Teams calls and OneNote checklists our team used to collaborate virtually. Despite the isolation from one another, we made it work, and I came out of that summer having learned a ton — with the specific goal of continuing in healthcare architecture.

_{Aerial overview of the OSUWMC campus.}

Fast Forward

A year later, DesignGroup offered me a full-time position and I’ve been working in healthcare design ever since. It was a dream come true, and yet not at all what I expected. Yes, by now we had all returned to the office. But in my case, the office was still kind of remote: a construction trailer in the shadow of that massive new inpatient tower at OSU. For more than a year, I got to see the project I worked on as an intern actually be built!

I loved my time on site – I could spin my chair to ask questions or walk into the building itself to check on something specific (like inwall details or toilet pod installations). Watching what I drew on paper become real and seeing for the first time the various issues that come up during construction, influenced how I will document projects for the rest of my career.

_{View of an inpatient floor under construction during Marissa's first week on site at OSU.}

In the background of working on this and other projects, I was studying hard to take the six exams required to become a Registered Architect. My original goal was to be done with the exams within two years of finishing grad school. After struggling to study and work at the same time during my first eighteen months post-graduation, I decided the best thing to do was focus on work to get the experience I needed to pass. Two years later, in 2024, I passed my final three exams.

Just as I’d hoped, those two years working proved to be formative and inspiring. My DesignGroup managers assigned me to the new emergency department at the OhioHealth Trauma and Critical Care Center at Grant Medical Center, which I got to see from the end of schematic design through construction documents. In early phases, I worked with planners to imagine the space in different ways, and I helped the senior project architect draw details that would bring the design to life. I helped design and build different mock-ups of the treatment room, and I was in every client meeting, working directly with them to create the best space possible.

_{Grant treatment room mock-up where we worked with users to get all the details right.}

After all that, preparation for those exams was much faster and easier. I was able to connect study materials and test questions to my experiences with Grant and The Ohio State University. It was not the path I had planned, but I came out a better architect. That experience made all the difference. I’m now working on OhioHealth’s Dublin Methodist Hospital Expansion, and I couldn’t be happier. It’s the largest planned expansion for the Hospital since it opened in 2008.

Mentorship is Key

During my time on each of those projects, I worked with experienced teams from both DesignGroup and our partner firms. I always had someone to turn to with my questions. I was good at asking questions; during my internship, I called senior project architects with even longer lists of queries, which they would patiently go through one by one. Today, instead of questions about markups I’d been given, I ask about details I drew from start to finish, to get them just right.

Without the mentorship I received, I would have been overwhelmed by these large-scale projects and their hundreds of sheets of drawings. But DesignGroup took the time to help me understand both the details and the big picture. It prepared me to be a Project Architect who is confident in tackling projects of any scale, from small, single-room renovations to a new patient tower. I will always be thankful for the teammates and mentorship that got me to this point.

Marissa and DesignGroup team touring the hospital tower construction site

_{Site tour of the new OSU Inpatient Tower with DesignGroup founders.}

DesignGroup is working with HDR and The Ohio State University Wexner Medical Center on the New Inpatient Tower for the Wexner Medical Center.

The OhioHealth Trauma and Critical Care Center at Grant is designed by CannonDesign in collaboration with DesignGroup.

Marissa Andrews

RA, LEED AP BD+C

Project Architect

More about Marissa

Healthcare, Community, Commercial

Insights and Inspiration: Our Five Most-Read Articles of 2020

Two years ago, we made a commitment to share more stories of the projects, experiences, and partnerships that happen every day at DesignGroup. We wanted to give our people a platform for their unique perspectives, and they did not disappoint. Last year alone, nearly a third of our staff shared their opinions, inspiration, and expertise.

And our followers really responded to it. How do we know? Like any business committed to continuous improvement, we looked at the data. Our 10 most popular articles alone were viewed nearly 3,000 times and made more 11,000 impressions on social media. The number of readers opening and viewing our email newsletter was, consistently, nearly double the industry average.

We’re proud to share the inner workings of our industry and inner thoughts of our associates. We’ll keep it going in the year ahead. This week, however, we’re looking back on our five most popular posts from 2020, in case you missed them the first time.

5. If All the World's a Stage, I Want Better Lighting

More than 40% of electricity used in healthcare facilities goes toward lighting, and yet too often thoughtful lighting designs are overlooked when a project is more focused on patient-centric care. Anastasia Markiw explains how she uses dynamic lighting to promote healing and comfort, assimilate elements found at home, and allow the staff to perform their jobs effectively.

4. The Grand Opening Blues: When a Project Team Moves On

The conclusion of an architecture project brings different emotions. For those who use the new space, it’s an exciting beginning. For the professionals who designed it, it’s the end of an intense and fruitful relationship. John Ryan reflects on the moment when client and team members go their separate ways.

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

Building information modeling, or BIM, provides powerful 3D design and review capabilities to any project. When the project is this big, though, it needs to be managed with extra care. In this deep-dive Q-and-A, BIM managers from DesignGroup and HDR describe their successful collaboration on a massive new OSU Wexner Medical Center project.

2. Returning to Work Soon? Make the Most of It

In a new world of Zoom, Teams, and Webex, collaborating with your coworkers can prove much harder than it used to be. In this article, Nikki Wildman gives five rules for engagement in a post-Covid workplace that mixes in-person with virtual collaboration. “Humanity is on our side!” Nikki writes. “Cherish the opportunity to work together; be patient and poke fun at the meetings in this strange, new normal.”

1. What’s Next for Workplace Design? Five Trends To Understand

Let’s hear it for Nikki, who wrote both of our top articles of 2020. In this one, from last August, she looks at the future of workplace design. As the world adjusts to work environments that balance work-from-home with in-office productivity, there are lessons to be learned. “Will the pendulum finally swing back from open-office to the private office?” she asks. “Or is the office itself a thing of the past?” Here are five design trends she says we should watch for.

Healthcare

Inpatient Room Design: Five Time-Tested Strategies for the Future of Your Hospital

by Chris Haedt

AIA, ACHA, NCARB, LEED AP BD+C

Principal, Columbus Healthcare Practice Group Leader

Let’s be real – no one wants to stay in a hospital. Until we create a medical ward like Star Trek, where diagnosis and cure are provided almost instantly, we’ll need hospitals and beds. And as we’ve discovered in 50 years of healthcare design, there are always ways to improve them. The best institutions are never satisfied. They always seek new ways to serve and accommodate patients, visitors, and staff.

So if you aren’t thinking about revitalizing your beds, or evaluating the number you have, it’s probably time you did. The best way to start is by defining what you need, then applying strategies to get it right. Here are five future-focused ideas to consider, and some real-life examples that show what’s possible.

1. Improve Bed-to-Care Dependencies

In a hospital setting, not all beds need the same considerations. As you think through any bed expansion, it’s critical to understand the inter-dependencies those beds have with other services in the hospital. For example, DesignGroup recently assisted a hospital client expand its facility. As a PCI-designated stroke center, understanding the relationship between its ICU beds and the rest of the hospital was crucial for ensuring life-saving care. Most of the patients in neuro specialty ICU beds enter through the emergency department, and from there speed is essential for imaging and surgical interventions.

Yet even more important is how these patients (in their most delicate and vulnerable state) are transported from the surgical department to their patient rooms. During that journey, there isn’t a lot of life-saving infrastructure in hallways or elevators, so placing ICU rooms a short distance from the surgical platform helps get patients to a stable location as quickly as possible. The alignment of these floors allowed the clinical team to move quickly between all stages of the care process.

Healthcare design is about putting decisions like these into perspective. A friend of mine recently experienced this stroke-care journey. Although his case was rocky, his amazing clinical team – and the improved alignment of emergency care and ICU bed – saved his life. And for that I am forever grateful.

nurse walks down hospital corridor — Washington Health System CARE Center for Family Birth & Women's Health

2. Simplify and Update

Patient rooms today have changed from their original design intent. As many hospitals upgrade their inpatient floors, simplicity is key. It allows uniformity for staff between old and new units, ease of use by patients and family, and cleanability for infection prevention.

As DesignGroup worked through this process with a recent bed tower expansion, our team worked hand-in-hand with clinical leaders and hospital administration to define both the pain points and successes of their current inpatient floors. For this project, most of our work involved editing the original room by studying and discussing what could be removed or integrated in a better way. This wasn’t only about the perspective of infection control, maintenance, family, or staff, but also included how the space looked and felt – making sure it would work within the culture of the hospital.

The result of this exercise: a room design that echoed what had worked in the previous design but brought new improvements to patient satisfaction, better meeting the clinical team's needs through contemporary headwalls, new medical fixtures, and bright and welcoming finishes. Bringing in a simplified design also allows for ease of integration of forthcoming technologies, allowing the room to adapt long into the future.

inpatient room — Mercer Health Tower Addition Patient Room

3. Design for Flexibility

In every conversation I have with hospital leaders, a major pain point is the possibility of shutting down beds. As many health systems deal with staffing shortages (especially in more advanced care settings), leaders are looking to flex or cross train their staff for greater flexibility on bed floors. From disrupting the care team ratio of the unit, to backing up services elsewhere in the facility, most health systems want to keep their beds open and operational if they possibly can.

That means if you’re starting any bed project and evaluating if you have enough (or too many), you should discuss flexibility. And it’s best to look at it in a multi-faceted way: in terms of clinical care, maintenance, and a mindset of future possibility. In a recent project with a clinical team, the big-picture discussion was about building ICU-level care on all floors. But starting day one only one true ICU floor and two medical/surgical floors that could be upgraded. Each updated room would use a modular headwall/footwall system, allowing for the easy transition in the future to additional medical gasses and power needed in an ICU room without heavy construction.

Most important with flexibility is anticipating how technology could change in the future. Hospital beds are designed years before they are ever implemented. Using these modular systems in rooms means quick and easy transitions from, for example, a more analog patient care board to a fully integrated digital patient care system. While modular solutions should be evaluated to meet specific goals and budgets, it can be a very effective way to reduce downtime and future-proof room design.

4. Think Holistically

When you establish a patient room, it’s not just for them, of course. It needs to serve a wide array of people who will be in and out of it, around the clock, during the patient’s stay. Our job is to design rooms to reduce stress for all of them. And one way to do that is to build upon the different room zones: care team, patients, and family.

For the patient and family, we try to provide as much comfort as possible to accelerate recovery. This is where we can learn from hospitality – in this sense, we are catering to the consumer. Patients and family want comfortable, clean environments that affords them ownership of the space for healing. Clinical teams on the other hand need to monitor their patients. Our job is to help reduce the footsteps into the room to check in on a patient, help improve the visibility to the patient, and reduce the clutter of the items that may need to provide the care.

Simple concepts can be applied to keep staff organized, while helping reduce the perception of “institutional-ness” in the room, such as not mounting glove box holders on the wall. Instead, adding integrated storage solutions to the casework allow these items to be organized and out of sight. Finally, we want to minimize the time spent servicing and maintaining these rooms. From materials management to EVS, we look for ways maintenance staff can access the room without entering it – using concepts like double-sided nurse servers and inboard toilet rooms.

hospital registration area — Mercer Health Tower Addition

5. Listen to Your Teams

When we talk about the room of the future, it usually involves technology. But in my opinion, the room of the future has many connotations. Whatever you do, it should be rooted in the culture of your institution. If you can’t make it “sticky” with your culture and staff, it’s an investment that may not pay off. I recommend taking a deep dive with your front-line care teams – what are their pain points and aspirations? Speaking with staff recently, one of their frustrations was simply spending time messing with remotes and TV functionality, and getting things for the family members. The solution was finding systems that were easier to interface with – touch screen panels at the bedside table, for example – that allowed for the control of MyChart or the TV channels.

To the Future

With the introduction of AI and new technologies, we are on a rapidly changing road. We are already seeing remote patient monitoring with cameras and wearable devices that allow clinical teams to keep an eye on patients without the constant disruption into their rooms. Very quickly we might see this shift to integrating holographics or other digital technology bringing advanced specialty care and people into the patient room (something I’m sure we all wished we had during the pandemic). These are all just applied technologies, and they should be seen as supportive tools that enhance the care delivery and culture of your institution.

A friend of mine recently told me that what she loves about our industry is that we are always looking forward to “what can be.” Any inpatient renovation can be a huge undertaking, and these rooms need to be able to function 10+ years into the future. Remembering these five basic strategies can help create flexible spaces that adapt over time to your needs, your people, and your culture.

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

Empathy for Family and Caregivers: How Inpatient Room Design Can Do More

by Angela Kolosky

ACHA, AIA, NCARB, LEED AP BD+C

Principal, Healthcare Planning Market Leader

When designing inpatient rooms, no matter the specialty, countless details must be anticipated. Have we mitigated fall risks? Can providers easily access the patient? Are supplies and meds easily restocked and close at hand? Patient and medical staff needs are paramount.

But what about family members and caregivers? Their space in an inpatient room is often the last to be factored into a project – and with varying success. In the last few decades we’ve seen some improvement (especially with the advent of the private patient room) but many inpatient rooms still overlook the needs of loved ones caring for a family member or friend.

And that’s a shame, because these are more than visitors. They’re an important part of the healing process.

Designing a patient room that’s empathetic to these users can be broken down into two fundamental objectives: Helping caregivers as they interact with the patient, and helping as they themselves exist in the space.

Care for the Patient

Having a friend and family caregiver in the room is so important for patient well being – for both psychological and physiological benefits. Sometimes referred to in research as patient guardians, caregivers not only provide companionship within the hospital setting, but can also be an advocate, provide spiritual and psychological support, ensure patient compliance, and aid in personal hygiene and toileting needs, among others (Gwaza and Msiska 2022). In a study about the impact of family presence on patients’ outcomes, it was found that both patients and healthcare providers felt that family members had a positive impact on healing, pain reduction, sleep, reducing anxiety and depression, length of stay, reducing risk of falls, and improving overall patient satisfaction (Fakhry and Mohammed 2022).

As I’ve written before, I love reflecting on my own hospital experiences to inspire design solutions. I remember caring for a loved one during their hospital stay, and how the simple act of washing her hair with her own shampoo (versus what the hospital provided) made such a difference in her demeanor. She was brighter, more alert, and engaged. While it may have been the warmth of someone caring for her, the washing away of a multi-day, bed ridden stay, or the simple aromatherapy from her favorite product (or all three!), there’s no question it improved her emotional and physical state.

As the person trying to give her a shampoo, however, I struggled to do it easily. Despite the room being a new build, I couldn’t run the water long enough to easily fill the small bucket, nor could I get it warm enough. No work surface near the patient bed meant an awkward balancing act as I tried not to soak her. While the primary function in any inpatient room is in support of clinical care, minute changes can have a strong impact on the ease of the family member and caregiver in navigating their environment. I keep these real-world needs in mind on every new project I’m a part of.

nurse prepares bed in inpatient room — UPMC Mercy Hospital patient room with flexible, multi-purpose furniture

Care for Themselves

Let’s be honest: a lot of time in a hospital is spent doing very little. For patients, that often means precious rest. For family members…well, it’s just waiting. And that creates challenges to their own physical and psychological comfort.

Before COVID, in an effort to give family and caregivers respite from the patient room, communal spaces were added to many patient units. Post COVID, these spaces have been under used as family members and caregivers choose to stay in the room. Not just for an infection prevention standpoint, but also for simple proximity to the patient and physicians making rounds.

Increasingly complex patient acuities require caregivers to navigate more interactions with hospital staff. An inpatient study from 2002 to 2017 found that patients are more likely to have multiple co-morbidities and medications, more likely to experience an adverse event, and are more likely to be treated for multiple acute medical issues when admitted through the emergency department (Lowry 2024). And the COVID pandemic further accelerated this shift. The result: family members and caregivers are spending even more time in the hospital setting – and experiencing higher stress.

Another real-world example: I recently spent time with a friend who was hospitalized for multiple days. I had spent the night so their partner could return home for rest. The room was designed to have a recliner at the patient headwall and a built-in (and very uncomfortable) “couch” at the footwall. When the partner returned, I offered the recliner so he could be closer to the loved one. As the patient slept, we attempted to decompress by watching TV…which was directly over my head. Nowhere in the room was there additional seating or comfort. Worse, when the rounding physician came in, it was difficult for us both to feel heard and understood. Which, of course, strained the provider in their attempt to meet the clinical needs of the patient and provide empathic communication with us.

Ideas for Better Room Design

How can we improve these inpatient experiences? One way is to engage with family advocates to understand the nuances of the caregiver experience. Patient room design traditionally has the standard zones: for providers, patient, and family. But reality is much more complex than that. Designing flexibility into sink areas, worksurfaces, and even the patient head wall can help both the clinical team and the family member feel less confined and more at ease while providing care and support.

Modular and mobile furniture solutions have a high potential here for improving flexibility and allowing the room to be rearranged to meet varying needs throughout the day. For instance, if the patient has two visitors, the room can be arranged to allow both to sit at the head of the patient as opposed to one being relegated to the foot of the bed.

Just as clinical teams are adapting to meet more complex patient needs, so too must the patient room adapt to the needs of complex care teams that include friends and family members. By designing for flexibility and the guest’s emotional and physical needs, we can create rooms that are more adaptive and empathetic to all who spend time there.

woman sits in chair in inpatient room — Norton Giles patient room featuring mobile furniture solutions

References

Fakhry, Mohamed, and Wisam Mohammed. 2022. "Impact of family presence on healthcare outcomes." Alexandria Engineering Journal Volume 61 (Issue 12): 10713-10726. doi:https://doi.org/10.1016/j.aej.2022.04.027.

Gwaza, Elizabeth, and Gladys Msiska. 2022. "Family Involvement in Caring for Inpatients in Acute Care Hospital Settings: A Systematic Review of Literature." SAGE Open Nursing 8: 1-15. doi:10.1177/23779608221089541.

Lowry, Fran. 2024. "Hospitalized Patients Have Become More Complex Over Time." Medscape Medical News. 01 18. Accessed 04 18, 2024. https://www.medscape.com/viewarticle/hospitalized-patients-have-become-m....

Angela Kolosky

ACHA, AIA, NCARB, LEED AP BD+C

Principal, Healthcare Planning Market Leader

More about Angela

Healthcare

Inpatient Room Evolution: Five Ways to Improve Light and Sound

by Riley Zollars

NCIDQ, Associate IIDA, LEED AP

Associate Principal, Senior Interior Designer

When I think of healthcare design, a quote from Maya Angelou often comes to mind: “People will forget what you said, people will forget what you did, but people will never forget how you made them feel.”

Few places activate intense feelings like a hospital.

A hospital visit triggers an array of emotions in patients and their families – many of which are less than warm and fuzzy. In fact, the experience can be sensory overload. Unfamiliar sights and sounds envelop them as they enter and interact in the building. While great care is put into the physical design of a space to supplant negative impressions, there are also intangible elements that play an equally important role in how patients, guests, and staff feel: the light and sound. Both are important in support of physical healing and mental well being.

The inpatient room is a great space to examine this. When you enter a patient room, you rarely focus on the light and sound – unless they’re particularly bad – because there’s a general acceptance that lighting is what it is, and that hospitals are inherently noisy environments. Unfortunately, that mindset can have a dramatic effect on the health and wellbeing of both patients and clinical staff. They should never be underestimated. Here’s why.

inpatient room bed and headwall — The sights and sounds of a hospital are often overwhelming for patients

Let There be Light

Lighting design integrates both artificial and natural light. Well-designed lighting that mimics natural daylight patterns can support the synchronization of patients' circadian rhythms, which promote physiological processes, natural repair mechanisms, and immune function.

And beyond the benefits to patient and clinical staff wellbeing, proper lighting increases visibility and reduces hazards. Well-lit spaces promote infection control by aiding in the identification and removal of potential contaminants. Ideal lighting levels minimize the risk of trips, falls, and other accidents for patients, caregivers, and visitors. This is especially important for elderly and geriatric patients who need more light due to yellowing of their lenses as they age (Salvi, Akhtar and Currie 2006).

Here's how DesignGroup optimizes lighting in patient settings and why it makes a difference.

Light Temperature: A light’s color (also known as temperature), along with its color rendering index (CRI), is important for both proper viewing of the patient and reduced eye strain during detailed work. Color temperature around 4000K is ideal as it is considered “natural light” by color reference scales (Rock 2023). Natural light promotes bright spaces with clarity and consistency. More importantly, this color temperature also blends well with daylight that enters windows in the patient room.

Controls: Controlling light is just as crucial for patients to heal within their spaces as it is for clinical teams to perform their tasks. Within the room, patient function lights can allow for both patient and family to adjust lighting needs simply and easily by selecting a pre-set control, such as exam, reading, ambient, etc. Combining these pre-set controls with different light zones within the room means a patient can sleep, a family member can read, and a clinical team member can administer medication all with appropriate lighting levels.

Shades: Just as artificial lighting controls are important, so are controls for daylighting. Providing dual shades with both a small weave and a blackout option means patients and family can choose the appropriate light for the moment. Allowing daylight to reach a patient can help the healing process and decrease length of stay; studies have shown that proximity to windows in a multi-patient room meant a reduced LOS (length of stay) for patients closest to the windows (Park, et al. 2018).

inpatient room with large window and nature views — Large windows provide natural light to patient rooms at Norton Brownsboro Hospital

Lowering the Volume

Hospitals can be incredibly noisy spaces. Between patients and their amenities, collaboration at nurse stations, overhead paging, and medical equipment alarms, this cacophony can be detrimental to patient and staff health alike. A study found that at times, hospital noise can peak to 85 decibels A (dBA), exceeding the noise level of heavy traffic (Joseph and Ulrich 2007). Gentle and soothing sounds can create a tranquil space, reducing stress and anxiety levels while masking disruptive equipment noises.

Types of Sound: While lowering volume is important, masking sounds can also promote healing. Allowing patients to choose from different masking sounds (such white or brown noise, nature sounds, or even their favorite radio station) can impact them positively. Music in particular has been shown to reduce stress, heart rate, and blood pressure by reducing the production of cortisol, and specific favorite songs or artists can positively affect the pleasure center of the brain (Shapiro 2022).

Sounds and Staff: While we often think of noise reduction for the patients’ benefit, it’s easy to overlook the effect it has on clinical staff. With already increasing concerns for provider and staff burnout in the healthcare industry, sound, particularly with alarms, is yet another contributing factor. A recent article of collected research showed that medical alarms (pumps, ventilators, etc.), even for innocuous events such as rate change, can lead to medical errors and fatigue (Jawadi and Chern 2023). Designing to prevent an accumulation of sounds on staff can help them respond more appropriately when an alarm does sound indicating immediate need of medical attention.

In every healthcare project, DesignGroup explores opportunities for thoughtful integration of lighting and sound to enhance the overall sensory experience for both patients and caregivers. It’s vital for reducing stress, burnout, and errors, and increasing healing, positivity, and overall well being. Next time you’re in a hospital, think about the ways these intangibles affect your own emotional and physical state and of those around you.

References

Jawadi, Zina, and Alexander Chern. 2023. "Hospitals are noisy. They don’t have to be." Association of American Medical Colleges. 08 10. Accessed 04 23, 2024. https://www.aamc.org/news/hospitals-are-noisy-they-don-t-have-be#:~:text....

Joseph, Anjali, and Roger Ulrich. 2007. "Sound Control for Improved Outcomes in Healthcare Settings." The Center for Healthcare Design (4): 1-17. https://www.healthdesign.org/sites/default/files/Sound%20Control.pdf.

Park, Man Young, Choul-Gyun Chai, Hae-Kyung Lee, Hani Moon, and Jai Sung Noj. 2018. "The Effects of Natural Daylight on Length of Hospital Stay." Environmental Health Insights Volume 12: 1-7. doi:10.1177/1178630218812817.

Rock, Garrett. 2023. "Improving Healthcare with Human-Centric Lighting." Insights by Alcon Lighting.November 8. Accessed 04 23, 2024. https://www.alconlighting.com/blog/lighting-design/improving-healthcare-....

Salvi, S M, S Akhtar, and Z Currie. 2006. "Ageing changes in the eye." Postgrad Med 82: 581-587. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2585730/pdf/581.pdf.

Shapiro, Marc. 2022. "Harnessing the Healing Power of Music." Johns Hopkins Medicine. 08 31. Accessed 04 23, 2024. https://www.hopkinsmedicine.org/news/articles/2022/08/harnessing-the-hea....

Riley Zollars

NCIDQ, Associate IIDA, LEED AP

Associate Principal, Senior Interior Designer

More about Riley

Healthcare

AI and VR in the Hospital: The Inpatient Room of the Future

by Kristina Bertocchi, Ken Redman

Very few things dominate the national conversation like artificial intelligence (AI). For every person enamored with the potential of ChatGPT and its brethren, there’s someone else decrying these platforms as a workplace cheat code that will potentially put people out of jobs. How it will all play out is unknown.

But here is the reality in healthcare: Trends suggest the workforce is dwindling and shortages in nursing seem inevitable. AI could help alleviate some of those workforce needs, and allow us to use the existing workforce more effectively. It could speed up diagnostic recommendations. And it could help wrangle the terabytes of data the industry generates and do more with it. Equally interesting, though not yet talked about as much, is the role of virtual and augmented reality in healthcare settings.

These technologies can be a miracle for rural and other patients, for example, who today have limited access to specialist care. With these possibilities come considerations, of course. There could be legal and ethical questions, along with the learning curve and adoption by staff who are used to tried-and-true practices.

At DesignGroup, we’re always exploring how new technologies can advance the improvement of healthcare service, safety, and chains of command. In fact, Kristina (co-author of this article) is currently planning and will moderate a special session on technology Summer for the Leadership Summit this July, sponsored by the American College of Healthcare Architects’ and the Academy of Architecture for Health. Our panelists will discuss how leading hospitals and designers are grappling with both the amazing possibilities and unknown perils of AI-powered healthcare.

It’s a rich topic and we’re looking forward to sharing what we learn from the panelists. Until then, here are some initial thoughts on AI and VR, and how we think it could improve experiences for patients and staff alike.

woman sits at desk in medical office building workspace

Artificial intelligence (AI): technology that enables computers and machines to simulate human intelligence and problem-solving capabilities.
(https://www.ibm.com/topics/artificial-intelligence n.d.)

AI applications in healthcare could range from life-saving treatments based on predictive analytics to managing routine and time-consuming tasks that increase the amount of time a caregiver spends with their patients. Again, let’s look at the drivers AI could solve. We have a clinical shortage and burnout is becoming more relevant as well. There is also a need for higher levels of clinical effectiveness. The nursing shortage is real and many related tasks could be performed with AI: automated documentation, collection of vitals, and bed turns, allowing nurses to download patient history from the previous shift. In fact, this is already in practice in some hospitals. (Holston Sept 2022)

Wearable devices and/or sensors embedded in the room infrastructure could continuously collect vital signs and other data, enabling healthcare professionals to detect early signs of deterioration and respond with faster intervention. AI can create more time for physicians and care teams to research and diagnose underlying medical conditions and accelerate healing, with reduced cost.

In terms of direct engagement with the patient, chatbots could provide instant, 24/7 availability for patients to ask questions, report symptoms, and track their health progress. The idea that a virtual “care companion” could listen to and build a relationship with the patient has lots of potential; AI would be alongside them during their journey, accessible at any time.

Virtual reality (VR): an artificial environment which is experienced through sensory stimuli (such as sights and sounds) provided by a computer and in which one's actions partially determine what happens in the environment.
(https://www.merriam-webster.com/dictionary/virtual%20reality)

VR technology has potential for helping lower patient anxiety, reduce boredom, and even alleviate pain. Virtual reality and augmented reality headsets can create immersive experiences that allow patients to visualize their conditions and treatment options more effectively. Imagine a surgeon using VR to simulate a procedure you or a loved one will experience. This could help them explain the process to you and reduce the unknowns. (We don’t know if we would need or want to see everything, but we love having it as an option.)

VR headsets could also simulate relaxing environments for patients in extended stays, or those who struggle with confinement in the bed or room. Apple’s VisionPro VR simulates IMAX-size movie environments in an easy-to-manage headset that is self-contained and untethered from a PC or gaming platform. It’s believed that VR could aid in pain management, too, by providing a distraction for patients recovering from painful procedures, helping them relax, and contributing to their overall well being.

woman wearing VR headset — VR headsets can be used to simulate procedures, relax patients, or provide entertainment.

While many changes like these coming to the inpatient room are virtual, the space and personal experience is still (and always will be) physical. Creating a physical space that is working with, not against, the technology is crucial. We should strive to strike a balance between clinical functionality and hospitality comforts to create healing environments that feel less institutional and more welcoming.

Advances like these have so much promise to remove the burden of rudimentary tasks on nurses and physicians, allowing them to provide even greater hands-on, empathic clinical care. It also has the possibility of easing the experiences of long-term patients, fostering quicker recoveries, and lessening the emotional toll of a hospital stay.

Kristina’s panel discussion with Cleveland Clinic’s Director of Planning Travis Tyson and Anita Smarth, CEO of Clinovations Government + Health, will take place during the July 26-28 Senior Leadership Summit. To learn more, please visit https://healtharchitects.org/summer-leadership-summit-sls/.

Kristina Bertocchi

AIA, NCARB

Designer

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Ken Redman

AIA, ACHA, LEED AP BD+C

Senior Healthcare Planner

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Healthcare

Patient Centered Design - A Shift in Perspective

by Kendra Brown

Marketing Manager

As 2016 comes to an end, many people find themselves reflecting on the year, their accomplishments and how they can improve in the year ahead. As a marketer for an architecture firm, part of my job is to think about what healthcare clients’ needs are for their facilities, what keeps them up at night and how our team can help them achieve their goals. As a patient, I’ve had the unsolicited opportunity to see it from a different perspective. In April 2016, I was diagnosed with cancer. Over the last eight months, I’ve had more than 70 appointments with physicians, surgeons, nurses, oncologists, genetic counselors, radiation experts and various other cancer specialists. Needless to say, I have spent a lot of time in healthcare facilities this year.

After years of writing about how my firm finds design solutions for healthcare environments, I now find myself thinking about it as a patient. What could make my experience and the experience of other patients more enjoyable? Trust me, there’s nothing you can do to make chemotherapy feel as relaxing as a massage at a posh spa, but I do have a few ideas on how design elements can contribute to a more tolerable experience for patients.

Amenities or Necessities?

Consider the dozens of hours spent during imaging, chemotherapy, surgery consultation, radiation and physician appointments in waiting rooms, exam rooms and treatment spaces. While anxiously waiting and receiving care in these spaces, two things can make or break a patient’s experience: the quality of care they receive and the facilities in which they receive it. I am fortunate to say that I have had the best care imaginable. I had a smart and thoughtful team of cancer experts that mapped out a strategy to save my life, and it worked. While I do not take that lightly, the actual treatment is just half of the equation. The physical spaces in which patients receive care undoubtedly contribute to the healing process. Before I was a cancer patient, I didn’t realize how much this mattered. Reflecting back on my recently completed treatment, I want to share just a few key design elements that influenced my experience.

Patient Privacy

In my opinion, patient privacy is one of the most frequently discussed, yet least thoughtfully executed elements in healthcare facility design. Physicians discuss cancer and other major illnesses every day with patients, perhaps as nonchalantly as someone giving you directions in a foreign country, taking for granted that this is a completely new and unfamiliar subject matter. However, as a patient dealing with a new normal and uncertain future while absorbing new information about a diagnosis and treatment plan, this is a very delicate time. It’s challenging to deal with a new diagnosis, not to mention sharing it with the world before you are used to the idea. I remember sitting in my general physician’s office just three days after finding out I had cancer. I was numb with anxiety and fear. Sitting on the paper-lined table in a small exam room, I could very clearly hear her chatting with patients in the adjacent rooms.

Then, in one loud, swift motion, my physician entered the room, similar to that of the one pictured above, sat down and in a booming voice said, “well, we know it’s cancer.” All I could think about was the patient in the room next to me, overhearing my news through the thin walls while they waited for their antibiotics or annual physical. Sure, the door was closed and I was in a private room, but the sound carried like she was shouting it through a 400,000-watt heavy metal concert speaker. That was my first, but not last experience involuntarily sharing my cancer with complete strangers.

When I first learned that chemotherapy would be part of my treatment plan, I vaguely understood what that entailed. I never had time to contemplate the details of the room or who else would be there. I never considered the fact that as I received my treatment, other patients and their families would be continuously walking by, glancing over at me as I sat less than five feet away from other patients. I often wondered if there was a VIP area for the swanky cancer patients. Maybe they had private rooms and an endless supply of lattes while they were treated. But while I accepted my reality as each new phase presented itself, I also reluctantly accepted the lack of privacy offered during my treatment.

Access to Daylight and Nature

Prior to my cancer experience, the only cancer facility that stood out in my mind was DesignGroup’s Cancer Center for Adena Health in Chillicothe, Ohio. Floor to ceiling windows encase the exterior of the building as patients’ chairs faced toward green space and a healing garden just outside.

That was my only look inside an infusion room prior to my diagnosis. The treatment room where I received chemo had the treatment chairs arranged with their backs to the exterior walls in a U-shape, with the nurses’ station in the center. The building was surrounded by a parking lot and I wouldn’t consider the views to the outside as serene or calming. Despite this, looking back at the time spent in that chair, I would have preferred to look outside rather than my only view being that of other patients and their families.

One Chance to Make a Good First Impression

We’ve all done it; as soon as we arrive at a new place, we size it up and draw conclusions before we even step inside. As I pulled up to the building where I would see my oncologist for the first time, I was already swimming in a sea of uncertainty. I think about how I felt walking into that building, not yet aware that the care I would receive there would ultimately save my life. When I first walked through the front door, I remember immediately soaking in the largest waiting room I’d ever seen, filled with people dealing with a similar diagnosis. I was instantly hit with what felt like a bleak reality. Some of these people had already lost their hair, some seemed really sick and weak. Aside from a handful of rogue cells, I was a strong, long-haired 32-year-old gaining access to a club I never wanted to join. That first impression was a strong dose of reality. Thinking about how it felt to walk in and see other patients at varying stages of cancer, I wonder if there could be a more thoughtful way to soften those first moments in a cancer treatment facility.

Forging Ahead

Let’s face it, no matter where you work, you will inevitably spend time in a healthcare facility, as a patient yourself or with a loved one. The next time you step into an outpatient building or hospital, take a look around and consider your surroundings. How would it feel to be in that space when dealing with life-altering decisions? Does the space contribute to or lessen your anxiety and well-being?

If you are a healthcare designer or facility administrator, put yourself in the shoes of a patient entering that facility for the first time. Think about their sensitivity to sound and privacy, the opportunity to bring daylight in and provide views to nature. Study their path through the building and their first impressions. Does the space build confidence in the quality of care that patients will receive?

This year has reminded me of how fortunate each of us are to wake up each day, filled with possibility. Some of us have the greater fortune to be able to positively impact patients’ lives through the spaces they receive treatment. These spaces are living vessels contributing to ways in which people are healing, learning and growing. Every detail in a building is an opportunity to make those experiences better. Would you consider those details as nonessential amenities, or as vital necessities?

As you hit the ground running with resolutions in the new year, remember the role that spaces play in your lives as designers, healthcare providers, facility administrators, as people. More importantly, remember that every day and every fleeting experience is a gift. I know I will.

Kendra Brown

Marketing Manager

Healthcare, Commercial

Better Design for the Heroes of Healthcare

by Angela Kolosky, Joe Mayer

When we ask healthcare workers what could make their work environment better, they always start with patient care. While it’s wonderful they’re so dedicated to their jobs, part of our job is to care about them when we consider the design of a great healthcare space. So when we press them a little harder to focus on their own needs, healthcare workers often point to many of the same things preferred by office workers. Different worlds, but common needs.

A huge number of Americans – some estimate 12 percent of all workers [ 1 ] – are employed in healthcare. But even best-practice workplace standards (such as the WELL building standard, which advocates design for the health and wellness of occupants) focus almost exclusively on corporate office space. As planners and designers, we can better meet the needs of healthcare workers by drawing inspiration from best practices in these other markets.

While there have been gradual moves, the COVID-19 pandemic has shined a bright light on what needs to change. It’s time to do something that improves the experience of our healthcare heroes. To follow are five strategies for improving the healthcare workplace. Perhaps a lasting silver lining on the other side of this pandemic will be a lasting realization of how the quality of the healthcare work environment affects the quality of care provided.

1. Ergonomic Control

Thoughtful ergonomics is more than a well-designed desk chair – it’s about supporting workers throughout their day and providing customization of their work spaces in various forms.

Why it matters: 33% of workplace injuries and illnesses stem from musculoskeletal disorders. [ 2 ]

Providing staff comfort and individualized control at both the bedside and workstations reduces discomfort and stressors. All of which helps keep staff healthy — and better focused on patient care.

hospital room with ergonomic nurse workstation

2. Sensory Control

A key indicator in any office or work environment is the Indoor Environmental Quality (IEQ), which is most significantly impacted by lighting, acoustics, and climate. In healthcare environments, these elements are too often designed around the comfort of patients — at the exclusion of staff. It’s critical to consider both populations in the design of good patient care spaces.

Why it matters: Allowing staff individualized control when possible helps maintain circadian rhythms, which in turn helps regulate mood and keeps employees happier. [ 3 ]

hospital staff station with glass enclosure

Lighting Controls

In many patient care areas, lighting levels are mandated by federal guidelines. It’s important to provide flexible staff areas where light levels can be adapted with dimmers or through the use of individual task lighting. This also means orienting workstations to reduce glare from natural light.

Acoustics

Hospitals are notoriously noisy places and healthcare work can require extreme focus to minimize errors. Acoustical separation when desired and alternative work locations help improve acoustical comfort. Acoustically absorptive materials and sound masking can help mitigate noise in staff areas.

Climate

Providing more individualized control of specific staff work areas can help improve staff focus and performance. This could mean control of a thermostat in a staff respite room or simply access to a breezy outdoor space when desired.

3. Workday Decompression Spaces

Providing various types of staff spaces beyond patient care zones (such as private meditation rooms, small conference rooms, and staff break rooms with access to natural light) allows for staff to decompress over the course of the day or right after an event. The quality of care provided by a hospital is a direct link to satisfaction and value that healthcare workers feel.

Why it matters: Providing and encouraging staff to use decompression spaces dedicated to them shows them that you care about them as individuals. Mental health in healthcare workers has taken center stage with the current pandemic, but even after this has passed, staff will need places to manage their own health throughout the day.

4. Transitional Decompression Spaces

Like all workers, healthcare staff have work and home stressors. Yet few jobs have such impacts when those stressors start to overlap. The COVID-19 pandemic has shown the importance of the process to decompress before transitioning from work to home and vice versa.

Why it matters: Healthcare workers need to be focused at work; when their shift ends, their compassion buckets needs to have a little left for home. Allowing for a decompression zone on both sides of the work/life spectrum gives them a chance to re-energize and focus towards the next endeavor. This zone could be a garden between a staff entry and their car, a convenient coffee shop, or well-placed inspirational artwork. It can even be as simple as a well-appointed, aptly located locker room with the right amount of personal space.

5. Access to Basic Necessities

In traditional office environments, we often take for granted how easy it is to access basic necessities like daylight, convenient food and drink, and easy opportunities to collaborate. These common luxuries are often not available to clinical staff. And that can conflict with patient care and safety.

Why it matters: Giving staff access to these basic necessities improves their mental focus and shows how much they are valued and the work they provide.

Daylight

Studies have shown that access to daylight and views is critical to a body’s regulation and health. Providing staff adequate access increases alertness, reduces fatigue and eye strain, and improves how they feel.

Nutrition

Patient care is demanding work, so the ability to stay adequately hydrated helps improve overall health as well as staff comfort and focus during the workday.

Staff Interaction

Providing workspaces that facilitate multiple scales of interaction between staff – from the two-person huddle room to larger staff stations where clinical staff can congregate – allows better collaboration on patient care and the mental support and camaraderie so important to any work environment.

We believe in a post-COVID-19 world, that collaboration will continue to be king. We’re already seeing it in the way we’re working this week. Workplace design will integrate materials and safety protocols from Healthcare, and Healthcare will integrate concepts of ergonomics and office architecture to promote wellness. We’re eager to help influence how this synergy will benefit workers in the future.

References

1. [ https://www.kff.org/other/state-indicator/health-care-employment-as-tota... ]
2. [ OHSA Ergonomics; https//www.osha.gov/SLTC/ergonomics/ ]
3. [ Walker, W. H., 2nd, Walton, J. C., DeVries, A. C., & Nelson, R. J. (2020). Circadian rhythm disruption and mental health. Translational psychiatry, 10(1), 28. https://doi.org/10.1038/s41398-020-0694-0 ]

Angela Kolosky

ACHA, AIA, NCARB, LEED AP BD+C

Principal, Healthcare Planning Market Leader

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Joe Mayer

AIA, NCARB, WELL AP

Principal, Designer

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Healthcare

A Tool for Covid-19 Healthcare Facility Planning

by Sherm Moreland

AIA, ACHA, LEED AP BD+C

Chief Executive Officer

Facilities devoted to healthcare and health education face difficult and uncertain planning decisions. Given the parallel realities of potential viral spread and the desire to return to “normalcy,” the DesignGroup planning team sees two timelines ahead for those determining if, when, and how much their facilities need to change.

The first timeline considers solutions in a time when we begin to feel safe, the interim period before a vaccine is available. The second timeline considers post-pandemic solutions, after a vaccine has been developed and widely administered. The space between these timelines is unknown; therefore, planning for changes in current standards or significant capital expenditures must be considered carefully and patiently. DesignGroup developed a planning tool to help our clients find clarity during this ambiguous time.

As you can see below, it organizes priorities for near-, mid-, and long-term planning. While the solutions reflect current challenges, the organizational framework is a timeless result of our decades helping clients manage change in uncertain times.

This chart an actionable representation of planning strategies discussed in a companion article, How to Plan in Response of Covid-19.

We recently shared this tool with two contrasting clients: a university with a nearly completed medical teaching facility, and a community hospital about to embark on a new phase of construction. Both faced questions they never expected while managing a once-in-four-generations crisis: How much should our plans adjust to keep staff and users safe? Where best should we spend funds? What’s the most urgent need? Will our investments be flexible and useful in the long run?

We designed this tool to help organizations provide leadership during a time with so many unknowns; it’s framework for this moment. We believe its structure can bring calm and clarity to the planning process, reduce the urge to overreact, and offer a place for all ideas to be documented and then evaluated consistently against agreed upon strategy and hierarchy.

We find it very useful – you might as well. If you need help applying it, please call us and we will assist you.

(For a broader look at planning strategies during the pandemic, please see our companion article.)

Sherm Moreland

AIA, ACHA, LEED AP BD+C

Chief Executive Officer

More about Sherm

Healthcare

How to Plan in Response to COVID-19

by Sherm Moreland

AIA, ACHA, LEED AP BD+C

Chief Executive Officer

In this time of uncertainty, we stand at a fork in the road.

The road on the left is one of action. If we take it, we move forward making the best planning decisions we can given the best information we have. It is the path of the leader, the optimist, the builder.

The road on the right is one of caution. Choosing that path, we wait and defer as we gather more information, collect more inputs, and hope for a clear signal of certainty to appear.

Which road should we take? How will we know?

In my 30-year career as a healthcare planner, there have been dramatic changes and events that informed and reshaped the future. The tremendous wave of hospital mergers and acquisitions that occurred in the early 1990s. The proposed healthcare reform of the mid ‘90s (the Clinton health care plan) and again in the 2000s (Obamacare). The hardening and terror-proofing of our critical infrastructure after 9/11. The fear and reaction to SARS and Ebola. And now the once-in-a-four generation (and hopefully never again) international pandemic of COVID-19.

We can’t trivialize or simply forget watershed moments like these. Indeed, in answering the question of which road we take, I look back at the responses to those earlier challenges and find inspiration.

Today, as we did then, I believe it’s essential we choose the path of action, optimism, and positivity as we move forward.

So how do you do that?

While no issue or event is the same, reliance on the ideas listed below can help you bring order to chaos and guide decision making in turbulent times. Keeping these ideas in mind will provide clarity and confidence in decision making as you map the path forward.

1. Understand the system.

Good planning must first truly understand and acknowledge the “system” in which we work, the aim of the system, and the system’s inherent interdependencies. Systems thinking and evidence-based knowledge are essential to accomplishing desired results that are resilient and sustainable. Without the discipline of systems thinking, both the causes and consequences can be easily misunderstood, or worse, overlooked altogether. (The concept of systems thinking fills many books and scholarly articles; to learn more, I would recommend the work of W. Edwards Deming.

hospital staff working on a planning exercise

2. Identify and canonize self-evident truths.

A common planning mistake is to move too quickly through theoretical iteration and rush to the tactical phase of decision making. Time spent early in the process understanding, debating, and building consensus on the absolutes – both the obvious and the ridiculous – will encourage better questions throughout the process and ultimately speed decision-making later. Write these self-evident truths down, agree on them, and don’t spend time revisiting and rethinking later. These ideas become the foundation on which a plan is built.

3. Simplify the complex, and make data and decision making visual and visible.

This is a mantra at DesignGroup. It’s a hallmark of our planning and fundamentally necessary for strategic prioritization. In times of complexity, try to maintain a bias for simplicity, consistency, rhythm, and repetition around an easy-to-articulate message – simple, but not simplistic. Participants in the planning process will have all kinds of ideas that are strategically viable, but the process of writing it down, defining it, testing it, and getting stakeholders to say yes confidently will be the difference between succeeding or falling short. This is a leader’s imperative.

Several years ago, DesignGroup made the decision that all staff – 100% of us – would be lean trained. Lean’s A3 process, a structured template for solving problems for continuous improvement, helps simplify complex issues, makes them visual, accelerates the decision-making process, and improves the quality of the results. Tools like these allow decision makers to better visualize and understand the entire system and to use evidence-based knowledge.

Sherm presents a slide about risk to DesignGroup staff

4. Focus on the consumer experience.

At the risk of being cliché, we often use Amazon as a simple model for an organization delivering on what customers truly want – simplicity, speed, and low cost. In fact, our firm extensively researched and studied Amazon during a recent corporate retreat. Despite Amazon’s often cited shortcomings (success at the cost of local retailers; questionable treatment of employees), Amazon has an amazing focus on customer needs – and how to respond to them. We encourage clients to learn from the best parts of Amazon and apply that relentless focus on customer satisfaction to every decision made.

5. Always bet on technology.

And prepare to embrace it quickly. In recent discussions with several major healthcare clients, virtual doctor visits for primary care – telehealth – has gone from less than 10% pre-pandemic to more than 80% during quarantine. Keep in mind, this change has happened in just the past 10 weeks. Let that sink in. These changes are here to stay, and new tech will continue to emerge to meet these new needs and routines.

6. Maintain your sense of empathy.

Sometimes the word “customer” doesn’t establish the right mindset for every decision. One key, non-negotiable fact the pandemic made perfectly clear: people need other people. Human connections and interactions are essential to survival, and they cannot live in quarantine and isolation forever. Prioritize and pressure test solutions for empathy — try to understand where the audience is as human beings, as you might as a family member. Again, lean training teaches respect for people. Despite the uncertainty in the world with COVID-19 and recent political unrest, people are still the center of all of it — and should be central to any strategic prioritization.

These strategies are a call for action, optimism, and leadership; a call for planning. There are many approaches to planning and many tools at our disposal. The ideas presented here draw from 30 years of experience and highlights essential, time-tested strategies appropriate and necessary for this moment. I encourage you to try these ideas. They build on lessons learned and help ensure a better planned, better prepared future.

For even more tactical advice for planning, please see our companion article “A Tool for COVID-19 Healthcare Facility Planning and Decision Making.”