Published in Behavioral Healthcare, December 2013
For healthcare facility designers, flexibility has become a driving demand.Healthcare leaders find it hard to predict, with the coming changes in healthcare reform, how facilities can best respond to new paradigms for reimbursement and patient care.This is particularly true for behavioral health facilities.
To cope with that uncertain future, Northwell Health's Zucker-Hillside Hospital wanted maximum flexibility for its new behavioral health facility. With a portion of its current hospital beds housed in outdated individual cottages dedicated to specific populations (i.e. adolescent, women, dementia, geriatric) management faced challenges as well as census fluctuations. When the NSLIJ project began planning the replacement behavioral facility at its Glen Oaks, New York campus, they wanted a facility that would successfully support different mental health needs, as well as support the System’s migration to a cross-trained workforce. By working closely with clinicians, the project team was able to design the new “Behavioral Health Pavilion” with enhanced amenities and better safeguards for patients and staff. The design also gives hospital management the option to adapt the facility for future use.
Key insights for healthcare leaders
A behavioral health facility, with enhanced security, does not need to look institutional. In the new Behavioral Health Pavilion (BHP), the project team created inviting spaces for patients, staff and visitors, de-institutionalizing the environment by using beautiful yet maintainable materials combined with safety-conscience design. Using elements that work with behavioral health therapy, such as natural light and artwork, the space embraces a hospitality feel, instead of a clinical environment. Also important is ensuring the layout promotes and reinforces communication between patients and staff, by incorporating spaces that encourage these interactions.
Understanding the unique patient profiles and acuity levels and creating an environment supportive of each type: adult, geriatric and adolescent patients are of the utmost importance. Adult populations in some cases may require a higher level of security, necessitating a second means of egress, something to consider early in the design process. Geriatric patients require corridors for ambulation and special lighting as well as handrails and robust programs to reduce falls. In addition, flooring materials with minimal transitions and contrast in color should be selected for those with vision impairments. Adolescent patients need spaces for education and entertainment. Outdoor activity space is beneficial for all patient groups, and should include a variety of active and restful spaces.
Flexibility is fundamental
The design for the new 139,000-square-foot, 115-bed hospital building provides six 19-bed units (two adult, one adolescent, two geropsychiatric and one women’s). The hospital has an additional 106 adult beds in another building on campus with a total bed count of 221.
To maximize flexibility, the building’s design features inter-connected units. This allows the Zucker-Hillside staff to cross-train staff to float between units, if necessary. The single building approach, versus the multi-cottages the system had, allows them to make short-term changes that best serve the patients and staff.
The design employs a universal room model, with each room within a unit designed identically whether private or semi-private, allowing the facility to flex up or down to meet census. This allows hospital staff to simply change the room features such as furniture, artwork or color to make it appropriate for a different population. In addition, entire units can be modified-- if necessary by changing flooring or adding handrails if the system has an increase in elderly patients-- without costly renovations. Another example of built-in flexibility is through the use of multi-purpose space, such as designing seclusion rooms in such a way that they can be converted to a calming room in the future.
‘Non-institutional’ exterior and interior design
The Behavioral Health Pavilion has an atypical exterior and interior for a behavioral health facility, differing from the institutional look of many psychiatric care hospitals. Located in the heart of an academic medical center, the exterior, designed by Ennead Architects, features a welcoming arrival sequence. The front of the building incorporates a glass curtain wall with a vine-covered truss system to create a sustainable ‘green wall.’ The remainder of the building is clad in a fiber cement rain screen system in different colors, giving the building a striking profile on the campus.
Array developed an innovative floor plan based on the “Disney Model” - a design that provides on-stage and off-stage areas and locates support spaces adjacent to a service elevator and vestibule. This way staff can support unit needs from behind the scenes without physically walking onto the unit. Supporting the residential feel of the overall environment, a three-corridor system creates distinct public, patient and staff zones. This allows visitors to arrive at their destination without passing through the patient zone. Staff circulates between the patient and support zones and can go “off stage,” away from the public or patient areas to concentrate on paperwork or take a break.
The public zone includes a two-story light-filled rotunda at the entrance, which serves as a waiting area in which visitors can chat or grab a snack at the Au Bon Pain kiosk. With views to nature and comfortable furniture, visitors can take a restful break. The rotunda also serves as a lounge space for students and teaching staff to decompress.
The interior public corridors have floor-to-ceiling glass and a cable structure with vines to enhance the shading characteristics and lessen solar heat gain. Large scale, impactful art serves as a wayfinding device at key entry portals, complemented by soothing colors and materials.
Care also was taken to maximize views to nature and natural light for patients. For instance, activity rooms and dining areas feature partial-height partitions and polycarbonate and resin walls, allowing sunlight into the central core. The 1st floor adult and adolescent units have access to an outdoor activity area with a basketball court. The 2nd floor units have enclosed terraces. Patient corridors include large pieces of art, such as landscapes, framed by benches and soffits, to give patients the feel of sitting on a porch as well as create a unique identifier to assist in finding their room.
Another unique feature is the “calming room,” which some patients can use instead of a seclusion room. Unlike a padded seclusion room built for one patient, the calming room can hold up to four observed patients and has comfortable seating which engages all the senses and has been proven to lessen anxiety and depression-like symptoms.
Safety design into the building
The design, interiors and furnishings of The Behavioral Health Pavilion promote safety in innovative ways. Having three corridors in the design—each with its own secure service elevator--creates an advantage for service staff. For instance, foodservice workers, housekeeping, and other staff can access and support the Units without entering the patient zone; this configuration is ideal and promotes comfort and safety for patients and staff alike.
Likewise, the infrastructure such as VAV boxes can be accessed from outside a patient’s room, so routine maintenance doesn’t disturb patients. This creates enhanced security, without the risk of exposing patients to tools.
The safety of clinical staff was also a paramount concern. Patient consultation rooms were designed with two forms of egress, so if a provider feels uneasy, he or she can easily exit the space into the staff zone. In addition, nurse station transaction tops are higher and wider than on a traditional medical-surgical unit, creating a deterrent for patients to reach over. However, the openness was maintained to provide good visibility and encourage patients to approach the desk much differently than the "old model" of glassed-in enclosed nurse stations.
Material selection also played a role in safety. The facility planners wanted natural light, but not the danger of broken glass that would shut down an area and disrupt operations. The exterior glass curtain wall features an internal layer with polycarbonate glazing. This “sacrificial layer” of polycarbonate was designed to take impact without shattering. The sacrificial layer protects the exterior glass building envelope and reduces the chances of injury and costly repairs.
The bathrooms were outfitted with the latest, state of the art fixtures promoting the highest level of safety. To provide patients with an additional level of comfort, their faucet controls allow them to change water temperature by 10 degrees in two-degree increments. Simple push button type faucets offer no ability to change water temperature, and therefore can cause dissatisfaction and agitation for patients.
The Zucker-Hillside Hospital was truly a collaborative effort with the leaders at Northwell Health, who set out to re-imagine ways to meet patients’ clinical, emotional and physical needs. They were determined not to continue business as usual, and they’ve succeeded with this non-institutional facility that promotes safety while it fosters healing with welcoming spaces imbued with light, color and comfort.