Over the past several years, healthcare facilities
have adopted design characteristics traditionally found in hospitality and residential environments. Interiors have become more home-like and familiar, and less institutional and clinical.
Behind the design decisions are a greater focus on patients’ psychological needs and an understanding that environments have an impact on the healing process. A holistic approach to healing considers the mental, emotional, social, physical and spiritual aspects of healing. Applying this approach to the design of places where people heal is resulting in more humane, personal and comfortable environments—including behavioral health facilities.
In the past year, two prominent organizations have published design guidelines for behavioral health facilities intended to create holistic and safe environments: the National Association of Psychological Health Systems (NAPHS) and the Department of Veterans Affairs’ Office of Construction and Facilities Management (VA). The VA health system, in particular, has been instituting a culture of transformation for several years. This transformation impacts approaches to care, as well as the architecture and interior design of its facilities. The changes have also begun finding their way into the VA’s behavioral health system.
In December of 2010, the VA’s Mental Health Facilities Design Guide became available to designers and architects (available for download at www.cfm.va.gov/til/dGuide/dgMH.pdf). The guide supplies technical, architectural and engineering
specifications, as well as guidelines for what ultimately leads to a culture of transformation. Excerpted from the Guide’s introduction:
This Design Guide reflects a new vision and philosophy for designing mental health facilities that is rooted in hope, healing, and recovery. Strong emphasis is placed on design approaches that incorporate home-like, non-institutional, and patient-centered environments that imbue healing, familiarity, and a sense of being valued.
Facility design impacts the beliefs, expectations and perceptions patients have about themselves, the staff who care for them, and the services they receive… The Design Guide also places important emphasis on patient safety. Developing mental health facilities that are safe and healing are not incompatible processes or goals.
Likewise, the NAPHS, with authors David Sine and James Hunt, published edition 4.3 of the Design Guide for the Built Environment of Behavioral Health Facilities in May of 2011 (available for download at www.naphs.org/Design%20Guide%204_3%20FINAL.pdf). This guide states that designing behavioral health facilities that are more residential and less institutional in nature should be a primary goal for healthcare designers.
“The recent focus on patient and staff safety has had the
tendency to push the aesthetics
of [behavioral health] units toward the appearance of a prison environment. It is important to constantly strive for the safest possible healing environment while also striving for as much of a non-institutional appearance as possible,” write the authors.
creating safe, welcoming
Our colleague, Candi Caraway of Herman Miller Healthcare/Nemschoff, recently partnered with the VA on a new inpatient facility in the Midwest. Describing the inpatient area, Caraway says, “Its interior design is quite different from the VA mental health facilities of the past. More square footage is allocated to open spaces and multiuse areas. The main nurses’ station is open, too. The message is ‘We’re available, we’re accessible and we’re here for you.’”
The facility’s design also creates a safer environment. It features nurse pods at each end of the unit, providing staff with workspaces that are closer to patient rooms. Staff work areas offer lines of sight into group rooms and open areas as well. This design provides more continuous visual monitoring—an added safety benefit over the outdated approach of walled-in nurses’ stations and enclosed group rooms. An open and connected space results in more efficient work flow, since staff can see more of the unit without having to leave their work areas. The open design also has another benefit: natural light passes throughout the unit. The resulting environment is pleasant and calm, and patients are less agitated.
Another of Nemschoff’s clients is a privately owned behavioral health network. The manager of hospital-based services says the NAPHS guidelines informed a number of her organization’s approaches to facility design, from incorporating more open architecture to their decisions on materials and colors. One of their facility goals is to create welcoming, pleasing environments that are safe in every way.
A large component in creating these sorts of environments comes from the specification of specialized furnishings. Nemschoff, for example, produces a line of products designed for mental health applications. These products typically draw their origins from standard healthcare furnishings, but feature custom assembly and material choices in order to meet safety criteria for mental health applications. By doing things like adding protective seat panels that cover springs and fasteners, and adding weight to make a piece of
furniture difficult to move or pick up, we can create a chair that is safe for both patients and staff.
Designers can also work with manufacturers to coordinate seating products throughout behavioral health facilities, from the patient areas to public waiting areas and lounges. Incorporating warm wood finishes and pleasant yet durable fabrics into soft seating can make a big difference in the look of a space, without sacrificing durability.
the healing power of space
Understanding the unique requirements of behavioral health facilities, particularly inpatient environments, is critical to their design. Safety is the first concern and should always be top-of-mind when making design choices, but it is no longer considered in isolation. Modern behavioral health environments are integrating familiar, residential elements into environments that used to be stark and institutional in their design. This reflects the larger transformation that is happening in the overall design of these facilities.
We believe space has the power to influence all sorts of things, from improving staff productivity to fostering collaboration. The design of spaces, including their architecture and furnishings, can also reassure patients, enhance comfort, foster well-being and enhance safety. Thoughtful design solutions take into account the special requirements of inpatient mental health facilities. The power of such spaces is that they don’t compromise safety over healing.
The power of such spaces also lies in their ability to support staff with efficient, pleasant, comfortable workplaces. When staff can observe patients while completing administrative tasks, and when they work in a unit that is designed to provide natural and frequent interaction with patients and visitors, their productivity and safety is improved. A more pleasant workplace also has positive implications for staff satisfaction.
We applaud the efforts of the VA and the NAPHS in advancing a spirit of healing and safety, and the power of space to balance both.
Scott Reynolds, vice president of product development for Nemschoff, has been involved in nearly every aspect of Nemschoff’s healthcare furnishings business for over 28 years. He currently leads new product development efforts at Nemschoff, including standard and special project initiatives, as well heading the customer service and order entry groups.
Doug Bazuin has been senior researcher for Herman Miller Healthcare for 11 years. He champions the interests of patients and caregivers during product development efforts to improve their experiences and outcomes.