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Relieving Patient and Caregiver Anxiety through Sustainable Healthcare Design, By Gary Jereczek and Lynn Drover, CID, IIDA


Two patient and caregiver populations are more likely than others to feel the negative impact of anxiety: cancer patients and the parents of infants in Neonatal Intensive Care Units. The architectural design of treatment spaces for these fragile patients can have a big impact on their emotional well being. When special attention is paid to sustainable design elements, patients and their caregivers can experience soothing, healing environments that reduce stress and anxiety.

Background
The diagnosis of cancer has a profound impact on a patient’s emotional health and a ripple effect on his loved ones. “Most patients, families, and caregivers face some degree of depression, anxiety, and fear when cancer becomes part of their lives,” says the American Cancer Society. “Fear of treatment, doctor visits, and tests may also cause apprehension (the feeling that something bad is going to happen).”

Additionally, Stanford University has focused on alleviating acute stress disorder and post traumatic stress disorder for the parents of preemies. “Research has indicated that having an infant in the Neonatal Intensive Care Unit (NICU) is highly stressful for parents and multiple studies have demonstrated that parents can develop significant psychological reactions to this experience.” Left untreated, these disorders “…can lead to problems with the parent-infant relationship, and in turn, negatively impact the infant and the family as a whole.”

Serene Setting Calms Cancer Patients
The majority of radiation treatment facilities are located in the cold, dim basements of local hospitals, their treatment vaults sequestered below layers of concrete. In contrast, daylight, natural wood finishes, and landscaping form the centerpiece of Kaiser Permanente’s Cancer Treatment Center in South San Francisco. Despite surrounding urban density, the standalone structure was carefully placed on its triangular site to provide optimum access to natural light.

Dr. Joseph I. Song, M.D., the site’s medical director, sought to make this a flagship cancer treatment center for Kaiser Permanente in California. He worked side-by-side with the design team to incorporate many sustainable design elements. The building is arranged as a series of small spaces that appear expansive. The prominent entry courtyard is visible to all: patients and caregivers have outdoor access from the waiting room, while the glass-walled conference room and staff break room are strategically placed alongside the courtyard.

A key sustainable design element in this structure is daylighting. Linear skylights and expansive windows in all exam rooms and offices flood the structure with natural sunlight. The skylights intentionally direct patients through the high-traffic center corridor of the building. The staff treasures this light-filled space. As sunlight reflects off the wood finishes, a quality of warmth and a sense of security permeate the building. This serene quality helps patients, caregivers and staff to manage the symptomatic emotional trauma of cancer treatment.

“There is phenomenal natural light throughout the center and it is very calming for patients and staff,” said Marcy Kaufman, M.S., R. N., Kaiser Permanente’s radiation oncology administrator. “We treat 75 patients a day, but it doesn’t feel like it. Everyone is friendly and very positive in this setting.”

The cancer center was designed to LEED® Silver equivalency. Wood panels, certified by the Forest Stewardship Council, bring a feeling of warmth to the interior finishes. Selected for their low-VOC content, carpet tiles incorporate a leaf pattern to guide patient wayfinding to treatment spaces. Walls in critical locations are free of miscellaneous devices and are rich in botanical-themed artwork. Even the nature-based names of the treatment vaults (Big Sur, Yosemite, Tahoe, and Sequoia) divert a patient’s attention from the high-tech radiology procedures they will undergo.

Addressing Environmental Concerns in the NICU Setting
The healthcare industry now recognizes the positive role played by the natural world in a healing environment. A new Neonatal Intensive Care Unit is under construction at the Tom and Billie. Long Patient Care Tower at John Muir Medical Center-Walnut Creek. Numerous sustainable design elements were incorporated to ease the anxiety of infants and their parents. Natural light inside each private patient room is controlled with PVCfree sunshades and blackout shades. These adjustable shades protect sensitive pre-term babies’ eyes from sunlight, while allowing older babies the opportunity to grow accustomed to daylight as they prepare to leave the hospital. Windows with scenic views to the outside and clerestory windows bring natural light into interior spaces, while rooftop gardens provide parents, visitors, and staff with easy access to nature.

While challenging, it is possible to produce an environment virtually free of volatile organic compounds (VOCs), mercury, and other persistent bioaccumulative toxins (PBTs), all of which affect the indoor air quality for patients, family, and staff. To help assure this, the design team worked closely with Valerie Briscoe, RN, MSN, CNS, NNP, the clinical nurse specialist and sustainability champion for the new 35-bed NICU, to create an environment that is as toxin free as possible.

Through our teamwork, we identified some of the hiding places where PBTs, VOCs, and other harmful chemicals can be found, including:

  • Flooring
  • Millwork
  • Paint
  • Wall Finishes
  • Ceiling Finishes
  • Furniture
  • Medical Devices
  • Cleaning Agents
  • Electronic Equipment
  • Window Coverings
  • Bedding
  • Tubing

Each patient room is equipped with a rolling chair/recliner made of upholstery that avoids phthalates, dioxins, and per-flouro-chemicals to facilitate “kangaroo care,” skin-to-skin bonding between the parent and baby. Resilient flooring made of renewable resources provides a hygienic surface. Finally, a nature-based palette of finishes reflects the hospital’s setting at the base of a nearby mountain range and is composed of high performance/low-VOC materials serving to mitigate patient and parental anxiety.

Anxiety-Relieving Benefits from Sustainable Healthcare Design
Healthcare clients may not be aware of the wide range of sustainable finishes available in today’s marketplace. Architects and designers can advance the cause of environmentally conscious purchasing decisions by presenting sustainable materials and educating clients on both their aesthetic and green attributes. Given the option, we have found many clients willing and eager to incorporate sustainability throughout their new medical structures.

Our most successful sustainable healthcare projects occur when we work with an internal champion, such as Dr. Song with Kaiser Permanente or Ms. Briscoe at John Muir Health. We encourage you to begin each new design by identifying and teaming with a sustainable design advocate from the client’s team. Together, you can make a significant impact on the environmental and emotional health of patients, visitors, and staff.

The environmental design elements with the greatest impact include:

  • Views or access to nature
  • Access to daylight, 24-hour diurnal light cycle
  • Materials and finishes that don’t “off gas” (e.g., PVC-free shades) or require strong off-gassing maintenance chemicals
  • Passive diversions, such as nature-based artwork

Winston Churchill once said, "We shape our buildings, thereafter they shape us." Patients and caregivers who experience the benefits of sustainably-designed healthcare settings absorb the tranquility around them. Additionally, staff stress is reduced in these settings, resulting in fewer medical errors. Healing environments can shape their inhabitants by diminishing patient and caregiver anxiety.

About the Authors
Gary Jereczek is a Senior Associate-Senior Project Manager for RATCLIFF’s Healthcare Practice Area. He led the design of the Kaiser South San Francisco Cancer Treatment Center. Mr. Jereczek earned his M. Architecture and B. A. Architecture from the University of California, Berkeley.

Lynn Drover is an Interior Designer-Interiors Specialist for RATCLIFF’s Healthcare Practice Area. She is currently leading the interior design of the new Tom and Billie Long Patient Care Tower at John Muir Medical Center-Walnut Creek. Ms. Drover earned her B.A., Interior Design, from San Francisco State University and a Certificate in Healthcare Design from Canada College.