Healthcare is the second fastest growing segment in the U.S. economy. Healthcare facilities demand 24/7 operational support for a variety of complex functions. Customer and caregiver needs and expectations vary depending upon location and type of service rendered, i.e., inpatient versus outpatient, emergency, acute care versus diagnostic, chronic care. Healthcare facilities are also complex buildings that can have a significant impact on the environment.

Increasingly, healthcare leaders are embracing the social responsibility associated with green design, building operations and the ongoing promotion of healthy, sustainable lifestyles for caregivers and patients. The challenge lies in integrating environmental, health and safety concerns with green product design, lean and green operations, closed-loop supply chains, and a focus on the health and well-being of patients and caregivers.

In healthcare settings, nurses are the architects of both how the ideal patient experience is delivered and how resources are used to promote and preserve the environment. Therefore, it is imperative that nurses help design the healing environment so it can support healthy, sustainable living for both caregivers and patients.

Integrated Health, Safety, Sustainability and Stewardship

Healthcare organizations are beginning to adopt the HS³ model, which was developed by Weiss Health Group LLC, as an integrated approach to health, safety, sustainability and stewardship (the healthcare triumvirate). Integrating HS³ through an organization’s policies, values and actions can promote healthy lifestyles, reduce risk and injuries, protect and preserve the natural environment, and provide workers the support to perform critical tasks effectively.

Each area of HS³ has an interrelated impact on the delivery of patient care and the caregiver. Nurses who leverage their role and promote integrated HS³ can improve the work environment, improve health and safety, protect and preserve the natural environment, increase productivity, and increase job satisfaction, which leads to increased employee- and customer-attachment levels.   

Transformative Natural Design

Transformative Natural Design, or TND, is a concept developed by Weiss Health Group LLC to aid in the development of environments that support healthy, sustainable lifestyles. TND incorporates the principles of the Experience Ecology model, biomimicry and building information modeling to design healing environments that simultaneously support the needs and expectations of patients (customers) and caregivers (workers). TND uses experience-based design strategies, which require front-end involvement of all stakeholders from project conception to completion.  

Traditional interior healthcare space design follows the same path: definition of needs, visioning, design direction, materials selection, finish palette review, interior finishes selection and warranty/maintenance binder information. However, when experience-based design is the foundation on which new healthcare environments are conceptualized, designed and built, the process must change to accommodate innovations on a daily basis. This becomes even more complex when the building owners require that the environment address organizational values tied to health promotion, safety, sustainability and stewardship.

Experience Ecology Model

Experience Ecology, a concept developed by Tyink for Miron Construction Co., frames the delivery of the exceptional customer experience via the physical, behavioral and informational spheres of influence. Three key areas to consider:

1. Physical elements include all aspects of spatial integration. These include the furnishings, with the microelements of fabric pattern, color, illumination, texture, scent, temperature, sound and taste all linked to nature.

2. Behavioral elements include all movement-sequence interactions between workers and customers. This determines person-to-person interaction, time to complete a process, and sustainable practices.

3. Informational elements include all the documents, forms, signs and communication activities, i.e., the spoken word, gestures, postures, impressions and idea exchanges, between customers, workers and the environment.

Experience Ecology requires that all the microelements be designed together based on the desired outcomes for customers and caregivers. The balance is fostered by integrating the elements under the umbrella of sustainability. Ideal patient experiences (IPE) must trigger, not restrain, creative innovations and foster both customer and caregiver attachment.    

In healthcare, the architect, the builder and healthcare providers must be committed to a team-based approach to simultaneous facility design and process improvement focused on patient-centric care. Interdisciplinary teams must identify each patient attachment point and design ideal patient experiences in detail, including the physical, behavioral and emotional components of the experience. Each process is mapped out and the expected outcomes delineated by the team members. The goal is to fuse the design process and ideal patient expectations to strengthen the brand in the marketplace.

Architects, interior designers and caregivers can use a variety of tools in this experience-based design process focused on IPE processes and sustainable, health-nurturing environments as driving factors. Design concepts, such as circles of care, can be manipulated and measured with BIM to help stakeholders make informed choices. These innovation team discussions provide insight for facility design and standardization of patient care processes. 

Biomimicry

Biomimicry is the science of infusing the environmental strategies of the natural environment into the built environment and human experience. Nature is the ultimate healer, efficiency and sustainability expert. The principles of biomimicry exploit this expertise to bring about a transformative environment that supports healing and wellness.

Research has shown that green buildings that incorporate natural vegetation and other links to nature improve functioning, decrease stress and improve both healing and moods. For example, subjects working in a windowless room with plants work more efficiently and have lower blood pressure readings than workers in the same room without plants; and people with nature views scored better on direct attention testing than those with views of built environments.

Negative environmental impacts include ambient conditions, noise, temperature, air quality and lighting. In 1991, researchers from Rensselaer Polytechnic Institute were the first to measure the correlation between comfort and productivity at the new West Bend Mutual Insurance Co. office space. It was discovered that median productivity improved 16 percent in the new building; 2.8 percent of the improvement was attributed to personal environments modules (PEMs), which control temperature, ventilation, lighting and sound masking.

Despite the fact that providing physiologically and psychologically healthy interior environment quality is important to improve employee health and productivity, traditional interior design practices, material costs, and lack of understanding of life cycle all adversely impact the application of sustainable environment design practices.

In healthcare environments, design considerations that need to be addressed include the impact of off-gassing from fabrics, carpets and finishes; the use of recycled content (post consumer and pre consumer) composite wood, agrifiber and wheat board; and low-emitting adhesives and sealants.

Design imperatives for indoor environmental quality include the length of entryway systems, which should be at least 6 feet long in the primary direction of travel to capture dirt. Exposure to latex, plastics and other potentially toxic materials; shielding from radioactive materials, exhaust systems for hazardous chemicals; disposal of biological and hazardous materials as well as safety mechanisms for high-end diagnostics – these are also design factors. 

Building Information Modeling

Building Information Modeling, or BIM, is a workflow tool that allows all stakeholders to be involved in the microelements that are the foundation for the design and construction process.   For example, placement of stairs versus elevators, signage to encourage stair use, location of supplies, access to technology, etc., all impact on the care-delivery processes as well as health-promoting activities. BIM is continuous computer-aided design that minimizes errors and omissions and looks at overlap and redundancy, construction sequencing, and accurate materials acquisition and use. 

Healing environments utilize the microelements of nature to design versatile spaces that allow for evolving uses. The choreography of microelements that comprise the total healing environment can be a daunting task. BIM ties these microelements together in meaningful ways helping all stakeholders focus on the end result. 

Spanning the Boundaries

Nurses must be involved in Transformative Natural Design to instill the principles of integrated health, safety, sustainability and stewardship into the design of future healthcare environments. Nurses are boundary-spanners -- they have a huge influence on healthcare delivery in every setting -- and nurses have the skills to lead HS³ model implementation.

Nurses are at the hub of hospital activity, natural leaders who desire to learn more and be more environmentally proactive. By designing health-promoting environments, nurses can demonstrate their leadership in environmental stewardship.

Nurses can improve patient health and safety as well as protect and preserve the natural environment. As patient advocates, nurses can build bridges with other departments and impact waste removal and procurement policies. The HS³ model helps nurses to work more closely with facilities, environmental services, pharmacy and other support functions to focus on the “healthcare triumvirate.” Nurses can help organizations learn and adhere to environmentally preferable purchasing policies, improve waste management processes, decrease use of chemical pollutants, and promote healthy food choices.

From the use of IV bags and tubing to the selection of pesticides, herbicides, fungicides and pest-management practices, nursing has a role in designing health-promoting environments. Nurses can foster discussions on the use of healthy food in the staff cafeterias and the procurement of local foods, hormone-free milk and poultry. They can even facilitate the hosting of educational sessions and farmers markets on hospital grounds. The opportunities are endless.

Summary

Transformative Natural Design can be a tool that provides organizations with a built environment that supports patient-centric care. Nurses, however, are the architects of both how the ideal patient experience is delivered and how resources are used to promote and preserve the environment. Therefore, it is imperative that nurses help design the healing environment for both caregivers and patients. The result will be healthy, sustainable lifestyles, healing environments, and ideal patient experiences.

Editor’s Note: This article is adapted from the white paper “Encouraging Healthy, Sustainable Lifestyles and Healing Environments: Nursing’s Role in Transformative Natural Design.” The paper, along with references, can be found at www.weisshealthgroup.com.