This year’s Design Connections conference was full of dialogue around the continuum of care. It addressed care population needs and extended into the material selections required for successful healthcare settings for all ages. I encourage design professionals and manufacturers to include this venue on their 2016 calendar. The sessions, relationships, and overall knowledge shared is guaranteed to be worth your time!
As part of the three-day programming, Teri Bennett, RN, CHID, IIDA and Andrea Hyde, CHID, MDCID of Johns Hopkins in Baltimore and I were tasked with leading two breakout sessions exploring the continuum of care. Teri and Andrea took half of the attendees for a discussion focused on hospital and outpatient care, and I led the other half through a discussion of long-term care. Later in the day we presented our findings across the board, to highlight commonalities between different sectors and identify opportunities for improvement.
Surveys Set the Stage
Prior to the event, we sent a survey to attendees, and the results provided some interesting points about the evolution of healthcare environments. Approximately 10 years ago, the most important measure to designers was aesthetics, according to a survey sent to the Healthcare Forum Membership. Now the top two criteria have become durability and cleanability, according to the Design Connections results. Both findings indicate an increased focus on adverse events—such as healthcare-acquired infections (HAIs), higher acuity of patients and residents in healthcare settings, longer time periods between cycle renovations, and higher traffic from mobility devices, carts, and equipment.
Unsurprisingly, surface materials were of the most interests to designers surveyed. They seek options that better support the many demands of healthcare settings. One survey question about acoustics revealed that wall treatment and flooring are the biggest concerns in this area, while a question about which product categories required more innovation shows a virtually equal balance among upholstery, furniture, surface materials, and modular casework. (See charts.)
Survey responses from the acute/outpatient care designers also indicated that there has been an uptick in design work in outpatient care, which was anticipated with the ACA and Accountable Care Organizations. As a true complement to the care continuum, the designers working predominantly in the long-term care area are seeing a strong repositioning with independent living settings and community-based services.
Side Sessions Probe Problems
Once everyone was gathered into the two breakout groups at the event, we facilitated discussion around the following scenario:
You have a care setting built in the 1980s or 1990s. What challenges do you have with older infrastructure? What are current best practices and how can they accommodate these older setting? What changes have occurred that have significantly impacted design solutions supporting person-centered environments?
That seemingly simple prompt unleashed a whirlwind of ideas, and sparked far more conversations than we had time to complete or even fully digest. But it was thrilling to see so many eager participants, and a clear sign that we should find more opportunities to keep the dialogue open in the future. For now, we can recap a few of the main takeaways.
Renovating concrete block walls—bearing as well as non-bearing—presents infinite obstacles, specifically with utilization of advanced technologies. Even with wireless technology, signals are blocked by the thickness of walls combined with rebar configurations. Therefore, design professionals are looking for products that work better in older infrastructure. Discussions included abatement versus replacement or encapsulation—as asbestos in flooring, ceilings, and insulation still exists and causes cost concerns in complete renovations.
Another challenge is completing renovations in occupied buildings, particularly settings where residents or patients have cognitive issues. The lack of compliance with ADA and building codes was an important point in the discussion. Furthermore, minor improvements for accessibility are often not completed because bathrooms and other key areas are not completely compliant with requirements. Unfortunately, most jurisdictions treat this as an all-or-nothing scenario, so incremental updates are not allowed. This may be a good topic for the Facility Guidelines Institute and ICC to consider, working closer with the Federal Access Board to create mutually acceptable resolutions.