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Balancing shared and private spaces

November 1, 2008
by Michael Meehan, AIA, LEED AP
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A design firm works to create the optimal patient room

Figure 1. A patient room at Hazelden's Women's Recovery Center. Photo by Gallop Studios

The successful design of behavioral healthcare facilities involves listening to the stakeholders, understanding how they provide care, and synthesizing what you hear with what you know to suggest for even better ways of doing things. Recently BWBR Architects worked with the Hazelden Foundation to design its new Women's Recovery Center at its Center City, Minnesota, campus. Throughout the process, the design team worked hard to understand the needs of patients, counselors, and facilities staff. One area we focused on was the patient room (figure 1).

Patients spend more time in their rooms than any other space in a treatment facility, and the right design solution can create a healing environment that supports the recovery process. The design of patient rooms at a residential treatment facility involves a balance between shared and private spaces. Patients want privacy for sleeping and studying, as well as for a retreat from others while they work through the first steps of their recovery.

Privacy also is determined by clinical priorities, such as the optimum number of patients in a room and patients' ability to interact and support each other. In addition, privacy in patient rooms needs to be carefully designed to limit the ability of patients to keep secrets from one another or conceal contraband substances.

In many facilities, beds, desks, and dressers are arranged around the perimeter of the rooms, so all the space is shared by the roommates. There are advantages and disadvantages to this layout. On one hand, patients who stayed in dormitory-style open rooms, with little separation between beds, reported to our design team that there was not enough privacy. With a wide-open room, there was no opportunity for modesty when changing clothes or opportunities for solitude. On the other hand, without private sleeping quarters, patients were very aware of everything their roommates were doing. They did not have opportunities to hide themselves or substances from roommates.

BWBR's challenge was to create a design solution to support Hazelden's clinical procedures. For Hazelden's new Women's Recovery Center, counselors determined that three patients to a room was optimum for recovery. With three to a room, there is an opportunity for support and community. As one roommate graduates out of the program, another is moving in, and the other two serve as experienced guides for the newcomer. Three people discourage one-to-one alliances and secrets, as it is more difficult to keep drug or alcohol use concealed from two people rather than one. Should one roommate start to falter, there are two additional sets of eyes and ears to pick up on the distress signals.

Thus, the design team created a three-person room subdivided with low partitions for each patient's sleeping area. A desk and dresser were placed next to each patient's bed so all of her personal belongings were in a defined, defensible space. Studying, sleeping, or changing all can happen in a designated area for each patient. While each roommate occupies a discrete part of the room, there is also a degree of openness that allows the three to bond as a group. The room becomes a blend of shared and private spaces within a larger room.

The design team looked at the different activities that would occur in the patient rooms, and how much space three users might need. We quickly identified a bottleneck at the bathroom: How would three people with the same schedule be able to cycle through their morning routines? A bathroom for each patient room was required to provide privacy and dignity for everyone. But it could be challenging and expensive to create one large enough for multiple users. It was another instance of balancing privacy with openness.

To solve the problem, the team decided to provide a sink and mirror in the patient room, in addition to the bathroom vanity. The sink in the room is wide enough for two women to stand side by side. While one uses the bathroom in privacy, the others can brush their teeth or use the mirror at the patient room vanity.

Evaluating the balance between privacy and openness by looking at floor plans is sometimes difficult for people unaccustomed to reading architectural drawings. To communicate our concepts to the staff and clinicians on Hazelden's design team, we created a full-scale mock-up of a patient room (figure 2). Some kind of model, either digital or physical, is an integral part of any design process. A mock-up is useful because it lets architects and staff get into the space physically.