Hospital design can have a significant effect on health outcomes. Human error in medical practice, staff and caregiver health, time spent in the hospital and during recovery, and long-term effects of treatment can all be affected by the physical hospital building. Designing a hospital, then, includes creating a building that maximizes patient wellness and facilitates hospital staff in making the best care decisions. In turn, patients can have better experiences during treatment and recover more quickly.
VCBO knew this when we were one of the firms selected to design the new Primary Children’s Hospital Miller Family campus, which opened its doors in Lehi, Utah at the beginning of the year. To design a facility that promoted health outcomes, VCBO and our partner, Page Architecture, employed Lean Design, a systematic approach to eliminating waste and optimizing the performance of the building. We applied the Lean Design process to accomplish the objectives set forth by Intermountain Health for the design of every Intermountain facility:
- Design for patient experience
- Design for safety
- Design for quality
- Design for stewardship
- Design for engaged caregivers
These five objectives became the guide for each decision we made during the design of the new Primary Children’s Hospital. Principal in Charge, Jeff Pinegar, and other members on the team walk us through a small portion of the thought processes that went into the design of the Primary Children’s Hospital Miller Family Campus.
Design for Patient Experience
The Primary Children’s motto is “The child first and always.” When it comes to designing hospitals that help children heal, much of our focus was providing a comfortable and safe environment.
Encouraging Physical Activity & Emotional Health
One design principle that can be found throughout the entire hospital is the idea of discovery and positive distraction. As you walk through the hospital, you can find dozens of tiny details worked into the design — animal footprints in the floor tiles, murals along the walls and nurse stations, patterned fabric used for seating upholstery, colored glass and lighting, art installations, and more.
Each of these details was incorporated based on the principle of positive distraction, defined as features that promote positive feelings and avert attention from stress or anxious thoughts. The benefits of positive distraction are multifold:
- Hospital visits can be anxiety-inducing experiences. Discovering the many details worked into the design can distract children from their fear and anxiety.
- Many patients at Primary Children’s Hospital will need to return for many hospital visits, sometimes for months or years. The design details help keep interest over multiple visits.
- Art and other design features promote an aesthetically pleasing and comfortable environment.
Implementing positive distraction and the ability for children to discover new elements can provide health benefits ranging from improved emotional well-being to enhanced healthcare satisfaction and recovery.
On a recent visit to the hospital, Jeff says he witnessed a young non-verbal boy being pulled from the parking lot into the hospital by his parents. “He was obviously not excited to come to the hospital,” says Jeff. “But as soon as he entered the main lobby, his eyes grew wide as he spotted a yellow spaceship, and he bolted toward it.” He recalls watching as the parents had to pull him away, only for him to see something else that made him rush forward with excitement: “It was at that moment that I knew we succeeded in designing for positive distraction.”
These opportunities for distraction can be as large as multi-level art installations in the main stairway to something as seemingly small as the tile pattern on the floor. At Primary Children’s Hospital, the flooring pattern features winding paths. “Have you seen children walk down a hallway?” noted interior designer Madeleine Helgren, “They don’t walk in a straight line.” VCBO applied this concept to the flooring pattern, giving the children a pathway to follow as they walk down the hall.
Dichroic glass on the stair guardrails also adds a dynamic element to the environment. This glass shifts color depending on how the light hits it and adds visual interest as the colors shift throughout the day, both amplifying the natural light and providing additional opportunities for positive distraction. To augment the changes in ambient light, we designed three round light fixtures in the ceiling that change color. These features work together throughout the hospital to help provide for the emotional health of its residents.
Natural Light & Outdoor Space
Incorporating nature, light, and outdoor spaces in a hospital is linked to less stress, reduced feelings of pain, and overall improved health outcomes. With this in mind, VCBO paid special attention to how we incorporated light and outdoor space into the hospital. One of our primary objectives, in line with Intermountain Health’s design principles, was to optimize views of surrounding landscapes and provide access to daylight and healing outdoor spaces. These spaces were intentionally designed to encourage movement, exploration, and relaxation.
While many different sections have access to nature and the outdoors, one special design choice was a private balcony located in the infusion clinic.
Children receiving chemotherapy have compromised immune systems, which limits their ability to interact with other children or explore other areas of the hospital. For this reason, VCBO designed a balcony off the infusion clinic on the third floor specifically for these patients. This way, the patients have a private area where they can spend time outdoors without the risk of infection. The patients also all have their own rooms with natural light coming in to maximize their access to nature, even when they’re forced to spend hours at a time in the hospital.
“It’s interesting to see young patients, IV pole in tow, outside on the balcony or roaming the halls of the infusion clinic,” said Jeff.
Helping Parents Support Children
In considering all design factors for a pediatric healthcare project, the experience of parents, guardians, and other family members is often overlooked. More than doctors and other staff, it is often parents who provide the most support to sick children. To this point, Madeleine, one of VCBO’s interior designers, shared her own experience as a child at Primary Children’s Hospital and how her mother supported her throughout her many visits:
“During my chemotherapy treatments, I was required to stay in the hospital for three days every two weeks, and was joined by my mom. She had a full-time career and became my full-time home nurse, teacher, and holistic diet expert, all while also managing the health and welfare of my older brother. She slept on a recliner next to my bed that leaned back until it was not-quite-flat, and cooked the healthiest food she could in the nurse's breakroom microwave..”
Recognizing the importance of a parent’s role in a patient’s health outcomes, VCBO was intentional about designing hospital features to support parents as they, in turn, support their children. Design elements at the new hospital include more comfortable seating for parents to sleep beside a child’s hospital bed, places for them to prepare food, and bathrooms that allow parents to shower without having to leave their child’s room.
The hospital also has a daycare area where parents can leave children who aren’t receiving treatment. It can be especially difficult for parents with multiple children to care for a child who needs extra attention while in the hospital. This feature helps relieve parents in a small way that can have a huge impact on peace of mind.
Madeleine was able to tour the Miller Family Campus with her mother after the building was finished. She recounts it being an emotional experience for both of them, seeing the difference between the hospital they remembered during her childhood and the new building.
Creating Space for Vulnerability
VCBO Associate Principal Levi Lloyd pointed out that many patients are at their most vulnerable when at the hospital. “Whether in the behavioral health wing or any other part of the hospital, we want the hospital to be a comfortable and safe space for all abilities.”
One place where VCBO literally created space for vulnerable patients was in recessed nooks located throughout the lobby areas. These nooks are padded for comfort and provide a surrounded area for patients who like closed spaces that are protected from the surrounding environment.
While these nooks were designed with diverse patients in mind, they can be used by anyone – especially patients feeling anxious about their visit. This idea follows the recent shift in healthcare thought that there is no such thing as a “typical” individual. With that in mind, we focused on designing inclusive spaces for everyone who visits the hospital and increasing overall accessibility and comfort.
Design for Safety
Safety was at the forefront of every design decision. It included a process that ensured all safety standards were met, limited ambiguity within the design and the process, and enhanced transparency within the facility. Technology, building layout, and many other details throughout the facility work – at the forefront or behind the scenes – to ensure patients and staff have a safe environment to work and heal.
A Focus on Behavioral Health
More than ever, the importance of mental health has become an integral component of a child's overall well being. To that end, we wanted the Behavioral Health areas to express the same design elements as the rest of the facility – to be comfortable, safe, and focused on accessibility.
While we didn’t want the Behavioral Health area to feel isolated and different, we also recognized; however, that the special circumstances that led these patients to these areas in the hospital required a special design. This included ligature-resistant fixtures and furnishings, no ledges, no sharp corners, shatter-resistant windows, light fixtures, special door locks, and other features to ensure the safety of patients and staff.
As Levi points out, “We put in just as much effort to design this section as any other, but there are different features because the patients there have different needs.”
Design for Quality
Lean Design is employed to optimize performance, make informed design decisions, and reduce waste. In this case, waste not only refers to materials but time, energy, and effort. To create the highest quality facility, VCBO and our partners focused on applying Lean principles to the seven flows of healthcare:
- Flow of patients & family
- Flow of staff & clinicians
- Flow of supplies
- Flow of medication
- Flow of information
- Flow of equipment
- Flow of processes
Wayfinding elements, like the different color themes on each floor, help patients and their families find their way within the facility, reducing the time and energy required to navigate the hospital. In a similar way, Lean principles were applied to the design from the floor plan to the medication drawers to help people and materials flow more efficiently.
We first needed to understand current processes intimately so that we could find ways for these flows to improve. This process of discovery included meetings with numerous user groups. Jeff explains that he used the “5 Whys” approach to find out the best way to make improvements based on actual use cases. The approach involves asking a question, then continuing to ask “why?” five times to get to the core reason behind different decisions and processes though defining, measuring, analyzing, improving, and controlling. With this understanding, it was possible to make improvements.
Design for Engaged Caregivers
Though children often have to spend considerable time in the hospital, it is the staff who will be there every day, working continuously to save lives. We wanted to provide a beautiful building for the hospital staff to work and spend large portions of their time. Additionally, we paid special attention to design factors that impact how well medical staff can perform their jobs.
The design process for Lehi Primary Children’s Hospital included multiple design meetings with user groups – doctors, nurses, and other staff – that began in the earliest stages of design and continued into construction. Jeff notes that there were over 130 people involved in this process. From day one, our design team engaged with hospital staff that included doctors, nurses, administrators, helicopter pilots, security and maintenance, and many others to gain valuable insight into how these people used the facility and how we could optimize it.
Setting the Standard
One of our objectives was to create an environment that enhances the quality of work of all caregivers. Hospital standardization – like making every room the same size and putting all the equipment in the same place – is an important method to reduce human error in healthcare. Standardized rooms allow hospital staff to find equipment quickly and in some cases can even save a life.
When VCBO and our partner teams designed Primary Children’s Hospital, there was not yet an institutional standard for the pediatric patient rooms. It fell to us to determine the best room size and orientation to accommodate the patient, doctors, nurses, and required equipment. The room had to be small enough to provide easy access to necessary equipment while being able to fit all the people that may be needed in the room.
To determine the ideal design, we set up cardboard mockups of inpatient and exam rooms and ran tests with doctors and nurses to simulate various procedures and emergency situations.
Based on the data and feedback from these tests, the Primary Children’s Hospital’s pediatric rooms have now set the standard for Intermountain Health’s future buildings. This standard will help hospital staff do their jobs better and result in a better experience for patients and staff.
Setting up Primary Children’s Hospital for Continual Improvement
Before the hospital opened in February, VCBO staff had the opportunity to tour the hospital and see these evidence-based principles applied. It was obvious to see the dedication, research, and careful listening that went into each design choice – each with the intent to improve the experience of everyone who visits the hospital.
But the job of an architect or designer isn’t finished with a successful building. Lean Design is a continual practice, constantly improving as technology changes and the practice of healthcare itself improves. While our team and partners employed the newest and most effective technologies, our design was also made to be flexible – to accommodate both seasonal changes in care needs and future growth and improvement.
As technology and medical practice evolve, hospital buildings will need to evolve with them. As Levi puts it, “The practice of medicine changes over time, and that in turn affects our design process.”
About the Contributors
A proponent of evidence-based and Lean Design principles, Jeff excels at the intricacies associated with complex medical projects. His focus on communication and collaboration ensures challenging projects are executed accurately, efficiently, and at the highest level of quality. He has served in several roles, from principal to project manager, on many significant, award-winning, and complicated projects.
With his keen eye for detail, Levi excels when given the opportunity to create meaningful spaces. With his experience at building information modeling (BIM), Levi produces comprehensive construction documents and works collaboratively with construction personnel through the construction administration process. This knowledge helps him ensure that each project is completed to his client's satisfaction.
Madeleine understands the impact interior design can have on the physical, mental, and emotional wellbeing of an occupant and strives to create spaces that protect her clients’ safety and welfare. Madeleine uses her technical skills with programs like AutoCAD, Revit, and Adobe Creative Suite to create and execute designs that provide a positive and uplifting experience to all who inhabit the space. During her time working for a boutique Los Angeles design firm, Madeleine developed a love for eccentric and curated commercial spaces, which she often integrates into her designs.
