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Listing all articles within the Planning category.

What Can 4th Graders Teach Us about Designing for Health

The questions from a fourth-grade student at St. Gabriel's Elementary School give BWBR's principal designer Jim Davy, AIA, an opportunity to see hospitals through different eyes.
The questions from a fourth-grade student at St. Gabriel's Elementary School give BWBR's principal designer Jim Davy, AIA, an opportunity to see hospitals through different eyes.

What would you put in a hospital to entice people to come there?

What would your hospital look like that would make you say, “That’s awesome!”?

How would you design your hospital to make it comfortable and nice?

If you could go to the hospital for something more than being sick or injured, what would you go there to do?

Think about those questions for a moment. Ask most adults about hospitals, their minds will immediately jump to being sick, injured, sitting in sterile environments, and costs.

But, what if we could start from scratch and not think of hospitals as places where care services are delivered but as places where health is promoted?

That was a bit of the idea prompting us recently to visit the fourth grade class at St. Gabriel’s Elementary School in Prairie du Chien, Wis. It’s not that we were out of ideas, or that we couldn’t maybe think of some answers ourselves as we began to plan the new Prairie du Chien Memorial Hospital.

However, in answering those questions as adults, we often bring our experiences and prejudices to the discussion. What will this cost? Will the community think this is frivolous? No one goes to a hospital for THAT! What we wanted to explore was the idea that if we could elude these biases and previous experiences, what could we envision with no limitations?

Windows with flower boxes. Skylights and waterfalls. Colors. Desks for homework and tables for board games. A gym for exercise. Solar panels and windmills. Healthy food. Gardens with ponds. Giant teddy bears. A mowed lawn. Tube slide. A big sign that tells the community, “We love you.” Moving lights at night. Fish tanks. A place for animals. Green Bay Packers’ colors. (Hey, it is Wisconsin. Just think of the sponsorship possibilities!)

OK, maybe the Packers’ colors might be a little out there (where would Bears and Vikings fans go?).

What their answers showed us, though, is that a place for health to fourth graders is not all about doctors and nurses and hospital beds. Get beyond how we deliver care services, and you can see in these fourth graders’ comments that there are many opportunities for a hospital to engage people in being healthy. Many of these ideas even reflect strategies we have already adopted in other care facilities in recent years – facilities where people have asked us to think beyond care service delivery.

For many small rural communities that have a hospital, the chance to create a replacement hospital comes around maybe once in most people’s lives. Always taking a sober and mature view to creating a new facility, cost and safety rise to the forefront of issues. That’s reality, and being an adult.

We live in an exciting time, though, when we are redefining what it means to be healthy and have health care. To see this revolution through the eyes of a child who is not burden by past experiences, we can create a health center that is a resource for living, not simply a resource for care and rehabilitation. Afterall, what we create today is what we pass on to these fourth graders tomorrow.

 

Respite for Health, Not Just Healthcare

A coffee bar with lounge and fireplace gives employees reasons to leave their work stations, relax, and recharge. Such places also can serve as impromptu and natural areas for discussion and collaboration, providing a boost to productivity and innovation.
A coffee bar with lounge and fireplace gives employees reasons to leave their work stations, relax, and recharge. Such places also can serve as impromptu and natural areas for discussion and collaboration, providing a boost to productivity and innovation.

The Green Guide for Healthcare defines a place of respite as “a place on the health care campus to connect health care patients, visitors, and staff to health benefits of the natural environment.”

The question the definition begs is if a place of respite works in a health care setting, why couldn’t it work in a another setting, be it commercial, industrial, or corporate?

The fact is it can, and more people and organizations would benefit if planning strategies included places of respite in space design. Evidence has suggested that places of respite measurably reduce levels of stress, increase  a sense of calmness, confidence and focus and improves mood.  Results from a Cooper Marcus, C. and M. Barnes 1995 study showed the following information:

How do you feel after spending time in a garden?

  • More relaxed, calmer .......................79%
  • Refreshed, stronger .........................25%
  • Able to think/cope ...........................22%
  • Feel better, more positive .................19%
  • Religious or spiritual connection ...........6%
  • No change of mood ...........................5%

 

Many health care organizations have easily adopted the idea of respite spaces because they offer space for spiritual, mental, and physical healing. However, the idea of these spaces where people can escape don’t have to be wrapped around the act of healing as much as a place where people can go and relax and recharge. Why do cities have gardens and squares?  Why do people like having porches and patios at home?  Why do people enjoy a walk around the lake?  These are everyday examples of places of respite.

These spaces are important to us because they offer opportunities to relax and interact in a stress-free environment. We feel recharged, grounded, calmer and more equipped to move back into our day, ready to meet the challenges of the world.

As human beings, we require these outlets for healthy and enjoyable lives. In a world where we spend more and more time indoors and attached to electronic gadgets – and experience the inherent stress of doing so – the need for places of respite is amplified.  Health and wellbeing are affected by stress, which, in organizational terms, also affect our productivity and creativity. 

Places of respite are important to each of us, at all stages of life. We need them to function and be happy. If these are attributes that make us better employees, how do we address these needs in the workplace?

This is the first of a series of posts looking at health and wellness in the design of spaces.

Harnessing Collaboration to Plan Collaborative Spaces

Energized discussion at a recent SCUP workshop illustrates how collaboration can lead to innovative learning space design.
Energized discussion at a recent SCUP workshop illustrates how collaboration can lead to innovative learning space design.

Creating change is difficult.

Think about it. We are all creatures of habit and have been trained by previous generations to act and behave in a certain manner. It makes us resistant to change because change will challenge the behavior we have learned.

The question becomes, how do we create change that meets the least amount of resistance?

Recently we had the opportunity to collaborate with stakeholders to imagine what the learning space of tomorrow could be. The one-day workshop at the Society of College and University Planners North Center Conference – facilitated by Minnesota State Colleges and Universities (MnSCU) and Learning Spaces Collaboratory (LSC) – brought together a broad spectrum of users: faculty, facility managers, architects and designers, and researchers of learning space design.

Discussions explored topics such as flexibility, grounding the planning of learning spaces on pedagogical planning, and creating a usable vision to get results.  Insights came from renowned leaders in the education field, such as Jeanne Narum of LSC (every space is a learning space); Sally Grans-Korsh of MnSCU (students like a parallel play); and David Van Wylen of St. Olaf College (we need to build on the ideas of others and spaces matter).

The atmosphere of the discussion was energized by the fact that it was not a room of like individuals participating in a group-think exercise. Rather, it was a cross-section of professionals who manage, use, or design academic spaces really challenging what has been a static classroom design for the past century. It opened the discussion to how we envision learning environments that are flexible, social, robust, and, above all, collaborative.

It allowed us to see change as something that enhances our behavior rather than something that wants to change our behavior.

Collaboration can, at times, appear as a word-du-jour. However, to create spaces that encourage collaboration, we have to start from a position of collaboration.

By generating new ideas and sharing information across disciplines, we can reduce resistance to change and move forward creating change that is necessary for the evolution of learning.  

What is An Active Learning Environment?

Students no longer compartmentalize learning and social activities. Spaces need to be designed to facilitate the active learning style students seek.
Students no longer compartmentalize learning and social activities. Spaces need to be designed to facilitate the active learning style students seek.

Pedagogy – it’s a heavy word. However, what seems to be strictly academic may have more social implications than what we think.

Strictly defined, pedagogy deals with the art, science, or profession of teaching. In practice, it deals with how well we are empowering students to learn. As pedagogy evolves to improve the delivery of subjects, the questions arises how well we are evolving the environment to improve the learning?

It’s not enough to look at technology and imagine how we integrate that into the classrooms. We also have to look at how students use technology, balance demands inside and outside of the classroom, and see themselves in the relationship between teaching and learning. Gone are the days of the “sage on the stage.” Students seek a cooperative relationship between themselves and the instructor. They want to be part of the teaching, not just an audience to it.

This is active learning, and the evolution of such learning now demands an environment to accommodate it.

Mobility among students and technology requires designers to look beyond the classroom – every space can be a learning space. It’s robust, social, reflective, encourages collaboration and creativity, and changes how we think about designs for learning.

We are continually engaging people to learn more behaviors to inform the design of spaces to support how instructors want to teach. Evolution now demands that we also ask how students want to learn, or, rather, what types of activities are happening here and how will this space contribute to the attributes of active learning (collaboration, group inquiry, etc.)?

These meaningful discussions with students and professors about learning offer an opportunity to truly rethink the design of learning spaces.
 

Sometimes, our inspiration comes from within

As designers of health care environments, like the health care industry itself, we look to the outside for ideas designing solutions: hospitality for comfortable environments, aviation for safety protocols, manufacturing for process.

For all the academic and evidence-based influences that help guide those solutions, sometimes it’s our own experiences and those of our family and friends that inspire the experiences we help create in spaces.

Our coworker, Al McAllister, and his wife gave birth to a daughter two years ago who was born with a rare genetic disease, Pfeiffer’s Syndrome. Only one in 100,000 people are affected by the genetic disorder, and his daughter, Kate, has already had 34 surgeries to try to alleviate the effects of the disorder, which causes premature fusion of skull bones that prevents the skull from growing normally. (Learn more about Pfeiffer Syndrome here.)

Kate the Great shows us how resilient children can be, even in what adults would define as some of the worst experiences in life, and how, in the end, they still deserve the opportunity to be a child. And Al and Stacy remind us that when a child goes into the hospital, treatment must focus on the whole family, not only the patient.

Kate, thank you for reminding us why we do what we do and why we must always strive to do it better. We wouldn’t want any less for the people who are close to us.

Visit Kate’s CaringBridge site to read more about her incredible life.

Focusing on What Matters in Health Care Costs…Health Care

Beyond comfort, patient rooms create a better healing environment through noise reduction, placement of equipment, and furniture to facilitate family support.
Beyond comfort, patient rooms create a better healing environment through noise reduction, placement of equipment, and furniture to facilitate family support.

Can we improve patient care and experience by controlling costs?

Read the question and ask yourself: What is the focus of the question, costs or patients?

A story recently ran in USA Today under the headline, “Hospitals try to find savings, cut unnecessary care.” The story focuses on health care systems that are using data to determine effective care protocols given the wide variation of care delivery techniques that permeates the system currently, and how much of that care is practiced more on tradition than on best practice.

Reading the USA Today headline, though, the focus is definitely on costs, to which we ask: Shouldn’t it be on the patients and improving their care and experience? While changing a practice can reduce the cost of the care provided, haven’t we improved the patient’s experience if we make it less expensive or less invasive without any loss of quality?

Therein lies the hurdle that we are having a hard time overcoming in our efforts to improve care for patients. Many bifurcate the definition of costs into outlays and income, payers and providers. Limiting the discussion to only those two subsets, we overlook others who have a stake in the debate, mostly patients and staff. Yes, the rising cost of care has been unsustainable, and, unfortunately, the outcomes have not always justified the costs of that care.

As that last sentence suggests, though, these discussions should be led by outcomes, not simply costs. By improving the outcomes or improving processes to maintain effective outcomes, we can improve the costs, i.e. better healing environments, lower infection rates, reduced staff fatigue, fewer medical errors, etc.

The article hits the nail on the head. With access to better data, it is possible to examine variables that influence our care and study their effectiveness. With better information, we can make smarter decisions about delivering that care. Smarter decisions mean better care for patients and better finances for an organization. The headline, as well as the debate, should reflect the focus on making smarter decisions about the care patients receive, not simply looking at the costs.

Now Here’s the Way to Break Ground on a New Facility

BWBR's CEO Steve Patrick gets a different point of view during the groundbreaking for the Minnesota Army National Guard Field Maintenance Shop.
BWBR's CEO Steve Patrick gets a different point of view during the groundbreaking for the Minnesota Army National Guard Field Maintenance Shop.

The shovel can be so cliché.

OK. The shovel was used. Admittedly, it’s hard to dig from the perch of a turret. But, the view is kind of cool, especially for those of us who don’t get to sit in one of these very often.

On Tuesday, the Minnesota Army National Guard broke ground on its new Field Maintenance Shop at the Arden Hills Army Training Site (AHATS) in Arden Hills, Minn. The new 109,000 s.f. operations building will provide needed upgrades to the maintenance work spaces and administrative offices, storage areas and support spaces in one state-of-the-art facility. It is a major component in the development of the AHATS as a premier Army and National Guard training site.

As a state-of-the-art building, it is designed for its technical use as a vehicle maintenance facility for the Guard’s tanks, troop carriers, trucks, humvees, and radar equipment; and it is expected to exceed the Guard’s mandate for achieving LEED-NC Silver Certification for energy use and sustainable design.

When you examine what the National Guard is doing nationally, the pursuit of LEED is significant and could provide a model for other guard units developing new campuses. Using the Xcel Energy’s Enhanced Design Assistance program, extensive energy modeling and analysis has been conducted to guide the design of daylighting systems, efficiency of the building shell, and selection of energy efficient resources. Models indicate the building will achieve 43% energy savings better than code guidelines.

Additive bid items have been incorporated for alternative energy systems – solar thermal, photovoltaic, and future connection to a potential geothermal system.

The campus also stands out for its location in a growing suburban community. Campus aesthetics will help the campus fit in with surrounding residential neighborhoods, and, to that end, the design of the building complements surrounding buildings, including the Grow the Army Readiness Center and neighboring Ramsey County/City of Arden Hills Public Works Facility.

Construction is expected to be complete in 2012.

Creating a Health Care Experience by Learning from Consumers

What does health care look like, both in a consumer setting and in a consumer-driven economy?

It is not a question seeking a definitive answer. Rather, it is a solicitation to the consumer to help shape their health care experience.

This is the premise of Mayo Clinic’s step into the ultimate consumer experience, the Mall of America. And it is the word “œexperience” that takes center stage in Mayo’s new presence, Create Your Mayo Clinic Health Experience.

Part store, part clinic, part social laboratory, there is nothing like Mayo’s effort in the nation, possibly the world. It is an experiment, an invitation to the general public to influence the future of health care. While health care traditionally has been a reactive practice, Mayo is changing the model with its presence at the Mall of America, empower and motivating people to take ownership of their health and change the course of health care.

To say that this has been an exciting project is a bit of an understatement. We live in a revolutionary time for health care. The changes that have occurred in clinical, ambulatory, and tertiary care have improved both the quality of care and quality of the work environment for patients and staff, respectively.

As wellness becomes more of a part of the definition of health care, how we define health care delivery must evolve. This challenges us to think differently, both in the creation of the space and the siting of that space. As consumers, it’s our duty to own our health and wellness. Mayo Clinic’s experiment is opening the door for us to take that ownership.

Check out this interview with the Mayo Clinic Administrator Jim Yolch. And, if at the Mall of America, stop by the Create Your Mayo Clinic Health Experience. Mayo wants to know how you define health and wellness.

Breaking ground on future prosperity for children, region

Children take charge in the ground breaking for the Early Childhood Family Center in Stillwater.
Children take charge in the ground breaking for the Early Childhood Family Center in Stillwater.

Breaking ground on a new project usually represents a milestone in the process to bringing a vision to life.

Last week, that vision went beyond a facility in planning for years. It includes the success of children in the community of Stillwater, and for region itself. When put into that context, it was more than apropos that the people who turned the dirt over for the ground breaking were the children.

The success that investment in early childhood education produces is well documented. If we can begin a student’s academic career prepared to learn, we increase that child’s earning potential out of high school by more than 8 percent. Studies also show a 12 percent rate of return from the public investment in early child education programs.

A child’s brain at age 3 is twice as active as an adult’s brain and remains so for several years. By age 5, a child raised in a nurturing environment is likely to hear 32 million more words than children raised in a more limited environment. By the time a child enters kindergarten, he is already on a path for academic success, and any deficiencies in a child’s development before kindergarten can set that child behind the learning curve, leading to other issues such as school absenteeism and behavioral problems.

This is not a small issue. In Minnesota, 13 percent of children entering kindergarten do not possess the skills, behavior, or knowledge necessary to be proficient in language or mathematical thinking.

When we look at the Early Childhood Family Center for the Stillwater Area Public School District, we can see an expenditure that is providing a 45,600-square-foot facility for families in this historic, growing St. Croix River valley. When we look further, though, we see that this is an investment in the lives of children and the community’s future economic well-being. That makes it more than just a facility, and making the ground-breaking more than just a photo-op.

If you want to learn more about some of the benefits of early childhood education, check out the policy brief prepared by the Great Twin Cities United Way as well as the Minnesota Early Learning Foundation.

Are we selling rural communities short by lack of investment in care?

Investment in critical access hospitals improves operations through better efficiencies for staff and better care environments for patients and their families.
Investment in critical access hospitals improves operations through better efficiencies for staff and better care environments for patients and their families.

 

On July 31, Jamestown Regional Medical Center will open. The name, as well as the facility, symbolizes how important this critical access hospital is to the surrounding region. Once called Jamestown Hospital, located in the middle of town, the new “œregional medical center” brings with it all the efficiencies and tools to both attract staff and serve generations in this growing rural area.

It’s not a typical story for rural communities. In 1965, health facilities investment as a percentage of overall health care spending peaked in the United States at 13 percent, with a significant portion of that capital spending going to rural communities to strengthen the nation’s hospital system. Today, that spending is down to less than 4 percent, and much of it concentrated in more populated areas.

For communities in the Midwest, the lack of investment in rural hospitals is especially acute as more than 30 percent of all critical access hospitals in the U.S. are concentrated in Minnesota, North and South Dakota, Wisconsin, Iowa, Nebraska, and Kansas. With many of these facilities reaching 50 years in age, significant populations are left with treatment in outdated and inefficient facilities that are becoming more and more expensive for administrators to operate and more difficult to integrate into the nation’s health network.

Even with changes in Medicare reimbursements, administrators are challenged to allocate the resources necessary to adapt their facilities to demographic and care delivery changes. While these facilities often represent one of the largest drivers of the local economy with direct and indirect employment, the question becomes can these communities afford to wait for the resources to bring their health care resources up-to-date and in line with community needs?

Most critical access hospitals are products of the post-war boom era. They were sized at a time of thriving growth and planned for much longer lengths of stay than what we see today. The emphasis then was more on the number of inpatient beds and less on diagnostics and procedure spaces.

Today, the model of care has changed, and that is forcing facilities to change.

Jamestown was in a fortunate position to take advantage of USDA funding to invest in its new medical center. They found resources to make the investment in their community possible. Not every critical access hospital is in such a position. For them, they have to discover other strategies to adapt. For us, we have to ask: What can we do as planners and designers to help them adapt and enhance the delivery of care in their communities?