Case Studies

Evidence of these trends and new product applications can be gleaned from recent building projects, ranging from entire replacement hospitals to relatively minor refurbishment work-the latter being increasingly common due to the scarcity of capital funds, notes CHA's McLeod.

In Chicago, for example, Northwestern Memorial Hospital (NMH) is building and opening new facilities-its entire Lake Forest campus, for example, and most recently its Northwestern Organ Transplant Clinic in Joliet, IL-but in downtown Chicago the hospital is hunkering down on basic facility upgrades to streamline operations, cut costs, and improve the patient experience, says David Stout, NMH director of Facilities and Engineering. "We're upgrading our carpeting and refurbishing with materials that are much easier to maintain and have a longer lifespan, such as wall protection, automatic doors, and wall paint that's longer-lasting," he says.

A primary focus has been reducing maintenance needs while improving sanitation in the hospital's hundreds of staff and public washrooms, says Stout. "The hospital started a refurbishment program, and as washrooms are renovated, we're installing equipment and materials that are much easier to maintain and have longer life spans," he says. "In many cases, our low-flow plumbing lines were clogged with paper towel waste, so we've put in fast, hot air electric hand dryers, and it has made all the difference in the world." Says Stout, "we have basically eliminated our plumbing issues and reduced labor hours on maintenance; the cost savings have been significant."

Hygiene and safety are the number one priority in healthcare so the facilities team coordinated with the NMH infection control department for consultation on what electric dryer models would be the most hygienic. Trough-style hand dryers, which collect water at the base of the drying area, were ruled out, as the team felt that dryers with high velocity heated air streams afforded them the most hygienic option.

Lighting is another area of focus for NMH and other healthcare organizations, in part due to recent research findings that draw a causal connection between quality of illumination and quality of care. A recent study at a Boston-area hospital, for example, found that operating room lighting can exacerbate surgeon fatigue due to the contrast between high luminance levels on patients and work surfaces as compared to darker vertical surfaces, such as walls. For that reason, the study concluded that wall washers would be an effective strategy in surgical suites.

The same benefits accrue in other patient care areas including examination rooms, a fact that has led to new lighting approaches throughout the healthcare industry. One realization is that, "Whether lying in a recovery unit, inpatient room, or being transported, the patient spends a great deal of time looking at the ceiling plane," says Jill Cody, a designer with HGA Architects and Engineers. For that reason, more dimmable and shielded, indirect light sources are being used in circulation areas where gurney-bound patients are located.

At the new Beaman Neonatal Intensive Care Unit (NICU) at Baptist Hospital in Nashville, the architect, Thomas Miller & Partners, specified cove lighting and "hole in the wall" fixtures to shield patients from glare and associated stress. The $9.6 million expansion, which added 25 beds in about 20,000 square feet of space, features "pinwheel-shaped pods for privacy in an inviting design with soft, elegant colors and curved, flowing lines throughout that help soothe, comfort and nurture," according to the hospital.

The shielded, muted lighting fixtures are made with glass-fiber-reinforced gypsum to easily recess into the gypsum-board walls. Lighting controls are integrated with remote-controlled large windows to ensure a high level of daylighting in the NICU areas for infants, caregivers and families. "We took a hands-on approach and visited other hospitals around the country to ensure we implemented the best practices in NICU design," says Damian Skelton, facilities director for Baptist Hospital.

Evidence-Based Upgrades

Like Baptist Hospital, other healthcare providers are focusing on evidence-based design in their refurbishment and new construction planning, although recent market data shows a recession-induced erosion of EBD practices among facility managers. In a Health Facilities Management 2010 survey conducted with the American Society for Healthcare Engineering (ASHE) and the American Society for Healthcare Environmental Services (ASHES), 51 percent of the survey's respondents reported "always" or "mostly" using evidence-based design, while qualifying that EBD is "not playing a large role" in their projects.

The University of Michigan's Cardiovascular Center, designed by Boston's Shepley Bulfinch Richardson & Abbott, of Boston, employed evidence-based design principles in using glazing to add daylighting through the $215 million, 48-bed facility. Photo courtesy of Guardian Industries

For new buildings, however, the commitment to EBD has remained strong. The design of the University of Michigan Cardiovascular Center in Ann Arbor, designed by Boston's Shepley Bulfinch Richardson & Abbott is an instructive example. The five-story, $215 million center, which contains 48 inpatient beds, eight operating rooms, 11 procedure rooms, dozens of rooms for outpatient visits and diagnostic tests, and offices for hundreds of doctors and staff, was carefully designed to employ EBD principles to create a healing environment for patients and families.