The Health Guidelines Revision Committee (HGRC) is already hard at work updating the “Guidelines for Design and Construction of Health Care Facilities,” set to be released in 2014. Every four years, a consensus group of architects, engineers, designers and healthcare professionals consider public proposals and comments before adding or clarifying information in the nationally accepted guide in an effort to ensure healthcare facilities are the very best marriage of form and function.
With each edition, tales from the frontlines help further refine the guidelines so that evidence-based ideas and design principles truly translate into the efficient, effective … and … aesthetically pleasing delivery of patient care. And there is always plenty to review or add. The 2014 edition, for example, will contain a new chapter devoted to requirements for critical access hospitals.
Scott Corbin, AIA, an architect with nearly four decades of experience in healthcare design, sits on the Codes and Standards Committee of the AIA’s Academy of Architecture for Health. In this role, he is helping draft revisions to the current guidelines. “I’d complained about the guidelines so much, I thought it was high time I put my money where my mouth was,” he said with a laugh of accepting the volunteer position to tackle the massive updating task.
Corbin, an architect with Hoefer Wysocki Architects in the metropolitan Kansas City area, began his healthcare career in Nashville with Gresham Smith & Partners designing HCA hospitals and later with Hart Freeland Roberts with offices in Tennessee, Kentucky and Missouri. Fresh out of architecture school, he said healthcare facilities weren’t initially what he considered a glamorous design sector, but a comment by HCA founder made him rethink his initial view about how hospitals could look and function with smart design.
“Tommy Frist said one time he thought hospitals should be hotels with surgery,” he recalled. “That’s a trend today,” Corbin continued, “but it was envisioned by other people 30 years ago.”
Deinstitutionalizing the look of healthcare facilities is a common practice now as architects and designers find ways to soften the hard edges but marrying that design aesthetic to the highly technical, heavily regulated healthcare industry can be difficult at times, particularly when delivery models, technology and government requirements are continually evolving. It’s one of the reasons the guidelines also continue to evolve.
“As long as I’ve been doing hospitals, I still learn … and almost every time, it’s from the nursing staff. They’re the ones on the frontlines of healthcare delivery … and they don’t mind telling you,” Corbin added.
Sometimes changes are necessitated by new federal requirements. A prime example, noted Corbin, was the move that all newly constructed rooms be private. “Primarily that was infection control,” he explained.
An offshoot of that requirement has been that the headwalls of private rooms traditionally back up to each other with electrical and plumbing housed in between the two rooms. The result is that the rooms are mirror images of each other — a left-handed room next to a right-handed one. The “same-handed” patient room concept, however, is gaining in popularity according to Corbin. “You lessen the confusion. Every time you walk into a room, everything is in the exact same place,” he explained.
Although there is a slight increase in cost since you lose the efficiency of the shared headwall, Corbin said the additional cost is certainly not prohibitive, and the gain is in patient safety since providers know every room is exactly alike. “If you’re reaching for gauze or an IV stand, they are in the same place every time,” he pointed out.
The guidelines, he continued, are beginning to incorporate some of the newer evidence-based design concepts increasingly favored by architects, administrators, providers and patients. Providing more natural lighting is an example of aesthetically pleasing design that has measurable outcomes. “Evidence-based design shows us if you give nursing staff natural light, absenteeism drops,” Corbin said. “That’s taking the evidence and putting it into practice.”
Similarly, he said even simulated light appears to have an effect. Research coming out of the Planetree model of care, which has focused on patient-centered healing environments for 25 years, has found tapping into a patient’s natural circadian rhythm, even if the patient is unconscious, still has an impact. In the ICU, for example, Corbin said, “If you simulate day and night, it aids in healing. There’s lots of interesting research coming out of Planetree,” he added.
There is also a design push to incorporate more sustainable materials with the advent of the green movement, he noted. “You are even seeing stone countertops now where you used to see plastic laminates.” He added a cadre of new materials gives designers more choices to soften the edges for patients, families and staff members to create an environment that is less frightening and much more welcoming. “You’re seeing fireplaces in the lobbies of hospitals … just so you can create that environment we’ve been talking about to deinstitutionalize hospitals and make them more calming,” Corbin said.
He added the guidelines … and trends … are applicable to a range of facilities including outpatient surgery centers, assisted living and skilled nursing facilities. Corbin also said tight budgets don’t have to restrain good design. Many affordable options are available to create efficient, effective, aesthetically-pleasing spaces.
Although public proposals to update the 2010 edition ended last October, a public comment period on the 2014 rough draft just opened last month and is anticipated to continue through much of the fall. For more information on the revision process or to comment on the draft, go to the Facility Guidelines Institute at www.fgiguidelines.org.