Interior Design gathered an intimate group of industry professionals last week—all members of Interior Design 's Healthcare and Wellness Advisory Council 2013 —to take stock of the up-to-the-minute issues impacting the healthcare industry. The conversation followed Interior Design’s roundtable of 20-plus healthcare designers and executives during NeoCon 2013 to discuss the market’s explosive growth and an increasing awareness of healthcare design. Here’s the discussion breakdown:
#1. Has the Affordable Care Act , which goes into effect in October, changed the sense of opportunity in the market?
Designers opinions were mixed on this issue, with Jane Rohde, principal and founder, JSR Associates , remarking, "The last few years were all about feasibility, with clients always wanting to look at more options before committing to a project. But now, people are. . .moving forward with the idea that they will do it in a really smart way. We're seeing more projects coming to fruition, and we've hired two people to handle the load."
Haley Driscoll, Senior Associate, Francis Cauffman , agreed with this noticeable forward movement, saying of clients that, "They've waited as long as they possibly can, and now they're moving forward. We've hired four people, just since June." Other council members, however, attributed this attitude of forward movement to clients' frustration with the stagnant economy in past years rather than the arrival of the Affordable Health Care Act. The bottom line: the trends toward growth and hiring are undeniable.
#2. What challenges are design firms facing with today's healthcare facilities?
The arrival of branding in the healthcare market was described as both a challenge and an opportunity. Donald Cremers, senior designer, HOK , identified a huge healthcare boom on the West Coast, including smaller renovation projects within communities. "Sometimes the operator knows that they need to be branded, but they don't know what their brand is," says Cremers. "That becomes a challenge for the design team, because then you don't quite know what you're designing to. The brand becomes a moving target."
Yet Discroll pointed out that branding is opening up doors for designers: "They use the brand as a methodology to emphasize the standardization that, up until now, a lot of facilities didn't see the value in. I think now they are starting to see that interiors can support that brand, and can also streamline some of the smaller renovation projects so that they can get economy with products and materials on the smaller jobs," Driscoll says.
Designers agreed that healthcare clients are realizing they have to look as creative as other industries. A willingness to invest in design, and in better materials that will last longer, is also helping to increase design fees. For instance, Marmoleum , a natural vinyl, is becoming preferred over vinyl composition tile (VCT) for it's long-term durability, even though it's more expensive.
#3. Is technology becoming a larger and larger factor in designing for healthcare?
Technology, like branding, was identified as another moving target. "Clients still haven't figured out how to support the mobile worker in a really good way," says Cremers. "They try all these various handheld devices, but in the end they are just kind of awkward. I think they are looking for devices that are small enough that they could hang on a neck chain, so there are all sorts of things being tested."
#4 Hospitals can get a 2-15 percent savings in operating costs by upgrading outdated facilities. Does this help generate business?
Designers identified a balance or juggling act that happens in tandem with doing a facility-wide assessment. "We look at what the cost would be to make the changes to the existing facility to meet demands— often bed capacity or stretcher alcoves, for example—versus what the cost would be to do that at a greenfield site," says Driscoll. The lack of a standard, consistent metric for really assessing the ROI was agreed upon by the roundtable.
#5. What about evidence-based design—are administrators getting the need for design at a higher level?
Benchmarking was the catchphrase for this segment of the discussion, which focused on renovations to existing facilities. "People who are doing multiple facilities and are trying to improve outcomes within an existing setting," says Rohde, "are looking at benchmarking post occupancy and ongoing benchmarking. That's true for electronic records in terms of doing a 'life plan' instead of a health record that looks at things more holistically." Post occupancy benchmarking provides research that argues for a more thorough, functional programming process, and nonprofit clients are proving the most committed to focusing on the outcome.
In the context of renovation, designers noticed there are often interim steps to helping clients move forward, eventually to new builds that, due to new guidelines for builds, will be held to higher standards. Sometimes the renovations are part of the journey to get funding for building a new, optimized facility.
#6. Has there been any shift in the conversation regarding proper maintenance of facilities, a hot topic at the June roundtable? Can design be utilized to help ongoing maintenance?
Sonja Bochart, senior interior designer, SmithGroup , kicked off this topic, saying that her firm stays as connected as possible to clients after a project's completion, which helps when maintenance or repair issues come up. "That way, if questions come up on maintenance, or if someone within the facility wants to make a change," says Bochart, "they know to call us to ask us about. By fostering those close relationships, we're able to help shape that."
Close client interaction was identified as a must during early phases of healthcare projects as well. "It's important to have involvement with all the key stakeholders as we're developing designs to begin with," says Driscoll. "It's not just administration, but folks from the environmental services department and from facilities. We like to have opportunities to interview them so that we can align ourselves and be pragmatic about how we select the finishes and products in the beginning." Driscoll added that pragmatic product and finishing selections also come back to sustainability— sometimes what designers can do to make things look the best longest turns out to be the most sustainable choice anyway.
Cremers spoke out regarding the challenges of maintaining large-scale facilities: "The biggest struggle we have is when dealing with larger projects where a new product can be applied to only one area. That means it requires different maintenance procedures than other areas, which can be really, really confusing to EVS." Clients can't casually tell which material requires which finish, and there often isn't anyone on site whose job it is to tell workers what they should be doing room by room, explains Cremers. Communication, especially in these large-scale projects, seemed to be the hot ticket to success in maintaining healthcare design.
#7. What are the product needs in healthcare and wellness design?
Seating was immediately identified as a huge issue, particularly when it's upholstered in fabric, which holds up to different types of cleaning procedures (non-bleach vs. bleach, etc) depending on the product's composition. "Facilities are having a hard time committing time and fees for having upholstery cleaned," notes Driscoll. "Even if it's just steam cleaning. Housekeeping can come in and wipe down a vinyl finish, but they are not willing to commit to having fabric cleaned." In order to guarantee proper cleaning, designers agreed—the more vinyl polypropylene product, the better.
Concerns over materials selection turned the conversation to the red listing of materials. "We're not supporting the red list approach," says Rohde. "We support materials selection from a life-cycle analysis approach, by looking at multiple attributes of products and the full life cycle to fully evaluate all the different aspects." LEED v4 is heading in that direction, explains Rohde, along with a host of other initiatives that are putting a spotlight on the development of standards for materials. In the meantime, Francis Kaufman asks for a healthcare ingredients list from manufacturers: "If they can provide that list," says Driscoll, "it will help in the interim before we have a mechanism to identify the needs."
#8. Have there been any recent improvement in acoustics in healing environments?
The new FGI guidelines from 2010 and 2014 include acoustical guidelines, and 2010 was the first time that was in the licensing code. "It's starting to be introduced in sustainability standards in terms of indoor environmental quality," says Rohde. "We've ended up hiring a consultant for one project, but it's not an easy process to get through, nor to add the consulting fees into the infrastructure."
In the context of renovations, evolving guidelines have allowed designers to pull the trigger on better acoustical tile. Says Driscoll, "We've just finished a renoation of a patient unit, previously with double bedded rooms, as all private rooms, and immediately that takes half the population off the floor. That's a remarkable transformation acoustically." Between just being able to upgrade the acoustical ceiling tile and decanting the number of people in a unit, the latter is significantly quieter. Designers agreed that the very nature of the guidelines and the trend towards private rooms changes the density of a unit significantly.
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