Design and layout matter immensely when it comes to healthcare facilities – namely because physical and psychological comfort during treatment and recovery depend on the environment of care. And this especially applies to children’s hospitals.
While it’s true that all patients need to be in a clean, comfortable, and caring facility, pediatric patients respond to their environment in ways that are much different from adult patients. The ability of children to heal and walk out the hospital door can be affected by the rooms inside. Listed on these pages are several techniques that will help you create and maintain the best healing environment for the children who walk through the doors of your hospital.
Every successful building involves listening to the client. In this case, the “client” is your patient. To design, construct, and manage the best children’s hospital, you need to listen to children. An ad hoc family advisory group made up of a dozen patients and family members, in addition to the standard staff advisory group, can offer extraordinarily useful advice about how a facility should be designed or updated. By engaging the advisory group in the schematic design stage, the facilities team can learn a lot from brief meetings that tackle topics as fundamental as these:
- “What makes you happy?”
- “Draw us a picture of the ideal patient room.”
- “Which of these room pictures makes you feel most comfortable?”
Advisory groups should be composed of children and families whose hospital stays are prolonged, and children who represent different age groups. Rather than taxing already weak patients, participation in the group proves engaging and stimulating for parents and children alike. A mini design charrette with families can be enlightening for all participants.
Although every hospital is unique, the following elements are critical to patients of all children’s hospitals.
1. A hospital room that feels like a bedroom. Children want to bring personal items from home to soften the edges of the hospital rooms, so it’s important to make room for unobtrusive shelving that can hold photos and favorite toys. Flat-screen monitors for television, Internet, and healthcare information are costly, but also desirable, and will remind kids of home. The ability to plug in immediately reduces the stress of isolation by connecting the child to his or her friends, and parents to their work, to their child’s medical information, and to caregivers. WiFi makes immobility tolerable. Another pointer: It may seem like a small issue, but if you give patients the ability to control the lighting in their rooms, they’ll feel empowered to take control of other aspects of their illnesses.
2. A place to play on every floor. Playrooms are a necessity on each hospital floor; this space can be another place to offer computers with Internet access, as well as a site for family visits. The definition of “family” varies with each patient, and the play spaces must accommodate siblings of all ages in addition to patients. The playroom must be carefully designed to be sunny, spacious, safe, and alluring so children are motivated to move and interact if their illnesses warrant.
3. Design that appeals to teenagers and preschoolers. Design and arrange waiting rooms to be appealing to preschoolers and teenagers since both are patients in children’s hospitals. Put toys on one side of the area, and place televisions and other items of interest on another side so teens can choose where to sit. Throughout the hospital, vary color, texture, and interest items to create a soothing environment from the moment a child sets foot inside. Interior themes, like the sea, astronomy, and sports, can be used to identify corridors for easier recognition by the patient and family members.
4. Accommodation for families. Design some patient rooms with movable walls so a single room can be expanded into a double room to accommodate medical supplies and equipment, family, and loneliness. Although the trend in pediatric design is toward private rooms, a child who is going to be in the hospital for a while, and whose parents can’t stay with him or her, may want to be in a room with another child.
5. Sound absorption. Carpet the corridors. Patient room doors are usually open, and the footsteps from visitors and staff can be noisy. Carpet in the corridors not only quiets the traffic, but it’s also easier on nurses’ feet. Acoustic walls are also very important in terms of keeping patients from being exposed to noises and distress coming from adjacent rooms.
6. Comfortable bathrooms. In hospitals, as in homes, bathrooms define cleanliness, comfort, and convenience. It’s important to have enough bathrooms on each hospital floor. With a 24- to 30-bed floor, there must be at least two bathrooms for visitors – one close to the waiting area and one close to the play area. There should also be two for staff only.
7. Access to the outdoors. It’s important to have sunshine and the outdoors available to pediatric patients. Many hospitals have supervised terraces on each patient floor; others have park benches and grassy areas on hospital grounds. One well-known institution even had a fishing pond and reels available. Most importantly, ensure that the sun can shine in to all patient rooms directly, or, at the very least, through light wells. In addition to the research documenting the biological importance of adequate levels of vitamin D, sunshine makes people feel good, which is a factor in healing that can’t be overemphasized.
8. Cafeterias that feed the soul. Americans have lost sight of the fact that so many health problems are tied to the food we eat. For pediatric patients, how they eat is nearly as important as what they eat. Dining with others helps children eat better. Cafeterias should be bright, well-designed spaces, just like any restaurant that wants patrons to enjoy their visit. Those that work the best are stylish and comfortable. Easy access to the cafeteria or a communal area on each patient floor where children can interact mitigates trauma and enhances healing. Since many meals are served in patient rooms, hallways must be designed for efficient delivery. Corridors should have well-lit alcoves for food trays that are at least 4 feet deep by 6 to 8 feet long, and must be wide enough so carts don‘t interfere with gurneys. Service elevators for food carts and laundry bins should be unobtrusive, but accessible to staff.
9. Imaging machines that are grouped together. To avoid forcing children to walk long distances, design the structural and mechanical/electrical systems to allow MRI equipment, CT scanners, and other imaging equipment to be located adjacent to each other. This will improve the efficiency of caregivers and reduce patient stress; it also helps contain infrastructure costs. Harnessing electrical surges and supporting equipment weight are necessary precautions that can be easily applied to a designated area instead of spread out across the building.
10. Design for parents. The design of the hospital must take into account the fact that children will likely have at least one omnipresent parent (and many intermittent visitors). In addition to the in-room cot, the building should be located within walking distance of a hotel because there must be places for visitors to stay comfortably for longer periods of time.
11. Green design. Pediatric facilities must be healthy buildings, from materials to methods, actively involving the native landscape, energy from the sun, and nature-inspired, stress-reducing interior finishes. Additionally, roofing, insulation, and exterior finish systems can contribute to energy conservation, while high-efficiency cooling and pumping systems can be designed to respond automatically to environmental needs. To aid the health of the patients inside, the building you design must be healthy itself.
Anthony Kelly, AIA, PE, LEED AP, is a healthcare project manager at EwingCole. James Wolters, AIA, is a healthcare architect with EwingCole.