Carolyn BaRoss, principal of Perkins + Will, discusses the design of the new Johns Hopkins Charlotte R. Bloomberg Children’s Center and Sheikh Zayed Tower and how the facilities promote wellness for both patients and staff.
Johns Hopkins, a participant of the Healthier Hospitals Initiative, opened the Charlotte R. Bloomberg Children’s Center and the Sheikh Zayed Tower this past May. Designed by award-winning architectural firm Perkins + Will, the buildings create a healing environment for patients and families. The children’s facility boasts 205 private patient rooms, a 45-bed neonatal intensive care unit, 10 surgical suites, a dedicated pediatric radiology unit, oncology and psychiatry floors, and a pediatric cardiology outpatient unit, among other world-class health care amenities, all designed with an eye toward wellness.
Greenhealth: What are some of the overall themes you have discovered as a designer that promote wellness in health care facilities?
Carolyn BaRoss: Of course, there’s the body of readily available research on evidence-based design, but also explorations through observation and anecdotal feedback about our work offer insight. The power of natural beauty and its positive impact on emotions are, in my experience, underestimated. So many driving forces in health care design focus on important but pragmatic functional needs that the environment can be aesthetically compromised. I don’t think the choices are “either function or aesthetic”—but the spiritual aspects of beauty can be ignored and balance between comfort and durability can be lost. One example is roof gardens. Many times these are dismissed as maintenance problems, but there are successful examples with positive effects on the emotional health of patients in rooms that overlook these roof gardens. Gardens can be created in “leftover” spaces and have a hugely positive emotional impact. People need meaningful access to nature; there is no substitute for natural lighting or a nice view to make a space comfortable. There’s also comfort in a space that is orderly and elements that are intentionally placed with an understanding of how the space is used, which impart a feeling of respect of the occupants. Devices cannot overpower humanity.
Acoustical performance is absolutely critical to staff performance and patient comfort And color, lighting, and art cannot be additive; the combination is most effective when it is conceptualized and supported in the overall solution. Health care furniture needs to be comfortable and supportive, but it can be both functional and beautiful. The delightful, sophisticated art program at Johns Hopkins is an example that engages at many levels. There’s an authenticity and quality both in the work and in the overall curatorial concept as well as integration with the buildings that are atypical. Buildings are most successful and engaging when imagined experientially, on a human scale, from the inside out as well as functionally and conceptually. They need to have a humanity and an authenticity that connect with the community using it.
GH: What are some overall concepts in design that promote wellness for both patients and staff in a health care facility?
CB: The overall concept in support of wellness and healing is to reduce environmental stressors. Providing orientation and context of wayfinding and a connection with daylight and views redefines the hospital experience, creating an uplifting, joyful interior environment in color, art, and furnishings. Enhancing a meaningful connection to nature is also important.
In the new Johns Hopkins clinical building, every opportunity was taken to turn spaces between and around the buildings into nature-engaging moments. The access to these is enhanced by use of many large glazed-glass expanses that maximize the benefit of the gardens both inside and out. In the Arcade, a main connecting corridor between the Charlotte R. Bloomberg Children’s Center and the Sheikh Zayed Tower, vistas always connect to outside views and provide orientation within this large building.
Objectives for the interior design concepts include the following: Create an environment that is safe by promoting staff work and communication and by providing quiet comfort for patients; enhance an uplifting, joyful experience through beautiful color balanced with light-reflective natural surfaces, furnishings, and art as well as daylight-filled spaces for patients, families, and staff; supply needed amenities and family support; enhance orientation and clarity of wayfinding through context and connection to nature, light, views, and interior environments; and provide emotional support for patients and families. To achieve this, the following solutions were implemented. Lighting is balanced: The day lighting is enhanced with the lighting design, color accent walls glow, and surfaces shimmer. Light is used to create a hierarchy of space and light is also modulated to break down scale; it is indirect and gentle and creates wayfinding.
The windows in public and patient care areas provide lots of daylight and views beyond the OLIN-designed gardens, the city streets, and the harbor in Baltimore. Because the building is relatively tall in this area of East Baltimore, there are orienting vistas. In such a large complex of buildings, it is possible to be oriented to the urban context from parking bridges, public lobbies, elevator lobbies, connecting corridors between buildings, patient unit circulation, family lounges, pediatric playrooms, and treatment areas. Staff areas also provide access to natural light and views. Nursing units have large windows at ends of corridors; circulation outside of operating suites is lined with large windows that look out at the site. Prep/postanesthesia care unit (PACU) areas have either borrowed light or windows to the exterior; conference rooms, many work areas, and staff break areas on different units have windows wherever possible.
In addition to connecting with nature, high-performance acoustical design was a driver in design solutions. We worked with acoustical consultant Stephen Lindsey from Cerami & Associates to integrate strategies to mitigate sound transmission that leads to increased noise for patients. Starting with patient rooms, there are view windows at satellite charting stations and in doors with integral blinds so that doors can be shut yet maintain staff visibility. Headwalls are detailed with sound insulation around devices, and gypsum is also skim-coated with plaster around the face of these devices as double protection to keep sound contained within the rooms.
Charting stations outside every pair of rooms are the designated location for staff conversations. We provided brightly colored fabric-wrapped acoustical panels at these walls, and we also worked with lighting designer Rob Leiter of Hillman Dibernardo Leiter Castelli (HDLC) Architectural Lighting Design to design a custom lighting fixture that happens to be sound absorbing. The idea is to trap sounds before they travel into rooms and down the corridor to bother patients. The face of the fixture is actually a large-scale high-NRC ceiling tile without its paper backing. The fluorescent lighting source can be dimmed by switching off lamps; evening lighting levels are achieved with a soft glow from this fixture because only one lamp is illuminated.
GH: How does the design promote wayfinding?
CB: We created a system of colors and materials that would work for the overall building and would also define the identity of the individual towers. Light-reflective neutrals used throughout supply a backdrop for color accents and art. The challenge lies in the enormous scale and complexity of this project, so we sought simple ways to break it down for wayfinding clarity.
The color and material design feature a balance of warm and cool colors. Wood is used in areas of patient and family assistance/interactions to reinforce intuitive wayfinding and provide warmth; the wood paneling in waiting areas is also acoustical to soften these spaces. Bold full-spectrum colors are used for reinforcement of identity and wayfinding and throughout patient areas for pure aesthetic delight.
There is a palette of neutral architectural materials applied in public and semipublic spaces on each floor to provide visual clues to public circulation zones. The main lobbies feature large-scale glass terrazzo ceiling tiles and accents of limestone and marble, and patient amenities and conferencing facilities adjacent to these lobbies feature solution-dyed carpet and wood paneling. Public zones on patient floors utilize a more economical terrazzo tile and feature paints to achieve a similar character of space.
GH: How were finishes selected?
CB: Patient unit finishes were analyzed through the lenses of patient experience, cleanability, and maintenance and budget requirements. A challenge in this very large project was the impact to the overall budget of price ranges for finish materials. Selections were made by weighing patient experience and long-term durability against cost; materials were upgraded when it was determined the change would have a positive effect on patient experience or would alleviate maintenance concerns.
The clear color strategy uses a saturated green for the adult tower and bold blue for the children’s center. These colors are inspired by Spencer Finch’s artwork on the exterior: a glass curtain wall between two layers of colored glass of 26 different shades representing each letter of the alphabet. These organizing colors start at the parking garage, where floors of the two bridges are paved with terrazzo in each color. Walls of the public elevator lobbies in each tower are either green or blue glowing glass that reinforces these two identities.
GH: How do the patient rooms promote wellness?
CB: To promote overall wellness, the patient rooms provide a quiet and comfortable space in which to rest and heal: comfortable furnishings (ergonomics and acoustics), choice of food (via room service), access to entertainment (television and video entertainment for children, as well as internal hospital programs), and variable control of light (window shading and variety of lighting levels within each room).
Johns Hopkins clinical staff actively participated in the room design to ensure highly functional and efficient rooms suited to workflow, with enhanced safety, infection control, and patient safety being considerations; in addition, families can be accommodated to provide emotional and care support. Staff work zones are outside patient rooms at charting stations as well as immediately inside patient rooms at the computer workstation, hand wash station, and supply cart. At the center of the room is the patient. There is night lighting, a soft wall-wash lighting fixture at the footwall, and a multi-option lighting fixture over the bed for general lighting, exam lighting, and patient lighting. The family zone is near the window; overnight accommodations are provided for the family, as is a small light recessed in the headwall for illuminating the family area without disturbing the patient. Walls are painted a mix of bold colors and light neutrals. We created a zone around the headwall of the patient that is white so that light reflected from it onto the patient would not be influenced by the bold color in the room.
Furnishings in the patient rooms, such as pieces for overnight accommodation, are modern, sculptural, stylish, ergonomic, comfortable, and intuitive to use. Extensive testing of seating was conducted by Johns Hopkins in the clinical environment to inform final selections, and upholstery fabric testing was conducted to ensure the selections would also be durable and maintenance-friendly.
GH: Were you able to source building materials that did not have chemicals of concern?
CB: We avoided vinyl wherever possible. In the neonatal intensive care unit (NICU), acoustically backed rubber flooring was installed to help maintain quiet; playrooms and family waiting areas in the children’s tower also have rubber flooring. We used paint with low amounts of volatile organic compounds (VOCs) on the walls. We were most successful in eliminating materials of concern, especially vinyl, from the furnishings; polyurethanes were specified instead, as were fabrics treated with nanotechnologies. Both were found to be most suitable for the rigors of maintenance.
GH: What are some theories behind the connection between art and wellness?
CB: There are theories that point to the idea that specific features in art, such as nature scenes, will contribute to wellness. For this project, the art program is anything but prescriptive. Artwork is an important part of it, and the interior design was developed based on the intent to integrate art to maximize its impact: The environment enhances the art in materials, lighting, and detailing. Nancy Rosen, the art curator, commissioned pieces inspired by children’s literature for the children’s tower and gardens and used nature and the natural world for the adult tower. Her imagery is engaging and very delightful, with wonder and whimsy in much of it.
Art imagery was also commissioned and printed on the window shades in every patient room, and many of the designs created by artist Jim Boyd were inspired by the Chesapeake and surrounding area as well as by the historical gardens of Baltimore. Not only were images for custom-printed shades tested with patient groups to meet aesthetic standards, but advanced cleaning methods were also used on the shades to ensure durability; a new system creates hydrogen peroxide vapor that potentially could be used to disinfect rooms and protect against drug-resistant bacteria.
My observation is that the entire art program reveals a profound respect for people and their intelligence. The art engages at many levels. It is original, uplifting, and whimsical—a mirror of the personality and friendliness of people and the surroundings of Baltimore—and this environment blends with the excellence of the institution. As a result, the art connects with the human spirit, and it provides escape and alleviates stress while entertaining, delighting, and educating.