Key Considerations - A Photo Gallery
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“Just walking into the lobby is so friendly and less intimidating. You can’t measure how meaningful that is to patients and families, the environment makes a big difference in the healing process.”
–A family member
Doernbecher Children’s Hospital
Portland, Oregon
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In planning any health care space, a number of key design features and issues should be considered. Among these considerations are the following:
1) First impressions. There are often a series of first impressions in a hospital-the parking area, the entrance and lobby areas, the entrance to each clinical area, and the entrance to the patient room. First impressions are powerful. They set the tone for all interactions that follow. First impressions can be long-lasting. They shape an individual’s or family’s perception of a facility and those who work in it.
The first impressions of a health care setting should be welcoming, inviting, and reassuring. They should convey a place of competence, caring, and compassion, a place where patients and families are valued, and a place that they can manage and comfortably navigate.
Bronson Hospital in Kalamazoo, Michigan, designed by Shepley, Bulfinch, Richardson, and Abbott Architects, is an example of a health care facility that has given careful attention to first impressions in its recent renovation by using glass-walled walkways from each floor of the parking facility to the main building, placing touch-screen kiosks and volunteer greeters at each entrance, and using greenery, natural light, flowing water, and soft music in the garden atrium.
Windows, natural light, and clear simple signage in the parking garage create positive first impressions at Cook-Fort Worth Children’s Hospital, Fort Worth, Texas.
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The lobby at Hasbro Children’s Hospital creates welcoming first impressions for families. The scale of the lobby is such that is not intimidating to children and families. The reception desk’s low front counter is positioned so that children and families can be greeted as they enter. There is a stage for special community events, bringing the community into the hospital.
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A plant, home-like lamp, and supportive wording on a welcome desk sign are reassuring to families at the entrance to the pediatric intensive care unit at the Hospital for Sick Children in Toronto.
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Having a “Hall of Hope” as the entryway to the newborn intensive care unit at Christiana Hospital in Newark, Delaware was an idea that originated with a parent-chaired committee. Beautiful color photographs of children whose first weeks and months were spent in newborn intensive care are placed along both sides of the hallway. Below each color photo are a small picture of each child as a tiny baby and a brief medical history. The Hall of Hope is inspiring to both families and staff.
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Flowers, a notebook on how to connect with other families, and a bulletin board with attractively displayed information create welcoming, reassuring first impressions for families entering newborn intensive care at Memorial Hospital in Colorado Springs, Colorado.
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2) Wayfinding. Ease of wayfinding can help create a sense of welcome and a feeling of
ease among visitors to a health care setting. Wayfinding includes an array of architectural and design cues
(signs, maps, and other “landmarks”) to guide users and make the process of finding one’s
way as intuitive as possible. One important aspect of wayfinding is clear, welcoming signage. An activity
to help assess wayfinding and signage in an institution is available on this website.
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At Yale-New Haven Hospital in Connecticut, a statue of Babar the elephant, created out of Legos, is a clear wayfinding symbol, signaling to children and families that they are in the pediatric section of this large urban academic medical center.
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Children's Hospital of Los Angeles is a large urban hospital that has been renovated many times. In efforts to improve wayfinding, especially for the diverse cultures that this hospital serves, the institution has both created signs in multiple languages and used visual cues. Themes were created for the lobbies to enhance ease of wayfinding. For example, the Beach Lobby used symbols from the beach (lighthouse, shells, starfish) on the walls, flooring, and furniture to help orient children and families even if they are not able to read the Beach Lobby signage.
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3) Noise and Lighting. There is a growing body of literature that speaks to the
necessity of paying close attention to sound and lighting in health care facilities. Appropriate lighting
and the control of noise are important to patients of all ages, their families, and staff.
A special supplement to the Journal of Perinatology focuses on sound, its impact on fragile infants,
and the neonatal environment (Journal of Perinatology, 20(8S), December, 2000.) While this publication
focuses specifically on newborn intensive care, much of the information on sound control is very relevant
to other areas within health care facilities. Copies/reprints can be ordered from the publisher at
http://www.naturesj.com/jp.
Design standards for neonatal intensive
care units (NICUs) directly address the important issues of ambient lighting and noise abatement.
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For the new newborn intensive care unit at Memorial Hermann Children's Hospital in Houston, Texas, particular attention was given to sound and lighting. There was careful planning of traffic pathways to channel noise away from the baby and support staff in their work.
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Additionally, each of the patient care rooms was equipped with:
- Adjustable lighting for each bed
- Adjustable indirect area lighting
- Large double-pane thermoregulating windows and adjustable blinds
- Full walls with highly absorbent acoustical materials on floors and ceiling
For further information on this project, contact: Kathleen M. Philbin, RN, PhD, at Hermann Hospital; D.
Kirk Hamilton FAIA, Watkins Hamilton Ross Architects, Bellaire, Texas; and/or Acoustical Engineer: Jack B.
Evans & Associates, Inc., Austin, Texas.
4) Patient rooms. Creating zones for the patient, family members, and staff enhances
the comfort and function of patient rooms. Most pediatric and adult hospitals are moving towards having the
majority of rooms be private and also towards providing more comfortable sleep chairs or beds for a family
member or support person.
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The Woodwinds Health Campus in Woodbury, Minnesota has placed a bed for a family member or other support person in each of its adult patient rooms, including the rooms on the critical unit.
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Special features in each of the patient rooms at Rainbow Babies and Children's Hospital in Cleveland, Ohio include clouds painted on the ceiling, a dry erase board used to enhance communication, a TV/VCR, a small refrigerator, and both a rocking chair and a bed for the parent.
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The pediatric intensive care unit at Eastern Maine Medical Center in Bangor, Maine has placed a parent bed with homelike wall-mounted lighting in each patient room.
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At Doernbecher Children's Hospital in Portland, Oregon, the pediatric intensive care unit has single rooms, each with a bed for a parent and a large window with a view of a pleasant outdoor patio.
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5) Nurses’ stations. Traditionally, nurses’ stations and work areas have
been surrounded by walls that have created an intimidating tone on a unit, separating staff from patients/families.
Recent innovations have lowered or removed these walls to encourage collaboration in care and care planning.
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On an adult oncology unit at Rush Presbyterian Hospital in Chicago, there are no walls around the nurse's work area.
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The kitchen is a familiar gathering place for most older people. To create a more homelike feeling at Baycrest Centre for Geriatric Care in Toronto, the nurses' station is located in the kitchen with papers and charts stored in cupboards.
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Low counters, natural wood with curved lines, and delightful back-lit visual images create a warm and welcoming tone at the nurses' station on the Infant Transition Unit at Cleveland, Ohio's Rainbow Babies and Children's Hospital.
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A round table adjacent to the nurses' station at the Children's Hospitals and Clinics in St. Paul, Minnesota encourages families to participate in care planning.
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6) Outpatient areas. Attention to the architecture and decor of outpatient areas sets a tone
for welcoming patients and families, making them comfortable, and inviting collaboration.
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Special attention was given to first impressions of the reception and main waiting area for the Cancer Center at the University of Virginia in Charlottesville. Fresh flowers are always at the reception desk, and a playroom for children is adjacent to the waiting area for this adult oncology area. For more information on the facilities of the children's medical center, please visit www.hsc.virginia.edu.
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At the Lakeview Center for Senior Health in Des Moines, Iowa, a bench is placed in the hallway outside the exam rooms as a place for older people to rest and orient themselves.
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Teens developed the Beach Club theme and basic design for their outpatient chemotherapy treatment area at Phoenix Children's Hospital.
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At The Children's Hospital at Providence in Anchorage, Alaska, families participating on design teams for the pediatric ambulatory clinic, wanted a round table in each exam room. A round table symbolized partnership to them. Families wanted to be able to sit at these tables with their care team members to plan their child's care.
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7) Information and education. Increasingly, patient and family education is recognized
as essential to the provision of quality health care services. Hospitals and outpatient health centers are
responding by developing patient and family libraries, resource centers, and education facilities.
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The Ann Byron Waud Patient And Family Resource Center for Healthy Aging at Rush -Presbyterian-St.Luke's Medical Center in Chicago offers a broad range of information about aging and health, specific medical problems, Medicare, caregiving, long-term care and other resources. Its patrons can utilize books and journals and make frequent use of computers and the Internet. The center is located at the entrance from the main hospital into the Bowman Health Center. More information on patient and family resource center »
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At the Children's Hospital of Philadelphia, 4,000-square feet have been dedicated to the Connelly Resource Center for Families. The center includes a Family Library with a library/business center; a children's library; computer/internet access; and a wide selection of written and audiovisual resources. The Center also incorporates a Family Living Space with a living room, sleep rooms, and kitchen and laundry facilities and a Family Learning Center with classrooms and a full-size patient room for home health teaching.
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At Montefiore Medical Center in the Bronx, New York, a mother of a child with sickle cell disease suggested the name for the new family resource center: The Family Learning Place.
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Hospitals are beginning to develop satellite patient and family resource centers on specific units or in ambulatory clinics. At UMASS Memorial Medical Center in Worcester, Massachusetts, the NICU Family Resource Center is located near the reception desk for the unit. The design for the 9' by 9' Center was developed by 7th graders participating in Worcester Polytechnic Institute's summer program for girls interested in engineering and technology.
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8) Family support spaces. In addition to accessing information, families facing the stresses
of a loved one’s illness or hospitalization need places to gather, relax, and both provide and receive
informal support.
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At Foothills Medical Center in Calgary, Alberta, a recent renovation at the newborn intensive care and transition nursery included the expansion of a family lounge. The lounge now includes a full kitchen, a play area for young children, and a computer for family use.
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The living area of the Connelly Resource Center for Families at the Children's Hospital of Philadelphia provides a comfortable place for rest and relaxation as well as for informal family gatherings. Coffee hours are held here for families on a regular basis throughout the week.
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At Christiana Hospital in Newark, Delaware, a committee chaired by parents contributed many ideas for the design of the Comfort Area for newborn intensive care. The area includes a comfortable living area (not shown), a kitchen and dining area, and a playroom for young siblings. A special feature is the telecommunications system at each bedside that facilitates families viewing their baby from the Comfort Area.
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Lockers for storing personal belongings are available in the family lounge near the critical care unit at
Children’s Hospital Medical Center in Cincinnati, Ohio. The attractive, colorful mural of a mountain scene
also contributes positively to the ambiance of the room.
At Griffin Hospital in Derby, Connecticut, every unit has a kitchenette where patients and families can prepare
meals to their liking. Rooms in the intensive care unit are layed out so that one door leads to the nurses’
station area and one leads into a family lounge.
9) Art. Using a variety of different artistic media can contribute to the healing environment
of a hospital or clinic. When strategically placed, art also can be important to the facility’s wayfinding
system. By using art created by the population served, personal connections are developed, and hope and inspiration
are encouraged. Recognition of the diversity of cultures served is another important consideration for architecture
and both the selection and placement of art.
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The nose on the brass koala bear at Children's Hospital and Health Center in San Diego has become quite shiny, having been rubbed frequently by children passing by. The strategic placement of this brass statue on the window ledge also serves as a wayfinding cue.
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All of the artwork displayed at the University of Virginia's Cancer Center, in Charlottesville, has been created by cancer survivors. There are both a permanent collection, and rotating exhibits in some areas within this outpatient setting.
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The Bowman Center for Healthy Aging at Rush-Presbyterian-St.Luke's in Chicago has an art collection created by Chicago area citizens over the age of 65. Each work of art is labeled with the artist's name and age.
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Parents participating in planning a renovation of the pediatric outpatient specialty services at Fletcher Allen Health Care in Burlington, Vermont suggested the "art bus" for the hallway as a way to showcase art created by the children served by the clinic. The windows on the bus have Plexiglas frames. Children create pictures that can then be placed on the "bus."
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At Maimonides Medical Center in Brooklyn, New York, patients, staff, and their families collaborated in a weekend event to decorate a primary care clinic's waiting areas, hallways, and exam rooms with tissue paper art.
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At the Alaska Native Medical Center in Anchorage, Alaska the lobby area was constructed in a circle, an important symbol for gathering places in many Native American cultures. Geese are depicted flying in a circle, all in the same direction, supporting one another. The shape of the building and the artwork, with visual images familiar to Native Americans, convey messages of mutual support and create positive first impressions for patients, families, and staff alike.
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10) Play and developmental support. Play has been called the work of children. Even when
children are ill, opportunities to play are central to their well-being. Environmental design in settings for
children, or settings where children may accompany or visit adults, should creatively incorporate spaces that
encourage and facilitate play. The opportunity to create art and poetry can be a healing form of “play”
for adults as well.
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In addition to a developmentally supportive playroom, Children's Hospital at Dartmouth in Hanover, New Hampshire has a play area outside each cluster of patient rooms.
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Adolescent patients helped design the new teen lounge for the Children's medical center at the University of Virginia in Charlottesville.
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11) Spiritual support. Many hospitals have created chapels, or quiet rooms, that allow a quiet
space for spiritual reflection or prayer by patients and families of many faiths. Additionally, the need for
spiritual support can be recognized by providing office space for a pastoral care department.
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Children's Hospital in Columbus, Ohio recently created a children's chapel reflecting the diversity of cultures and spiritual beliefs among the staff and families served by the hospital. There is flexibility for which religious symbols are in the chapel at any particular time. Additionally, prayer rooms facing Mecca are adjacent to the chapel for use by Moslems.
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Pediatric patients contributed ideas for the stained glass window at the chapel in the Children's Medical Center at the Medical College of Georgia in Augusta.
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12) Nature and the out-of-doors. Several resources attest to both the healing value of gardens
and outdoor spaces in health care settings and the benefits of rooms with a view to the outdoors and/or the use
of nature-related murals in treatment and other rooms.
Some publications on this topic include: 1) The Center for Health Design’s report titled
Gardens in Healthcare Facilities and 2)
Healing
Gardens: Therapeutic Benefits and Design Recommendations (Wiley Series in Healthcare and Senior Living
Design) by Clare Cooper Marcus (Editor), Marni Barnes.
Woodwinds Health Campus in
Woodbury, Minnesota, is designed so that visitors can enjoy panoramic views of the adjacent wetlands from
the day waiting areas. See more photos at the above link.
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The Woodwinds Health Campus takes every opportunity to capture the beauty and serenity of nature surrounding the hospital. Families on the maternity floor are offered an informal breakfast in an area overlooking one of the ponds on the campus. Also, stenciling in the patient rooms continues the theme of connecting with nature.
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Shepley, Bulfinch, Richardson, and Abbott Architects incorporated
trees and other live plants in their design of Bronson Methodist Hospital in Kalamazoo, Michigan and used a large nature mural on the ceiling in a CAT Scan room at Valley Hospital Ridgewood, New Jersey.
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Even in winter, children, families, staff, faculty, students, and trainees enjoy the delightful outdoor Prouty Garden at Children's Hospital in Boston. There are many hidden sculptures that surprise and please as they are discovered amidst the winding paths, trees, and bushes in the garden.
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At Doernbecher Children's Hospital in Portland, Oregon, outdoor patios are strategically located so that children and families have easy access to the out-of-doors. Most patient care areas, including critical care units, have views through beautiful etched glass directly to the patios.
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The new addition to the Family Resource Center at the Children's Hospital and Regional Medical Center in Seattle creates a comfortable living area for families with large windows and views to the outside.
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Patients and Families as Advisors »
The Design Planning Process »
Selecting an Architect »
Key Considerations - A Photo Gallery »
Issues to Consider »
Additional Resources »
Environment & Design - Main
