4 hospital lobbies provide a healthy perspective

A carefully considered entry zone can put patients at ease while sending a powerful branding message for your healthcare client. Our experts show how to do it through four project case studies.

This five-story atrium links all clinical areas at the Duke Cancer Center, drawing the eye to a custom wood screen. The design was inspired by the campus’s collegiate Gothic tradition, as well as the region’s native loblolly pines. ROBERT BENSON PHOTOGRAPHY
April 02, 2013

Personalized medicine is a watchword in modern healthcare. Hospital systems are under enormous pressure to achieve better clinical outcomes. They are responding in part by developing a deeper understanding of the behavior of individual patients—a goal that is shaping facility design as well.

Increasingly, owners want their facilities to provide a competitive edge by making patients feel affirmed and comforted from the moment they reach the front door. Like the practice of medicine itself, however, healthcare lobbies are far from a one-size-fits-all proposition.

“There’s been a trend in the major medical centers to look at the facility as a ‘distinctifier’ for patients, as an opportunity to solidify their brand identity in healthcare,” says Kate Wendt, IIDA, Director of Interior Design and Associate Principal at Tsoi/Kobus and Associates (www.tka-architects.com). According to Wendt, a patient’s first impression can also have significant psychological implications. “Depending on what is going on with them, most patients are a little anxious, and we do a lot to try to subtly relieve stress via the lobby,” she says.

TK&A Senior Interior Designer and Associate Chu Foxlin says that patients’ access to healthcare information, and their growing ability to navigate among providers in a crowded marketplace, is also influencing hospital administrators’ ideas about lobbies. “The physical environment offers important branding opportunities in managing increasing competition, responding to a savvier patient population. The lobby needs to convey ‘who we are’ and ‘why you should come here for care.’”

Many healthcare systems are using patient surveys and individual interviews to make sure evidence-based design extends beyond the clinic, OR, and ER. “They’re all trying to understand, from a marketing standpoint, why people come where they come for treatment,” says Wendt.

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“They’re also trying to recruit and retain the best staff. They’re working with input from their internal user groups, and often there is also a donor with a weigh-in on the final look of the project.”

While all public lobbies require a design response to basic issues of access and egress, security, wayfinding, and maintenance, healthcare lobbies call for special considerations, notably:
• Infection control
• Diminished concentration among patients and visitors due to heightened anxiety and stress
• Beefed-up safety measures to protect frail, disabled, or vision-impaired patients

Four recent TK&A projects illustrate a detail-oriented approach, with spaces that reflect very different patient populations and owner objectives.


1. Hope and inspiration in a hypercompetitive market

The lobby reception desk and working fireplace at the Duke Cancer Center are situated in a low-ceilinged area that brings a human scale to the entry. Behind the wood wall, patients find an easy-to-navigate suite of services, including a pharmacy and a wig and prosthetics shop. A café is also within easy walking distance. PHOTO: ROBERT BENSON PHOTOGRAPHY


The 267,000-sf Duke Cancer Center at Duke Cancer Institute, Durham, N.C., opened in 2011 to provide integrated clinical and support services. Patients can see all their caregivers at a single site, from doctors and nurses to pharmacists, social workers, dietitians, and providers of prosthetics and wigs.

Patients in North Carolina’s Research Triangle have multiple choices for high-quality care. The lobby design immediately establishes the Cancer Center’s branding, a message that was influenced not only by patient input but also by Building Team tours of other major cancer centers. “There was an extensive amount of front-end work with this project,” says Wendt. “We did a lot of benchmarking to figure out what to do in the lobby."

The primary feature is a five-story atrium, fulfilling Duke’s request for a light, bright, cheerful space. A custom wood screen incorporating pointed arches suggests a cathedral-like serenity and also functions as a clear point of orientation. It extends to a lower level, where the radiology department is located.


Duke patients were asked to submit inspirational sayings, which were used to create a permanent art display in the terrazzo floor of the lower-level radiology department. Radiology has its own entrance; the artwork is the centerpiece of the secondary lobby. PHOTO: ROBERT BENSON PHOTOGRAPHY


To balance the scale of the atrium, the Building Team created an adjacent two-story lobby with a reception desk, soft seating, and a working fireplace that honors donors. “North Carolina is not always warm, and they thought a fireplace was a nice idea for crisp days,” says Wendt. “It’s intended to convey a more homelike feeling.” A café, a wig and prosthetic boutique, a patient learning center, and the pharmacy are all located nearby.

Putting everything in an easy-to-reach, easy-to-navigate space is a reflection of Duke’s long history of involvement with cancer patients’ physical and emotional needs, but a lot of market research went into the lobby, too. “The design involved the healthcare campus architect, the CEO, the COO, and the nursing staff, as well as user group studies,” says Wendt. “They gave us a very detailed report regarding patient desires.”


2. Neighborhood healthcare suits a changing urban environment

The signature terra cotta rainscreen at Shapiro continues seamlessly into the lobby, orienting visitors to the reception desk and elevators. Wheelchair access and storage are a key consideration for healthcare lobby design; here, a low Corian counter is a suitable height for the seated patient. PHOTO: JEFFREY TOTARO


The Carl J. and Ruth Shapiro Ambulatory Care Center consolidates outpatient diagnostic and therapeutic services at Boston Medical Center. Opened in 2011, the nine-story, 245,000-sf facility occupies a highly visible site at the edge of the BMC campus, bordering venerable low-rise residential buildings. Respecting the neighborhood context, serving an inner-city population, and attracting private patients were top-of-mind goals for the Building Team.

BMC was created in 1996 from a merger of the public Boston City Hospital and the private Boston University Medical Center Hospital. “About 70% of BMC patients come from under-served populations,” including low-income families, elders, people with disabilities, minorities, and immigrants, according to Robert Biggio, BMC’s VP of Facilities and Support Services. The design team worked with the donors and BMC officials to create a supportive, safe, and durable environment.

Light, warm wood finishes predominate in the daylit lobby, combined with a terra cotta wall that extends from the exterior façade. The need for tough finishes is reflected in the reception desk, which incorporates metal panels and Corian worksurfaces, and in the patient furniture, where wood and heavy-duty vinyl predominate. Except for a small, carpet-tiled seating zone, the floors are terrazzo, which withstands heavy cleaning and abuse. Artificial bamboo offers a touch of nature without the maintenance demands of real plants; it draws patients toward an open staircase leading to a small café. Murals depicting local history reinforce the founding institutions’ deep roots in the neighborhood.


Natural materials, light, and thoughtfully divided activity zones help the Shapiro lobby feel like a calming oasis. The open staircase, acccented with artificial bamboo, leads to a small café. A glass feature at the landing mimics a waterfall without the maintenance hassles of a real water feature. PHOTO: JEFFREY TOTARO


With a large non-English-speaking population, wayfinding was a crucial consideration. Much of the signage is multilingual, but orientation does not rely completely on verbal skills. “The patient elevator bank, primary circulation corridor, and all the waiting rooms are located along a curtain wall so that patients will always know where they are in the building and in relationship to the exterior as they enter or exit a clinical suite,” says Biggio.

TK&A’s Wendt explains further: “Lobbies can get crowded, and as hard as we try to make it intuitive, people coming to medical facilities are distracted and can miss some visual cues.” Because medical buildings are complex spaces, you have to keep telling the wayfinding story. “We try to make lobby elevators especially clear and obvious, in terms of materials and ceiling treatments,” she says.

For the Shapiro project, all elevator lobbies were accented with wood ceilings and identical light fixtures. Card readers control access at key entries and exits and within the building, as well as at storage and supply closets.

The Shapiro building is a crucial piece in BMC’s plan for growth, and the lobby—with finishes reminiscent of an upscale hotel—reinforces this fact. “Ambulatory care is an increasingly important component of the services BMC provides,” says Biggio. “The design needed to be patient-centered within a friendly environment.”


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