Filling the Void

Collaboration on a behavioral health room mock-up is creating new resources to inform design going forward by: Brian Giebink, Kimberly McMurray and Mary Therese Hankinson

GROWING AWARENESS of the importance of behavioral healthcare is renewing focus on the design of inpatient psychiatric facilities, with the goal to provide welcoming, relaxing, safe environments that put patients at ease and help them be receptive to their treatment. However, according to leading researchers in the field of health environment design, evidence on the subject isn’t sufficient to influence the design of such spaces.

The Institute for Patient-Centered Design (IPCD), a nonprofit organization dedicated to improving the built environment to better meet the needs of patients and their families, has been working to fill this void over the past several years.  In 2015,   IPCD held a design competition focusing on the behavioral healthcare inpatient bedroom and bathroom, for which three finalists presented their ideas using virtual reality during an educational session at the Healthcare Design Expo & Conference. Conference attendees then voted on the top design, selecting HDR’s “One Haven” project as the winner.

 

HDR’s restorative environment was designed to empower patients to take active ownership of their behavioral health wellness journey while maintaining a safe and secure environment  for all.  The team used an evidence-based design process and consulted peer-reviewed journals, case studies of existing behavioral health facilities, experts, patients, and families to gain important perspectives. Strategies to promote safely for all parties in every aspect were incorporated, from the fixtures and furniture to the flooring and doors.

 

Providing patients an appropriate level of choice and control of their environment was also important in the design, to empower patients in their recovery and to convey a sense of respect from caregivers. For example, a patient-controlled digital artwork display on the footwall allows patients to choose the natural landscape they wish to view.

 

MOCK-UP DEVELOPMENT

But the work didn’t stop with the conceptual design. HDR spent the next three years working closely with the IPCD’s team of advisers, including lead juror Jim Hunt, founder and senior consultant at Behavioral Health Facility Consulting (Topeka, Kan.), and juror Mardelle Mc­Cuskey Shepley, professor at Cornell University (Ithaca, N.Y.). The group developed a mock-up of the design, including a low-fidelity version, during a design charrette held in 2017 at Savannah College of Art & Design.

 

IPCD also teamed with the U.S. Department of Veterans Affairs New Jersey Health Care System (VANJHCS) to build a high-fidelity mock-up on its campus in Lyons, N.J.  Eighteen manufacturers and vendors donated specialty products and materials, and VANJHCS provided the space and the labor to build the unit, which was completed in early 2018.

 

The goal of the mock-up was to apply an evidence-based design approach to gain feedback from veterans, staff, and outside groups regarding preferred design features, such as furniture, lighting, door hardware, toilet accessories, and plumbing fixtures. In support of the V.A’s guiding principles for its behavioral health service delivery system to deliver hope, self-direction, empowerment, respect, and peer support to patients, the design also incorporated elements that give patients choice in basic life activities, such as controlling temperature and flow of water in the shower.

 

GATHERING FEEDBACK

After construction was completed, IPCD held an open house event for groups to tour the space and provide feedback on the design features and products incorporated in its construction. Shepley, along with Naomi Sachs, founding director of Therapeutic Landscapes Network and a postdoctoral associate at Cornell University, and staff from Cornell University, collaborated with the project team on performance improvement activities. Those included two evaluation methods of the mock­up room used by the VA, listening sessions and written feedback. In gathering feedback, participants were asked to agree or disagree with statements about the design of the room, including aspects of patient and staff safety, communication of respect, patient privacy, patient empowerment, patient and family participation in treatment process, connection to nature and daylight, comfortable accommodations, and acoustical control. Three listening sessions, two with staff and one with patients, were held in a group setting and intended as a qualitative follow-up of the written feedback form.

Informal results indicate that the mock­ up’s design and product choices were generally positively received and considered to be “peaceful.” For example, the viewers found the furnishings comfortable and less institutional than traditional behavioral health furniture. The light fixtures near the bed were noted for minimizing glare and allowing control of brightness. One element that received mixed reviews was the open shower, which has no walls or curtains separating it from the other bathroom fixtures. Viewers suggested that patients may not be comfortable with the lack of privacy, while staff members may prefer the added visibility of patients.

 

MOVING FORWARD

Shepley is wrapping up the project with a thorough evidence-based design study of the high-fidelity mock-up, which will contribute evidence­ based design data to help fill the shortage of research regarding inpatient behavioral and mental health facilities. The Veterans Administration Office of Construction and Facilities Management is also currently undertaking a comprehensive revision to the VA’s Behavioral Health Design Guidelines and will use these findings to help inform its process. Additionally, IPCD presented the project in detail, as well as lessons learned, at the 2018 HCD Expo in Phoenix.  This collaborative work will continue to inspire innovation and provide resources that enable designers to improve behavioral health environments. More information on the project may be found at www.institutepcd.org/behavioral-health.

Brian Giebink, AIA, LEED AP BC+C, EDAC, is project architect at HDR. He can be reached at BRIAN . GIEBINK@HDRINC.COM.  Mary Therese Hankinson, MBA , MS, RD, EDAC, is chief of patient-centered care and veteran experience at VANJHCS. She can be reached at MARY.HANKINSON@VA. GOV. Kimberly McMurray, AIA, EDAC, is principal at Behavioral Health Facility Consulting LLC and vice president of design for the Institute for Patient-Cetered Design.  She can be reached at KIMBERLY@BH FCLLC.COM.

Designing Behavioral Health Facilities

Building, Design and Construction University course by Debbie Gregory, James M. Hunt, Kimberly N. McMurray and Ben Szela

Integrated inpatient Healthcare Design

SAFETY FOR ALL: Integrated Design for Inpatient Units

Integrated inpatient Healthcare Design

Patient Safety & Quality Healthcare magazine

Bringing integrated healthcare into the inpatient environment is essential to help keep safe the 20% of all adults who are currently on a mental health medication.  The Joint Commission has reported that 25% of inpatient suicides do not occur on psychiatric units.  Designing for suicide resistance must be extended to all inpatient rooms and toilets.

Common Mistakes in Designing Psychiatric Hospitals – An UPDATE

FGI_CommonMistakesPsychiatricHospitals_1505This white paper was originally published by the American Institute of Architects in their Academy of Architecture for Health Journal in 2009.  We continue to be asked to help hospitals with newly constructed facilities correct the mistakes that were designed into their buildings.  This UPDATE provides insights into the current best practices in Psychiatric Hospital Design and is published by the Facility Guidelines Institute (FGI).  Download Free, CLICK HERE

Behavioral Healthcare Design – Ten Things You “Know” That “Just Ain’t So”

AIA AAH Journal 17

Preliminary meetings involving architects, psychiatric hospital management, and unit staff members often result in decisions that crystallize into critical details of facility design very early in the planning process. These can be very difficult, if not impossible, to change later on.

During these sessions, it is not unusual for psychiatric hospital staff to state any number of time-honored platitudes that, through sheer repetition, have come to be “known” as unchallengeable facts of psychiatric facility design. Typically, staff comes to “know” such things because they have heard them during their education and throughout their professional lives in the facilities in which they have worked.  But using such “common knowledge” while designing new psychiatric facilities can be very problematic and very costly.
Former baseball great Satchel Paige explained the problem best when he said,

“Its not what you don’t know that will hurt you; it’s what you ‘know’ that just ain’t so.”

And so it is, I find, with the design of psychiatric hospitals. The intelligent and highly educated people who are brought together in preliminary design meetings frequently fail to consider whether what they have come to “know” about psychiatric facility design is now (or ever was) valid.  Let’s look at the data available from some credible sources to see if some of these “known” statements are actually correct.

How to Stretch $50 Grand

Summer 15 cover 50 grandBehavioral Healthcare recently presented top experts with a design challenge, asking for advice on what facility upgrades they might prioritize if they had a budget of only $50,000. While it’s easy to make improvements with $1 million in hand, not all centers have that luxury.

Letting the Light In

Finding creative ways to introduce natural light into behavioral healthcare units and other creative solutions to drastically improve the therapeutic environment for patients and staff.

Behavioral Health Design: Codes, Guidelines and Resources that Promote Best Practices

Health Facilities Management Cover Jan 15Behavioral healthcare facilities are subject to different code and regulations than general hospitals.  The applicable codes, regulations and guidelines to consult are identified and explained.

Three Design Fixes to Help Integrate Behavioral, Medical Care

The term “Integrated Care” is being used a lot these days, but little is being said about the physical environment in which this will take place.  Perhaps we need to start defining what Integrated Healthcare Design will be developed.

Healthcare Design Magazine: November 2014HCD mag Nov 14 cover

Eliminate Curtains from Patient Areas

 

BH Magazine May/June 2014

Current thinking among some leaders in the field of behavioral health care design is now that curtains of all types should be eliminated from the patient environment. This includes curtains at windows, showers and privacy curtains in multi-patient rooms.

BH Magazine May/June 2014