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Transcending the conventional: Creating flexibility and durability for behavioral health

December 6, 2013
by Jon Sell, Principal & Healthcare Planner, Array Architects and Joseph Schulman, Executive Director, The Zucker Hillside Hospital
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For healthcare facility designers, flexibility has become a driving demand. Healthcare leaders find it hard to predict, with the coming changes in healthcare reform, how facilities can best respond to new paradigms for reimbursement and patient care. This is particularly true for behavioral health facilities.

To cope with that uncertain future, North Shore-Long Island Jewish Health System’s (NSLIJ) The Zucker-Hillside Hospital wanted maximum flexibility for its new behavioral health facility. With a portion of its current hospital beds housed in outdated individual cottages dedicated to specific populations (i.e. adolescent, women, dementia, geriatric) management faced challenges as well as census fluctuations. When the NSLIJ project began planning the replacement behavioral facility at its Glen Oaks, New York campus, they wanted a facility that would successfully support different mental health needs, as well as support the System’s migration to a cross-trained workforce. By working closely with clinicians, the project team was able to design the new “Behavioral Health Pavilion” with enhanced amenities and better safeguards for patients and staff. The design also gives hospital management the option to adapt the facility for future use.


Key insights for healthcare leaders

A behavioral health facility, with enhanced security, does not need to look institutional. In the new Behavioral Health Pavilion (BHP), the project team created inviting spaces for patients, staff and visitors, de-institutionalizing the environment by using beautiful yet maintainable materials combined with safety-conscience design. Using elements that work with behavioral health therapy, such as natural light and artwork, the space embraces a hospitality feel, instead of a clinical environment. Also important is ensuring the layout promotes and reinforces communication between patients and staff, by incorporating spaces that encourage these interactions.

Understanding the unique patient profiles and acuity levels and creating an environment supportive of each type:  adult, geriatric and adolescent patients are of the utmost importance. Adult populations in some cases may require a higher level of security, necessitating a second means of egress, something to consider early in the design process. Geriatric patients require corridors for ambulation and special lighting as well as handrails and robust programs to reduce falls. In addition, flooring materials with minimal transitions and contrast in color should be selected for those with vision impairments. Adolescent patients need spaces for education and entertainment. Outdoor activity space is beneficial for all patient groups, and should include a variety of active and restful spaces.  


Flexibility is fundamental

The design for the new 139,000-square-foot, 115-bed hospital building provides six 19-bed units (two adult, one adolescent, two geropsychiatric and one women’s). The hospital has an additional 106 adult beds in another building on campus with a total bed count of 221.

To maximize flexibility, the building’s design features inter-connected units. This allows the Zucker-Hillside staff to cross-train staff to float between units, if necessary. The single building approach, versus the multi-cottages the system had, allows them to make short-term changes that best serve the patients and staff.

The design employs a universal room model, with each room within a unit designed identically whether private or semi-private, allowing the facility to flex up or down to meet census. This allows hospital staff to simply change the room features such as furniture, artwork or color to make it appropriate for a different population. In addition, entire units can be modified-- if necessary by changing flooring or adding handrails if the system has an increase in elderly patients-- without costly renovations. Another example of built-in flexibility is through the use of multi-purpose space, such as designing seclusion rooms in such a way that they can be converted to a calming room in the future.


‘Non-institutional’ exterior and interior design

The Behavioral Health Pavilion has an atypical exterior and interior for a behavioral health facility, differing from the institutional look of many psychiatric care hospitals. Located in the heart of an academic medical center, the exterior, designed by Ennead Architects, features a welcoming arrival sequence. The front of the building incorporates a glass curtain wall with a vine-covered truss system to create a sustainable ‘green wall.’ The remainder of the building is clad in a fiber cement rain screen system in different colors, giving the building a striking profile on the campus. 

Array developed an innovative floor plan based on the “Disney Model” - a design that provides on-stage and off-stage areas and locates support spaces adjacent to a service elevator and vestibule. This way staff can support unit needs from behind the scenes without physically walking onto the unit. Supporting the residential feel of the overall environment, a three-corridor system creates distinct public, patient and staff zones. This allows visitors to arrive at their destination without passing through the patient zone. Staff circulates between the patient and support zones and can go “off stage,” away from the public or patient areas to concentrate on paperwork or take a break.