In recently attending the ASID and IDC Impact Summit 2015: Health + Wellness in the Built Environment at Lake Nona Medical City in Orlando, Fla., it became clear that additional focus on a collaborative approach to programming, planning, and design are more essential than ever to create a successful solution. To date, often health and wellness has been evaluated as a separate component of the designed physical environment. However, in utilizing a framework that evaluates several design considerations, there are many commonalities that also include health and wellness as a desired outcome when utilizing an evidence-based design approach.
One inspiring panel at the Impact Summit included Rosalyn “Roz” Cama, FASID, EDAC, the board chair at the Center for Health Design; Sandra Vance, senior director of interoperability initiatives at HIMSS Innovation Center; and Deborah German, MD, the VP of medical affairs and dean of the College of Medicine of the University of Florida. The topic of discussion was “What is the Future of Intelligent Homes and Communities?” Roz addressed the importance of understanding the research to create innovative design solutions and produce measurable outcomes, and Sandra discussed the need for technology integration —both supporting health and wellness within the built environment. Dr. German would be the ideal client—she was so clear on the need for collaboration to achieve goals for projects within Lake Nona Medical City. One of the questions she asked of the design team when developing building concepts was, “How do we create delight?” Further, she met her goals of changing the paradigm from traditional medical planning to more creative approaches that better support students, practitioners, patients, and staff in planning the facilities on the Lake Nona site—including lifestyle, health, and well-being.
From the Beginning
Expanding on the concept of health and well-being, the WELL Building Standard has gained traction within the design community. The goal of this standard is to focus on human health and wellness, based on a body of medical research that evaluates the connection between the built environment and its impacts on occupants. In evaluating the seven areas of consideration (air, water, nourishment, light, fitness, comfort, and mind), it is interesting to note that the Green Globes Continual Improvement for Existing Buildings for Healthcare (CIEB-HC) also addresses many of the same topics that are outlined in the WELL Building Standard. In evaluating different rating systems, guidelines, and building and licensing codes, there are many commonalities among them, so it is recommended to evaluate design considerations right from the beginning of a project process. For healthcare projects, this is called the functional programming process and the design considerations include:
- Establishing the care model and intended care population
- Sustainability goals
- Resilience needs based upon region
- Operational needs, circulation, and service delivery
- Risk and safety assessments
- Establishing desired staff, patient, resident, and visitor outcomes
- The environment of care, including evaluation of access to nature and views
- Health and well-being goals
- Benchmarking and performance improvement goals
By establishing these design considerations right from the start, it is possible to lay out a research agenda that will inform decisions to be made regarding these elements, and support decisions that maximize the potential of positive outcomes. The go-to resource for healthcare design research is the Center for Health Design, which includes not only research, but also key point summaries to assist with searches on different topics being evaluated.
Raising the Bar
Setting a research agenda for meeting continuous improvement goals is a proactive step in evaluating a completed project. Starting a post-occupancy evaluation and utilizing the completed functional program framework provides the performance base for comparison of results. Usually the terminology “commissioning” is immediately associated with energy, water, fenestration, and other types of building system evaluations, but this term can also be used to evaluate any type of system—built or operational—that is being reviewed and benchmarked for continual improvement.
The goal is to meet the basic performance criteria that was established at the beginning of the project process and then complete on-going assessments for continual performance improvements. This establishes a sustainable cycle for not only the physical setting, but also for the operations, user outcomes, and organizational mission and core values. Health and well-being, similar to other design considerations, are directly relevant to the outcomes of the users. In healthcare settings, satisfaction surveys completed by patients, residents, and staff are utilized to benchmark performance. HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) and NHCAHPS (Nursing Home Consumer Assessment of Healthcare Providers and Systems) are the first national standards for collecting and publicly reporting information on a patient’s or resident’s experience of care, allowing for valid comparisons among comparable healthcare settings and care models. Survey results and adverse event information, coupled with increased availability of healthcare design research, allow providers to make better informed decisions that result in measurable positive outcomes.
Interior Design: Expanding Roles
In addition to interior designers applying innovation to performance-based project design to raise the bar, it is also time to increase the service opportunities! At the Impact Summit, a robust discussion on how an interior designer can broaden their service offering by incorporating health and well-being consulting as a value-add was a lively topic. I recommend that not only health and well-being, but all of the design considerations discussed above, become part of the interior design service package. Interior designers are well suited to facilitate and complete the functional programming process, as they are the closest to the interior spaces, operational flows, utilization of space, and patient, resident, and family needs. Interior designers have a tendency to be great multi-taskers, as often they are juggling multiple projects at one time. Facilitating workshops and focus groups are a natural fit, when engaging multiple departments on discussions of processes, work flow, and other detailed information. I am going into my 20th year of practice and can definitely recommend expanding consulting services to include involvement throughout a healthcare project’s entire planning, programming, and design process, as it makes a positive difference in project outcomes for the people we serve.
Jane Rohde is the founding principal of JSR Associates, Inc., located in Ellicott City, Md. She champions a global cultural shift toward deinstitutionalizing senior living and healthcare facilities through person-centered principles, research and advocacy, and design of the built environment. Clientele includes non-profit and for-profit developers, government agencies, senior living and healthcare providers, and design firms. She speaks internationally on senior living, aging, healthcare, evidence-based design, and sustainability. For questions or comments, please contact her at email@example.com.