Our 2013 Behavioral Healthcare Health and Human Services Showcase has a different look and something of a different feel this year as we, together with our design jury, elected to “raise the bar” on the facility projects that the Showcase would consider this year. To that end, we asked entrants to:
• Detail the pre-design and design planning processes used by the architect and project team.
• Discuss any sustainable or “green” design features.
• Explain the types of treatment and services provided in each facility, together with the anticipated conditions and acuity levels and lengths-of-stay for patients being served.
• Review patient and staff safety measures, features, or technologies incorporated into the facility.
• Discuss up to three significant design challenges that were met and overcome during the design and construction of the facility.
• Submit only completed or substantially completed facility or renovation projects so that our design jury could evaluate the overall quality and consistency with which the aesthetic, functional, and safety aspects of each design were executed in the finished structure.
While none of this year’s entrants was awarded our highest honor, the Certificate of Merit, jurors agreed that project entrants faced a tougher evaluation — a higher bar than before — and that entrants responded with entries of consistently high quality and completeness. These factors add a bit of extra gloss to the recognition earned by this year’s entrants (which can be viewed here in the digital issue).
Concept or complete?
This year’s requirement that Showcase facilities were to be substantially completed structures was a plus, according to jury members. “In behavioral health, so much in the environment of care is in the details. It’s the little things like, ‘does the can light have a lens cover on it?’ Those sorts of things are really seen better in a complete project than in a project concept,” said a juror.
Said another, “It is easy to make claims about safety, but there is no way other than a built project to evaluate those claims, to see if the intent was really carried off.” Despite the best-laid plans, the juror asserted that during the course of construction, “it’s inevitable” that some things “don’t come out the way you had expected for any number of reasons.”
Overall, per-square-foot expenditures ranged from $100 to $528, excluding the cost of land. And, the budgets did have an impact on the jury’s thought process. Try as they might to evaluate projects using precisely the same yardstick, jurors admitted feeling more “sympathetic” toward two types of projects—renovation and small-budget projects. Compared to new facility designs, “renovations are tougher to do, since they involve more constraints,” said one. And, jurors were somewhat more likely to grant designers of small-budget projects “the benefit of the doubt” — though not the benefit of a better evaluation — when they questioned or disagreed with decisions that project designers had made.
“When you’re evaluating a project that has been done on a tight budget, it means evaluating not only the project, but the ability of the team to prioritize needs,” said one juror, while another said that “if you’re working on a shoestring, that can help to explain some of the design choices that were made.” On the other hand, jurors noted that big-dollar projects cannot help but face high expectations. And woe indeed to those who spend much yet still don’t get it right, joked one juror: “If you have the money, but you still do it wrong, there’s no mercy for that.”
Fortunately for readers, the Showcase entries reflect positively in all the essentials. However, jurors caution that what you see in the photos may not always reflect “best practice” design, but a mix of informed decision making that takes into account multiple factors and concerns. One put it this way: “There are no ‘right’ answers, just ‘right’ ways to handle things.”
Jurors agreed that one “right” way to ensure optimal project design is to involve patients, clients, and family members in the facility planning process. Yet, one expressed concern that only one entrant mentioned such participation in the planning phase of their project. “The patient and family have a lot of valuable information to offer,” the juror warned, “even if they are not among the project decision makers.”
Private or semi-private rooms?
Jurors agreed — and said that clinical professionals would agree — that private rooms are generally preferred for clients receiving mental health treatment. “Feedback from my clients is that many patients don’t do well in semi-private rooms,” said one. But that doesn’t mean that all rooms must be private. “We can’t fault designs that include two beds in a room because, particularly in a renovation project, maintaining the bed capacity may be a design constraint for the project,” said another.
Jurors recognized that the number of beds in the room wasn’t the main question. Instead, the therapeutic issue turns on how many of the beds are being used? Recent designs discussed by two jurors included a number of semi-private rooms primarily for purposes of facility or unit flexibility and capacity. One design sited a couple of semi-private rooms nearest to the nursing station, with private rooms further down the hall. “From a care standpoint, the intent really wasn’t to use them as semi-private rooms on a frequent basis,” the juror explained. But all agreed that if a facility faces a capacity squeeze, or when a patient has a special need, it is wise to have semi-private rooms available.