By John Michael / Special to Health Facilities Today

The Affordable Care Act (ACA) has changed the economics of healthcare sparking an increased shift towards large, all-encompassing healthcare systems called Integrated Delivery Networks (IDN). The IDN concept has been around since the 1980s but it’s more appealing now than ever before because of the incentives offered in the ACA. 

Instead of being paid on capacity, rewarded for filling beds and performing more tests and procedures, the new legislation makes healthcare facilities responsible for more of the total cost of a patient’s care. Today’s IDNs aim to promote high-quality care while controlling costs through increased efficiency, avoiding the duplication of services and reducing fragmentation. 

In an IDN, a number of facilities and providers work together to offer a continuum of care as one network. An IDN may include a hospital, cancer center, rehabilitation facility, urgent care center or pediatric unit, among others. These mega care complexes can span multiple buildings across multiple locations but need to have the “feel” of one facility. Furniture and interior design elements play a critical role in creating a cohesive, branded look across multiple healthcare facilities, as does signage and graphic language. 

A thoughtful, well-conceived facility design helps bring the patient, staff and families a better healthcare experience and enhance the overall quality of care provided.  

In this article we will explore the necessary design considerations unique to healthcare, the distinctive design needs and differences in facilities commonly found across an IDN (including cancer centers, children’s health, rehabilitation centers and urgent care) and how to bring everything together through interior design to create one brand identity for the health system. 

Designing for healthcare

Designing for healthcare is much more calculated than designing for traditional consumer needs. Good healthcare design creates an environment of care, protects patient privacy and promotes health and well-being. The right design, furnishings and décor can minimize infection, maximize patient comfort and extend the life cycle of the design investment. 

For example, in a healthcare facility all surfaces should be constructed of non-porous materials for easy cleaning and reduction of surface contamination. The flooring should be slip resistant to protect against slips and falls and fabrics should be durable and stain resistant. 

Working with an experienced medical design team will ensure the furnishings meet aesthetic goals along with functional needs. They can also make sure the project complies with state and federal codes. The right expertise will go a long way in avoiding potential code violations, costly change orders and dissatisfied patients.

The design of a healthcare facility must also be flexible to avoid obsolescence in the face of rapidly changing needs and technologies. New equipment, new treatment methods and changes in the patient population base impact the facilities and a good design will allow it to evolve with the times.

Healthcare administrators, physicians, nurses and even patients through the use of focus groups should be involved with the designers in the planning process. Make sure everyone is brought together early to provide input and avoid expensive re-work later down the road. 

Although there are universal traits when it comes to designing for healthcare, the specialized facilities found in an IDN have unique needs and characteristics that must be acknowledged. Understanding these differences and factoring them in to the design plans will help patients feel comfortable and improve the quality of care. 

Cancer centers

One of the facilities found in a common IDN is the cancer center. The National Cancer Institute estimates more than 13 million people are currently living with cancer in the United States, and as a result, today’s cancer centers must not only treat the disease but they must do so efficiently and effectively to improve a patient’s experience. Layout should be straightforward and the proximity of labs, radiation and exam rooms should be close to avoid patents walking back and forth around the facility at each visit.  

Cancer is also a family disease so it’s important to make sure the exam rooms, conference rooms and waiting areas can accommodate a family. The furniture must be comfortable, inviting and not feel like an institution. The use of lamps instead of harsh overhead lighting can make the setting appear less clinical as well. Creating a homelike setting that includes space for families can reduce anxiety for patients.

Cancer patients frequent a facility more than other types of patients as well. Whereas a heart or trauma patient may have a treatment plan lasting a day or two, cancer patients could visit a Cancer Center daily for months. Therefore it’s important to make Cancer Centers comforting environments that reduce stress and encourage physical and mental well-being. 

Children’s health 

Healthcare facilities for children have obvious operational and physical characteristics that differ from cancer centers and other facilities that make up the IDN. Pediatric units need to consider the emotional, medical, and security needs of children undergoing both short and long-term care. 

Because pediatric units serve patients from zero to 18 years old, facilities must account for that wide range of ages in the design and décor. Interior designs with bright colors or childish themes can come across as condescending to older children or teenagers. The design should be fun and calming without being too whimsical.

What’s more, child patients typically have a higher volume of visitors who remain in the hospital with their loved ones longer than the average adult patient’s visitors. Providing a space for overnight parents to sleep, a kitchen, showers and sibling lounge areas geared toward different age ranges will help families feel at ease and provide a sense of comfort during their prolonged hospital visits. 

Heightened noise levels may also increase stress for child patients, so extra consideration should be given to controlling the sound. Ceiling acoustic tiles, absorbent panels, walls, curtains, upholstered furniture and carpets can be used to absorb and soften sounds to provide a less stressful environment for children and their family.

Rehabilitation centers

In addition to cancer centers and pediatric facilities, these expanded healthcare systems also include Rehabilitation Centers, which provide extensive services that are not given in an acute-care hospital inpatient setting. Patients utilizing Rehabilitation Centers are typically recovering from a stroke, brain injury, neurological disorders, spinal cord injury or orthopedic injury. 

Most Rehabilitation Centers house a wide range of features including private rooms, dedicated unit for patients following brain injury, a therapy swimming pool, large inpatient/outpatient gym, therapy courtyard and an apartment or simulations for daily living training.

Because of the types of injuries suffered by rehabilitation patients, family members or caregivers are often times aiding in the treatment and long-term care of the patient. There must be adequate space in the patient room and therapy areas to accommodate the patients’ caregivers so they can learn and provide the necessary care outside the facility. 

Rehabilitation patients can be very venerable and maintaining their dignity is critical to quality care. Patients could be suffering from loss of balance, cognitive impairment, visual impairment and increased sensitivity to temperature and light. Good design should address these sensitivities and create an environment that supports recovery.  

Urgent care

The National Association for Ambulatory Care, NAFAC, says Urgent Care medicine is one of the largest growing practices in the United States, and more and more IDNs are incorporating these facilities. The demand is driven by 85 percent of the population who do not suffer from a long-term chronic disease or require the services of a hospital, but instead are looking for treatment of a disease, illness, or injury on an episodic basis. They want treatment quickly, and they want treatment that is convenient and affordable. 

Because of this trend, today’s Urgent Care Center should be designed for convenience and quick, easy access to medical services. The interior design should convey a warm, welcoming environment where patient comfort, peace of mind and convenience are top priorities. The Journal of Urgent Care Medicines cautions the “bus terminal” waiting room design where tenants sit in fixed rows, often facing the reception desk or a video monitor. According to their research, most patients prefer waiting areas that offer furniture in conversation groupings or other small clusters. 

It’s also important to allow adequate privacy for a patient to register and describe his or her symptoms. Since these are not long-term treatment facilities with set schedules for patient visits, an Urgent Care Center must take every opportunity to provide a positive experience for the patients so they will return.

Budgetary considerations 

Medical design teams tasked with creating brand continuity amongst facilities that incorporate an IDN should also approach each unique situation with budgetary considerations in mind. For example, facilities like cancer centers and pediatric hospitals tend to receive higher funding and donations, so the budgets allotted for these facilities’ interiors will likely be higher than those of rehab centers. Urgent care, however, will fall somewhere in the middle of this budget spectrum as many of these facilities are equipped to deal with a level of emergency. 

In terms of providing estimates for cost per square foot for each of these facilities, it’s really a moving target as this varies from system to system. For instance, national healthcare system chains have set standards allowing them to purchase products at a deep discount to serve many hospitals in multiple cities and states, so the cost to furnish interiors is typically lower than standalone hospital systems. 

The bottom line in terms of budgetary considerations is that all facilities exist to care for real people undergoing real medical issues – no matter how significant. Medical design teams should work within their means to ensure each space is properly equipped while ensuring comfort, quality of care, adhering to standards and also considering creating a cohesive, branded healthcare system. 

Brand continuity 

Whether the facility is a Hospital, Pediatric Care Center or Rehabilitation facility the interior design conveys a message to patients, visitors, volunteers and staff. And in an IDN, that message must be the same across all facilities. Disjointed spaces and mismatched furnishings can give the misperception that the quality of care is not up to par. A well-laid out, comforting and aesthetically pleasing facility plays a key role in a patient’s experience and their treatment. 

Studies prove that patient outcomes improve when design embraces evidence-based principles.  Designers leading the client should start project understanding the Guiding Design Principles, which serve as the core objectives and measured goals to be achieved.  For example, healthcare systems reacting to ACA as they create a better IDN model will likely have a significant public relations campaign.  As they adopt and incorporate facilities, a common graphic language is essential—from the printed materials to the apps for phone, graphic consistency is key.  This paradigm shift is basic Re-Imaging 101.  Whether it is landscape furniture or pylon graphic signs, the look must be the same.  Once patients enter a building, they want to recognize the continuity of special design, including the directory and information signage as well as the color scheme and the “feel” of the space.  If natural plants are common to the acute setting, this branded element should be common to the other types of healthcare services.

A consistent look and feel creates a feeling of continuous care and provides a level of added comfort regardless of which location patients use. A strong brand can provide differentiation among competitors and shape a patient’s experience. 

Conclusion

The importance of proper design cannot be over looked. Choosing the right finishes can reduce noise, ease anxiety and improve patient care and recovery. Choosing the right layout can improve workflow efficiency reducing wait time and allowing physicians to see more patients each day. 

Patients utilize healthcare facilities during times of uncertainty, dependency and stress so the design must not only meet the basic functional needs to provide treatment but it must meet the emotional needs as well. 

John Michael is vice president and general manager, Business Interiors by Staples.