I had just finished creating a walk-through animation of a new ambulatory surgery center the day before I got the call. Sure, I understood how to lay out a healthcare facility, how circulation through a hospital worked, where the "family zones" needed to be drawn on the plan, but I was about to get an unsolicited insider's perspective that would change my life.  My world came crashing down when a concerned voice on the other end of the line told me I needed to leave work and immediately be admitted to the cancer treatment center. I was diagnosed with acute myeloid leukemia, rare for someone in their mid-twenties.

Luckily chemotherapy brought it into remission, but spending so much time in the hospital proved to be challenging. As a designer I would try and focus on the comfort of the patient, but as a patient confined to my unit I felt imprisoned. Chemotherapy was so dizzying that I could barely stand up, so toxic that my family couldn't use my bathroom, and so nauseating that any faint smell would make me sick. Doctors had to perform exams and procedures right in my room because my immune system was nonexistent.

It was impossible to get two straight hours of sleep with blood draws at 2am, the beeping of equipment, or hearing the intercom announcing that a neighbor was coding. "Don't do the crime if you can't pay the time," a doctor joked with me after I complained about feeling like I was in jail after having spent a month and a half in the same room. I longed to go home, and privacy was a luxury I missed. As an insider and a designer I learned the importance of integrating the comforts of home into healthcare facilities. —Crystal

As life unfolds around us, we are able to draw upon our experiences as designers, passing along lessons learned to future clients and projects. Crystal's story is an example of just that. In healthcare design, it has been documented for over a decade that solariums, rooftop gardens and indoor landscaping improve the well-being of patients.¹ However, many of these features are not available to extended stay patients undergoing multiple stages of treatment due to infection control issues. New facilities should not overlook the impact of such features, and should focus on ensuring that all patients are exposed to their positive effects, regardless of patient status. Crystal's attending physician describes the beneficial aspect of her facility as "providing patients with privacy, while maintaining a physical sense of openness through natural light from windows or skylights, where patients, nurses and physicians can escape to non-medical surroundings."

As with any programming effort, we as designers know the difficulty of laying out key spaces in the much-desired location of exterior windows with views. When meeting with user groups we need to identify the hierarchy of required spaces and which provide the most benefit to the patient, clinical staff, and family caregivers. In an effort to overcome possible patient isolation, facilities can focus on bringing the outdoors in and extending patient areas into common spaces. Research has shown that exposure to natural daylight has been linked to reducing patients' depression, intake of medication, and length of stay.³ To capitalize on these benefits, "gathering" alcoves can be placed on the exterior walls of units, allowing patients a designated area to retreat, while being exposed to natural lighting and extensive views of outdoors spaces. Providing station exercise equipment is another way to utilize open and well-lit areas, which helps compensate for the lack of outdoor physical activity experienced by most long-term patients. Treadmills and stationary bicycles are desirable, as movement plays an important role in cancer treatment and recovery.²

Designers have learned that just as patients and staff members sometimes seek to escape the stress of medical surroundings, so do the family members of the patient. Relatives face the dual responsibility of acting as advocate for their loved one and maintaining some level of normalcy for their families. This juggling act can at times be overwhelming.  Studies have shown that including family members in the caring process can reduce the length of a patient's recovery.⁴ Evidence is clear that "family zones in the patient room result in fewer patient falls, reduced patient stress and depression, improved patient privacy and confidentially, improved communication with patient and family members, improved social support, and increased patient satisfaction."⁵ We also know that, until recently, few hospitals offered amenities and accommodations geared toward the families of extended stay patients. "We used to look at families and just see problems," Beverly Johnson, the president of the Institute for Family-Centered Care told the Wall Street Journal. "But hospitals now are looking less toward simply accommodating family members and more toward embracing and integrating them into the care team."⁶

As designers, we are challenged to accommodate the needs of family members while still efficiently programming clinical space. One example is to provide family lounges. Here, we can design a flexible and efficient retreat with a range of amenities including a work environment where minimal distractions would occur. A long hospital confinement for a loved one can make a family member a "mobile worker" overnight. By providing a dedicated workspace, a touchdown station becomes a satellite office. Equipped with wireless internet, proper lighting and ergonomic seating, family as well as staff can use this area to conduct day to day business or research. 

Identifying the need for such open and flexible patient and family areas is only half the battle when designing healthcare facilities, where expansion, renovation and space constraints may increase over time.  These areas are often the first spaces targeted by administrators to be removed or modified as they are considered a "luxury." Understanding that the treatment of patients doesn't just happen in the patient room, and care is not just administered by clinical staff, is critical for designers and healthcare facilities in order to succeed in today's healthcare environment.

Missy Kutner, NCIDQ LEEP AP BD+C, CDT, is an Associate of the Perkins+Will Charlotte, North Carolina office. Missy focuses primarily in healthcare design and has been most recently been involved in large healthcare projects including Moses Cone North Tower project, the Holston Medical Group MOB and the East Carolina Cardiovascular Institute where she collaborated with Susan Lee on the interior fit up and furniture package.
She can be reached at missy.kutner@perkinswill.com

Susan Lee is the director of interior design of the Perkins+Will Research Triangle Park, North Carolina office. Her 27 years of experience in interior design includes numerous projects for healthcare clients and healing environments. Susan most recently completed interior design for the University of North Carolina Hospitals Ambulatory Care Center Expansion, and collaborated with Missy Kutner on the interior fit up and furniture package for the East Carolina Cardiovascular Institute.
She can be reached at susan.lee@perkinswill.com

Crystal Richards, LEED AP BD+C, is a member of the healthcare team of the Pertkins+Will Seattle office with five years of healthcare experience.  She has most recently worked on the Fred Hutchinson Cancer Research Center, Harnett Health and Medical University of South Carolina. 
She can be reached at crystal.richards@perkinswill.com

Images, from top: Lounge overlooking patient garden at Stronach Regional Cancer Centre, Ontario, Canada; photo by Ben Rahn/A-Frame. Planned healing garden for Harnet Health Systems--Central Campus Hospital, Lillington, North Carolina; rendering by RTP and Perkins+Will Los Angeles. Possible touchdown stations at Irving Greenberg Family Cancer Centre, Ottawa, Canada; photo by Ben Rahn/A-Frame.

"Designing for Health" is a monthly, web-exclusive series from the healthcare interior design leaders at Perkins+Will that focuses on the issues, trends, challenges, and research involved in crafting today's healing environments. Past installments of "Designing for Health" include (click on title to access the full article):

- The Evolving Role of the Design Professional Through Public Private Partnerships
- Are Best Healthcare Design Practices Transferable to the Middle East? 
- Best Strategies for the EDAC Exam
- Traditional Culture in a New World
- The Perils and Pearls of Field Research in Healthcare Facilities
- What's Your Problem? A Research Approach to Quantifying Design Solutions

1. McKahan, Donald, AIA, "Healthcare Facilities: Current Trends and Future Forecasts." Planning Design and Construction of Healthcare Environments, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL 1997.  

2. Doyle C, Kushi LH, Byers T, et al. Nutrition and Physical Activity During and After Cancer Treatment: An American Cancer Society Guide for Informed Choices. CA Cancer J Clin. 2006; 56:323-353

3. Ulrich, Rodger Ph.D., Quan, Xiaobo, Zimring, Craig, Ph.D., Joseph, Anjali, Choudhary, Ruchi. 2007. "The Role of the Physical Environment in the Hospital of the 21st Century: A Once-in –a-Lifetime Opportunity Center for Health Systems and Design," College of Architecture, Texas A&M University

4. Venezia, Camille D., Knoll Workforce Research, Global Business Division, 2007. "The Voice of the Mobile Workers; Translating Practices, Relationship and Components into Effective Workplaces."

5. "A Review of the Research Literature on Evidence-Based Healthcare Design," Healthcare Leadership White Paper Series, Georgia Tech College of Architecture and The Center for Health Design, September, 2008, p. 53.

6. "Patient Rooms: A Changing Scene of Healing."  Herman Miller Healthcare; Research Summary 2010 www.hermanmiller.com