Edwin Beltran

Edwin Beltran

Principal
As a design leader within NBBJ’s interior architecture and design practice, Edwin has helped develop one of the nation’s most admired healthcare design practices and led some of the firm’s most notable and award-winning healthcare interiors. He believes that at its core, design is a selfless and optimistic quest to create meaning through beauty, purpose and empathy. He finds a great deal of intellectual stimuli in the cultural hustle and bustle of urban centers, and creative focus and clarity during his weekend walks along the beach.

Balancing Beauty, Dignity and Safety

Furniture and Finishing Strategies for Behavioral Health Facilities

October 21, 2021

Principal

A critical challenge in behavioral health design is the need to balance aesthetics, dignity and comfort with safety. This is especially true when it comes to the interior. Furniture and fixtures designed for these environments have historically exuded an institutional feel which undermines the familiar, calm, healing environment that research suggests is required to promote good outcomes. This challenge is particularly acute on projects which serve diverse patient populations with a range of needs—such as the Big Lots Behavioral Health Pavilion at Nationwide Children’s Hospital, the largest pediatric behavioral center in the nation. However, by building on evidence-based research and design R&D, and considering not just how furniture looks and functions but how it can be adapted and maintained over time, behavioral health facilities can reinforce both dignity and healing. Below are four key elements to consider when devising a furniture strategy for behavioral healthcare facilities, drawn from our research and experience designing the Behavioral Health Pavilion in collaboration with architecture+.

If It Doesn’t Exist, Design It
In researching furniture options, the Behavioral Health Pavilion team found that existing products tended to emphasize durability at the expense of comfort. To address the specific needs of a patient population which included both teenagers and younger children, more reassuring, comfortable furniture was needed, which at times required a custom-built solution. For example, the patient rooms, which are designed to feel more like dorms or living rooms, required a sleeping and seating platform which provided space for family and was made of natural, durable, economical materials.

Unable to find a commercially available product which met these requirements, the team created a L-shaped built-in bed with space for storage and for parents to sit, lie down and spend time with patients during their recovery process. Built by local millworkers, the custom element uses stacked plywood as a more economical wood option, which maintains a durable yet natural feel that takes on an appealing patina as wear and tear accumulates. Mockups—which served as a real-world example of the building’s aspirations for a more comfortable, familiar type of care environment—were used extensively to work out the design details, and as a tool to help raise mental health awareness and secure sponsorship through touring state legislators, community leaders and donors.

Ensure Adaptability
While furniture in behavioral health settings must be safe, durable and attractive, it should also adapt to different functional needs so that a seamless design aesthetic can be maintained across program areas and over time. Furniture selection for the Behavioral Health Pavilion was driven by this central premise. For example, all specified furniture adhered to a few pre-established contrasting options (soft vs. hard, light vs. heavy, assembled vs. molded) to ensure safety requirements were met and that all the pieces worked together harmoniously as a carefully curated yet highly flexible collective.

For example, chairs used in common areas can be filled with sand, making them heavier and less movable for spaces where safety protocols require it. The team also worked with the manufacturer to develop a durable tablet arm for the chair used in patient rooms, so that it could also be used in exam and consulting rooms. This strategy enabled the design team to use similar furniture in public, staff and patient areas, helping to normalize and destigmatize the patient experience. The approach was guided by evidence-based research suggesting that the design of an environment can help reduce stress and improve outcomes, especially if it promotes a normal, familiar atmosphere.

Use Modular Approaches
Because of concerns about safety and damage, durability is a critical consideration in furniture designed for behavioral health facilities. At the Nationwide project, furniture and fixtures were selected and designed to be modular wherever possible, so that damaged elements can be easily replaced. The bed and seating units in patient rooms and curvilinear seating benches in common areas, for instance, are modular and consist of removable segments to facilitate repair and maintenance. This approach also extends to the flooring, which is seamed in such a way that any single floor piece can be removed and replaced quickly while patients are elsewhere in the building, minimizing disruption.

Conceal Safety Features
Maintaining an uplifting and supportive atmosphere requires close attention to detail, including the concealment of institutional-feeling safety features. The informal motto “always present, never seen” serves as a frame of reference for the design, where safety infrastructure is embedded in the environment in subtle ways. Safety and prevention of self-harm are carefully considered in how materials are installed, joined and assembled—including understated, stylish tamper-proof lighting systems, and double action door hinges which are barely noticeable and ensure rooms are barricade proof. When available options felt too institutional, the team collaborated with manufacturers of bathroom fittings—including lighting, mirrors and soap dispensers—to use more understated products not yet on the market in exchange for feedback on their designs.

As behavioral health facilities evolve, there will be increasing opportunities to use furniture and fixtures to enable safer facilities that more closely resemble homes, schools and other familiar settings. This will require a considered approach that builds on research and strategies such as those discussed here to create more empathic environments that destigmatize behavioral healthcare and truly encourage healing.

Share this:  envelope facebook twitter googleplus tumblr linkedin
Comment Follow nbbX

How to Make Common Areas in Hospitals Safer During the Coronavirus Crisis

Six Design Considerations for Waiting Areas, Lobbies and Lounges

March 30, 2020

Principal

Editor’s note: Our healthcare clients are on the front lines of the coronavirus crisis. We seek to support them as they courageously care for the sick. So we’re posting design ideas based on work with them, in the hope that we can contribute from our base of expertise to help combat the epidemic. From all of us at NBBJ to the many doctors, nurses and support staff in hospitals and clinics, thank you from the bottom of our hearts.

This post was co-authored by Edwin Beltran and Josie Briggs.

 

Chronic illnesses like cancer, diabetes and heart disease don’t stop just because the rest of the world is at home. As the coronavirus crisis surges, healthcare providers struggle with how to best serve patients in the hospital with non Covid-19 illnesses, without enabling the virus to spread. This challenge is particularly acute in common areas such as building entrances, waiting rooms and lounges, where infected and non-infected patients and visitors congregate and transmission risks may be elevated.

While immediate solutions can address the current surge of demand on hospitals, hospitals planning future construction or renovation can optimize their ongoing infection control efforts — whether every day or during a pandemic — through six key design considerations:

Material and Furniture Selections
Furniture and finishes in common areas can be a vector for infectious diseases like coronavirus. According to preliminary research, the Covid-19 virus can stay alive on steel and plastic for up to 72 hours, around 24 hours on more porous surfaces like cardboard, and only four hours on copper. Consideration of material selection, especially the use of antimicrobial surfaces like copper, can be an important strategy for reducing transmission risk. Surfaces that prevent or reduce the spread of pathogens, including rubber or linoleum flooring, should also be considered.

The easier a piece of furniture or surface is to clean and disinfect, the less likely it is to serve as a vector. Furniture pieces with seamless detailing that eliminates hard-to-reach crevices and can be cleaned on all sides will be less likely to host pathogens. Furthermore, smooth upholstered surfaces, such as seat cushions, are easier to clean if there is a gap between the seat and back cushions — debris falls to the floor for easy cleaning, and a hand can easily wipe the surfaces with a disinfectant.

Solid surface materials, such as Corian, can be shaped and made seamless, making them easy to clean when used as a table, chair arm or handrail. Additionally, all furniture materials should be durable and able to withstand stringent disinfection and cleanings protocols.

Seating Arrangements
In recent years, there has been a trend within healthcare design to support a wide range of options for activity-based seating in waiting rooms. These arrangements can be moved or otherwise modified to create sufficient space between patients to minimize infection risk. However, consideration should also be given to the isolating effects such arrangements can have on patients and how to mitigate this impact through other measures. For instance, an array of small screened seating zones or connected rooms could support proper social distancing measures while still allowing for visual connection to others and the outdoors, reinforcing social connections and a link to nature.

Creating Separation
In some healthcare facilities, waiting rooms are being used for triage, to divide patients into infectious and non-infectious populations. This requires specialized signage and seating areas to be grouped into sections with sufficient distance between them to support social distancing. Some facilities could have courtyards or gardens separating different waiting areas which can also serve to create separation between patient populations. Facilities may also consider incorporating medical gas outlets concealed behind sliding artworks, panels or other elements in lounges and waiting areas to support potential surge needs.

Touchless Surfaces
Another method of minimizing the risks of contact transmission is to employ touchless technology in common areas. This includes automatic doors and hand sanitizer dispensers, as well as sensor-activated faucets, soap dispensers, toilets and towel dispensers in common-area bathrooms, which can be a hot spot for contact transmission. For entertainment monitors and interactive information displays, voice activated command technology can be used to eliminate the need for touching surfaces.

Mechanical Systems
Waiting areas and lounges in healthcare facilities aren’t typically a focus of specialized mechanical system design for infection control; however, given the current crisis and possibility of future outbreaks, it may be valuable to evaluate how methods typically applied to clinical spaces for air changes, filtration, or negative pressure may be incorporated within these areas to allow for more flexibility of use. This would require several challenges to be addressed: for instance, designing the space so it could be appropriately closed off from adjoining spaces to keep the appropriate pressure balance and control the flow of contaminated air.

Using Design to Uplift and Comfort
Hospital visits can cause anxiety at any time, but especially in a pandemic, under infection control protocols that, by their very nature, can be isolating and potentially dehumanizing. So it is important that healthcare common areas still serve to reassure and comfort patients, providing a sense of normalcy by giving them opportunities for respite, privacy and comfort. This is especially true for neurodiverse populations, who may require additional attention to issues such as color palette, lighting, temperature and varying degrees of shelter, privacy and “socialization.” The inclusion of elements like gardens, courtyards and views of nature can help alleviate anxiety and provide opportunities for positive distraction.

The coronavirus crisis sheds renewed light on the importance of healthcare facility waiting areas, lobbies and lounges. These common areas are on the frontlines of the pandemic fight as surge space for clinical overflow and as potential vectors for infection. Design has an important role to play in ensuring that these spaces play a more active role in preventing infection while optimizing their operational flexibility to consistently provide dignifying and humanizing settings in support of exceptional patient care.

 

How are you and your healthcare organization dealing with the coronavirus? We’d like to hear from you. Drop us a line at socialmedia@nbbj.com.

Banner image courtesy Sean Airhart/NBBJ.

Share this:  envelope facebook twitter googleplus tumblr linkedin
Comment Follow nbbX

Follow nbbX