Hospital friendly design

Hospital design is evolving along with advances in technology, safety and security.

Hospitals are complex machines. With public and private areas, wards and laboratories, in-patient and out-patient services, how do architects design hospitals to maximize patient confidence and enhance staff efficiencies?

The initial focus needs to be on how patients, staff and materials will move throughout the building.

“If you are an architect designing a hospital, before you draw a line, you need to draw flow diagrams. You must have an understanding of what is going where and how,” says Sharon Woodworth, a senior architect with Anshen + Allen in San Francisco. Woodworth has more than 20 years experience as a healthcare architect and has worked on projects around the world, from the Philippines to the United Kingdom.

Achieving an optimal flow sounds simple,” says Woodworth. “But it is not easy.”
Meanwhile, traffic flow should be deterred from high security areas.

“The rule of thumb for safety is that these secured areas, like imaging, should be designed as a dead end,” she says. “No uninvited traffic should be allowed to even go through that area. It is an end destination only and preferably with a double entry point, or intervening vestibule.”

RFID tracks patients

The design of hospitals, particularly of in-patient areas, is evolving along with technology. For example, nurse’s stations were originally designed and situated to serve as a control point.

“The nursing staff was acting as security guards using sight lines,” says Woodworth. “But, technically speaking, there doesn’t need to be a nursing station at all.”

That is because some hospitals in the United States have begun to use radio frequency identification (RFID) tags sewn into patient’s gowns and monitored by a nurse’s mobile device. This enables nursing staff to keep track of a patient’s location and needs.
“With full connectivity like that, a nurse can monitor who is coming onto the unit or even who falls out of a bed because that sensor in a patient’s gown has let them know,” she says.

The varying needs of different patients can also impact design.

At the Royal Children’s Hospital in Melbourne, Australia, keeping visual track of young patients is a top priority.

“Because we’re a children’s hospital, our patients need to be monitored 24/7,” says David Lee, technical officer in the engineering department. “In that sense, there is no privacy. Everything is glass. We have glass doors and large windows so that nurses have a bird’s eye view of all the patients.”

Handles out of reach

Other design considerations for young patients at Royal Children’s Hospital include door handles placed higher off the ground, out of reach.

“Because kids can try to wander around, all the handles on doors that lead outside are set 1.3 or 1.4 meters,” says Lee. Building regulations in Australia require door handles to be only 1 meter above ground, so the hospital required special permission and can only have the elevated handles in areas that have round-the-clock adult supervision in case of emergencies.

Architects designing children’s hospitals must also keep in mind that children are rarely alone, says Woodworth.

“You are really designing a family environment, even if the child is a teenager, their family is there with them,” says Woodworth. “So there are special considerations, like larger waiting rooms and larger in-patient setting.”

But whether you are in a children’s ward, a cancer care center or a general hospital, Woodworth believes all designers should keep in mind that they are creating an environment for people who are, to varying degrees, disabled.

In all hospital settings, doors and doorways often prove major trouble spots for patients and for designers.

Push plates on swing doors ease access for staff pushing a wieldy patient bed from Surgery to Recovery. Automating swing doors with large push buttons on the walls beside the entrance is another solution.

But the swing door may not be the easiest door for patients to operate themselves, says Woodworth. “Patients in wheel chairs, for example, may not have the upper body strength to open a door, and those that do have to maneuver around it.”

For that reason, Anshen + Allen often use sliding doors in their design projects.

Easy passage

“Hands-free” door opening goes even further, as hospital employees with embedded RFID tags trigger a sensor to open any door without using their hands for even a second.

“This same technology is extremely valuable for patients with minimal or poor upper body strength,” Woodworth points out. “It also has an added security feature that patients can only access appropriate areas with their embedded medical access card, while staff can access restricted areas.”

When considering other design elements to improve staff efficiency, and, as a result, patient care, Woodworth follows a rule of thumb.

“The magic achievement is when you’ve designed a space that keeps the caregiver at that bedside, whether it’s an in-patient or an out-patient, an exam table, a bed or a surgical table.” This means implementing design techniques that ensure healthcare workers have what they need close at hand, such as a nurse server closet. With a front door in a patient’s room and another in the corridor, it allows the nurse to stay at a bedside while the pharmacist delivers medication into the closet.

“All the nurse has to do is turn around and pull out the drug,” says Woodworth. “That same technique can be used in an ER (Emergency Room) setting and in operating rooms as well. And that’s the level of thinking we need to bring throughout healthcare settings, because there is an architectural aspect to it.”

In the end, says Woodworth, a good healthcare architect has to know what their client’s goals are. “You can build the right thing, but if it doesn’t meet a client’s needs, that facility is not going to operate the way it should and, ultimately, it will be a failure.”

By Rachel Sa