Incorporating Evidence Based Design at the VA

Through the course of my internship I have noticed more and more elements of evidence based design at the VA.  The area that I noticed a specialized focus on evidence based design is in the Mental Health building.  The more I learn of the design for mental health facilities the more I am amazed.  The designers that specialize in mental health design must spend massive amounts of time learning about designing for these patients.  Most mental health patients have been through traumatic experiences, have mental illnesses, or are suicidal.  Because of the mental instability these patients overcome their environment plays a huge role in keeping them calm, comfortable, and safe.  The Mental Health building at the VA is only a small, simplified example of the extreme process it takes to design this type of facility.

VA Biloxi,MS

Because most of patients coming to the Mental Health building are suicidal EVERYTHING within their environment must be considered.  The goal at the VA is to create the space for these patients that make them feel comfortable, but not so comfortable they don’t want to leave.  The patient rooms within mental health are very simple with little furniture.  The rooms only consist of a bed and a club chair.  The bed is built into the floor and has rounded corners so they can’t hang or cut themselves. The club chair is extremely heavy and requires multiple people to move.  The furniture must be immobile to avoid them hurting themselves or others.

The windows are locked to be inoperable for patients.  The windows I made with high impact glass that won’t shatter.  The blinds are inset between two panels of the window so that the patient may not access the string to the blinds.  When the blinds are to be opened or closed a nurse must come in unlock the panel to the window, open/close and lock the window back.

VA Biloxi, MS

Studies show that anything protruding from the wall higher than 6” with an allowable depth the patient could potentially hang themselves, with that in mind there is to be no exposed string, rope, or wires and anything protruding that could allow a patient to hang themselves.  Guardrails through patient hallways are not hollow and door levels have a push pedal.

VA Biloxi, MS

When patients shower they must be supervised to a degree by the nurses. The nurses wait outside the bathroom as the patient showers.  The door of the bathroom is slanted at the top so it doesn't allow patient to hang themselves on the corner of the door.  Also with more opening at the top and bottom of the door it doesn’t create a sound barrier so the nurse may hear what the patient is doing.  The door also may be pushed either direction and has no door handle.

VA Biloxi, MS

In the bathroom there are several areas that had to be paid close attention to in the design process.  The curtain is a breakaway curtain.  In the case that the patient tries to use the curtain to hang themselves in the shower, the curtain will break free.  The sink and toilet does not hold water to keep the patient from drowning themselves.  The dispensers such as soap dispenser, paper towels, and toilet paper are all inset the wall so to not allow the patient the height or depth to hang themselves.  The mirror is made to be shatter proof so that a patient can't break it and cut themselves.

 VA Biloxi, MS

VA Biloxi, MS

All artwork that is placed in the patient areas are made of canvas and bolted to the walls.  The artwork is able to hold the weight of a person so they can’t pull the artwork off, and has a shallow depth to avoid them hurting themselves or others.


After seeing these examples of incorporating evidence based design in mental health facilities I am completely amazed at the amount of thought and research required in designing these spaces.  Although I have already spoken of evidence based design in a previous blog I wanted to elaborate and show through these examples just how important evidence based design is.

VA Internship Summer 2012

The summer’s internship experience at the VA Biloxi has been a great experience that has really flown by.  I have learned a lot and feel more educated overall in health care design.  Before this internship I had very little knowledge of health care design.  Over my stay at the VA I have learned that health care design is unique all on its own.  Rules and regulations of health care facilities always changes and designers must accommodate to the building codes of the state, the health and safety regulations of the state, and the rules and regulations of the facility itself.  Health care designers are responsible in remaining updated with all codes and regulations to ensure the safety and comfort of the patients, visitors, and staff.  My internship at the VA has allowed me to experience the everyday jobs that the health care designers are faced.

The first few weeks I was at the VA I just spent time getting acquainted with the huge campus.  When the furniture installers came to assemble the furniture I was to walk them to the locations and watch as they stage the installation process.  As I watched the process of the men install the furniture I was able to be more knowledgeable of how the furniture was put together.  After watching them I was able to help with some of the work orders that consisted of replacing panels or parts to keyboard trays.  We also had several rep visits that I met and talked with.  Meeting with reps was a good opportunity to stay updated with the latest products and to gain more knowledge of the products.  A sculpture teacher I once had always repeated a saying to me, “Always know your materials”.  To me that saying is so appropriate to the design field.  It is important as a designer to always know your materials so that you may understand how the product works, where it works best, and how long it will last.  When the designer is educated on the materials he/she may also educated the client and help create a more sustainable space.

preliminary finishes

In the middle weeks of the internship I was able to help pick out finishes and artwork for new spaces.  For the new rehabilitation clinic I was in charge of picking out several different flooring types to be used throughout the building.  After listening to the reps I was confident I could choose the appropriate flooring to use in the various areas.  Because most of the flooring was going to be used for patient areas I had to find flooring that was more slip resistant and low light reflective.  I also selected art and paint colors to be used for Polytrauma and Mental Health department.  The art had to be simple, objective, and convey a positive message.  Polytrauma and Mental Health areas must be paid close attention to when designing because it consists of patients who have mental instabilities or brain injuries, which means they can be easily upsetted by their environment.  Bolder colors and abstract art are forbidden in these areas because it can cause a patient to get upset and potentially harming themselves or others.

Toward the end of my internship we became more involved with moves.  As new spaces open departments get moved around.  At the VA changes are constantly being made and moves are taking place every weekend.  The interior designers work with a team of people to plan for departments to be moved into suitable spaces with appropriate furniture and equipment.  I was able to attend the space planning meetings and walk throughs to get an idea of the codes and safety issues they must consider with their designs. Through the meetings and walk throughs I learned that the most important part of designing is good communication with the person occupying the space.  The designer must understand how the space is used to be able to make it as functional as possible.  Through my internship we encountered several space planning issues that couldn’t have been effectively resolved if there wasn’t good communication with the departments.

Exam room/office

Space planning at times can be very challenging for the VA especially when a small space is involved.  A common issue that kept arising was that the rooms required desks, exam table, chairs, and all medical equipment in small room.  The VA passed a regulation that when placing the exam tables there should be no feet to the door.  The reasoning behind the rule is to give more privacy to patients during exams.  With all exam tables having to be turned to have the feet face away from the door and data ports only being in certain areas of the room, options were very limited in arranging the furniture.  The designers did the best at planning the room to be functional and visually satisfying, but in some cases windows were blocked just to adhere to the rule.  The designers at the VA do the best possible to accompany to the needs of everyone and to adhere to all regulations, but because changes occur so regularly chances are the furniture will be moved around again.

The VA design team has taught me a lot about health care design and showed me real situations that occur.  Seeing first hand issues that they are faced with and how they resolve them helps put things into perspective when pursuing my future in interior design.  Health care design is truly unique and a design field all on its own.  I feel that my experience at the VA was very educational and will help me in my future career. 

Week 8 Learning Upholstery Specs

http://www.addicted2decorating.com/indestructible-fabric-maybe-not-but-pretty-darn-close.html

Considering Double Rubs?

During a rep visit this week I have learned the importance of knowing where the fabric will go and what specifications it should have for that area.  Of course it is a known factor that commercial upholstery should be used in commercial businesses but there is still more thought that should go into picking out fabrics. When the rep began to call out some of the specifications of different fabrics I began to have questions.  He mentioned the amount of double rubs that each had.  He explained the amount of double rubs a fabric has determines how durable the fabric is, this test is also referred to as the wyzenbeeck test.  I knew obviously that the higher the double rubs the more durable the fabric, but was there a minimum amount of double rubs that particular areas call for?  The higher traffic areas would call for a higher number of double rubs because furniture must withstand more wear.  Here at the VA designers choose not to use any fabric that is less that 30,000 double rubs.  Although the higher number in double rubs does mean a better quality fabric it could also be a bigger price difference.  At the VA designers must take into consideration that yes that fabric is durable helping it to last longer without tearing, but most of the time the fabric will stain and ugly quicker then the fabric wearing.  So is it really worth spending the price difference on the fabric for more double rubs if it will probably have to be replaced in a few years because of staining?

http://www.briteinc.com/Custom-Curtains/Cubicle-Curtains

What You Should Know About Patient Cubicles

When selecting fabric for patient rooms different considerations must be made. Selecting fabric for cubicle curtains I’ve learned that both the front and the back of the fabric must look appealing.  When a patient is laid in the bed of their cubicle they will see the back of the cubicle curtain more often than the front.  Choosing fabrics for bedspreads may be a challenge because not all fabrics are machine washable.  A designer at the VA was faced with a dilemma when she was trying to select a fabric for bedspreads in the patient rooms she was designing.  All the fabrics that she found that matched her scheme was not machine washable making it unsuitable.  Designers must pay attention to specifications of the fabrics to be able to ensure the success of the space.

http://www.onlinefabricstore.net/blog/what-is-railroaded-fabric/

Railroading

Once fabric is selected and to be upholstered on the furniture the designer may want to specify a direction of which the fabric should be placed.  When the fabric is being made it comes off the loom in a specific direction.  Unless specified, when upholstering the furniture the installer will put the fabric on according to how it unrolls on the bolt (same way coming off the loom).  For instance when the fabric comes off the loom the pattern may be at a horizontal direction, so the installer will upholster the fabric this way unless the designer specifies the opposite way.  If the designer wants the pattern of the fabric to be vertical, or opposite direction then he/she must specify “railroaded” or “up the bolt”.  Knowing these terms is beneficial for the purpose of specifying installations and when looking at fabric samples.  Some fabric samples may show at a railroaded direction which would say “shown railroaded: yes” on the specifications. 

Design Trends in Health Care

This waiting room shows the trend of incorporating bolder color within health care.

VA Biloxi, MS

Colors and Patterns

In the past health care facilities have always been filled with white or neutral colors and with solid or simple patterns.  As the years pass the trends within health care has shown a drastic change in design.  Today brighter and bolder colors are more incorporated.  Colors such as oranges and yellows with organic patterns are now becoming more seen within health care.  Today the common goal for health care design is to create an environment that doesn’t feel like a hospital to help the patient be more relaxed making everything easier on patients and staff.  

This patient room shows a more residential look.  The traditional dark cherry wood color seen

 in the picture is a more appealing trend for older generations.

VA Biloxi, MS

The lighter wood tones is likely to be a more comfortable residential look for the young generations.

VA Biloxi, MS

Patient Rooms

The trend for patient rooms is to feel as homelike as possible for the patient. Matching furniture in patient rooms such as headboards, dresser or amours, and night stands gives a more residential feel.  By adding elements such artwork, more natural lighting, and greenery it gives the patient a more homelike feel and helping them feel more relaxed rather than feel like they are in a hospital.  

Providing Personable Experiences

Designers and health care providers also strive to create a more personable experience for patients.  A new trend seen in a few hospitals are electronic patient communication boards.  The boards are placed in the patient rooms and digitally display photos, the patient’s name,  nurses and doctors caring for them, and the local weather and news.  The VA adheres with the trend of making a more personable experience by hanging pictures of the veterans they care for when they were on active duty.  By personalizing spaces and creating a more personable experience for the patient they will feel cared for and more comfortable about the care they are receiving (healthcaredesignmagazine.com). 

Piano Lounge

Providence Hospital Mobile, AL 

Rest Areas and Open Spaces

 Another trend that is commonly seen now with health care facilities is the incorporation of more lounges, gift shops, coffee shops, and restaurants.  By providing more inviting public areas this makes the hospital feel more like a mall.  In considering the patient guests, these spaces give them a place to momentarily get away, have a cup of coffee, and read the paper while sitting in a lounge area playing soft piano music.  Because in common situations the patients guest or family member will spend almost as much time in the hospital as the patient, it is important to accompany to their needs as well. 

Aurora St. Luke’s Medical Center, Milwaukee, WI

http://www.healthinformer.net/aurora-st-lukes-announces-construction-of-rooftop-healing-garden-and-conservatory.html 

Legacy Emanuel Children’s Hospital Garden, Portland, OR 

http://www.healinglandscapes.org/blog/2010/10/a-running-hollering-skipping-playing-place-guest-blog-post-by-addie-hahn/legacy-benches/ 

Providing garden sanctuaries are another great trend.  Outdoor garden attraction areas are more being seen across the country to motivate patients to get up and walk outdoors.  The patient will be able to get out for fresh air, enjoy the natural sun light, and get more needed exercise. 

Works cited:

Edmonson. 2011.http://www.healthcaredesignmagazine.com/article/five-need-know-trends-shaping-healthcare-design

Innovative Products

Innovative Products

Verve living systems

Verve is a unique wireless lighting system.  The verve system drastically reduces the amount of wastes and may programed to with occupancy sensor to save energy.  The verve system is an easy to install system and costs about the same as a regular wired system.  This system is expected to grow with a higher demand in both hospitality industry and in residential.

TESS MRI-LED & Non-MRI Products
Luminous Skylights and Wall Murals

"TESS Backlit Views to Nature™ in the form of Virtual Windows and Virtual Skylights meet the emerging healthcare market’s desire to implement evidence-based design and the patient’s desire for positive, stress reducing distractions.  TESS Advantage Systems announces its new state-of-the-art .96” LED Wall and Ceiling systems for MRI compatible and Non MRI applications, including all of our circular systems. And we are also presenting our 1/8” LED panels for our circular frame and grid work and custom shapes" (www.tessusainc.com). This product is a great feature in exam rooms and rooms for performing cat scans.  Examinations can be very stressful to patients and with these options available patients may feel more relaxed and less focused on the procedure itself.

ioa-hcf.com

Oncology Care Chair- by IOA

This chair is an example of a cancer patient care recliner that we have at the VA.  The recliner is very helpful to patients going through chemotherapy. This chair heats up according to the patients satisfaction on the seat and back.  Typically patients going through chemotherapy get cold so the chair makes an uncomfortable procedure a little more comfortable.  The chair also is motorized to lift the patient up to almost a standing position to ease the patient out of the chair.  This feature is beneficial for many people such as elderly, those with joint troubles, or in the situation of a chemo patient they may be weak after treatment so this ensures a safer and easier way for them to stand up. 

ioa-hcf.com

 House Side Sleeper Sofa- by IOA

The sleeper sofa is a great option for patient rooms.  This sleeper sofa may be used as a regular sofa by day and pulls out by night.  This sofa is also large enough to fit 2 people so the patient may have more then one family or friend to stay with them and make them feel more comfortable.  The sofa also conveniently has storage so that the patient or a family member may store their belongings.

safesecure24.com

Smart Home Security System

A smart home security system allows you to control all electronics including lighting, havac, and home security system all from one system set up in a single spot of the home.  The smart home system is beneficial for conserving energy, billing expenses, time and helpful to people of all ages.

• will automatically turn on lighting when sensors detect someone walking into the room and turn off after several minutes of detecting no one in the room.
• Can be programmed to dim lights when turning on at certain hours (ex: waking up in the middle of the night).
• When going on vacation system can turn lights on randomly throughout the house to fool burglars into thinking the home is occupied.
• Control HVAC to turn air up after several minutes of no occupancy in the home.
• Includes 2 way voice service and emergency panic button, which can be programmed to call emergency personnel or monitoring company.
• Can be included with smoke and carbon monoxide detector, upon detecting a fire it will automatically call the local fire department.
• When sensors detect someone entering the property it automatically turns on flood lights spooking potential burglars.
• Alarm sounds and calls monitoring company or emergency personnel if a window or door is opened when activated.
• May be programmed with a password and for that password to be used at certain times of the day. If the password isn't entered by the specified time then monitoring company is alerted and home owner is contacted. (ex:  You are unable to be home right when your child gets home from school. The child is given the password that you create and you set the system to call if the child is not home by the specified max time. If the child does not punch in the password by the time that was programmed then the monitoring company is alerted and then you are contacted.)

Kitchen Appliances

http://www.lg.com/global/press-release/article/lg-debuts-new-home-appliances-with-latest-smart-features-core-technologies-at-ces-2011.jsp

LG appliances

Over this year LG has introduced a new feature to all their appliances called the LG Smart Technology within this new technology includes the Smart Grid, Smart Diagnosis, Smart Access and Smart Adapt and Food Management.  This new technology enables the consumer to save time, energy, expenses, and improve living. 

LG THINQ- recommends the best times and lowest rates at which to run the appliances.  

LG SMART GRID- programs the appliances to run at the most cost effective times.

SMART DIAGNOSIS- identifies when there is a problem and displays an alert on a panel on the appliance or sends an alert to your smartphone device or tablet.

SMART ADAPT- allows you to preprogram your favorite recipes or program your dishwasher to a cycle the best suites your everyday needs and lifestyle.

FOOD AND MANAGEMENT- gives the advantage of allowing you to know where each food product is placed and when it expires.

http://www.amazon.com/Hydromaid-Water-Powered-Garbage-Disposer/dp/B002RY2O56

Water Powered Garbage Disposal by Hydromaid

The water powered garbage disposal is a good alternative to an electric garbage disposal because it is more cost effective, eco friendly, saves energy and easy to install.  The waste water from the drain is collected and used to power the garbage disposal.  The pressure used to power the disposal is the common water pressure, however 40 psi water pressure is required.  This water powered garbage disposal is also less damaging in the event that silverware may fall into the disposal.

Bathrooms

http://www.neoqi.com/?s=37

Energy Cocoons by Neoqi

This bathtub allows you to cleanse your body, give a message to relieve stress, and even help  with weight loss.  The tub features:

• infrared sauna
• steam sauna 
• color lights
• aroma
• mp3 music system
• air bubble massage
• hydromassage
• hand shower

Week 6

Despite being a holiday week, I would consider this week a little more stressful then normal.  With departments moving into new spaces every weekend now there is much to be done.  Though it was nice to have a little break for 4th of july it has put a big stress on everyone to meet the needs of the move before the weekend.  With everyone scattering to get everything ready for the move there has been a lot of craziness and irritated people.  This week has definitely proven a number one key tool in any profession is “patience”.

There are several steps involved before a department is actually moved from one space to another.  First the space to be moved to is determined by the design team and then reviewed over with the heads of that department as a courtesy and to address any concerns.  Once the spaces are agreed the interior designers arrange all the furniture needs. In most situations the department’s original furniture may be tagged to be moved with them.  If there is any additional furniture that is needed then a order is put in and the move date must provide plenty of time for the furniture to arrive and be installed.  Also in preparing for a department’s move in there must be informational signs with brail made and placed in appropriate areas for patients to see.  Finally just before the move takes place a walk through with the head of the department is performed.  The purpose of these walk throughs is to identify any potential issues of the space and further address concerns the department may have about a particular space.

Of course things can’t always be as easy as it looks or sounds. Like anything else, sometimes there are situations to come up putting a strain on things.  This week we hit a slight problem, when doing a walk through inspection we had noticed that one of the rooms that was assigned to have cubicles would not be suitable as planned because it didn’t have enough power and data connections.  Coming up with a quick solution,  it was decided by the design team that the best solution would be to use the break room right next door for the cubicles.  This room is the same exact size and has all the necessary connections for the cubicles as the room originally to be used right next door, naturally this seemed like the perfect and easy fix but we were wrong.  Once the head of the department heard that we were going to swap the break room with original room that was going to be used, they were not happy at all.  The argument from the staff was “our employees need that break room because they need a place they can relax and release the stress that they overcome from their patients”.  It was explained to her that they were still getting a break room that was exactly the same, the rooms were just simply being swapped.  She was so upset about this situation she had to put a request in to the higher department of the VA that the break room not be moved.  

The move is now to be delayed until another room is found suitable for all connection needs and agreed on.  Because the head of that department refused to simply swap the two rooms that are the exact same, the move is delayed and now delaying other moves as well.  Since another department was supposed to be moving into their old space the following weekend that move gets delayed too.  I find this situation a big test of patience and shows that though its not easy its very important to maintain professionalism at all times.

Week 5

At the VA changes are always being made and departments are constantly being moved around.  As our designers scatter around to achieve the best solution while trying to maintain organization and efficiency, this can be quite a challenge.  Each department has move dates in place but it isn't always accurate.  Many arrangements and tasks must be completed before a move can even take place.

As mentioned last week, when a department is moved the space they move to isn't always the same causing a problem for furniture needs.  The space must also be prepared by making sure the phone, data, and all electrical needs are in place and safely equipped before the move.  As you may have guessed this all takes time which could delay a move, and because of limited moving staff and avoiding chaos only one department is moved at a time or by day.  So you could imagine what a problem it is when a move is delayed!

Mobile VA

The interior designers here in Biloxi are amazingly taking on the work orders and design needs at all the VA locations on the coast.  Over the week we got to visit a sister VA clinic in Mobile, AL.  The Mobile clinic is much older, smaller, and shares a building with The University of South Alabama Medical Clinic.  Because the space is so much smaller it is more cramped then the Biloxi VA.  The spacial needs of this clinic are a big problem.

Here is an example of one of the space planning issues faced:

There are 3 work stations in this room all requiring a desk and task chair while keeping all furniture and equipment shown.  On the far left of the picture there is a door limiting where to place the desk and chair to keep it from interfering with the walkway.  Because there is a workstation with a desk behind the curtain, my idea was to place the desks back to back allowing room for the equipment to be placed on the wall.

This is another work station in the same room.  Notice how small this station is (all stations are the same size).  Again the requirement is that all stations must have a desk with a chair so employees may sit.  It is a challenge to make the space comfortable and functional that contains all needed equipment (shown in picture) while adding a desk and chair.