healthcare design

Will the real biomimicry please stand up?

2013-11-04T06:00:00.002-08:00

When you throw something away, where is away? Is there somewhere that magically eradicates trash and debris? If you're a plant, you have a system that takes care of that in an amazing way. Nature does things so differently than humans do. If a human wanted to make a leaf, he would take some green material and cut out a leaf, then throw away the left over material. Nature makes the leaf exactly the size that is necessary. There is no waste in nature. When a tree drops its leaves in the fall, those leaves become soil for the next year. If humans could learn from nature and design with a sort of ecosystem-like pattern, the world would be a different place and we would be practicing biomimicry.

There has been a lot of organic design going on lately, but this is copying the geometry of nature, not biomimicry. Biomimicry has nothing to do with appearance. The definition of biomimicry is imitating or becoming inspired by nature's forms and processes in order to solve human problems. The other way that nature has influenced design is through bio-utilization. This is using nature to solve a design problem, like using mushrooms in leeching fields where a septic tank drains waste. This bio-utilization is helpful, but should not be mistaken for biomimicry.

To begin the process of biomimicry, the designer must first research and examine an organism or ecosystem. Next, should come a thoughtful execution of the design principles found in nature's solution. At this point we are learning from nature, not about nature. We must always ask ourselves how nature would deal with an issue, then use biology as a tool for solving this problem or achieving a function.

There are two ways designers address the use of biomimicry in design. One is the problem-based approach. In this approach, the designer works with a biologist after defining the problem. They reframe the problem, find a biological solution, extract the biological solution and apply it in the design. The second approach begins at the solution. Once a biologist finds a solution, he must collaborate with a designer to see if it can be used as a relevant design consideration. When biological research influences our design, the collaborative process depends on the collaborators having relevant research, not on a particular design problem.

An example of problem-based biomimicry usage comes from a product called Smart Paints. These paints use a self-cleaning technique learned from lotus leaves. The paint surface has densely packed ridges like the bumps on lotus leaves. These little bumps prevent water drops from diffusing. They roll off the surface taking any dirt and debris with them.

Similarly, biologists were inspired by the way that conifer cones protect their seeds. This is a solution-based innovation. The spines close to keep the seeds dry on a rainy day and open up to let the seeds go during dry weather. The FAZ Pavillion, located in Frankfurt, Germany, is an example of biomimicry, which uses the conifer cone for its design. Like the conifer cone, the pavillion responds to weather changes based on a simple material element, which has an embedded sensor, no-energy motor and regulating element. The pavillion's surface is fully open on sunny days. When it rains, the humidity triggers a rapid, autonomous response, closing the structure to form a weatherproof skin.

These case studies encourage us to include biologists early and fully in the design process. They should not be "add-ons" in this process. We can accomplish a great deal more when working with scientists as a team, fully engaged in collaboration from the very start of a project.

Some biologists and designers believe that our future interior spaces; where we work, live and play, may be designed to function like living organisms. It is hoped that we will learn to use the surrounding nature to provide our energy and water. The author of this article hopes that in the future, architects and designers will be inspired by nature instead of machinery.

Meet Alison Jones, Principal @ Levino.Jones Medical Interiors, Inc.

2013-10-27T13:06:00.006-07:00

Ask anyone in Atlanta who to talk to about healthcare design and they will tell you to speak to Alison Jones. She is an icon of this industry and has been practicing for 25 years. The LeVino.Jones team designs hospitals, health departments, laboratories and research facilities, medical offices and clinical suites, outpatient surgical centers, and medical spas. (www.levinojones.com)

www.asidga.org

As I interviewed Ms. Jones this morning, she stated, "One of the differences in healthcare design today is infection control." With the new penalties for hospital acquired infections (HAIs), there is a great demand for design, which is attentive to the eradication of harmful bacteria. LeVino Jones does a tremendous amount of work in oncology clinics. Since the patients in these environments have challenged immune systems, it is the firm's number one concern.

Another design aspect the firm's designers work on is collaboration in clinics and hospitals. They create "huddle spaces" in out-of-the-way places for doctors, nurses, and other caregivers to discuss the patients' care. When designing for teaching hospitals, these spaces have to be large enough for a group of doctors to converse, bearing in mind that the patient's privacy (HIPAA) is of the utmost concern.

Alison Jones is EDAC Certified. EDAC stands for Evidence-Based Design and Certification.

Evidence-Based Design, (EBD), is the process of basing decisions about the built environment on credible research to achieve the best possible outcomes. (www.castleworldwide.com)

"EBD is more scientific than traditional design." says Ms. Jones. "EBD gives us good data and research to share with clients about new design and new products. A good example of this would be the use of silver and copper surfaces for infection control.

Alison Jones is LEED AP Certified.

LEED stands for Leadership in

Energy and Environmental Design.

www.healthcaredesignmagazine.com

I asked Ms. Jones how her firm addresses sustainability in their designs. One area of focus includes lighting design which will meet the energy codes and still provide adequate light for procedures and tasks. Designers usually have to push the lighting design to the limits of the energy code to provide adequate lighting in these important areas. She admits that this can be a bit frustrating.

Finally, I asked Ms. Jones what advice she could give to a student in interior design. What could she say to me that would guide me into the real world of design beyond the classroom?

She told me that designing and sharing a blog like this is a great idea (thank you, Dr. Chapin) and interviewing professional in the field can be very educational as well (thanks again, doc). Ms. Jones says that it is important to determine a specialty. Defining who you are as a designer starts with the super-important decision of deciding what your focus area will be.

She also gave me some advice on my capstone project. Whew! I've been sweating that one out! I think I have decided what my project will be and the location of it. Thank you, Ms. Jones.

Meet Jennie Connor, Executive Director Catawba County United Way

2013-10-16T04:49:00.001-07:00

Jennie Connor

Executive Director
Catawba County
United Way

Photo: courtesy of www.ccunitedway.com

I was completely amazed with the aggressive way Ms. Connor and the Catawba County United Way (CCUW) are addressing needs. Not only do they support transitional housing for the homeless, but they support a program at Sipes Home for young adults who are coming out of foster care and continue to need housing and support services.

They provide financial support through the Salvation Army for emergency shelter, along with help to families in need of assistance for rent and utilities. These funds are dispersed through a rigorous process requiring each applicant to go through an application for eligibility to receive services. CCUW also provides funding for victims of domestic violence. Along with an undisclosed shelter, they provide case management and counseling not only to women and children who have suffered abuse but to the male abusers.

It doesn't stop there. I asked Ms. Connor what they would do in the case of an earthquake in Catawba County. Her answer was extremely impressive. On a quarterly basis the Catawba County United Way convenes a meeting of community leaders, such as the fire departments, emergency management personnel, local American Red Cross and its volunteers, the sheriff’s department, retirees and other business representatives including the local natural gas company. This committee is called Citizen Corps (www.ready.gov). They meet for disaster preparedness. They talk about who will do what in case of an extreme emergency. They trade contact information. Ms. Connor said, "We bring people together to talk about assignments so organizations can be prepared when a disaster occurs." She says that in an emergency there are a lot of "unaffiliated volunteers" who show up willing to help. They even set up mock disasters to train to be prepared for these unaffiliated volunteers in a triage center. They interview volunteers, document skills and communicate with the disaster responders as to the availability of additional assistance from the influx of volunteers offering help. It is very important to know the disaster assistance providers and build relationships with them prior to a disaster.

That's not all....the Citizen Corps committee support the CERT program (Community Emergency Response Teams). This program focuses training for team members to take care of 1) Self, 2) Family, 3) Neighbors. It's sort of like when you're on a long airplane flight. The flight attendant shows you how the mask will fall down from the cabin ceiling in front of you in case of low oxygen levels. You, as a parent, are instructed to put your mask on first, and then take care of your children's masks. The idea is that if you pass out, you can't help your children.

Okay, here's the big one. These types of programs are being supported by United Ways all across the United States. Every county has a similar strategy. They are not going to let the horrifying conditions that happened post-hurricane Katrina happen again. I was officially impressed at the very beginning of the interview, but at this point I am holding back tears. After researching the recent disasters like hurricane Katrina and the earthquake in Haiti, I was wondering what would happen if we had a disaster in our hometown. Worse yet, what if something happened to my parents who live two hours away? I am relieved to know that the United Ways are having these important discussions.

Thank you, Ms. Connor and all the United Way staff and volunteers across this great country!

Meet Eric Krempa, Senior Healthcare Planner @ RPA Design

2013-10-09T07:27:00.000-07:00

Eric Krempa, RPA Design, PC

Focus: Emergency Room Planning

Photo: courtesy of RPA Design, PC

Mr. Krempa has been practicing healthcare design and planning for 24 years, so I really wanted to speak with him. Since he is located in Charlotte, NC and I am in Atlanta, GA, we conducted a phone interview.

I first asked Mr. Krempa how he addresses collaborative spaces in healthcare design within emergency departments. The more traditional hospitals are still asking for traditional methods for registration. He says that progressive hospitals are integrating more common work areas where the space has more than one user and the registration is being done in the treatment room. This allows the patient to get to the point of care faster. The infrastructure includes PDAs for each room or caregiver so that the patient can have everything done in one room instead of ping ponging for each part of their user journey. These care team areas include nurses, registrars, and other visiting clinicians.

Evidence-Based Design (EBD), is essential to his execution of design. He says, "We are always doing research." He finds out what the client wants, then pushes forward. When a client is progressive, he is able to design innovative, cutting edge spaces. RPA Design is a member of the Advisory Board Company.

The Advisory Board Company provides best practices research and analysis, software tools, and management and advisory services to the health care and education industries. The Company offers programs rooted in best practices in three key areas: best practices research, software tools and management and advisory services. Its management and advisory services programs assist member institutions' efforts to adopt and implement practices to improve their own performance. The Company's membership-based model, in which members participate in its research and analysis on an annual basis, is central to its strategy. This model gives it privileged access to its members' business practices and strategic plans and enables it to provide detailed best practices analyses on current industry issues. On August 1, 2011, the Company acquired PivotHealth, LLC. Advisory Board Co. (nytimes.com)

Sustainability is high on Mr. Krempa's "to do" list. He says the opportunities for sustainability are client driven which means that there is usually a need for researching the true costs of using a sustainability material. Usually, the initial costs are higher, but in the long run the savings are substantial enough to persuade the client toward a more sustainable product. He is always energy conscious, especially in the lighting area. He uses a lot of automatic controls, like sensors that turn the lights off when you leave the room. He always incorporates energy efficient systems.

Since the economic downturn of 2007-2008, hospitals are being much more frugal. Even though hospitals are scaling back, many are trying to remain progressive by integrating family-friendly areas and understanding the need for natural light, which helps in healing the patients and keeping the atmosphere light. One issue in new hospital design and the current frugality is minimum code allowances and best practices. The area required by the AIA Design Guides is a good bit smaller than the best practices area suggested for optimal patient care. This is also client driven.

Since I am specializing in it, I asked Mr. Krempa if he does any design for the aging. His firm does some senior living spaces and V.A. hospitals. They also are involved in greenhouse senior living workshops.

THE GREEN HOUSE® Project represents a revolution in long-term care, creating small homes that return control, dignity, and a sense of well-being to elders, while providing high-quality, personalized care. (www.rwjf.org)

Finally, I asked Mr. Krempa to give me advice for students of healthcare design. His answer; "Dive in and get as much experience as possible; plan and design in all departments. Try many specialties like interiors and equipment. Have a large, strong knowledge base so that you will be well-rounded."

Emergency Shelters for Real People

2013-10-07T04:55:00.001-07:00

On August 29, 2005, hurricane Katrina struck the coast of Louisiana at about 6 am. Reports estimate from 10,000 - 25,000 people found shelter in the Superdome. The horror stories that have come out of that "shelter" are difficult to stomach. I can find no reports that state how long it took for victims to get back into permanent housing.

allisonwright.com

When an earthquake struck Haiti on January 12, 2010, outdoor shelters were made for the victims. It is reported that 1.5 million people found shelter in these camps. (www.dec.org.uk)

minnesotapublicradio.org

Almost three years later, many are still living in these camps. I am reminded of an old idiom, "There, but for the grace of God, go I." This could happen anywhere. The victims in Louisiana, Mississippi and Haiti were not expecting disaster. They had no idea what was coming.

ASID is sponsoring a competition for emergency shelter design. This competition refers to the victims of large, unexpected disasters as a focus group for developing innovative housing in an emergency, using vacant buildings which are already ADA compliant and are climate controlled. I am entering this competition.

My focus in healthcare design is primarily the aging population in the U.S. I have decided to create an emergency shelter for people with disabilities. Hurricane Katrina took 1,833 lives. Almost half of those were over 74 years of age. (www.gnocdc.org)

In this blog I will be addressing issues of the aging population, as well as the care of those with disabilities not related to aging. I will appreciate any comments that will lead my research and help me to create an emergency shelter community that will be viable in a real emergency for real people.

Principles and Design Considerations for Sterile Processing

2013-09-27T12:40:00.000-07:00

When you eat at a restaurant, do you ever consider how your dishes got washed? Did a teenager wash them by hand at the rate of $7.75 per hour? Wouldn't you rather have them washed in a dishwasher? Would you feel like they had been sterilized if they had been in a dishwasher?

When the instruments in a hospital need cleaning, they usually go down to the basement to the central sterile processing room. The employees who clean these instruments are usually paid a little over minimum wage. They have to cover every inch of themselves to be protected from all the infectious diseases they are in contact with every day. This is made even more difficult by the high temperatures in the sterilizing room since hot water is used to clean the instruments. Sometimes the surgical instruments are cleaned with soap and hot water....only. Hmmm. Give me a dishwasher any day.

The American Institute of Architects in Atlanta gave a free CEU/Workshop last week at the offices of JE Dunn Construction in Dunwoody. Neill Moore, Business Development Director at Getinge USA, was the speaker. Mr. Moore introduced us to Getinge's sterile processing units, which work like dishwashers at a restaurant, only they save lives.

http://wefixitrt.wix.com

Sterile processing equipment is very expensive, but when you consider the penalties a hospital faces when they have a high rate of hospital acquired infections (HAIs), they will pay for themselves in the long run. Of course, the first consideration is the patient, but too many hospitals are struggling with finances these days.

http://www.getinge.com

Perhaps the insurance companies should consider investing in some sterile processing equipment in hospitals. After all, they stand to gain as much as the hospitals by having up to date equipment installed in every hospital. Hey...and let's get those workers some windows and a raise PLEASE!

Healthcare Design Webinar: Clinical Evidence for the Use of Copper Touch Surfaces in Healthcare

2013-09-25T08:33:00.001-07:00

On September 19, 2013, I attended a webinar sponsored by The Copper Development Alliance, (CDA). The speakers were Harold Michels, PhD and Dr. Archelle Georgiou, MD.

The CDA is a not for profit trade association whose website is www.copper.org. They represent the U.S. Copper Industry. Since copper is plentiful in the United States, and is easily recycled, it is considered sustainable.

www.filtered-news.com

Hospital Acquired Infections, (HAIs), are a challenge in todays hospital system. In the past, HAIs actually increased revenue for hospitals, but today there are federally enforced fines for hospitals that have more than their quota of HAIs. 80% of infectious diseases are transferred by touch. They are invisible to the naked eye and are expensive to the U.S. healthcare system. Methicillin-resistant Staphylococcus aureus, (MRSA), is a serious health problem since it is drug resistant.

The good news is that copper is anti-microbial. There is no special coating of additive that makes this happen. Simply put, copper kills germs. Copper kills germs fast. The most common copper alloy is brass. Nickel is another common copper alloy. Our coins are all made of copper and copper alloys. That is why germs are not usually spread through financial exchange. Germs, even MRSA, cannot survive on copper surfaces. Additionally, tarnish does not reduce this effect. Copper will kill 99.99% of germs that lie on it within 2 hours.

www.antimicrobialcopper.com

Some of the objects that people touch frequently in hospitals are: sinks, IV poles, patient transfer stretchers, railings, grab bars, building products such as light switches, work surfaces, door hardware, cabinet hardware, and keyboards. These products are becoming commercially available in copper and may bring about significant healthcare benefits to hospitals, their patients, their staff and visitors.

In thinking beyond hospitals, Harold Michels suggests that copper could prove beneficial in any situation where a patient has immune deficiencies, or where people gather and, possibly, spread germs. Some of the suggested places where copper might be used are schools, public transportation, food and hospitality venues, spas and fitness centers.

I'm thinking about replacing my kitchen countertop with copper.

Meet George Smith, Senior Architectural Project Manager at Grady Memorial Hospital

2013-09-25T03:17:00.002-07:00

George Smith has never met a stranger. He gets my congeniality award for the week. He should probably get the "Busiest Man on Earth" award as well. When I walked into his office on the eighth floor at Grady, he was all smiles behind a desk with several piles of paperwork a foot deep. No worries. He assures me that he knows where everything is.

Two years ago I toured Grady with a group of classmates with George as our guide. They were about to begin transforming the neonatal unit, making significant changes to the headwalls, finishes and lighting. As part of this interview on September 18, 2013, I got to see the new neonatal unit fully functioning. Wow!

http://www.knightarchitects.com/Featured-Project-Grady-NICU

As you can see, the circulation is greatly improved as is the lighting, acoustics, and overall feeling in this space.

Grady has received Energy Star Certification for its energy efficient air control and LED lighting. George says that Grady has been sustainable by using the existing building, changing their lighting, using energy efficient air control units, and using recyclable materials as much as possible.

Hospital design can be challenging because the technology changes more quickly than the architecture. Many hospitals have been facing economic challenges and have closed their doors. The Affordable Care Act, (or Obamacare), may provide even more challenges for hospitals when individuals have more choice as to where to receive treatment. If George has it his way, Grady will be one of the most up-to-date hospitals in the United States.

The Marcus Stroke and Neuroscience Center provides state of the art equipment for the care of patients with strokes, aneurysms, and epilepsy.

The Correll Cardiac Center at Grady was just unveiled this month. George took me through the family waiting area which features some of the beautiful 3M resin panels in the form of sliding doors and decorative glass in-door panels. He has been working on signage and way finding in the hospital and here is one of the new signs:

Of great architectural interest is the Chapel. George Smith was active in the restoration of this Chapel, financed by the Goddard Family who financed it originally in 1958 with Philip Shutze as the architect. The Goddard Chapel restoration won the Shutze Award for Craftsmanship in 2010. George had it restored back to its original color which is a sort of putty color. He describes its color and smooth finish as butter-like.

Finally, I asked George what advice he would give someone, like me, who is studying healthcare design. He suggests we take nursing classes, keep up on trends, take mechanical classes and urban planning classes. He says we should be familiar with zoning and circulation. George said, "These help you see the relationships with people and operations."

Courtesy of George Smith, Senior Architectural Project Manager at

Grady Memorial Hospital, part-time fisherman

India-American Adult Day Care Center

2013-09-20T06:34:00.001-07:00

The following images are from a course in which I explored and designed a place which would provide abundant life for an elder from India, living in America. I focused on two particular spaces: the bathing room and the puja room.

In India, bathing is meaningful in spiritual life, as well as personal hygiene. It is also a very important space in planning for the aging. The bathing room is in a corner of the day care center to provide privacy and to adhere to the Vastu Shastra philosophy.

Bathing Room - SW Perspective

Bathing Room - NW Perspective

The Puja room is for Indian worship, particularly in the Hindu religion. A person in a wheelchair can easily turn around, approach the altar and shrine during their personal worship time.

Puja Room - Perspective

This plan includes an area for storing shoes at the entrance, an exercize/yoga and dance floor, storage for yoga mats, various sitting areas for visiting, a reading room for reading or being quiet, a nurse room with locked storage for medications, four bathrooms and a bathing room, a viewing room for television and video, an office for administration, and an outside garden area with plenty of seating and a walking path.