Floorcoverings as a safety factor … and more - The Healthcare Design Council's research on heathcare facility design - Cover Story

Nursing Homes, Oct, 1999 by Judith Yarme

A manufacturer-financed design council is researching all the implications of an environmental change

The contribution of the physical environment to patient satisfaction, medical outcomes and safety is being investigated by leading healthcare and design researchers. To illustrate some of the issues involved, the evaluation of appropriate floorcoverings for patient and resident rooms points out the role flooring can play in creating a therapeutic setting, in supporting health and safety and in contributing to the health of the provider's bottom line.

Is this a big issue? It is indeed. Beyond the obvious factors of code compliance, room temperature and size, sufficient power supply and an efficient layout of furniture and equipment, room design can have a profound impact on the behavior of the patient, the visitors and the staff. The room also says a lot about the organization providing the care. Most patients cannot accurately evaluate the medications they receive, or the professional care provided, but most people can immediately tell if their rooms look institutional, smell of urine, have harsh echoes or look dirty. We are not talking about design "style." We are talking about the role of the facility, in this case the patient room, in reinforcing the strategic goals of an institution's healthcare program.

With budget constraints creating serious problems in healthcare, it is easy to understand why so many owners and facility managers focus on first-cost and maintenance costs when deciding on products and materials for resident rooms. Cost is obviously very important - but getting the right solution must come first. Once this is done, then the issue of getting the right solution for the most reasonable cost is the appropriate goal.

A safe physical environment is not optional. In healthcare facilities, slip-fall accidents are a major concern and deserve our full attention. Anyone involved in the process of designing, constructing, maintaining or operating a facility will be interested in some recent research relating to a more holistic approach toward safety in healthcare settings.

One research goal has been to learn whether a specific floorcovering in a nursing home is more prone to promote slip-fall accidents than another. Extrinsic factors, such as a slippery or wet surface, extension cords running across a floor, or protruding transition strips where hard and soft flooring meet, can all cause a person to fall and should obviously be minimized or eliminated. The reason for a fall could be intrinsic, however, perhaps caused by a resident's medication, disorientation, spontaneous fracture of a bone or a host of other factors that could cause a resident to fall anyway, no matter what the floorcovering. Therefore, if we cannot eliminate all falls, perhaps it is better to focus attention on flooring that absorbs the impact of falls, so that when they do occur, they are likely to do significantly less harm.

For healthcare facility owners and design professionals, there is so much technical information available that it is often difficult to understand how to apply what you need when you need it. Also, much of the information relating to safety is in engineering or biomechanical terms. How is an owner or designer to use coefficient-of-friction data for responsible decision making when specifying flooring, interior design and planning options?

However, safety evaluation is both a science and an art, and this is where the art comes in. The art of creating a safer environment requires a comprehensive balance of many contributing factors, including floor materials, color, texture, contrast, illumination, acoustics and maintenance. These can support residents, or they can produce potentially hazardous situations. Take, for example, disorientation. For the elderly resident, disorientation is often caused or exacerbated by "environmental noise" - in this sense, defined as acoustical noise, visual noise, glare, optical illusions caused by colors or patterns, etc.

Interior designers are professionally trained to understand the use of design elements, colors, planning and spatial relations as they apply to facility design, but what is further needed in healthcare is additional training and experience in socio-physical design - the relationship between physical environment and human behavior. It is time to start forging the missing link.

A group of professionals, including representatives from interior design, research, architecture, facility management and nursing, have joined together under the name of The Healthcare Design Council, specifically organized by the flooring manufacturer Collins & Aikman, to look at the interaction of science, art and common sense as they relate to healthcare facility design. This group is interdisciplinary and comprehensive; they understand the technical and statistical data that environmental scientists are developing and are very familiar with the design process, materials, products and code issues involved in creating quality healthcare facilities.