Innovative Design Trends for Health-Care Environments  

With health care dominating the news cycle every day, it’s not surprising that for most people, the topic first elicits thoughts of rising costs, insurance quality and affordability, and your provider’s credentials. But, increasingly, architects, construction professionals, and owners are considering how the building design aspects of health systems are critical components in order to improve the quality of care and deliver it at a lower cost by operating more efficiently, improving patient outcomes, and increasing patient satisfaction.

Photo courtesy of dormakaba

A new wave of innovative building products, such as these manual sliding ICU doors used at the Winslow Medical Center ER, help create modern, patient-friendly, efficient health-care environments.

According to a recent article in Building and Environment, “In recent years, the effects of the physical environment on the healing process and well-being have proved to be increasingly relevant for patients and their families (PF) as well as for health-care staff…Healing environments can be considered as ‘smart investments’ because they save money, increase staff efficiency, and reduce the hospital stay of the patient by making the stay less stressful.”¹

Building product manufacturers are taking the lead and meeting this growing demand for innovative solutions for health-care facilities. This course will examine a range of products—including doors and framing, hardware, window treatments, and flexible wall protection—and how they can aid in creating safe, structurally sound, efficient spaces that not only bring about patient satisfaction and optimal healing environments but also impact the owners’ bottom line.

Doors and Framing

Health-care settings—everything from multi-facility hospital systems to medical office buildings and local clinics—all share several common goals and challenges. Increasingly, governing boards, invested shareholders, and owner-partners are keeping a watchful eye on building practices so as to keep operating costs down while increasing patient volumes and their access to quality care. Regardless of the venue, efficiency is at the center of every decision. Designers and facility managers are constantly looking for ways to bring their buildings in line with these ideals, and the right doors and frame products can be an integral part of the solution.

Sliding Doors

Modern door products, especially sliding door systems that include a complete door, frame, and hardware assembly, can make an important contribution to clinic design and ROI through the efficient use of space.

The latest sliding door systems have been designed to cater to the specific demands of health-care environments and address issues of unique concern in medical settings, such as acoustics, cleanability, hardware options, smoke ratings, and reliability.

According to door experts at AD Systems, a manufacturer of specialty door and hardware solutions for commercial and clinic settings, “Contemporary, purpose-built health-care sliding doors for interiors can address health-care facilities’ challenging intersection of needs. These facilities are tasked with providing greater accessibility to differently abled people while maintaining efficient and reliable performance for busy staff. This requires products of a high quality with long lifespans that require minimal maintenance and guard against facility downtime for repairs or other issues. It is also essential that these sliding doors in health-care settings offer smart usage of available space and maximum sound abatement to protect patient privacy, all while being pleasing to designers and users’ aesthetic sensibilities.”

Benefits of Sliding Doors

Architects and professional building managers have many types and styles of interior doors from which to choose for medical facilities. Sliding doors can be a simple, smart solution that provides numerous benefits, some of which are outlined below.

Use of space: Sliding doors allow more exam rooms to fit into the same floor plate and provide a more efficient layout of individual rooms. When doors slide rather than swing out, an average of 14 square feet of valuable square footage is freed up for accommodating medical teams, furniture, and equipment. Health-care sliding doors, by their very nature, are designed to be unobtrusive, hugging the wall when open and gently gliding into place when closed.

Visually appealing: Sliding doors are generally thought of as an aesthetic upgrade that gives clinics a more modern, less institutional feel. Health-care sliding doors are available in a variety of materials and styles (example: flush wood or plastic laminate door leaves; clear, frosted, or decorative glass; or special features such as integral blinds or lead shielding) and will fit most budgets and décor. They may also employ a durable concealed roller system that provides a low-maintenance, smooth glide over their life cycle. Door frames may wrap the wall openings to protect them from wear and tear and give a long-term professional appearance.

Increased performance: Many sliding doors are designed so that performance is not compromised, i.e., architects can specify sliding doors with good acoustic performance (for instance, some newer products feature acoustical seals at all four sides for maximum and acoustical performance and acoustical design that addresses sound leakage at the lead and jambs), smoke ratings, locking and latching hardware, and a full range of decorative finishes.

ADA compliance: Some manufacturers offer sliding door systems that are ADA compliant in terms of operating force and clear opening dimensions. Products may include ADA-approved thumb-turn locks with occupancy indicators or keyways and self-latching doors options with handles that can be operated with only one hand. Another example would be sliding doors with soft-close features that offer protection to younger or slower fingers and that stop nerve-jarring slams.

Photo courtesy of ZGF Architects © 2016 Doug Scott

Today’s sliding door systems are designed to serve the demands of health-care environments, such as acoustics, cleanability and reliability—among others.

NEW SLIDING DOOR SYSTEMS: CLINICS AT MULTICARE INDIGO BUILDING, TACOMA, WASHINGTON

Photo courtesy of BCRA/Aaron Locke

A new sliding door design system allows for a more flush look than a mainstay surface-mounted barn door design at MultiCare Indigo outpatient clinics.

Challenge

When BCRA Architects of Tacoma, Washington, approached Goldfinch Brothers and a specialty sliding door manufacturer with a design request for its upcoming MultiCare Indigo outpatient clinics, it was the perfect opportunity to roll out a new product design to meet the space needs and aesthetic intent for the projects. Requiring a more flush look than a mainstay surface-mounted barn door design, a new sliding door design system was launched for the project.

Solution

The design features a door that slides over a sidelite where both the door and sidelite can fit within the rough opening (as opposed to surface mounted to the face of the wall with a standalone barn door design). The flush wood door has applied signage and a decorative glass sidelite that allows for light transmittance while safeguarding visual privacy. The inset design meets the key design intent of having the door rest flush with the wall for a clean aesthetic and preservation of hallway clearances down the corridors.

Door and Frame Products

There is always a need for affordable, cutting-edge products for evolving health-care applications, and door and frame products are often part of a complete health-care solution. Manufacturers, more and more, are anticipating the ever-changing challenges of increased security, patient and staff privacy, and microbial contamination. Additionally, the containment of radio wave and radiation interference in hospitals and clinics for X-ray rooms, PET scan theatres, or modern cyberknife clinics is essential. The use of high-security wood doors for patient rooms in behavioral health facilities provides a warm feel while maintaining a safe environment for patients.

The design and manufacturing of performance-leading door and frame products (such as acoustic resistant, bullet resistant, stainless steel, lead lined, radio frequency, and security wood doors) can add tremendous value. Stainless steel frames specifically are often used on patient rooms, and frames and doors are commonly found in operating and labs areas. According to Steve Peterman, director of sales and marketing, AMBICO Limited, “Today’s manufacturers must support architects by offering superior products and service to meet the often-demanding performance requirements associated with the built health-care environment.”

Some of the door and frame types that are popular for use in health-care facilities include:

Acoustic doors: Acoustic steel doors and frames are available that combine outstanding sound transmission loss with the appearance of standard hollow metal products. Such doors can be provided complete with acoustic steel frames, perimeter, and bottom seals. Acoustic wood doors and steel frames set the global standard for sound transmission loss. It is recommended that doors and frames be tested as a unit and supplied with acoustic perimeter and bottom seals. Wood doors are available in virtually any veneer species and cut to match other standard wood doors on a project. Custom stain or clear coat finishes are also available to match the appearance of commodity wood doors.

Radio frequency steel doors and frames: These door and frame assemblies should meet combined radio frequency standards. Assemblies shall be provided complete with perimeter gasketing, which is essential to product performance in the field. Materials can include mild steel or stainless steel formats to meet a wide variety of applications.

Bullet-resistant doors: Some manufacturers offer bullet-resistant steel doors and frames that are secure from ballistic attack yet have the appearance of standard hollow metal products. Many bullet-resistant products on the market can be furnished with factory-installed bullet-resistant glazing. Another option is bullet-resistant wood doors and steel frames, which can combine ballistic security with the appearance of standard wood door and steel frame products. Wood doors are available in virtually any veneer species and cut to match other standard wood doors on a project. Custom stain or clear coat finishes are also available to match the appearance of commodity wood doors. These products also can be furnished with factory-installed bullet-resistant glazing.

Lead-lined steel doors and frames: These are useful when there is a need to combine protection against radiation with the appearance of standard hollow metal products. Manufacturers offer fire-rated and non-fire-rated products. Materials here also can include mild steel or stainless steel, depending on the application.

Stainless steel doors and frames: These are used in health-care facilities where there is a demand for an extremely high level of cleanliness. Frames are readily available for use in ICU and operating room environments. Frames and doors can be custom designed and produced in alloys 304 and 316 with a wide range of finishes available.

Security wood doors and steel frames: These openings offer state-of-the-art security where patient or personnel security is a key concern. Offering a warm feel and a secure and safe environment for patient rooms in behavioral health facilities, these security openings include anti-ligature and anti-barricade hardware, providing safety and emergency access to patients at all times.

Photos courtesy of AMBICO Limited

Wood bullet-resistant doors in steel were used in the emergency areas of the 72-bed Major Hospital, a general medical and surgical hospital located in Shelbyville, Indiana.

Architectural Openings and Access Controls

Access control for architectural openings is another important management tool providing safety and security in health-care environments. In fact, electronic access control hardware and software can be an important touchpoint in the design of health-care facilities, in conjunction with openings with automatic sliding doors (including all-glass sliding doors and operators). Some product types that are being used currently include exit devices, door closers, cylindrical locksets, and electromagnets for hold-open systems.

As health-care facilities are complex and evolving environments, a well-considered access control strategy can be an enhancement, not an obstacle, to effective building performance in terms of ADA, fire codes, and occupant security. Furthermore, product and system specifications are integral to the definition of spatial boundaries and controlled movement through the entirety of a building. Effective application can correct issues in the present and provide adaptability in the future.

The bottom line is that for health-care facilities, the complex concepts of health, safety, and welfare are inextricably intertwined. Every health-care-related facility has a responsibility to provide a sterile, physically safe, and secure yet accessible managed environment in order to effectively conduct its daily operations.

For a successful project, it is imperative that the architect or designer become familiar with the latest products, standards, guidelines (including ADA), codes, and technologies specifically impacting the design and management of health-care facilities. Managing access and security and maintaining a sterile patient environment should always be top of mind in any health-care project.

According to Rick Ruppert, manager of architectural services at dormakaba Access Solutions Americas, “The inter-connectivity of access control, security, and even environmental systems now occurs at every scale. Something as complex as touch-free credentials activating automated doors that prompt a temporary HVAC override while the medical team makes its way to an emergency operating theater can be realistically accomplished. Once there, discrete recognition by the pharmacy cabinet security controls can create a virtual dispensary with highly exclusive access. Fundamentally, it all communicates through the same shared system.”

Photo courtesy of dormakaba

Access control strategies are vital to providing safety and security for health-care facilities.

ACCESSIBLE FLOORPLANS AND EASY-TO-NAVIGATE DOORWAYS FOR LEED GOLD FACILITY: LITTLE COLORADO MEDICAL CENTER (LCMC), WINSLOW, ARIZONA

Photo courtesy of dormakaba

Barrier-free access and access-control solutions helped create an accessible floorplan in an attractive and comfortable setting at Little Colorado Medical Center (LCMC) in Winslow, Arizona.

Challenge

Since 1954, the Little Colorado Medical Center (LCMC) in northeast Arizona has provided vital medical services to a rural population residing more than 50 miles from Flagstaff, the nearest major medical center. With the goal of improving care for patients who travel great distances for emergency treatment, LCMC recently expanded and upgraded its facilities. The 25-bed critical access hospital now accommodates five trauma rooms, five emergency rooms, a nurses’ station, redesigned waiting room, psychiatric room, and a rooftop heliport.

Barrier-free access and access control solutions were needed in order to meet the requirements of a highly accessible floorplan with convenient and easy-to-navigate doorways in an attractive and comfortable setting.

Solution

For the main entrance, LCMC required reliable barrier-free access to allow for fast-moving traffic. Two banks of automatic sliding doors were installed to enable the quick and easy traffic flow so essential during emergency situations. Once inside, unimpeded patient care relied on the same level of barrier-free access between adjacent rooms, provided by a low-energy operator that powers a swing door leading from the lobby area to the inner treatment rooms.

Once treated, patients who are not immediately released are cared for in one of seven intensive care cubicles, which needed to be visible and easily accessible from a central nursing station. The solution was to equip each cubicle with a manual sliding door that enables continuous observation of patients, while allowing quick and easy access during emergency situations.

Door Openings and Functionality

Beyond access control, architects must also recognize the importance of maintaining the functionality of a door or opening and how to design a health-care building with that functionality in mind. Oftentimes, this means finding the right hardware.

One new product type to help meet this goal is a three-way adjustable hinge system, which has been used successfully in Europe for many years in high-frequency institutional, commercial, and industrial applications, such as office buildings, schools, hospitals, and airports. Typically, continuous hinges are used in applications requiring robust hinges in North America. However, now there is a hinge system of a similar durability with an additional three-way adjustability feature.

Rudy Kessler, CEO of SIMONSWERK North America, explains, “Nearly every hinge in any European health-care facility is adjustable. When I moved to the United States, I saw the difficulty in maintaining a common commercial door. I wondered why they were going through such trouble and saw the opportunity for adjustable hinges. With recent advancements, there is now the ability to bring this type of system to a North American market and educate the architectural community on how adjustable, heavy-duty hinges can simplify the overall maintenance of an opening.”

Photo courtesy of SIMONSWERK North America

The correct door hardware, including hinge systems, can be a key factor in maintaining functionality within a health-care facility.

DOOR OPENING DESIGN AND PERFORMANCE: ADJUSTABLE HINGE SYSTEM

Images courtesy of SIMONSWERK North America

This illustration shows a standard commercial hinge (left) and a three-way adjustable hinge (right).

The functionality of a door opening is a crucial life/safety requirement for any commercial buildings, health care or otherwise—especially fire doors. If a door cannot be opened or closed, an entire section or area of a building may be closed off. Common door problems, like door sagging or warpage, require door assembly adjustments to maintain the functionality and meet these life/safety requirements. Standard hinges, such as butt hinges or continuous hinges, generally do not offer a three-dimensional adjustment feature. Without an adjustment feature on the hinge, the repair options are limited to resetting and/or shimming a hinge, modifying an existing hinge, re-machining a door, and/or un- and reinstalling the frame. It is often required to refinish an existing wall when a frame is reinstalled. Any modifications to a hinge can compromise the integrity of the entire hinge assembly. These repair options are time consuming and disruptive—not to mention, expensive.

The three-way adjustable hinge system described earlier was developed for wide, heavy-duty doors that require a robust and stable hinge and have maintenance-free slide bearing technology. Some other features to look for are corrosion resistance, fire and smoke protection, and ADA compliance that can include lower force and less friction, which could lower any interruptive costs.

HINGE SYSTEM ENSURES SMOOTH PATH: UNIVERSITY CLINIC, JENA, GERMANY

Photo courtesy of SIMONSWERK North America

An adjustable hinge system was used in the University Clinic project in Jena, Germany.

As discussed earlier, there is an adjustable hinge product that is new to the North American market but has been used successfully in Europe for many years in health-care applications. One such project is the “Universitätsklinikum Jena” or University Clinic in Jena, Germany. This campus was originally developed from individual buildings and now features a common area where the city is intertwined with the landscape. From the north, the campus was deliberately left open so that visitors can walk directly to the slopes of a nearby park. If you enter the new main entrance, you come upon a large garden hall, which connects the existing hospital buildings with the new buildings.

The initial construction was completed in 2004 and the second phase in 2013. The new building, with an additional usable area of more than 500,000 square feet, was completed in November of 2016. This building section has 710 patient beds, 12 operating rooms, three medical centers, two research buildings, and 15 clinics and institutes, as well as research and teaching facilities.

With regard to special requirements in hospitals, safety and efficiency play a large role in the planning and subsequent daily routine of hospitals. The demand for function, quality, and logistics in these buildings help ensure effective workflows. Patient beds, wheelchairs, or medical devices must be able to move seamlessly between the rooms and through the room doors. To ensure a smooth transport and a complete path through the doors, the builder and the architects decided to use a specialized hinge system.

With this particular hinge system, the dimensions of the frames always remain real through dimensions, as the doors can be opened completely to a 90-degree angle. Through the use of this hinge technology, the door leaf completely pivots out of the frame and opens the entire door width for a path through the opening. The door leaf does not restrict the door width and ensures smooth passage, even with beds or medical devices.

Walls and Curtains

Flexible Wall Protection

Beyond doors and door hardware, walls and wall protection is another area of importance in designing successful health-care facilities. As an example, there is a trend toward flexible wall protection with products that offer the ultra-durable performance of rigid sheet wall protection but in a flexible product, and are also available in an assortment of patterns and colors to match any décor.

A new generation of products is now available that combine the flexibility to become the showpiece of any interior, yet are durable enough to handle the harshest environments. Thomas Larwa, senior product manager at Inpro, explains the trend, noting, “Until now, designers have had to either compromise the look of their design with a traditional product or sacrifice preserving interiors for aesthetics. There are products in the market today, such as specialized flexible wall protection, that offer the aesthetic of wall covering but are very resilient.”

Antimicrobial Protection

Further, these products are not only able to resist the wear and tear that walls in health-care facilities receive, but they also fend off stains (and even graffiti), which can be removed completely from the surface, without damage, using the strongest of standard liquid cleaners. Silane-based antimicrobial fabrics are used for privacy and shower curtains, helping to fight odor-causing bacteria, mold, and mildew, along with the superior stain resistance mentioned above and being liquid repellent—making them ideal for cubicle curtains, shower curtains, window treatments, and bedspreads.

Another option being employed is the use of snap-panel curtains, which allow for easy change-outs of soiled panels. Both antimicrobial fabric and snap-panel curtains reduce the need for major laundering of curtains. When combined with standard track, these curtains are the better choice over certain proprietary curtain systems that end up locking the end user into higher-cost products, which can be very expensive over time. The idea is to help keep a facility cleaner and avoid higher expenses to do so.

Photo courtesy of Inpro

Antimicrobial cubicle curtains were installed at the new Parkland Hospital in Dallas.

Curtain Tracks and Privacy

Bendable privacy curtain tracks are another option, allowing curtains to be placed in any configuration. An additional benefit is the track and carriers are quieter, which can be an added benefit to a hospital’s overall noise-reduction program to help speed healing.

Fenestration, Daylighting, and Controlling Heat Gain in Behavioral Facilities

The final topic we’ll discuss here are products that aid in maximizing the benefits of daylighting and also control heat gain. As our main example, we’ll take a look at roller shades and the benefits they bring to health-care settings, with a specific focus on mental health/behavioral facilities.

Roller Shades

The benefits of roller shades lie in the ability to take advantage of daylighting and control heat gain, while still allowing for an outdoor view depending on the fabric’s openness pattern. In addition, allowing patients to adjust the level of light or brightness increases their sense of control.

Experts note that it is important to select shades specifically manufactured for use in behavioral facilities. They should feature:

• enclosed security roller boxes,
• cordless operation,
• durable fabrics that are easy to clean but difficult to damage, and
• locking devices that resist tampering by patients. On this last point, cordless roller shades can be much more cost effective and offer lower maintenance than encased blinds.

Photo courtesy of Inpro

Roller shades can offer numerous benefits—from allowing in natural light to providing patients with a greater sense of control of their environment.

Printed roller shades: Printed roller shades provide all the same benefits but go a step further. Again, the introduction of nature scenes has a benefit of reducing patient stress. An additional benefit of healing window treatments is that they reduce destruction where framed artwork is not allowed. There is anecdotal evidence from administrators at several behavioral health facilities that patients tend to not vandalize window shades in spaces where printed shades were installed. Patients appreciated the printed images and were less likely to damage or destroy them, due in part to decreased anxiety.

Photo courtesy of Inpro

Personnel at behavioral health facilities report that patients were less likely to vandalize printed window shades.

ACOUSTIC ENHANCEMENTS: ST. JOSEPH MEDICAL CENTER, TACOMA, WASHINGTON

Photo courtesy of Inpro

Bendable curtain track and carrier

Erik Miller-Klein, PE, of SSA Acoustics, a leader in hospital acoustics, was retained to provide detailed design solutions and conduct noise impact and acoustic measurements of cubicle curtain track at the completion of the open plan neonatal intensive care unit (NICU) renovations at St. Joseph Medical Center in Tacoma, Washington. These results are compared to the 2010 Facility Guideline Institute (FGI) standards for health-care environments and the NICU performance standards, and the improvements from the pre-design evaluation.

The new aluminum, core polymer-clad flexible curtain track and carriers used in the Level III area are 75 percent quieter than the existing carrier style track in the Level II area and meets the noise-impact guidelines.

Detailed Findings: Curtain Rail and Carriers

Before Renovation: The curtain track and carrier use a plastic carrier that slides in the metal track. This style of track and carrier has a tendency to repeatedly get stuck and then continue to slide, which creates rattling, and plastic on metal contact that produces excess noise. The curtain tested within the NICU produced 50 percent more instantaneous noise than the goal.

After Renovation: The new curtain track and carrier, shown supporting the privacy curtain in the image below, produces 75 percent less sound than the original grooved style and has been installed throughout the Level III areas.

Conclusion

According to a recently published article in Global Advances in Health and Medicine, “The U.S. health-care system is facing unprecedented challenges related to escalating costs, an aging population, health-care reform, and a struggling economy. In light of these challenges, there is an urgency to evaluate and implement new approaches and models of care with emphasis not just on curing disease but on prevention, wellness, and managing population health.” It goes on to say that “aligning mission and purpose with business strategies” is a powerful driver of financial success. Research conducted by Gallup scientists concluded that “mission can drive margin through loyalty, customer engagement, strategic alignment, and clarity for decision-making and priorities.”²

That said, with product advancements such as those discussed in this course, architects and designers are armed with the tools they need to continue working toward a goal of maximizing efficiencies and functionality in health-care settings—always with patient care and occupant well-being in mind. From optimizing acoustics, reducing infections, and creating safe passage down hallways and into patient rooms to safety and security concerns and structural integrity, these products as well as a host of others will continue to support the needs of patients and their family members as well as staff and facility owners.

End notes

¹Huisman, E.R.C.M. et al. “Healing environment: A review of the impact of physical environmental factors on users.” Building and Environment. Volume 58, Pages 70–80. December 2012. Web. 7 Nov. 2017. www.sciencedirect.com/science/article/pii/S0360132312001758.

²Sakallaris, Bonnie R. et all. “The Business Case for Optimal Healing Environments.” Global Advances in Health and Medicine. 1 Jan. 2016. Web. 7 Nov. 2017. www.ncbi.nlm.nih.gov/pmc/articles/PMC4756787/.