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Omaha Magazine

Behind-the-Scenes Safety: Flexibility Increasingly a Critical Aspect of Designing Health Care Environments

May 26, 2020 08:55AM ● By Scott Stewart
Sheila Elijah-Barnwell, co-founder Pact Studios

Photography by Bill Sitzmann

As health care workers scrambled this spring to prepare for a deluge of patients, one design factor in their facilities made all the difference: flexibility.

Flexible facilities could be adapted into isolation rooms, shifting capacity typically used for routine examinations or elective procedures into spaces suitable for those infected with the coronavirus.

Facilities not designed with flexibility in mind couldn’t be stretched in the same way, limiting the number of beds available as cases of COVID-19, the disease caused by the new virus, began to soar around the nation.

The design of health care facilities is inexorably linked to patient care and, ultimately, what the professionals working inside those built spaces can do to save lives.

“We’ve been looking for years at how to design for more flexible use,” said Sheila Elijah-Barnwell, co-founder of architectural firm Pact Studios. “I can see clients wanting to consider that more going forward.”

Elijah-Barnwell joined with her husband Chris Barnwell and fellow architect Shawn Coyle to launch Pact Studios last year. With locations in Omaha and Denver, Pact brings experience from both large international firms and small local firms to address the specific challenges related to the health care industry.

“We want to do health care. We don’t want to dilute our practice,” Elijah-Barnwell said. “In health care, it is important to be in touch with what’s happening. It’s important to understand all the codes, all the regulations, because there’s a lot.”

While the COVID-19 pandemic places that importance in stark contrast, a lot of everyday, small decisions go into designing a space, but the consequences of that work can be heightened in a health care environment. 

Consider a typical patient room, for example. The placement of the sink matters because when a health care worker washes their hands, particulates can fly off for several feet. 

“You don’t want any of that landing on a patient, and you don’t want it landing on a door that you’re going to touch,” Elijah-Barnwell said. “Anytime we’re designing in the built environment – so this could be community planning, a whole building or just one room—that solution can positively or negatively impact the safety of occupants.”

A lot of design goes into infrastructure that ultimately has patient safety in mind, said Michael Hamilton, managing principal of Altus Architectural Studio’s Omaha office.

“When you walk into a patient room or an exam room, what you’re visually seeing is really the tip of the iceberg relative to the infrastructure it takes to support that space,” Hamilton said. “The mechanical systems, the electrical systems, the life-safety components and the redundancy that is required to support those spaces is actually pretty amazing. The intention behind all of it is the health and safety of the occupants of that facility.”

Nearly half of the costs for a typical health care project are spent on the behind-the-scenes infrastructure, he said – much of it behind the wall, under the floor or just over dropped ceiling tiles.  

“There is just so much that you don’t see on the surface when you walk in that goes into health care design and engineering,” Hamilton said.

The more infrastructure supporting a space, the more versatile it can be, Elijah-Barnwell said. A lot of new health care projects are designing their regular medical-surgical rooms to meet the stricter requirements for medical gases and electricity found in intensive care units, along with the ability to shift from a positive-pressure to negative-pressure to control airflow and prevent the spread of infectious diseases.

“If we design those so that they have the requirements necessary to become an isolation room, then you can treat more critical patients in that room in the future,” Elijah-Barnwell said.

She said her favorite example of a flexible space is at a small community hospital in Virginia she designed for a previous employer. The hospital placed its clinical decision unit—a space where patients are observed prior to admission—adjacent to its emergency department.

The unit has its own infrastructure and a separate entrance, allowing it to be transformed into a pediatric unit during flu season, an additional intensive care unit for COVID-19 patients or even a biocontainment unit during the Ebola outbreak in 2014, Elijah-Barnwell said.

“It’s really been, in my opinion, one of the most flexible solutions I have ever been able to provide a client,” she said. “It’s self-contained. It’s separate access. It’s everything that you’d want it to be if it was its own little mini-building.”

Looking ahead, that adaptability is going to be increasingly important, and both Elijah-Barnwell and Hamilton expects regulations will adjust to encourage flexible environments.

“COVID-19 is going to change the way health care delivery is done in the United States,” Hamilton said. “This event is going to really drive some pretty big changes in terms of how the built environment is looked at in a hospital. Moving forward, projects are definitely going to address things like the pandemic we’re seeing right now.”

Altus, which also specialized in health care with offices in Omaha and Denver, was working with the U.S. Army Corps of Engineers to evaluate hotels, convention centers, and other spaces to be makeshift hospitals. Hamilton said hospitals will be more proactive moving forward.

In the short term, Hamilton said a lot of projects will remain on hold, as the hospital systems in Omaha and elsewhere evaluate their priorities and balance their budgets. He expects many of the projects will be retooled with pandemic preparedness in mind, even if it drives up costs.

“Doing it right the first time pays dividend in the long run,” Hamilton said.

Of course, other considerations will still remain important, Elijah-Barnwell said. Clients have come to expect health care facilities be designed with environmental sustainability as a key requirement, and designs will continue to emphasize patient experience.

“Most people going to the hospital—unless you’re having a baby, you’re not going there for necessarily positive reasons,” she said. “You’re a little bit anxious. You’re already worried. So making it easy to get where you’re going helps elevate that stress.”

Making it easy to find parking, clearly marking paths, and greeting patients with inviting, natural, aesthetically pleasing spaces makes a difference in health outcomes, Elijah-Barnwell said. 

Using durable materials is also critical, as health care facilities put up with a lot more wear-and-tear than a typical office environment. Physical safety—from an armed intruder or natural disaster—is another important consideration, and another area where flexibility is key.

“All of those pieces come together in a health care setting,” Elijah-Barnwell said. “You’ll hear a lot of health care architects refer to it as designing for the patient experience. Our job is to make the environment support all the people who provide the health care be successful.”

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This article was printed in the June 2020 issue of B2B Magazine.