Over the years, I have worked with a lot of architects on behavioral health projects. I have learned to understand how they see the world and go about solving the client’s design challenge. They are very good at figuring out how to design a healthcare floor plan within the budget, which is what clients need and expect. What is often missed is the impact that design decisions have on operational objectives and concerns.
Seemingly mundane details related to patient flow have a major impact on safety, and as such, these details are inherently germane to every BH design project.
- How do patients enter the unit for admission?
- How and where are patient belongings inventoried and stored and retrieved?
- How and where can visitors visit with patients?
- How and where do patients eat and participate in group therapy, socialize, and relax?
- How can staff control contraband vulnerabilities?
- How staff will complete their “checks” is essential. How will staff in the nursing station hear and see patients?
- How can the interdisciplinary team hear and see the patients, 24/7, during all group activities, during shift changes and at night?
These details are important for how we keep patients safe. They are, in simple terms, the way humans will experience the space. Those humans are the patients and the staff.
Staffing is usually the greatest expense for hospitals. Metrics such as a unit’s size, patient population served, and unit configuration all impact staffing and staff to patient ratios. I think about staffing like Goldilocks. You don’t want it too lean. You don’t want it too heavy. You want it just right. Through design, it’s important to find that sweet spot too. If the unit is too small, staffing will be too heavy and inefficient. If a unit configuration doesn’t maximize visualization of patients during all times of the day, staffing must be heavier to ensure safety. Maybe it works during group activity hours, but not at night, or visa-versa.
Having detailed conversations about size of units, patient population, patient flow, staffing, and the hospital’s financial objectives is fundamental to ensuring the long-term viability of the environment, clinically and financially.
