History lessons

Designing an interior for a health care facility — with multiple audiences that must approve the final design — is extremely subjective.

It's important to plan and create an atmosphere that makes patients and families feel welcomed, comforted and at home. It's also important to create a facility in which caregivers and staff are proud to work and that facilitates the delivery of high-quality care and day-to-day operations.

Health facility professionals want to please all groups while keeping budgets in check. However, managing these groups and the individual personalities of key participants can lead to conflict, delays and increased expenditures.

Post-occupancy evaluations serve a critical role in designing, constructing and delivering the right mix of functionality and personality.

Patients and their families appreciate when the hospital environment includes amenities from home. Nurses and the medical team welcome work spaces that are comfortable and allow maximum efficiency. The environmental services team values materials that will endure 24/7 use.

Assembling a team and conducting visits at other health care facilities is often an important step in achieving these results. In fact, it allows the interior designer an invaluable opportunity to understand and manage organizational — and individual — expectations. As with just about any project, establishing a process and understanding how one step connects to and builds on the next establishes credibility.

Assemble the team

Everyone has an opinion. From employees to family members to patients, each likely has at least one element he or she would design differently. Interior designers know this. They know that the best way to deliver a pleasing design is to collaborate with individuals from various departments with differing perspectives. The interior designer becomes the personality manager, creating a safe environment in which opinions are expressed freely, respected and considered.

Interior designers enter projects at various stages of the process but participating with the architect early to develop the schematic design will ensure that the interior is functional. Likewise, the facilities department often owns new construction and renovation projects, but it's important for interior designers to engage others toward managing and meeting expectations.

It's best for interior designers to build a team of individuals who share the following ways of working:

• They are engaged with the organization and view committee involvement as a reward.
• They identify opportunities for improvement and provide solutions.
• They understand, appreciate and welcome compromise.
• They work in the best interests of the organization and the department.

These skills become important as there will be an additional time commitment and need to address changes with better patient outcomes in mind. Individuals who inherently possess these skills typically are willing to invest and rise above personal issues in a manner that truly impacts design in a positive way.

When a new facility for Mercy health systems' Mercy Willard (Ohio) Hospital was being designed, for example, the interior designer understood the value in working closely with representatives from the organization to plan and deliver a design that met both operational and emotional goals. Hospital leadership welcomed the opportunity to engage its team actively in the process.

The Willard team included representatives from quality management, environmental services, nursing, administration and pastoral care.

Develop baseline expectations

The interior designer has a sense of the personality of the final interior design even before the larger design team is assembled. This is critical because it helps facilitate the right input.

The team's role is to help bring the design to life. While serving as a sounding board, the team solidifies the personality and finalizes the details. To do this effectively, the team clearly must understand what's being asked of it.

An initial meeting helps to align expectations; provide an important first step; and offer some context for the assignment. The team should be given its job description for the project, review the process and ask questions.

Although the Willard team members liked the overall feel of the Mercy Tiffin Hospital lobby, they wanted to create a slightly different look and feel while maintaining its warm and inviting atmosphere.

The designer has the opportunity to set the stage and learn what the team wants to achieve the most. For example, early in the Willard project, the designer learned the team felt the atmosphere of another hospital in the system was not the modest environment they hoped to create. Getting this input early allowed the interior designer to probe the underlying root of those perceptions. The designer learned the team wanted to make sure the hospital projected a welcoming and homey feeling when visitors entered.

As the leader, the interior designer must be prepared to define expectations clearly. As with any assignment, if individuals do not have a clear, shared vision when the time comes to function as a team, input will not be aligned.

Identifying the top five to 10 areas the team needs to address is a good way to minimize confusion and ensure alignment. These areas can be identified through questions like the following:

• What does the team like most about the feeling of the entryway? What does it like least? Why?
• What are the team's main concerns about product selection, ease of maintenance, cost and durability? What products previously used didn't stand up? What products previously used have delivered high-quality performance?
• What design features should be avoided? Why?
• What are the needs of the area each team member represents? How does the team meet those expectations? Where can a compromise be found?
• What do the team members like about the colors, lighting and furniture in their individual spaces?
• Which design features would each team keep, modify slightly or change completely?

The interior designer for the Willard project developed a spreadsheet that made capturing input simple and consistent. The team was asked to provide specific detail about likes, dislikes and wishes for atmosphere, patient rooms, work stations, workflow, flooring, finishes and color scheme.

Even before the first post-occupancy evaluation, the interior designer had a good understanding of the team's hot-button issues.

Conduct the tours

Through the course of post-occupancy evaluations at similar nearby hospitals owned by the Mercy system, the Willard team was able to express what it liked and didn't like by commenting on certain features used in similar hospitals. For example, the team initially was extremely adamant about keeping the color green out of the new hospital's color scheme. From an interior designer's perspective, such a limitation can be worked around. However, conducting the tours provided an opportunity to investigate and learn more. During a post-occupancy evaluation, for instance, it was discovered that the team didn't object to green per se, but a specific shade of green.

Identifying a cross section of examples is important. The Mercy Willard team toured three facilities in the Mercy Health Partners system, all of which were designed by the interior designer's firm. They included the two-year-old Mercy

Tiffin (Ohio) Hospital; the four-year-old Mercy Heart & Vascular Center in Toledo, Ohio; and the eight-year-old Mercy St. Anne Hospital in Toledo.

When conducting post-occupancy evaluations, the interior designer should be sure to adhere to the following practices:

Schedule tours within a few days of each other or on the same day, if logistically possible. This will allow for nearly consistent review by the team. Too much time in between creates memory gaps and causes potential confusion.

Develop a way to capture input. The designer may want to provide audio recorders or ask team members to document notes on a spreadsheet, putting a rating system in place as a way to help gauge the degree of an opinion.

Start each tour with the same instructions. Treating every visit as if it's the first helps to ensure the team understands its role.

Lead the discussion rather than allow someone else to lead. The interior designer should take command of the tour, asking questions at the appropriate times and recommending what the team should observe. Additionally, the designer should connect the dots for team members as they go from one facility to the next and help them understand the best way to capture their input.

Debrief the team immediately and outline the next steps. After each tour and after all tours are complete, the interior designer should lead a recap session where commonalities are outlined about what the team liked, what they didn't like and why. These findings provide the rationale for the design elements moving forward and should be compiled into a verbatim report.

Once the input was collected on the Mercy Willard project, the interior designer was able to complete an analysis ruling out stylistic elements such as pendant light fixtures and curvilinear floor and ceiling patterns. The designer had a better understanding of the team's expectations and the reasons for those expectations after walking through three facilities with team members.

Determine design elements

Once the tours have been conducted and input is collected and discussed, the interior designer must take that information and finalize a design that captures the essence, needs and functionality as identified by the team through the tours.

This also is the stage to work through any bubbling issues among team members. If such a situation arises, it's important to review the expectations of the individuals and their departments and facilitate appropriate compromise.

With all issues openly addressed and team input provided, the interior designer is free — within the limitations of working with stakeholders — to fully map out the interior design. Working closely with the architect to translate the exterior design appropriately into the interior, the designer then presents the plan to the team.

As each area's features, fixtures and elements are addressed, the designer should tie back the decision-making to the input and results gathered as part of the post-occupancy tour. This not only will validate the importance of such input, but will provide the baseline for the decision-making.

This is an important step when managing project expectations. Design adjustments still may be made but, ultimately, this stage is about gaining approval as the team will serve as ambassadors to the larger organization.

The Mercy Willard team had several heated discussions about flooring, for instance, which is an important interior design decision. The team was divided on whether to use carpet or resilient flooring in the family waiting areas. On one hand, carpet would add to the comfort of the space and help with acoustics. On the other, the resilient floor would be easier to clean and maintain and likely would last longer.

The interior designer served as a facilitator, taking the group back to the goals and objectives for the project. Carpet ultimately was selected because it aligned better with the goal of designing a warm, welcoming environment.

Explain the approach

It's best to leverage the team as the design is unveiled to the organization. If the team, both collectively and as individuals, takes ownership of the project, the internal audiences likely will feel more comfortable with the process and certainly the outcome.

It's a good idea for the interior designer to present the final design to the hospital's senior leadership first and then follow up by conducting departmental meetings. Also, the designer should work with the communications department to provide background and details that can be shared through communication channels such as newsletters, board communications and employee bulletin boards.

The Mercy Willard team assumed ownership of the final design. In fact, they welcomed and were proud to share the plans with their departments. Departmental meetings were scheduled and the team — along with the interior designer — met with departmental leaders and other stakeholders to unveil the interior finishes, color scheme and lighting selections. Overall, the design was well-received.

The main takeaway

A hospital interior often becomes the main takeaway for those visiting the health care facility. While the atmosphere certainly includes the quality of care received, individuals quickly make assumptions and set their expectations once they enter the facility. Inviting entries, welcoming patient rooms, accessible work spaces and attractive floors can make the difference.

The process to achieve great results takes careful planning and team engagement as well as an interior designer with a strong health care background to pull the right elements together. The group dynamic comes to life as an interior designer guides discussion in a way that allows for managing team expectations.

Conducting post-occupancy evaluations with a small group of stakeholders allows the interior designer to manage and meet expectations, so that the facility will please everyone from the patient to the CEO. hfm

Lynne Gochenour, IIDA, AAHID, LEED AP, is a senior interior designer and senior associate at SSOE Group, an architecture, engineering and construction management firm with locations across the United States, China and India. Her e-mail is lynne.gochenour@ssoe.com.