As hospitals, ambulatory care centers, and specialty clinics continue to transition to more hospitality-like settings, the flooring specified for those facilities is going in a new direction, too. Issues about cost, infection control, and maintenance are still top-of-mind, but joining the discussion is an emphasis on aesthetics, comfort, and the role of flooring in wayfinding.

“The conversation no longer is ‘I want this type of floor,’” says Iris Dates, vice president, director of design for healthcare interiors at HKS (Dallas). “Now clients say, ‘I want it to look like a hotel room or be warm, like something you’d have at your home.’”

Jennifer Mango, interior designer, Tsoi/Kobus & Associates (Cambridge, Mass.), agrees that aesthetics are playing a bigger role in flooring choices. “Healthcare is so focused on the patient experience that designers now have a lot more ammunition to push the aesthetics and feel as well as the performance. In the past, it was focused primarily on durability and maintenance, resulting in a very institutional look,” she says.

These changing criteria are making way for new styles, product features, and uses of flooring.

Products making strides
For most designers, there’s an arsenal of products to fit their designs; it’s a matter of listening to the client, understanding their needs, and presenting choices that will perform well for them. “There are probably five or six products that we use because we know what holds up and what doesn’t,” Dates says. “It depends on the situation and where you use them.”

For lobbies and high-traffic public spaces, many designers choose terrazzo because it’s seamless, durable, and easily maintained. Manufacturers are also adding lines with higher sheen levels that give it a shinier look without requiring a lot of maintenance.

A breadth of color choices and the ability to incorporate decorative pieces into terrazzo also make it appealing. For the Duke Cancer Center in Durham, N.C., Mango worked with the client to create an identity concept that referenced the facility’s Gothic architecture. A new medallion icon was woven throughout the interior design and into the epoxy terrazzo flooring at key locations, including entry points, atrium corners, and elevator cores. “One of the great qualities of terrazzo is that you can water–jet cut from a precast piece, which gives you unlimited design options,” Mango says.

Her flooring designs also incorporated recycled materials, including mirror chips and glass, “so when you walk in, it reflects the light to create an ethereal look in the lobby.” To offset the higher cost of using recycled content in the terrazzo, Mango specified domestic stones for 50 percent of the mix. “You have to balance design impact verses cost within your budget,” she says.

Rubber is gaining popularity with designers for clinical spaces, including nurses’ stations and patient rooms. While staff appreciates its softness underfoot, rubber’s sound-absorbing qualities, as well as its ability to be heat welded for infection control, make it a good choice for patient rooms.  Although rubber is on the top end of the price scale, HKS’ Dates says she started giving it a second look when manufacturers began introducing thicker options that can handle rolling traffic without denting.

Some manufacturers are also addressing rubber’s institutional, dull-like appearance with new lines that incorporate embossed patterns or by offering special pads that can be used to buff the surface to low-, medium-, and high-shine levels.

Projects seeking a non-clinical aesthetic that’s easy on maintenance can also opt for a hardwood look using a variety of options, including engineered hardwood, vinyl, and linoleum products. Carpeting is still considered a natural choice to warm up a space, especially a waiting area or lobby, with solution-dyed carpet nylon considered the best for standing up to traffic and sunlight exposure. But issues with staining and cleaning make it less desirable for treatment areas.

The right fit
When searching for the right product, concerns about infection control, cost, maintenance, and longevity will always be considered, but designers say they’re also looking at how many styles, colors, and finishes are available from a particular line.

Andy Keller, president, Keller Studio Inc. (Cincinnati), says he’s interested if a product is a chip-through material, rather than just a top layer over a black substrate. “When top layers get gouged, you end up with a black streak that can’t be fixed, but with the chip-through, it’s not as noticeable,” he says.

Waxed flooring is also waning in popularity as clients address issues regarding indoor environmental air quality, worker injuries, and maintenance. Luxury vinyl tiles are coming out in no-wax options, and new surface coatings on linoleum products give them a glossier appearance than before, without the need for waxing.

Still, shiny floors are in demand for healthcare facilities, despite issues related to performance or maintenance cost. On one project, Mango says, a client was sold on using a no finish linoleum product with a built-in top shield for its low-maintenance and environmental properties. Yet just before the facility’s opening, the client decided to add a top finish. “No matter how much an idea is sellable, at the end of the day, there’s still a lot of perception that shiny equals clean,” she says.

Finding the way
In addition to performance qualities, flooring is also being called upon more often to assist in wayfinding. This was the case for the 2011 expansion of Phoenix Children’s Hospital, says Dates. “In the existing building, the wayfinding was so bad that you had to have volunteers take every person to where they were going,” she says. Among the solutions was adding decorative patterns into the flooring to help move people in a desired direction.

Keller says he’s designed black-and-white patterns, colors, and shapes into flooring to help get patients and visitors from point A to point B with ease. For one pediatric interior, he installed a path of tiles with yellow circles worked into the pattern from the elevator to an important corridor. “It was clearly different and the staff could say, ‘Follow the yellow path,’ and that got people to the right area,” he says. “You shouldn’t just have to rely on a sign, because there are 8 million signs in a hospital and you can’t possibly see them all. Our task is to figure out how flooring can play a role.”

Testing the outcome
While manufacturers provide product information and testing data relating to their flooring products, many designers say doing a mock test—whether in a full-scale room setting or inside a high-traffic elevator—is the best way to know whether a product can withstand a specific environment. “We do as much preventive research as we can, but at the end of the day, it’s the chemicals that they use that are going to be treating this. If it doesn’t work, we need to find a better solution,” Mango says.


SIDEBAR: Controlling cost

When it comes to flooring costs, designers say it’s a matter of knowing how and where to get the most bang for your buck.

Iris Dates, vice president, director of design for healthcare interiors, at HKS (Dallas), says she’ll specify
a higher-end product in public areas and treatment rooms where patients and families are going to see it, and suggest more cost-saving options for the back of the house. “If you keep the same palette and color, but use different products, no one really notices,” she says.

For example, for the Benjamin Russell Hospital for Children in Birmingham, Ala. (See “TK title” on page TK), she used rubber in the corridors and patient rooms, then matched the same color in a sheet vinyl for storage and utility areas.

Still, creative design solutions may not be enough to overcome perceptions about flooring and costs. “If they say they want vinyl composition tile (VCT), they’re starting their reference point at $2.50 installed,” says Jennifer Mango, interior designer at Tsoi/Kobus & Associates (Cambridge, Mass.).

Mango says she tries to focus on maintenance and lifecycle costs, as well as a product’s performance characteristics, to get clients to open up to other suggestions. For example, VCT may be inexpensive and come in a variety of colors, but it also requires stripping and waxing that can eat up savings in maintenance costs.

Knowing which users will be exposed to certain areas can also provide ammunition to justify a higher-priced product. “They’re trying to recruit doctors, compete with competitors, and keep nurses, who complain their feet hurt,” she says. “Knowing that makes it easier to say a certain product might be the best option.”

Anne DiNardo is senior editor of Healthcare Design. She can be reached at

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