A Comfortable Place for Children to Heal

TFM panels are featured in most of the casework at the UW Children's Hospital.

Custom–Designed Casework Welcomes Patients and Families, and Reduces Stress on Caregivers

In a tough climate for new commercial projects, one bright spot has been healthcare construction. One project that has garnered national attention is the recently opened American Family Children’s Hospital, on the University of Wisconsin campus in Madison.

The six–story, $55 million project, bolstered by a $10 million gift from Madison–based American Family Insurance, is a pediatric teaching hospital linked by a walking bridge and a service tunnel to the main UW hospital. But despite their physical proximity, the Children’s Hospital is a different world than the main facility, which opened in 1979.

“We’ve always had a children’s unit, but it was a hospital within a hospital, which is typical of most university hospitals,” says the UW Hospital’s internal architect Ardis Hutchins, AIA, IIDA, AAHID. “We decided that we really wanted to reflect more of the children’s own identity. We were also tight for space in the main building, so by moving them out we created more space for the adult population. It was a win–win.

“It was important to be linked to the main hospital so we didn’t have to duplicate services. It is also more convenient because we are a very busy teaching hospital, and the link makes it more convenient for the students and the faculty.”

Hutchins says the new project has benefited greatly from the university’s experience making incremental improvements to its existing facilities.

“I saw this as a real opportunity to take some of the lessons that we’ve learned from our main hospital and incorporate them into a new facility. This is the first time in over 35 years we’ve done any major new construction in the inpatient areas. There is always remodeling going on, but you have to deal with constraints, so starting fresh with new construction has really been wonderful.”

Design for the project was a collaboration between the University of Wisconsin Hospital and Clinics and the Omaha architecture and engineering firm HDR. Most of the interior design was driven by Hutchins.

Creature Comforts for Families and Staff

“There were some important guiding principles for us as we approached this project,” says David Berry, vice president of the children’s hospital. “We wanted a facility distinctly for kids and families that was unique, not embedded in another hospital. We wanted larger private patient rooms, 300 sq. ft., up from 120 to 150 sq. ft.; we wanted an enhanced and better outpatient facility; and we wanted to grow to a facility with 80 beds.

“Our goal is to deliver family–centric care. We already offered excellent care, but what we didn’t have was a really good space in which to deliver it. The current hospital was designed in the 1970s, before family–centric care was even a concept. Family–centric care refers to creating spaces that are more comfortable with homelike qualities, and allowing choices for families – they can stay in the room and sleep on a sleeper sofa bed, the siblings can stay in the room or in sibling care area, they can entertain guests in the rooms or in a central living room area, and they can cook and eat together in a kitchen and dining room.

“It’s about providing homelike characteristics, but at a more fundamental level it’s about providing choices for families,” says Berry. “In most hospitals their choices are stripped away – what they eat, what they’re going to do when. So what we attempted to do was identify a way to return control and a sense of hominess.

“A children’s hospital has to create a space that’s childlike and whimsical without being childish. The finishes, the design, and the theming all has to convey a sense of wonder and whimsy, but not so much as to offend patients that are older, 16 or 17 years old, who don’t want to be in a world of trademarked rodents.”

Patient rooms are laid out in three specific zones, for the patient, the family, and the caregivers. Berry and Hutchins worked with patients and their families, people who would be “living” in the space, to find out what amenities and elements would make them the most comfortable. They also talked to child–life specialists, professionals who work with sick children to help create a sense of normalcy, distraction and play. And of course, caregivers were consulted as well.

“We agreed we wouldn’t change the space based on someone else’s feedback unless we went back to the ‘owners’ of the space, the patients and their families, for their approval,” says Berry. “Here’s a good example of how this project worked: many non ‘owners’ were convinced that the patients and their families would want refrigerators in their rooms, but in a focus group what they said they really wanted was storage. Kids travel with stuff, so a little nightstand next the bed made sense. Families travel with stuff, so we designed a bank of cabinets in the family zone.”

“In the patient rooms, the lengths of stay can be quite long,” says Hutchins. “We have a cancer center with some very sick children who may stay months and often come back for different surgeries, so families actually ‘live’ at the hospital. We wanted to be sure to have plenty of storage for them, so we put a lot of thought into the design of the cabinetry.

“The sofa bed was going to be right up against half of the cabinet, so we created an opening from the hanging closet side big enough to slide a suitcase into. That way we’re not wasting that space. There’s a drawer with a digital locking safe for personal possessions, the clothes hangar bar extends out, there’s a computer desk area…families can even check out laptop computers and use our wireless network.”

Hutchins and her colleagues have taken lessons learned and turned them into functioning, ergonomic solutions in the new hospital. One of the realities of the healthcare world is that the nurse population is getting older, with a median age in the mid 40s. And because nursing is physical and stressful work, designing facilities and fixtures that improve their efficiency makes common sense.

A common goal in designing medical facilities is to keep the distance between a nurse’s major duties to within 80 footsteps. Nurse servers – innovative wall cabinets that allow access from both the corridors and patient rooms – are a concept pioneered at the UW Hospital that help reduce the amount of walking nurses must do in their daily responsibilities.

“They store all the medical supplies that the caregivers will need,” says Hutchins. “They also hold clean linens, gowns, towels, washcloths and those kinds of things. In addition, they have an area for soiled linens and a soiled utility tray for anything that might need to be autoclaved or sterilized between each use.

“There are doors on each side with drawers that open in both directions. They are stocked from the corridor and accessed from the inside of room, which saves time and steps for the nurses and supply personnel. It also limits the number of people who need to go inside the patient room.

“We used the two–way drawers because of what we learned in the main hospital. There they used Tupperware bins on shelves that could be stocked from the corridor and pulled from inside the rooms, but our ergonomics team decided that the repetitive motion of lifting and replacing the bins was not healthy for the nurses.

“There’s also a pull–out work surface in the new nurse servers, not unlike a kitchen cutting board, which the caregivers can use to prepare meds or make chart notations. There’s a focused LED light in the ceiling right above it for when the room is dark and the patient is resting.”

The nurse server design was modified for ICU rooms. Instead of having built-in drawers, a rolling cart of drawers was specified so caregivers are able to roll the cart from a bay in the two-way cabinet to right beside the bed.

“We have rooms we can use as isolation rooms throughout the hospital, which requires special nurse server supplies. We roll the soiled linen cart into the room and bring in another cart stocked with isolation supplies – gowns, masks, cleaning sprays. This makes it easy if a room needs to be changed over to isolation. All they have to do is tell central supply to bring up the correct cart.”

Smoke–seal weather stripping on the corridor–access doors and rubber bumpers on the patient–side doors keep ambient and operational noise to a minimum.

Consultative Cabinet Design

To create the nurse servers and the patient room storage cabinetry, Hutchins and her team collaborated with Techline USA, a high–tech manufacturer of furniture and fixtures to the medical industry. Techline also supplied cabinetry for nurse’s stations, administrative areas and exam rooms throughout the hospital.

“The people at Techline have been wonderful to work with,” says Hutchins. “Their whole history has been working in the medical field. They’re used to having clients who are interested in the details because they know how important functionality and durability are in a hospital setting. When we ask for multiple mockups, or for them to redo something, they’re absolutely cooperative.

“They also bring so much knowledge to a project because they’ve helped solve so many problems on other projects throughout the years. They’re the ones who showed us what to use to keep our nurse’s station shelves from bowing under the weight of reference books and binders – thicker shelves were already their construction standard.

“We love the edgebanding on all their casework, even on the inside of the cut–out panel for the suitcase cubbyhole. It really adds to the durability and longevity of the cabinets, not to mention to the finished look. They can do this because they have a very high–tech plant, which we’ve visited. Their quality is just exceptional, and they have a great knowledge base to pull from.”

“We base everything we do with an eye toward sustainable design and cost of ownership,” says Paul Duren, VP and general manager of Techline USA. “People want a product that’s going to last longer than anything else in that room. They’re going to replace the carpet or the vinyl, they’re going to move things around, but our cabinets are going to last.

“That’s important because they don’t want to install a product that will need to be replaced in five or 10 years because the edging falls off, or because it can’t be moved and reinstalled elsewhere because it was designed just for that room. This is an expense that won’t have to be incurred again in 10 or 15 years, which saves our clients money and is good for the environment.”

Nearly all of Techline’s cabinet components are fabricated from thermally fused melamine (TFM) panels, which are 45–lb density particleboard sheets with woodgrain design melamine laminates thermally fused to the surfaces. Most of the casework in the American Family Children’s Hospital is Kensington Maple; some cabinets are also in American Cherry. Duren estimates that Techline has done 3,000 to 4,000 medical industry projects over the years.

“We’re AWI certified, so all of our work meets or exceeds that spec’ in terms of board quality and thicknesses,” says Duren. “One thing we know all too well from working for so long in this industry is that standard casework doesn’t fit into the footprint of patient rooms. You have to consider wheelchair access, patient bed dimensions, the visitors that have to be accommodated and the way the caregivers need to do their jobs. It’s all custom furniture.

“Our manufacturing line is one of the most advanced systems available, built by the German manufacturer Homag. We’re able to maintain tolerances of 0.2mm throughout our plant, and with the use of manufacturing software and CNC machining centers we get the highest possible yield from our materials, which minimizes waste and gives our customers the highest possible value. We can efficiently produce pieces in single–digit batches; our line automatically sets itself up for different dimensions in 30 seconds or less.

“The particleboard and TFM we use meets our demands for consistency of thickness, density and structural stability, and the TFM laminate surfaces can stand up to the heavy use and cleaning they get in a hospital setting. There’s really no other material that offers anything close to this kind of value for our clients.

“Cabinetry can be vulnerable at its edges and corners in such high–use applications, which is why we pay a lot of attention to the quality of our edgebanding. We use 1.4 mm PVC edges on most of our panels, applied with hotmelt glues under very stringent temperature controls. Although we’re able to apply any thickness, we’ve found over the years that the 1.4 mm is highly durable without being wasteful, and it will stay on for the life of the product.”

“There is also very little waste in the processing of our particleboard and TFM panels,” says George Polnow, VP of sales. “The 5’ x 12’ panels we purchase give us the highest yield in our manufacturing plant, which lets us provide the best value-engineered solutions for jobs the size of the Children’s Hospital. All told, we delivered over 4,000 cabinets for that project.

“We also try to always take a step beyond what other suppliers might offer. We seal all four edges of our adjustable shelves and the edges on the backs of our cabinets with edgebanding. A lot of companies won’t do that. We know that cabinets are going to be repurposed over their lifespan, pulled off the walls and reinstalled somewhere else, and if those back edges aren’t sealed they can break and chip.”

“Sealing all surfaces of the particleboard also minimizes any formaldehyde off–gassing, for anyone who is still concerned about that,” says Duren. “I’ve found that most designers understand that the levels of formaldehyde in particleboard are lower than other materials they work with, especially carpeting. But for those who want it, we can now specify particleboard without added formaldehyde from most of our suppliers.”

Techline’s connections helped them locate a tambour door for cabinets designed to conceal the array of gases and gauges at the head of each bed.

“We wanted to hide the gases from the children, who can get stressed when they see all that apparatus hanging there,” says Berry. “Kids will pick up on these things; hiding them keeps the room more home–like.”

“We have the same gases on each side of the bed,” explains Hutchins. “The vertical tambour doors are our own design. In the main hospital they were installed horizontally, but we didn’t have enough clearance in this area to install them that way. Caregivers don’t like hinged doors because they want to keep that space clear and open, they don’t want to contend with any obstructions.”

The collaboration with Techline led to other innovative solutions as well. Overhead cabinet doors have an extra inch of drop, eliminating the need for pulls. On the corridor side of the nurse servers special door pulls lock nearly flush with the doors, thus avoiding damage by beds and carts as they’re rolled through the halls. Computer–based charting workstations made from HPL and TFM are positioned between patient rooms to lower traffic. And Techline suggested hinge substitutions that improved durability, allowed for an extended warranty and resulted in significant cost savings.

Techline also supplied the high pressure laminate (HPL) and particleboard work surfaces in the nurse’s stations, but the millwork there and the accent lighting in the patient rooms – mirrors and headboards – were fabricated by Carley Wood Associates.

“We used matching laminates over particleboard cores for the patient–room lighting fixtures,” says Robin Carley, owner and project manager. “We were able to create the curvilinear pieces on our CNC router, and the cut–out designs with our pin router. This was a great project to be involved with.”

“We selected our materials very carefully, working with the architects and our internal maintenance and housekeeping people,” says Berry. “Everything meets our standards for durability, cleanability, as well as healthcare standards and codes. It also helps us create a sense of warmth and a homelike setting. Nothing in the rulebooks says a hospital has to be ugly white and institutional green. We wanted materials that families can relate to, that they would find in their own homes.”