For many years, healthcare facility teams have relied on standards programs to run the process of environmental updates and changes to the facility smoothly and efficiently. Staff decision-making time was minimized by referring to a manual, quite often produced by a consultant, to determine the facility’s preferred solution for architectural finishes, mechanical and plumbing items, lighting, furniture, and soft goods. The solution was product-based and, frequently, when the product was no longer available, the second choice wasn’t quite the same. It might not be as energy-efficient, or might be a slightly different size or color, or require a different electrical connection. And, unfortunately, the individual making the selection wasn’t always apprised of the original decision-making process or of the criteria used for product selection.

A more meaningful alternative to the traditional standards programs is to elevate the process from the development of product-based guidelines to campus-wide mission- and values-based programs. Working with administrative and department leaders, as well as with key stakeholders, Guiding Principles and Best Practices provide the philosophical foundation missing in most standards programs. Whether the task is the replacement of a discontinued product with newer or improved product or a more substantial change, the effort is simpler and more time-efficient when there is a clear understanding of the decision-making process that guided the original selection.

Armed with a clear understanding of the primary issues and concerns of a facility, designers and planners use the organization’s goals, vision, and mission to articulate a set of Guiding Principles. In turn, the Guiding Principles inform the planning and decision-making process for the campus and provide a keystone for development of Best Practices. Best Practices are defined as the most efficient and effective method as proven over time.

Facilities’ teams often make decisions, repeat processes, or select products by tradition: “This is the way we always do it, this is the color we always use, this is the lamping we’ve used for years.” Their evidence may be based on a professional recommendation—their consultants told them this was the best product, the best process, or the best way to do it—or a facility may use a nonscientific survey or sample, such as a mock-up: “We tried that carpet and we couldn’t clean it” (with the traditional products they always use!). Progressive facilities, aware of recent trends, find peer-reviewed studies a good source of evidence, which helps them to link their best practices to evidence-based design.

The Venn diagram shows how the concept of Guiding Principles focuses the information gathered from multiple perspectives and at different levels of detail.

Healthcare construction and renovation projects are complicated by the individual and personal values and vision-filters of their decision-makers and stakeholders. Consider the demographics of any decision: physicians, administrators with advanced degrees, staff attorneys and accountants, staff professionals including nurses and medical specialists, and research scientists, facility professionals, plant managers, maintenance and housekeeping specialists, security—the list could go on. Whether the project is multistoried comprising millions of square feet of new construction, or a cosmetic upgrade in a small rural facility, the challenge is to align potentially conflicting perspectives into a single point-of-view.

Finding a common language, a filter for ideas, is a mandatory first step. One of the easiest places to start is with the client’s own words. Copies of the facility mission, value statement, or philosophy are great resources. Some clients develop goals and objectives for the project prior to incorporating a consultant’s—find a copy if possible. Discovering similar words that appear across a variety of documents and creating a word bank is powerful preparation for the development of common language.

Sometimes clients are unable to verbalize, especially in the “designspeak” of their consultants, exactly what they want or like, or even need—they just know they need to make some changes. The most direct way for the consultant to understand the situation is to spend time on the campus in advance of the initial meeting. Interviews with department managers, conversations with staff, walks in the halls, observing the interaction between staff and patients and staff and family—all reveal critical aspects of the facility culture. Take pictures, eat in the cafeteria, sit in some waiting rooms, and ask for directions. How are the values of the culture expressed in the way the facility is used? Are there conflicts between their vision and mission statements and how and where money is spent? This is the time to take notes and develop lists of key issues.

Understanding the client and their culture helps the consultant to understand their tolerances for design sessions which, in turn, determines the pace of the process. Some clients reach their limit with a 90-minute session every other week; others prefer to schedule a full-day retreat off campus. Who participates in the sessions is also driven by the culture. It is to everyone’s advantage to include stakeholders that represent all the areas of the facility: physicians, nurses, administration, engineering/facilities, housekeeping, security, patient-liaison, marketing/public relations, and procurement. Keeping the number of participants to a manageable number is also important. The objective is to include as many perspectives as possible, but with enough control so that meaningful discussion occurs.

The Venn diagram (figure) shows how the concept of Guiding Principles focuses the information gathered from multiple perspectives and at different levels of detail.

One of the most effective ways to work with client groups to develop statements of principle that combine their values, their vision and their issues is to insert the words “Design for” at the beginning of each statement. For example: If the published vision statement includes the statement “We provide a safe environment,” and issues mentioned during interviews include: “a patient’s purse was stolen recently,” “medication errors,” “a guest slipped on the shiny floor,” “a patient fell on his way to the bathroom”, then the Guiding Principle can be: Design for Patient Safety.

Because Guiding Principles provide a foundation for the process of developing Best Practices, it is critical to keep the number of ideas involved manageable. As few as four or five but no more than seven or eight give the facility staff adequate depth and direction to make informed decisions, even as the details of specifications and requirements change.

Case study: Mobile Infirmary Medical Center

The Mobile Infirmary Medical Center (MIMC), founded in 1910, is part of a four-hospital system. The facilities team and WHR’s Interiors team worked together during two sessions of two hours each to develop a set of Guiding Principles for the facility.

Two of MIMC’s goals were:

  • To improve the workload for environmental services

  • To incorporate more environmentally friendly materials

A central tenet of their mission is Leadership. MIMC felt they could provide greater leadership in the community by addressing more sustainable maintenance methods and selecting more sustainable products.

Issues identified during interviews and tours included:

  • Durability of existing finishes

  • Increased costs of maintenance

  • Maintenance staff turnover

  • Interest in more sustainable products and maintenance methods

A Guiding Principle was adopted: “Design using appropriate finishes, furniture and accessories.”

As part of the implementation process, MIMC will install mock-ups of no-wax, PVC-free flooring products to determine which product will become a Best Practice.

In part 2 of this article, the process of developing Best Practices using Guiding Principles will be discussed.HD

Linda Porter Bishop, IIDA, ASID, AAHID, LEED AP, is the leader of the Interiors Studio at WHR Architects, Houston. For further information, visit or e-mail


Want to express your opinion? To comment on this article, visit http://www.healthcaredesign and click on Current Issue.