Biophilic Features: Evidence-Based and Sustainable

In other cases, water is being brought into the healthcare environment deliberately-though in limited and strategic ways, says Rob Morton, director of sales and marketing with Bluworld of Water. "Studies of biophilia and evidence-based design show that bringing various natural elements indoors, such as running water, can lower patient blood pressure and produce negative ions, which are known to enhance the immune system and boost alertness," he says.

Seminal review articles by the California-based Center for Health Design support the overall notion. Among the most-cited experts is Roger Ulrich, director of the Center for Health Systems and Design at Texas A&M University, whose 2003 study suggested that natural elements and nature art promote "restoration from stress" when the features contain "calm or slowly moving water, verdant foliage, flowers, foreground spatial openness, park-like or Savannah-like properties (scattered trees, grassy undershot), and birds or other unthreatening wildlife." These natural therapy environments have been shown in clinical studies to affect patients dramatically: "blood pressure drops, respiration slows, muscles relax, and moods brighten," wrote Ulrich.

Properly designed and maintained, Bluworld's Morton reports, water walls and "bubble walls" improve ambience in patient areas and recovery rates. In a few cases, he cautions, poorly designed or maintained water features have caused outbreaks including Legionnaires' disease, as in 2010 at the Milwaukee Hospital Aurora St. Luke's South Shore. Such issues are rare and preventable: "Filtration technology is very important, everything from ultraviolet light to ozone to ionizers that help combat living organisms within the systems," says Morton. "A modern water system should be able to combat both living organisms and nonliving contaminants."

In fact, a variety of new approaches to water features have been used by architects in healthcare settings, including antibacterial recirculating "encapsulated designs" with access panels for maintenance, as well as "bubble panels" in which a chamber of distilled water between acrylic panels is fitted with an air pump to produce a soothing, contained effervescence that may be highlighted with color-changing LED light sources.

Technology Drives Change

While these improvements to inpatient and outpatient environments contribute positively to care delivery and cost reduction, new and radical departures from traditional hospital organization will challenge architects anew. "Telemedicine will continue expanding physicians' geographic reach as well as treating patients who live in rural or remote areas-and those that have shortages in select clinical specialties," HKS's Kittredge explains. "Virtual ICUs and other virtual strategies will be more commonplace in order to deal with staffing shortages and provide a higher quality of care."

Studies of biophilia and evidence-based design show that bringing natural elements indoors, such as the running water on these glass partition panels, can lower patient blood pressure and produce negative ions, which are known to enhance the immune system and boost alertness. Photo courtesy of Bluworld of Water

In spite of these novel remote technologies, healthcare delivery is also more collaborative, leading many hospitals to add new videoconferencing facilities, says ELP's Hedberg. These rooms demand studio-quality lighting in an architectural environment, which can be accomplished with asymmetric-distribution lighting fixtures that provide vertical illumination on the doctor's face without creating discomfort.

Hospitals are planning other technology upgrades, too, according to recent industry surveys. Among the top five most common are asset-tracking products including RFID, bar-coding and instrument management systems, says Kittredge. New smart-phone applications are used to direct patient intake or deliver vital information. This year, for example, the Henry Ford Health System and Detroit Medical Center, have launched no-cost apps to help the public find the nearest urgent care center, complete with estimated wait times. Both medical centers say they are considering launching other smart-phone apps, according to the Detroit News.

"The integration of architecture and technology is critical to creating best-of-class facilities," says WHR's Watkins, who partnered several years ago with Genesis Healthcare International, Inc., a specialist in medical technology planning and strategy, to benefit a number of its clients. In addition to architecture and planning, WHR has been able to consult on technology adoption, long-range planning, capital management and operations.

The $9.6 million expansion of the Neonatal Intensive Care Unit at Nashville�s Baptist Hospital added 25 beds as well as pinwheel-shaped pods for privacy in soft, elegant colors. The architect is Thomas Miller & Partners. Photo courtesy of ELP