Design studio makes medical buildings lean and green

As the Southwest Florida health care industry continues to experience expansion, hospital systems are taking advantage of the opportunity to incorporate evidence-based, lean design principles in the construction and renovation of hospitals and free-standing subspecialty clinics.

Not only must acute care and outpatient care facilities function appropriately for providers, contemporary health care spaces have become more patient-focused in providing an environment that promotes healing factors that extend beyond medical treatment itself.

Studio+, a nearly 7-year-old integrated services design firm based in Fort Myers with offices in Tampa and Irvine, Calif., is on the front lines of the health care facility design revolution, specializing in acute care, outpatient care, behavioral health, senior living and hospice design and construction. Its portfolio also includes higher education clients. 

Founded by Damon Romanello in 2011 with a staff of eight working in a 500-square-foot office, it now employs 68, occupying 22,000 square feet in three markets, with an office in Sarasota set to open August. 

With Florida operation revenue topping $8 million in 2017, founder and CEO Damon Romanello points to his firm’s talent, its expertise in lean design and market expansion for the growth of Studio+.

“We've experienced phenomenal growth based on the fact that we're good architects, we do a phenomenal job for our clients and we respect their needs,” says Romanello, 42. “We built our company on our culture, and that has helped us to not only attract the right talent, but also has enabled us to maintain the clients we've had and attract new clients that fit into what we believe in and understand how our culture can drive value to them.”

The firm’s services include architecture, interior design, planning, lean design principles, branding and, most recently, Studio+ Surfaces, providing seamless integration of carpet and flooring design, production and installation. 

As design principles of health care facilities continue to shift from sterile and institutional to a patient-centric model, Romanello says Studio+ is well positioned to capture its share of the market. This is particularly true in Southwest Florida, Romanello says, where population growth and an aging demographic place high demand on health care systems to expand and adapt.

“In Southwest Florida, a lot of our larger, locally based hospital clients are looking to spread out into the community and have multiple touch points where their potential patients could be,” says Romanello. “While we still are working with hospitals, we are also now doing self-standing emergency departments and ambulatory patient buildings outside the hospital campus and out in the communities. They are trying to get the services where the people are.”

Community outreach

Dave Cato, Lee Health chief administrative officer of outpatient services, says the aging population of Southwest Florida — both permanent and seasonal — is the impetus for locating facilities closer to the residents and to incorporate lean design efficiencies that minimize waiting and exam room space while seamlessly moving patients through the process of the medical visit.

“Part of our strategy has been to bring services as close to patients as possible,” says Cato, who worked with Studio+ in the design of Lee Health’s Outpatient Center at Surfside in Cape Coral. “We're designing through the patient lens whereas design had traditionally be done through the health care worker lens. It does have its challenges, but at the end of the day hopefully we’re both more efficient and we can enhance the patient experience.”

That is reflective of the trend toward dedicating the central hospital for acute care and pushing out other services once performed in the main facility to free-standing clinics. No longer using hospital space for primary care, systems are decentralizing ambulatory care, psychiatric care, hospice and behavioral health, often converting existing facilities from one use to another to meet changing market demands. Those conversions often require complete redesign to serve its new purpose.

“In the Tampa market, we found that a number of hospital clients with demographic shifts have a need in the community for behavioral health beds,” says Romanello. “They are converting acute care settings to behavioral health in a meaningful way.”

In the process, designs must strike a balance between functionality for providers and repose for patients, all intended to create positive outcomes.

“It's patient-centered now,” says Patricia Rice-Spivey, Studio+ vice president of health care. “That’s what all the hospitals and medical facilities we work with are aiming for, because they understand that helps in healing.”

Family affair

When he began working in health care architecture more than 15 years ago, Romanello says clients expressed the desire to shift away from institutional design and adopt more of a “residential feel.”

“That's not prevalent in the industry anymore,” he says of institutional spaces. “It’s really a spa-like atmosphere, looking at natural materials and sunlight and bringing those qualities from a well-designed spa into the health care environment. When you think of the evolution of the last 15 to 20 years, what we’re doing now is looking to influence health care through aspects of design that contribute to wellness and a healing environment.”

Much of the evolution of health care space is driven by the Affordable Care Act as government reimbursements are tied to outcomes and patient satisfaction surveys. Market demand is another as patients seek the higher-level health care experience and as focus shifts to treating conditions related to aging, oncology and behavioral health. 

“When we worked with Studio+ on Surfside, we implemented new processes with how we care for and flow patients within the facility, and it’s worked very well,” says Cato of lean design concepts, the basis for current designs in Lee Health’s new facilities. “We try to see it through the patient’s eyes, to focus on the patient experience. It’s making registration easier, making way finding easier or just walking into a facility and feeling more like a hotel atmosphere versus a health care atmosphere and trying to make that experience more spa-like.”

In acute care facilities, design innovations extend from public spaces where waiting and sitting rooms have become “serenity rooms,” to the patient room where standards adopted by the state of Florida in 2014 require new rooms to be private. That allows patient rooms to extend to the family.

“Even within a patient room you have a family zone,” says Rice-Spivey. “You have an area designed around family and you have a caregiver zone. They do overlap, which they need to do, but you’re not designing just for the patient and the caregiver, but for the family also.”

Romanello says it’s all part of evidence-based design that promotes the best outcome probabilities that include shorter hospital stays and minimizing the probability the patient will need to return.

“It's really been an evolution over time as evidence-based design came to the forefront,” says Romanello. “It’s what does the practical data say that puts patients in a better position for recovery? Family care, environment of care and well-being. It’s an evolution of thought, really.”

That school of thought extends to ambulatory and outpatient facilities as health care systems expand to meet market demand, but in a thoughtful manner. 

Romanello says a project to design a cancer unit for NCH Healthcare System in Naples included a serenity room with a wall of video monitors that provided the visual and audio environment of a day at the beach.

“We had a videographer go to a beach in Naples and film from sunrise to sunset,” he says. “The patients can sit in this room with a whole wall of TV screens with this continuous image that corresponds to the exact time of day so they can sit in the chair and feel like they are outside. They are there not only to rejuvenate their body, but their mind as well.”