Before embarking on a career in architecture, ZGF’s Tammy Felker – featured in the below video – had an inkling that design was in her future, so much so that family-vacation itineraries were often dictated by visits to historical sites and buildings.
While working as a critical-care nurse at the University of Virginia Medical Center, her career intersected with architecture during her involvement with the university’s hospital replacement project. It became apparent to Felker that healthcare design could benefit from a clinician’s perspective. After 16 years in nursing, she earned a Master of Architecture in 2001 and has worked in medical planning and design ever since.
During her career, Felker has seen a dramatic shift in the way hospitals and healthcare systems approach behavioral health. Compared to all healthcare facility types, she says, the physical environment of an in-patient behavioral-health unit, in particular, has the greatest potential to impact patient outcomes.
When it comes to designing spaces for the greatest therapeutic benefits, Felker says ZGF’s approach is to introduce design interventions that promote a sense of normalcy and healing, while balancing patient and staff safety considerations.
“The spaces and rooms, the furnishings, the fixtures, they’re all tools to help with healing, just like an IV pump in a medical-surgical unit,” she said. “Presenting options for patients’ choice of care, control of the environment and interactions with others is really important as well. This can all be enhanced by the physical environment we create.”
At Swedish Medical Center’s Ballard Medical Behavioral Health Unit (BHU) in Seattle, the ZGF design team inherited two floors of an existing hospital that would be renovated into a 22-bed space promoting recovery, mindfulness and safety. Designed to simulate the activities of daily living, the facility includes private spaces for patient bedrooms, transitional zones, and communal spaces for dining, activities and interactions with fellow patients and staff.
In stark contrast to what Felker first encountered as an architect – when only prison-grade fixtures were available to those designing BHUs – the Swedish project incorporates wood, fabrics, wall coverings, Corian counters and even ceramic tile. These are familiar materials found in homes that also lend a feeling of sophistication. While elevating the experience for patients, these finishes also carry the dual benefits of safety and durability. Acoustical considerations also drove design decisions, as noise can often agitate patient populations, she said.
The solid-core reception desk at the main nurse circulation area serves dual roles. Custom-milled and built from Corian, its unique shape and textural edge help it act like an art feature. But the desk also provides a potential barrier between patients and staff when needed, in contrast to old models like the kind depicted in the movie “One Flew Over the Cuckoo’s Nest,” with nurses seated behind a wire-glass enclosure, and pills being slipped under a pass-through cutout.
Another key design driver for the Swedish BHU is the emerging trauma-informed model of care. To minimize the need to restrain patients – which can trigger memories of past trauma – the project includes calming rooms for de-escalation. The quiet spaces allow patients to change the color and intensity of lighting in the rooms, imparting a sense of safety and control. Patients also use them to meditate and practice breathing exercises, the kind of skills that can be developed in the inpatient environment to manage symptoms after being discharged.
An exercise room featuring a stationary bicycle, yoga mat and exercise ball – unique to the Swedish BHU – is helpful in combatting depression and foundational to overall health and wellness.
In common areas, tunable LED lighting helps synchronize patients’ natural sleep-wake rhythms, marking the passage of time and providing a sense of calm as the day winds down.
To destigmatize the environment in the BHU, existing structural columns were transformed into nature-inspired art features covered with glass and ceramic tile. This is another departure from BHU designs of old, where structural columns were wrapped in concrete and painted, leaving grooves, steel housings and fixtures exposed.
“What’s really important is the message we send to patients, their families and the community,” Felker said. “Through the design, we are signaling that these are valued members of society and that the hospital and the organization has invested in these spaces to provide comfortable, warm and therapeutic environments for their wellbeing.”
During the month of May, ZGF is recognizing Mental Health Awareness Month with a series of posts and videos that explore the topic of designing behavioral health spaces.
- Read Part 1 here for an overview on the factors driving the need for behavioral healthcare, and ZGF’s approach to designing these spaces
- Read Part 3 here to learn about UCSF’s first-of-its-kind care model for behavioral health