Accommodating Paradigm Change in Large Institutions: Layout, Circulation and Wayfinding in Emerging Healthcare Facilities

Abstract

Changes in financing, regulation, technology and philosophy have led to significant alterations in the ways healthcare facilities are planned, programmed and designed. Outpatient services are increasing, while the remaining inpatients tend to be much more acutely ill. Although budgets are shrinking, facilities are experiencing much greater competition and demands for higher levels of service. We examine how healthcare facilities are linking these organizational goals - greater competitiveness, higher efficiency, better and more caring customer service, decentralization of departments-to their spatial decision making and discuss how environmental design research might contribute to these efforts. In particular, we present brief case studies to provide a common basis for discussion, then explore tools and approaches that link these organizational goals to planning, programming, design and evaluation. Although this working session touches on a range of concerns, the focus will be on layout, circulation and wayfinding, issues that are particularly influenced by recent trends in healthcare. A particular concern is the impact of providing outpatients services such as day surgery as well as inpatient surgery within a single campus. How does this affect layout, circulation and wayfinding? Case studies include, at least: (1) redevelopment of National Health Service hospitals in Great Britain; (2) pre-occupancy evaluation of the new Santa Clara County Valley Medical Center North Tower; (3) redevelopment of Grady Memorial Hospital (Atlanta). Although this session focuses on healthcare, it also allows the group to consider more broadly how environmental design can be linked to major changes in policy. The session addresses such questions as how can policy be formulated in spatially-relevant terms and how can key organizational decision-makers understand the -importance of spatial decisions? Participants include Cheryl Fuller (Fuller Coe Associates), Bruce Nepp (Anshen + Allen), Kent Spreckelmeyer (Kansas), Saif-ul Hag, Mohammed Shraim and Sharon Tsepas (Georgia Tech).