The outdoor views and elements of nature, such as the fireplace, are an essential part of healing and lend a hand in creating an aesthetically-pleasing space at the OMNI Medical Campus in Billings, Mont
Just as research guides providers to the best protocols, evidence informs healthcare design. And much like the practice of medicine, creating healing environments is both an art and a science.
Nashville serves as home base for two busy professionals whose services are in high demand nationally. Their work and artistry helps soften the hard edges of high-tech healthcare facilities … and in the process … promotes healing through low-stress environments infused with nature, light and warmth.
Rebecca Donner, IIDA, is the principal and founder of Inner Design Studio, which has been in business 19 years and now employees five designers with a sixth on contract. Byron Jorjorian, owner of Byron Jorjorian Fine Art Photography, has been capturing nature for over 30 years and has more than 375,000 images in his files. His fine art prints are installed in healthcare facilities stretching from California to Texas to Tennessee … and most parts in between.
Donner said evidence-based design has become increasingly important. In fact, she noted, Pennsylvania officials required her company to include a written explanation about the ways evidence-based research was incorporated into the design plans for a recent healthcare project in the state.
The two experts shared some insights with Nashville Medical News regarding the direction design and art are taking in healthcare.
Replacing Trends with Timelessness
“You’re really seeing people getting away from trendy things,” said Donner. “Now you really have a conscious effort to invest in timeless pieces.”
As hospitals and practices … and more than a few homeowners … found, the mauves and teals of the late 1980s didn’t stand up well to the test of time. Unfortunately for the healthcare facilities, the expensive lesson was that replacing big pieces and installed items in that particular color palette came with a large price tag.
Now, Donner said, neutrals and timeless materials are used for the expensive, permanent pieces to keep from dating them. She added inexpensive areas, like paint or fabric accents, are great places to pull in pops of color.
Although often reserved for replaceable items, Donner said it was important not to underestimate the value of color and its ability to create an uplifting mood. Color also plays a key role in wayfinding, she said. Donner noted she and her staff use color, art, floor patterns, and design themes to differentiate departments and make facilities easier to navigate. “We’re trying to make things intuitive instead of having to read a bunch of signs,” she explained.
One ‘trend’ that has had staying power is borrowing from the hotel industry to create spaces and patient rooms that are welcoming and feel hospitable.
Design with the Patient in Mind
The patient-centered care movement has certainly influenced design, according to Donner. “There’s such an emphasis on it, and we’re starting to see results from that.” She added the evidence is catching up with the theory that such designs promote healing.
Donner noted a chief concern patients have going into a procedure or a stay at a hospital is a feeling of helplessness. She added there are a number of simple measures that address the issue. One relatively inexpensive item she often adds to a room is a patient information board that includes providers’ names for a given shift, time information for scheduled test, when to expect the physician … all items to help keep a patient in the loop. Other solutions include allowing patients control of room temperature and lighting.
“You try to ease that anxiety and give them a little bit of control over their day,” she noted.
Another key area, particularly with inpatient rooms, is social support. Quickly disappearing are the small, hard visitors chairs that used to be the only place for family members to perch. “Now we make a huge emphasis on having a pullout couch that makes a bed so family members can stay. It’s an easy fix,” Donner said. She added many rooms are now configured with patient, family and provider zones.
Connecting with Nature
Byron Jorjorian understands the deep connection to nature and inherited an artists’ eye. Coming from a family filled with visual and commercial artists, he set out to write a nature article as a young man. “I went and bought a little inexpensive camera to take a picture … I never wrote the article, but I took back the camera in two weeks and traded up to a better one.” Two weeks later he traded up again and began adding attachments … and was completely hooked. In the beginning, when he wasn’t working at his job in a camera store, he could be found at Radnor Lake or the Cheatham Wildlife Management area lining up shots. “I spent virtually every minute I wasn’t working taking pictures,” he recalled.
It’s highly doubtful the young Jorjorian could have foreseen how in demand his work would become for healthcare facilities. In the early 1990s, a designer working on a hospital project approached the photographer, whose work has appeared in numerous magazines including “National Geographic” and hangs in private collections around the world, and asked for a soothing image to hang on the ceiling.
“That was the beginning of it, and it’s just grown over time,” said Jojorian. Today, he added, “My work has been purchased by over 150 healthcare facilities all over the country.”
The reason, he thinks, is simple. “It’s part of our nature to like nature. Evidence shows this, but I think we intuitively have a sense of peace and calmness from seeing nature images.”
Donner readily agreed, noting art can create ‘positive distractions.’ She has used artwork in the ceiling with backlighting to give a patient lying flat the illusion of staring up to see trees and a sunlit sky. In fact, research shows such positive distractions measurably lower pain and stress levels.
Jorjorian explained, “I think it does occupy a person’s mind and gives them a sense of peace and place, which takes them out of the moment which may be painful or stressful.”
Typically, Jorjorian noted, he stays away from abstracts, compositions with sharp edges and even oversized landscapes. “Sometimes a landscape can be so vast and big that a person doesn’t feel connected to it.” Instead, he leans toward close-ups or medium landscapes where people feel they could walk into the scene.
He added the calming benefits of artwork extend beyond patient rooms and treatment or diagnostic areas. Indeed, he noted, nurses and physicians are also subjected to high-stress environments, and evidence shows providers benefit from the soothing effects of nature photography … particularly when a window to the outside isn’t feasible for a workstation.
Ultimately, Jorjorian said, he has always believed nature and nature photography were essential to a person’s sense of wellbeing. “To have the evidence begin to back that up and then see its acceptance in healthcare facilities is even more rewarding for me.”
The Constant Battle with Noise
Once staff and patients have been soothed by beautiful art, it’s a shame to have a constant clamor jangle the nerves again.
“We want all hospitals to be cleanable so we put a lot of hard surfaces that can be wiped down, and that’s for infection control … but then there is nothing to absorb sound,” Donner said of the constant battle to balance clean and quiet.
To win that war, Donner said it just takes a bit of creativity. Some solutions are more prosaic — beefing up acoustical ceiling tiles and wall panels … having providers use beepers and mobile devices to communicate rather than overhead paging and announcements.
Other ideas use design to fool the eye. Donner said in the Intensive Care Unit at the Monroe Carell Jr. Children’s Hospital at Vanderbilt, a fabric-wrapped panel replaces traditional crown molding. “The fabric wrap is in the same color as the paint so you don’t really even see it, but it absorbs so much sound.” Another creative solution was implemented in the pediatric area of an outpatient surgery center in Fairfax, Va. “It’s built like a circus tent with clouds that drop down … they (the clouds) are actually acoustic panels,” said Donner.
Of course one option to absorb sound is carpet. However, that solution went out of vogue because of health concerns for many facilities. Now, though, new product lines have made it a viable option again. “There are antimicrobial carpets,” Donner explained. She added, “We put carpet tiles down so if there’s a spill you can just pull it up and replace it.” Once pulled up, Donner said many of the tiles are designed to be reused once they have been hosed off and thoroughly cleaned.
Another breakthrough is ionic silver technology, which incorporates an antimicrobial silver thread into fabrics and kills germs on contact. “The bacteria cannot live on the privacy curtain because of the silver that is threaded through the fabric,” she said, adding the fabric choices come in entire lines of patterns and colors to complement design choices.
Marriage of Form and Function
Ultimately both Jorjorian and Donner said it is possible to marry functional spaces with beautiful lines and colors. Whether it’s a courtyard garden or a peek “outdoors” through nature photography, a lovely wooden built-in to hide supplies or dangling clouds to absorb noise, when form and function merge seamlessly, evidence points to a net result of happier … and ultimately healthier … patients, families and staff.