Healthcare designed for healing
by Jeannie Akridge  

Brayton Ripple bench

Selecting healthcare furniture and floor coverings involves much more than simply choosing contemporary over traditional design or incorporating hot new color trends. Today furnishings play an integral role in the healthcare environment. Well-thought out furniture and flooring choices can make a difference in public perception, can positively impact the environment and can even have an effect on patient healing.

Numerous studies have focused on the importance of design in healthcare. A recently released report by the Center for Health Design, “The Role of the Physical Environment in the Hospital of the 21st Century: A Once-in-a-Lifetime Opportunity”¹, recounts a project in which a team from Texas A&M University and Georgia Tech poured over more than 600 articles and reports to establish how hospital design can effect clinical outcomes. One key finding that is making its way into healthcare design and furniture and floor covering choices: elements of nature can distract both patients and visitors from the challenges of treatment and can positively affect outcomes. The Center for Health Design's Pebble Project research program, which was initiated with San Diego Children's

 Hospital & Health Center in 2000, provides examples of healthcare organizations whose facility design has made a difference in quality of care, as well as their financial performance. Through the Pebble Project, research partners are demonstrating that facility design can improve the quality of care for patients; attract more patients; recruit and retain staff; increase philanthropic, community, and corporate support and enhance operational efficiency and productivity.

Steelcase Inc. (Grand Rapids, MI) has also conducted research that indicates that the healthcare environment can help attract patients, inspire talented physicians and nurses, promote healing, and even reduce the potential for medical errors. To better understand the connections between critical issues affecting healthcare (overworked staff, the need to increase productivity, regulatory compliance, etc.), and the needs of hospital staff, patients, and visitors, Steelcase launched an extensive, four-phase research and design initiative over a four-year period. And since nurses, physicians, administrators, visitors, and even patients play a critical role in the process of healing, Steelcase conducted its research from a variety of perspectives, to best help the healthcare industry have a positive impact on the way care is delivered through research-based product applications. An article titled “Building a healing environment” is available at http://www.steelcase.com/Files/
9613ac5e788d4ed78ea7347ea3ac
9160.pdf. 

Brad Dickey, Hill-Rom's operational marketing manager, healthcare furniture, provides these pointers, “Specifiers (Purchasing Managers) should always keep the needs of the staff in mind when specifying seating products. Reliability, durability, utility and function should always be the first consideration when determining the role of furniture. Furniture serves as a key focal point in these four dynamics.

“Once you have determined these specifications you can address style, design schemes and color. These three factors require additional considerations such as patient psychological needs, marketing/image of the hospital and staff recruitment and retention. These factors drive the public perception of a hospital”. He notes several factors to consider about the role of furniture in a healthcare environment: attracting and retaining customers, patient and employee safety, infection control, regulatory/safety standards, recruiting and retaining employees and room synergy.

Lounge furniture
The right furniture in the waiting area of a healthcare facility can make a great first and lasting impression on visitors. There is certainly no shortage of design, color, upholstery and other options available for the healthcare facility. Buyers should feel free to don their creative hats to evoke a unique look and feel for their facility.   

Hill-Rom Opera

Nemschoff (Sheboygan, WI), which today focuses exclusively on healthcare furniture, has an extensive collection of lounge furniture with a variety of single and multiple seating options and complementary pieces that can be used throughout the healthcare facility. The family-owned company recently launched its Pillow Back sofa as a trendy, yet classic-styled option for waiting rooms, lobbies and lounges. Paul Nemschoff, regional sales director, notes that the Pillow Back sofa is a reincarnation of a product from the company’s original residential line circa 1950. “The Pillow Back is the second product in our Nemschoff Classics line where we’ve taken some of our older products, made them entirely appropriate for healthcare and reintroduced them to the marketplace,” said Nemschoff. Nemschoff offers complete furniture families, crafted exclusively from American hardwoods, that can be mixed or matched to provide designers with creative freedom. The company provides a substantial collection of standard fabrics as well as grades in specialty fabrics on a daily basis.

Hill-Rom (Batesville, IN) launched its Art of Care furniture line in 2004 and now offers styles for design schemes from traditional to transitional to contemporary. The Art of Care line features four family styles (Artisan, Metropolitan, Aero, and Opera) with offerings for patient rooms, lobbies, waiting rooms, lounges and other public areas of the hospital. The comprehensive line includes visitor and patient chairs, ganged and spanned seating, 3 Position Recliner, large capacity seating, occasional tables, and bedside cabinets. Hill-Rom recently introduced its “Design Your Own” Web site that allows customers to match up fabrics and wood finishes to instantly visualize their new furniture. With over 500 upholstery choices there are literally thousands of possibilities.

Brayton International (High Point, NC) has some very unique lobby options for healthcare facilities that include benches and beam seating and even an undulating wave form, called the Ripple Bench which was recognized with a Good Design award from the Chicago Athenaeum Museum of Architecture and Design. The contemporary-styled bench allows users to assume a variety of seating positions.

Brandrud Furniture (Auburn, WA) provides lounge chairs, sofas, loveseats and a nice selection of multiple seating options that are available in a variety of arrangements complete with adjoining tables.

KI (Green Bay, WI) also provides a complete line of lounge chairs, multiple seating options and other unique lobby seating worth investigating.    

Multi-function sleep furniture
Evidence continues to mount towards the healthy effects that visitors have on patients. In response, manufacturers are providing more and more options for guests to stay overnight in the patient room. 

Nemschoff has made guest sleeping furniture somewhat of a specialty, and offers one of the most comprehensive lines available. In fact, they’ve even trademarked the name SleepOver®. “Each healthcare facility has different needs for sleep-over seating and we feel the need to provide a variety of products to suit their needs,” said Nemschoff.

Nemschoff’s line of six different types of SleepOver seating products includes two different SleepOver chairs, a SleepOver sofa which extends out for multiple people to sleep on, and the new static footprint SleepOver Flop Sofa, available in several versions and even custom widths. The SleepOver Flop has multiple seating positions and turns into a bed for a single person without extending into the floor plan of the room. With a flip of the cushion you have a sleep surface that‘s 78” x 28” and has an antimicrobial fabric. “With patient rooms getting smaller in certain areas, whatever you can do to leave a static footprint is crucial”, said Nemschoff. The Flop has storage options either in the arms or underneath. The Nemschoff SleepOver Flop sofa was awarded a 2004 Nightingale healthcare design award. SleepOver Setee is a smaller sofa, with an arm that extends out to reveal a sleep surface. Nemschoff also has a foldout chair in its SleepOver line called the SleepOver 123, a chair that opens up into a bed. “It has the smallest footprint in the industry for a sleep-over chair, yet has a generous sleep surface,” said Nemschoff.

Brayton Cura

Brandrud Furniture offers some unique guest sleeping options for the patient room with its Slumber chairs that pull out for a single-person sleep surface, as well as the Revive Guest Center that is part of the Revive suite of patient room products. The Guest Center is a sofa that extends to a sleep surface of 72” x 32” and includes a variety of convenient features to make guests feel at home, including storage drawers, side tables and light receptacles.

“Family centered healthcare is becoming more the norm. We will continue to develop product to help make that easier on the facility,” said Lee Falck, president, Brandrud Furniture.

Brayton International offers its Sieste Sleeper as well as the Serene Sleep Chair.            

Patient chairs
Seating options for patients continue to take on additional features that aid in healing and help them feel more at home.

Brandrud Bloom patient chair

The Bloom Patient chair is a multi posture chair that was developed by Brandrud in collaboration with designer Mark Kapka, based on researching patient needs. The chair was designed to provide an alternative between a bulky, fully articulated recliner and the straight backed patient chair. The chair is designed with a flex in the straight back for a less-restrained feel. A matching ottoman tucks underneath the chair and provides storage capacity. The Bloom has an option for integrated fold down arms that would allow the patient or caregiver access to the chair from the side, which is a lower impact way of movement for the patient to get in and out of the chair.

Nemschoff Serenity II treatment

Nemschoff has had success with its Serenity II treatment chair that has infinite reclining positions to a completely flat position, includes an upholstered headrest and features heavy-duty casters. Also new from Nemschoff is the Erica Therapeutic, which is a patient-adjustable reclining back chair. It’s complementary to the entire new Erica family of patient and lounge seating. With a compatible foot stool that goes underneath the chair, it makes a compact patient room solution.

Stryker Medical’s Symmetry treatment recliners were designed to be an easy-to-use patient room accessory, said Erin Dvorak, product manager, Stryker Medical (Kalamazoo, MI). “They’re like your La-Z-Boy at home,” she related. The chair features a handle on the side that the patient can pull back to recline the chair into infinite positions to a full flat bed position. In addition, the locking foot rest prevents the foot rest from wearing over time and dropping to the floor.

Hill-Rom Art of Care

Brayton International was awarded the 2005 ADEX Platinum Award from the Design Journal for its Cura healthcare seating and table product line which includes patient room seating. Its unique breathable CuraNet knit suspension system reduces pressure points and heat build providing comfort for the user.

Hill-Rom’s Art of Care 3 Position Recliner also features removable arms to aid in side ingress and egress.  

Bedside stands and tables
More than just a place for patients to store personal items or eat their meals, bedside stands and overbed tables are also incorporating additional functionality.

Brandrud Revive daystands

Styker Medical recently launched a selection of bedside stands that offer several unique features designed to help improve durability. According to Dvorak, Stryker product designers traveled around the country talking to interior designers and architects to uncover new aesthetic trends in the healthcare industry. As a result, the company introduced its Traditional, Shaker and Contemporary styled bedside stands. 

The Stryker stands incorporate a thermoform manufacturing process borrowed from the countertop industry. The process vacuum seals a thermoform film onto the top of the stand to make it extremely durable and cleanable. Dvorak claims the table-tops could literally be soaked in water without any damage. The stands retain the aesthetic look of wood, but because it’s vacuum sealed for a seamless surface, there are no nooks and crannies for water or dirt to settle in. The bedside stands from Stryker also have casters underneath that are hidden from view to provide a homier feel, while at the same time, preventing a mop from getting tangled in the casters. A sealed bottom edge on the stand prevents pooled water from warping or cracking the cabinet. In addition, the internal potion of the drawers can be completely pulled out so that it’s component replaceable.

Stryker TruFit

A little over a year ago, Stryker launched its overbed tables which earned national honors at the Nightingale Awards competition at the 2004 Healthcare Design show. One major distinguishing feature, the Stryker overbed tables have a U-shaped base versus an “I-bar” type of base. The u-shape enables the overbed table to cradle technology on beds, stretchers as well as wheelchairs and chairs, so that you’re really able to get the table up close to the patient, said Dvorak. The Stryker overbed table was also intuitively designed to be easy to use by both nurse and patient alike.

In designing the column that moves the overbed table up and down, Stryker was able to reduce the number of parts in the column by half in order to minimize complications and make maintenance easier. According to Dvorak, the Stryker overbed table has the largest eating/storage surface on the market. It’s available in either a single or split-top model with vanity options. The tables come in a variety of color options for the column, base and laminate top.

Brandrud’s new Revive Daystand complements the Revive suite of patient room products and provides yet another innovative approach to the standard bedside table with its two-tier design that incorporates use of the vertical space while maintaining a small footprint.

Headwalls and maternity suites
For labor and delivery rooms or VIP suites, Nemschoff has recently introduced custom headwall options in addition to its standard headwall offerings. Nemschoff describes the custom headwalls as being competitive to a millwork-type product both in superior quality and cost. The headwalls are also designed to be very easy to install, and easy to remove if the room changes.      

Stryker Medical offers a selection of solid wood maternity suite options including headwalls, bassinettes, armoires, delivery carts, side tables and monitor cabinets. Stryker also has in-house design capabilities for custom headwall options.

Hill-Rom also provides a variety of headwall options. Its Perinatal Furniture collection includes a TV/Armoire, bassinet, Data Management (DM) cart, monitor cart, drop leaf table and glider.  

Office and lab environments
An article in the November 2004 issue of Healthcare Design, titled, “Healthcare Office Workers Need Interior Designers”, by Linda Porter Bishop, ASID, IIDA, examines the need for healthcare institutions to provide a more accommodating environment for employees.

Steelcase Lab Bench

“Sadly, healthcare institutions are considerably behind the times in their office workplace solutions,” said Bishop. She suggests that healthcare facilities look to the innovations and successes prevalent in corporate America. In light of the nursing shortage, hospitals would do well to consider enhancing the working environment of the nurse.

Key to providing a positive work environment for hospital workers who multi-task and work from multiple layers of information is flexibility, notes Bishop. Furniture must be “easily reconfigured, moved, adjusted for height variances, and personalized,” she said.  

Steelcase provides a variety of flexible options for the healthcare office environment. The company’s new Think Chair is able to anticipate user needs and react to them as users change postures and sit for long periods of time. The Think chair provides adjustments for seat height, seat depth, seat edge flex, lumbar height, an adjustable headrest and 4-way adjustable arms. The passive seat edge flex alleviates pressure under user's thighs compromising pelvic support. The 4-way adjustable arms provide a retraction feature that enables the arms to automatically move out of the way when they come into contact with a worksurface, allowing users to get as close as they desire to their work.

In addition, the new Steelcase Lab Bench was designed in conjunction with the Van Andel Research Insitute in Grand Rapids, MI, to provide a flexible laboratory furniture solution. Van Andel wanted to be able to reconfigure their 14,000-square-foot laboratory over a weekend, without tearing down walls, changing furniture or removing items from drawers. In addition, the solution had to be able to support heavy test equipment and sustain vibration. The overall intent of the design would be to help facilitate communication and collaboration among researchers.

Developed with Steelcase’s experience with the office environment in mind, Lab Bench provides desk-like support, integrated electronics, proper ergonomics, inherent flexibility and an aesthetic that matches the facility’s office space. Two people can move, disconnect and connect the benches to be configured in virtually any combination or direction, using only a dolly and a wrench.

Lab Bench provides easy access to components like sinks, storage, hardware elements and electronics. The foundation of Lab Bench is the structural module that can be combined into benches of almost any length and configuration. Utilities like power, data, vacuum, water, etc, are easily routed through this infrastructure. 

          KI also offers moveable wall panel systems and office furniture that can turn any healthcare environment into a modular, easy to change office environment.              

Maintenance and cleaning
Taking care of furniture has never been easier thanks to new upholstery and finish options. One such fabric being offered by several furniture suppliers including Nemschoff, Stryker and Hill-Rom is Crypton, an extremely durable, cleanable fabric that maintains the feel of fabric yet repels blood, urine and betadyne. Crypton fabrics are available with CAL 133 fire standard approval. 

“There are a variety of performance fabrics out there that are designed for high use situations and situations in which more fluids get involved,” said Nemschoff. “Fabric companies come to us very early on with their new performance fabrics and we work with them in bringing them out. Recently we also released the new Nemschoff Vinyl Card which mixes great new patterns with the performance of vinyl.”   

He notes that Nemschoff also uses an extremely durable, environmentally-friendly polyurethane finish that is scratch resistant and can withstand harsh healthcare cleaners.

Clean-out and wipe-out spaces that allow loose dirt to fall through the seating to the floor enable cleaning and maintenance. Nemschoff includes these features in all of its furniture. Several other manufacturers such as Hill-Rom and Brandrud offer similar features.

Component replaceabilty is another key feature designed to cut costs associated with maintenance by eliminating the need to replace furniture. Most Nemschoff products are designed with complete component replaceabilty, including armcaps, seats, backs, fabrics and more. “These are long-living assets that need to perform in the facility,” said Nemschoff.  

The Hill-Rom Art of Care line incorporates a replaceable upholstery and arm cap feature. If the upholstery or arm cap is damaged it can be replaced simply and quickly. “Typically, a chair is taken out of service in this situation,” said Dickey. “These features allow a hospital to maximize their seating investment over time.”          

Hill-Rom’s exclusive six-step process, “Healthcoat 222 Finish” is a durable finish that protects the wood against surface damage by ultraviolet rays and results in an intermolecular bonding of the first and second coatings that is impervious to most healthcare chemicals and cleaners, said Dickey.

Many Brandrud products have the ability to be “field recoverable” where the cover is affixed with hook and loop fasteners and is easily replaced. Brandrud’s Reliant Multiple seating family of products can be ordered where the seat is plastic with an upholstered pad, so the upholstery can be replaced without taking the product out of service.  

Mondo USA

Flooring
Considerations in healthcare flooring include environmental issues, infection control, air quality as well as comfort and aesthetics.

Health Care Without Harm has a fact sheet available which documents reasons to avoid PVC or vinyl flooring. Increasing evidence associates PVC (polyvinyl chloride) flooring with asthma; the manufacture and incineration of PVC can release highly toxic dioxins; and PVC floors also release reproductive toxicants. Alternative (non-PVC) flooring options include rubber, polyolefin, and linoleum flooring. A chart of alternatives is available at http://www.healthybuilding.net/pvc/
HBN_PVC_Free_Alternatives_chart.pdf (see chapters 11, 12, 13 for flooring).

Health Care Without Harm also suggests a preference for products that are compliant with CA 1350, a protocol developed by The Collaborative for High Performance Schools (CHPS) for evaluating emissions from interior building materials. Selecting products complaint with CA 1350 may help improve a facility’s indoor air quality. CHPS has developed a list of products that have passed CA 1350 for a model building, available at http://www.chps.net/manual/lem
_table.htm. At least 24 non-PVC resilient flooring/adhesive sets are listed as having passed CA 1350.

Lees Life Elements

Kaiser Permanente is incorporating PVC-free flooring alternatives system-wide in millions of square feet of new construction. In response to a performance-based RFP issued by Kaiser Permanente, Tandus Technologies developed a new carpet product that has recyclable backing made from plastic film reclaimed from discarded laminated safety glass, noted Malkan.

Another interesting flooring choice being used in sustainable projects, noted Malkan, is bamboo. An article in the February issue of Interior Design magazine highlights the Jay Monahan cancer center (named for Katie Couric’s deceased husband), which was designed without using materials linked to cancer.

Shaw Industries (Dalton, GA) has also made advancements in sustainable, environmentally preferable floor covering products.

Mondo USA provides rubber flooring options that are naturally antibacterial and anti-microbial, provide cushioned comfort and are easy to maintain. These environmentally friendly flooring products are free of plasticizers, PVC, halogen, heavy metals, asbestos, CFCs, chlorine and alloyed compounds. Mondo’s newest 3mm flooring option, Natura, is available in ten colors with a marbleized pattern and a sealskin texture. A dense, waterproof, non pourous wear layer provides stain resistance. The flooring also provides noise reduction benefits, is able to withstand heavy loads in excess of 1 000 lbs. per square inch (PSI), and exceeds ADA requirements for slip resistance. Mondo notes that the Natura product provides the benefit of a low life-cycle maintenance cost compared to carpet or sheet vinyl.  

Where applicable, carpet can provide a comfortable, pleasing aesthetic that also provides improved air quality.

Carpet manufacturer Bentley Prince Street (City of Industry, CA) notes that all of their carpet offerings address the concerns of 24-hour facility including:  Ease of use for mobile equipment; microbial growth inhibition; sound construction; appearance to create warm, clean environment; improved air quality; resistance to stains, spills and soiling; appearance over time with high traffic; maintenance ease and reduction in seams to avoid hazards and help rollability. Bentley Prince Street offers custom coloring capabilities at low minimums and through its website feature, Local Color, users can view color and pattern options as they would appear in a photo realistic room. The company’s patented stain resistant coating Protekt provides a barrier against soiling and staining to enhance the longevity of the carpet and reduce the need for frequent major cleaning.

Lees Carpet (Kennesaw, GA) offers a line of resilient textile sheet flooring called NeoFloor that serves as a hybrid product of sorts combining the warmth, underfoot comfort and acoustical advantages of carpet with the durability and ease-of-maintenance of resilient surfaces. NeoFloor creates a durable, slip resistant surface that is impervious to moisture and easy to roll equipment over. Its cushioned impact dampening backing system enhances overall comfort by reducing back and leg strain and absorbs sound for a quieter environment. Among Lees’ broadloom carpet options is its nature-inspired Life Elements Collection available in tile and six-foot widths.                   

Healthcare turns green
There has been increasing interest on the part of the healthcare community in implementing environmentally friendly or “green” policies. To help aid in this process, the new Green Guide for Health Care (GGHC) (www.gghc.org) was released in November 2004, the first set of green building guidelines created specifically for the healthcare industry.

Following the release of the new guidelines, more than 650 people joined a teleconference to talk about trends in healthcare green building and the Green Guide, remarked Stacy Malkan, communications director for Health Care Without Harm. More than 1,600 people have already registered to download the new pilot version of GGHC.

Based on (though not a product of) the U.S. Green Building Council’s LEED Rating System, the GGHC is intended to be a best practices guide for integrating enhanced environmental and health principles and practices into a facility's planning, design, construction, operations and maintenance. A voluntary self-certifying system, the GGHC offers credits for environmentally preferable furniture, low emitting materials, innovation in design, and elimination of persistent, bioaccumulative toxins, to name a few credits that could apply to furniture and flooring, notes Malkan.

Major healthcare facilities, including Kaiser Permanente have agreed to pilot test the Green Guide over the next year.

According to the Centers for Medicare & Medicaid, national healthcare construction expenditures are expected to total $26.3 billion in 2005, a 5.2% increase from 2004 with the trend expected to continue over the next decade. At the same time, surveys show increasing interest in “green" construction. 

“With the healthcare sector in the midst of a major construction boom, a new tool has arrived to aid hospitals in their efforts to build facilities that are healthy for people and the environment,” said Malkan.

Many healthcare manufacturers have already taken the lead to provide sustainable products for healthcare and have long incorporated green manufacturing processes.

Steelcase Inc.’s wood plant in Caledonia, MI, is the first manufacturing facility in the world to obtain LEED certification. Allan Smith, director, communications and environmental strategy, Steelcase, notes the importance of “Life Cycle Thinking” in obtaining sustainability. “In the past most industries and manufacturers focused their environmental efforts primarily on the prevention or minimization of pollution. We need to broaden our focus to every stage of a product's life, from materials extraction to end-of-use and every stage in between.”² Effective life cycle analysis examines materials, production methods, transportation, packaging and end-of-life recycling. 

To that end, The Steelcase Environmental Partnership can help healthcare organizations resell, refurbish, donate or recycle all office products manufactured by Steelcase. Several Steelcase products have received GREENGUARD Certification, the world’s only guide to third-party certified low emitting interior products and building materials.

Brandrud Furniture (Auburn, WA) has incorporated environmental programs and practices for many years. “Our style of manufacturing is what makes us green”, said Lee Falck, president, Brandrud Furniture “We are dedicated to achieving the goal of becoming a sustainable business; to create products without reducing the environment’s capacity to provide for future generations.” Over 85% of Brandrud’s waste, including wood scrap, sawdust, foam, fabric/leather, and packaging, is recycled through various means, and the company uses pre-consumer recycled materials in its manufacturing. Over 90% of all Brandrud finished product is shipped wrapped in reusable, fabric-padded blankets.

Nemschoff’s green commitment includes producing high quality products with an extremely long life expectancy; designing products with replaceable components; constantly monitoring suppliers to ensure that no CFCs are used; using only low odor, untreated woods that are kiln-dried at the Nemschoff facilities; sourcing lumber from within a 500 mile radius; using only water-based glues in on-site assembly; using only uncoated springs; testing and designing products for extremely low formaldehyde emissions; using wood waste to heat kiln and facilities and shipping products in reusable blanket wraps.

Lees Carpet recently earned Envrionmentally Preferable Product (EPP) certification from Scientific Certification Systems (SCS) for its Unibond and Unibond RE backing systems. Over 90 percent of Lees’ broadloom product line are available under the certification. The company’s Glasgow, VA manufacturing facility earned ISO 14001:2004 certification this year for minimizing harmful effects on the environment and achieving continual improvement of its environmental performance. In addition, all Lees Carpets pass the stringent CRI Green Label Plus program.

Carpet manufacturer Bentley Prince Street was the recipient of the 2004 Governor’s Environmental and Economic Leadership Award (GEELA) for the State of California. Through its ReEntry program, the company will take back any carpet (including a competitor’s) at the end of its useful life.

The CleanMed environmental conference explores issues surrounding green buildings and environmentally preferable products. The next one will be held April 18-20, 2006 in Seattle, WA. HPN

References

1. Center for Health Design, “The Role of the Physical Environment in the Hospital of the 21st Century: A Once-in-a-Lifetime Opportunity”, is available at http://www.healthdesign.org/research
/reports/pdfs/role_physical_env.pdf.

2.  Steelcase Healthcare Report, Vol. 1, Issue 3, “Going Green, an interview with Allan Smith, director, communications and environmental strategy, Steelcase Inc. Available at http://www.steelcasehealth
carereport.com/