Ambulatory surgery centers being built and upgraded today focus on both the clinical aspects of care and the experience of patients and their families. "We are approaching ambulatory surgery center design as a way to create a less institutional feel and more a sense of 'home’ and comfort," says Barbara Dokulil, IIDA, LEED AP, an interior designer at BJAC. "This is happening in new surgery centers as well as in retro-fit projects where new materials bring facilities up-to-date."
Here, Ms. Dokulil discusses the trends in ambulatory surgery center design and modernization to optimize the patient experience and working environment.
1. Integrate architecture and design. "We are approaching these projects holistically," says Ms. Dokulil. "The integration of the design and architectural disciplines at the beginning stages of the project is a multidisciplinary approach that achieves the best results and the greatest level of consistency across the finished project. Collaboration creates a more appealing and better functioning interior environment and facility."
While the architect can bring building expertise, the interior designer can advise on the more "human" elements of surgery center design. "The interior designer has a different perspective that considers how patients, visitors and staff members will feel as they walk through the space," she says. "Their focus is on the human scale and the experiential aspects of space. When interior designers are involved from the beginning, we can ensure the best experience possible for the public, patient and family, as well as for staff and operations."
2. Build flexibility into public spaces. Public spaces, such as waiting rooms, should be flexible — not just open spaces with chairs. Family members need options for more private compartments of space within a larger public area, as well as opportunities to take advantage of positive distraction.
"We can create private compartments to promote family-centered spaces," says Ms. Dokulil. "Many surgery centers have a TV for positive distraction, which can be helpful, but you also want to accommodate quiet moments."
Furniture in the public space should add to the surgery center's aesthetic quality and be functional. "The furniture must be appropriate for public use," says Ms. Dokulil. "We find that a mixture of self seating, tables and motion pieces like swivel chairs reflect the different ways people occupy a public space. Some folks prefer to sit and read while others work on laptops. A good mix of coordinated pieces throughout can easily accommodate these different needs."
3. Expand pre- and postoperative areas. One trend is the expansion of pre- and postoperative areas to make them more private and allow family members to spend time with patients before and after a procedure. "Larger and more private pre- and postoperative areas allow family members to become more involved, which leads to better outcomes," says Ms. Dokulil. "These spaces used to be small bays with curtains, but now we are configuring spaces so family members can become part of the healing process."
Pre- and post-op areas are also being designed for patient comfort and privacy. Beds are often positioned sideways, so patients aren't exposed to others walking by in the hallway. This requires spaces be configured properly and include special furnishings such as chairs for family seating.
With some surgery centers providing 23-hour stay rooms, interior designers must again respond to new regulatory requirements. Twenty-three-hour stay rooms are typically private and must be sized correctly with a window for natural light, which promotes higher patient satisfaction and faster recovery.
The surgery center must also clearly indicate where patients and families are able to go and which areas are restricted to staff only. "When there is limited family access to the patient, the design must clearly communicate where family members can go," says Ms. Dokulil. "This type of wayfinding can be accomplished with floor patterns, color and signage."
4. Privatize registration. Interior design is responding to changes in regulations and policy in the healthcare field, and surgery centers are increasingly choosing to seclude registration areas to emphasize privacy for patients and their families.
"With new privacy requirements, patients typically register in enclosed rooms," says Ms. Dokulil. "Size is very important because you might have to accommodate a wheel chair or other forms of mobility assistance. Designers also must make sure several seating options are available for family members while the patient is registering."
5. Added services for family members. Surgery centers are now adding unique spaces to their facilities, such as retail or refreshment options, for family members who have a long wait. "The addition of an element such as a coffee bar to a renovation or update project has become an important component for some clients," says Ms. Dokulil. "This can help family members with longer wait times."
These areas can also positively distract the family members by giving them work space or WiFi access beyond just the waiting room environment. In addition, they provide a welcome respite from what can often be a stressful time.
6. Facility environments inspired by nature. Interior design can help surgery centers encourage better patient outcomes by creating more comfortable and inviting environments that evoke a sense of home and nature. For example, balance softer warm and cool hues to create a sense of comfort with bold accents and natural, textural elements such as wood or stone for visual and sensorial appeal. "We are using a lot of natural elements — either naturally derived or man-made materials that evoke nature — for the floor and ceiling," says Ms. Dokulil. "In public spaces, this creates a warm environment and familiarity that reminds visitors of home."
Patients and their families will feel more at ease with natural décor. "The thoughtful placement and use of natural materials and textures also contributes to a facility's image," says Ms. Dokulil. "Design should be timeless, instead of simply following trends. Consider how your design choices will serve the surgery center in the long run, in terms of patient experience, staff satisfaction and facility maintenance."
7. Create a positive and efficient working environment. Staff members are a vital part of the culture of a surgery center. Thus, the design and operation of their spaces promote ergonomics, efficiency and a positive working atmosphere. "Spaces for staff and back end operations are critical to the success of a surgery center," says Ms. Dokulil. "Workspaces must be ergonomically designed with furniture that optimizes efficiency and flexibility. For example, decentralized nursing stations allow for easy patient monitoring, shorter travel distances for staff, and clearer sight lines. Making a facility work well for staff, such as nurses, has proven to result in better patient outcomes."
Furniture is an important aspect of all staff areas. "As designers, we look at how to help staff members with the various tasks of their work, such as nursing and administrative support," says Ms. Dokulil. "Administrative staff needs easy access to system components such as printers and records, so we install furniture to facilitate their work flow."
Designers must be equally sensitive to the experience of patients, visitors and staff. Locating staff break areas away from the patient and visitor flow can allow staff a necessary reprieve from the demands of the clinic.
8. Emphasize wayfinding. The entry sequence — a patient and their family's first experience when they come through a surgery center's doors — must be well planned so the reception area or information about the surgery center are encountered first.
"Designers must configure the entry to provide clear direction and sight lines for visitors," says Ms. Dokulil. "For example, a reception desk ensures that the first thing a visitor sees is someone who can help them. We also use other focal points (accent colors and lighting) to direct patients to the right location."
9. Art for more than art's sake. Ms. Dokulil said that art within the surgery center can take many forms, from the purely aesthetic to art that adds function and reinforces a center's brand.
"Art can be integrated into information pieces, engage the community and highlight local artists," says Ms. Dokulil. "A feature wall can be placed behind the reception desk to integrate the facility name. For example, a facility's logo can be fabricated in artistic glass or metal. We often place art at the end of a hallway to make a soothing statement or add art to an entry for the public. Facilities are finding art installations are a terrific way to engage their local communities."
The art can also work in many different functions. "Art can be multipurpose," she says. "For example, art and signage can be integrated. Or etched glass panels, which create visual privacy, can serve as an artistic touch that can also communicate the facility's brand."
10. Consider function in designing green. Ms. Dokulil says designers and planners can help owners select the best sustainable features for their facilities. Green design is not limited to LEED certification. Thoughtful sustainable design decisions can positively impact the owner's bottom line by reducing maintenance and life cycle costs of finishes and furnishings. For example, one of the most important elements of the building or upgrade is flooring. Flooring doesn't change often, but can have a big impact on functionality of the surgery center space.
"We often use resilient flooring with lower maintenance option." she says. "Some resilient floors don't require waxing and utilize neutral cleaners that are far less harmful for the environment and also less costly for the facility than what is needed for other surfaces."
Some surgery centers are considering their environmental impact in other areas as well and using environmentally friendly upholstery, utilizing low Volatile Organic Compounds finishes, and making their centers PVC-free. "Green design for surgical centers requires more than just a consideration of trends," says Ms. Dokulil. "It's about providing your clients with a facility that will function well in the long term, be easy to maintain, provide a good return on their investment, and, ultimately, enhance and improve the patient experience."
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