I was recently asked to spell out my priorities when working with clinicians and architects to establish the plan of a new facility. I enjoyed answering the question so much, I decided to write it all down and share it with the readers of our website. So, here it is. Enjoy:
In my mind, the planning of a psychiatric unit, units or hospital must start with a deep understanding of how the treatment program works. Every place is different. It is essential to understand how they work and how they would like to work before you ever put a pen to paper. Our preference is to start with a detailed conversation with the program leaders and follow that up with a day embedded in their existing facility so we can watch and observe a “day in the life”.
The second thing we want to do is have a detailed conversation about the client’s clinical beliefs on key planning issues that vary from facility to facility: open vs. closed nurse stations; private vs double rooms; en-suite vs corridor accessed toilet facilities; centralized or decentralized therapy/ social space. This is the WHY phase. I wrote another blog on that so feel free to check it out for more detail.
In this initial data gathering phase we are trying to figure out if the client already has a well thought out idealized operational plan. In many cases, we find that clients have developed programs around the limitations of their existing facilities. By introducing design thinking exercises, our job is to help them imagine a better way to do things. It is absolutely critical that this process happen early. In my experience, clinical leaders’ minds get opened up during the process and they start to more effectively imagine this wonderful future. Unfortunately, those thoughts often coincide with design deadlines and result in last minute changes. We want to get it right the first time, so taking the time to design the operational program first is the key to reducing the design team’s stress level along the way.
Once we have established the program we are designing for, our next step is to explore plan options around some key experiential factors:
- Efficiency. Yes, I know. That sounds boring, but efficiency in planning is a key driver for staff productivity which is a key driver for economic viability. A program that is not economically viable will not help patients no matter how beautiful the building.
- Social Dynamics. We have posted some other blogs on this, so I will not belabor the point, but the plan needs to consider all the options for providing viable social and treatment space to provide patients with as much choice and control as they can be allowed. Carefully designing for social dynamics is a key driver for reducing environmental agitation.
- Acoustics. Speaking of environmental agitation, very few things are as impactful on levels of agitation as acoustics. You might think that is a design detail and not a planning move, but I strongly disagree. Because the nature of a BH space limits your sound absorbing options, the layout of rooms must consider all the factors that impact acoustics such as non-parallel walls, variations in ceilings and connected spaces.
- Daylight and views. Some projects offer more possibilities in this area than others, but that only means that we must plan from the start to get the most bang for whatever buck is available. It seems like circadian rhythms is one of the hottest topics in the design profession today and it also seems like a lot of designers are struggling to understand the dizzying array of lighting options. I know this: The impact of real, natural sunlight is unquestioned in its positive impact on all humans. Giving patients and staff access to this bit of magic is a critical planning element that simplifies so many other decisions down the road.
- Sight Lines. This is often misunderstood as simply estimating the sight lines from the nurse station, but I refer you back to my earlier comments in this blog. Some programs do not use the nurse station as an observation point. I once had a clinical director explain that there are no nurse stations on their units. All observation takes place on the milieu and staff are dedicated to that job. She did want glass around the charting rooms so that staff doing heads down work could identify issues quickly when they arise, but under no circumstances did she want us designing them as “observation points”. If we take the time to understand how the client will observe the patients, we can design an environment that is best suited to that operational paradigm.
There are other critical issues like safety and security that are generally design detail questions but understanding where they will lead can have a planning impact. For example, if you allow a smoke barrier (or any other rated wall) to bisect the unit, safety will impact the plan. That simple planning move creates a rated door that the staff will want held open. That means it cannot have a surface mount or even concealed closer which would represent a ligature point when the door is open. There are other closer options, but many of them have significant maintenance issues. Rather than search for a technical solution to a design flaw, the planning process must anticipate these issues and prevent them wherever possible
Planning a psychiatric treatment unit is a complex endeavor. To do it right requires a detailed conceptual understanding of the idealized operational program; a thorough understanding of the psychology of space and the keys to a therapeutic environment; and the experience to understand how the little details that will come along later will manifest in the planning decisions. That is why hX brings both operational and design experience. We use our talents to supplement talented architectural teams so the whole process delivers an outstanding result for the client. In the end, our clients treat some of our most vulnerable neighbors. We owe them nothing less than our best.
