“Most healthcare providers are moving to mobile tablet charting and encouraging an environment that allows the care providers to be on the unit interacting with their patients rather than sitting behind a care desk monitoring their patients,” Perreault says. “Care desks and nurses stations do not need to be as large as they used to be and really only need to support one or possibly two staff members passively monitoring the unit in the evening while patients are sleeping.”
Mural says one of the ongoing considerations when it comes to facility design has always been safety: striking a balance between making settings safe without making them feel institutionalized or “prison-like.” Healthcare organizations run the risk of designing spaces that are too sterile-looking, so there has been a push to create therapeutic but also beautiful settings of care.
One behavioral healthcare challenge for residential facilities in particular, Mural adds, is that there is no industrywide standard for ligature-resistant products. While there are guidelines and catalogs of products that could easily be implemented, he says those involved in the decision-making process must understand the associated risks of the population that will use the facilities.
Ultimately it boils down to organizations evaluating whether risks would be addressed by design or clinical solutions, he says. For example, installing weight sensors at the top of every bedroom door can provide alerts but so can having staff manage patients that have been deemed potentially suicidal.
Working with different facilities and clinical teams across the country, another trend Perreault has observed is a move toward trauma-informed care and the reduction or elimination of seclusion and restraint practices. Experts believe trauma affects a significant number of people who seek care for behavioral health needs, and it’s becoming a business imperative to recognize it in patient populations.
“Most hospitals that we’re working with have their own initiatives to not re-traumatize patients,” Perreault says. “This relates directly back to the design environment with the introduction of spaces such as quiet and comfort rooms to allow patients to emotionally self-manage, de-escalate and to passively separate patients when needed.”
Mural adds that patient dignity has become a recognized driver in inpatient design, where more organizations are moving toward establishing private rooms for patients with the intent to reduce stress. Likewise, art therapy rooms might help to deescalate patients before they feel a need to lash out.
Acoustics, aesthetics, and natural light
Evidence-based design shows that certain material selections for acoustics, window views, outdoor access and natural daylight all help to reduce stress, anxiety and depression in treatment settings. In particular, the acoustics need to be carefully considered, Perreault says.
“While these environments need to be durable and safe, they also need to be calming,” she says. “Noise is a pervasive stressor in healthcare environments, and we are seeing new products coming on the market to address safety, durability and acoustics.”
Sell says there has definitely been a move toward natural lighting to allow facility space to appear more familiar and home-like, which is inviting yet safe for both patients and staff.
Facilities are asking for as much light as they possibly can get, he says. One solution might be floor-to-ceiling polycarbonate panel windows that can provide light but are also sturdy enough to withstand someone throwing their weight against them.
Sell adds that while security is paramount, treatment settings should be warm and have an open, residential feel. New interior finishes and products for lighting and furniture, for example, have continued to improve and are not nearly as institutional as they used to be.