When a person needs to be hospitalized, should there be a different expectation of the experience whether it’s in an urban or non-urban environment? Philosophically, the answer should be no. And yet, by necessity, there are unique and specific differences that make the design of urban facilities different than that of suburban or rural design.


Customization: The urban welcome
One of the first experiences considered in any healthcare design project is how the patient and/or visitor will find the appropriate front door in an efficient and timely manner. Unlike suburban campuses that have a curb cut onto a beautiful site that was once a cornfield or a corporate park, urban facilities span multiple city blocks and have different street addresses to many doorways that lead a visitor to a whole host of interior destinations.

Each of these destinations must be navigated through a confusing warren of interconnected buildings, tunnels, bridges, and corridors.

How a person is greeted, directed, and/or escorted is directly related to the volume of visitors a facility handles in the course of a normal day. For those arriving by car, valet services have become commonplace, as parking is always a challenge in cities. Proximity to public transportation stops and/or a taxi line becomes an important site-planning issue and lobby design consideration.

Dealing with those who’ve come through the wrong doorway or who are incapable of self-navigation has led to a whole host of guest services typically not found in healthcare 10 years ago. These services all need a design feature to support their prompt delivery and a cultural delivery shift that makes that arrival sequence appear customized.


Care delivery model: Specialty/academic branding
Most large academic medical centers are located in urban centers close to medical schools. The specialty of the physicians found in these advanced facilities will draw patients from out of the area and, in some cases, from outside the country.

As the model for specialty care grows, most of these centers have constructed their own buildings and, hence, their own front doors. In some cases, this has not occurred, and specialty patients arrive through the same doors as the general medical patient.

This is where the branded arrival experience comes into play. It isn’t just important to patients and visitors; it’s also an important aspect in the organization’s ability to recruit those who are top in their field, showing that it’s a destination medical practice within an expanding market. In these cases, design revolves around image and brand, creating a specific portal to support an economic model of care.


Safety: Perception or reality?
“Concierge with a gun” might be one way to perceive the urban hospital experience; urban areas are likely to have the most substance abuse and violence because of their large and varied populations. Arrival sequences in these facilities have to be secured, not only for the safety of the patients and visitors, but also for staff.

But violence isn’t the only safety concern in urban settings. Many urban hospitals haven’t undergone the same level of renovation as community hospitals over the past decade. Therefore, many of these large urban facilities remain multibedded without handwashing stations, increasing the likelihood of patients contracting a nosocomial infection.


Patient and family-centered care: Including extended family
Many urban healthcare environments are filled with recent immigrants who represent a variety of cultures, typically accompanied by an entourage of visitors to help navigate a confusing health system. This phenomenon alone demands that waiting areas and treatment areas be larger in size and that alternative amenities help entertain those who are less focused on specific patient-related conversations.

The inclusion of patient advocates in planning and design makes an urban facility feel more connected to its constituency.


Maintenance of finishes and materials: Level of use and abuse
The higher levels of facility use and abuse triggered by sheer volume in urban settings require finish details and specifications that can take a beating and be easily maintained. Add the size and complexity of these facility maintenance programs to the mix, and it begs for a different palette of material usage than their community counterparts.


Positive distractions: Connection to nature
The single most important contribution that evidence-based design has offered the urban hospital is the understanding that nature has a positive impact on health outcomes and staff performance. In dense urban settings, getting to that tree in Brooklyn might seem almost impossible, but many are accepting its positive return on investment by installing pocket parks and/or rooftop gardens.

As healthcare delivery continues to change, many of these large urban environments will consolidate into larger systems, streamlining services so the general hospital can focus on acute care delivery while allowing neighborhood-based centers to focus on wellness and prevention with much more aggressive, hands-on, home-based programs to monitor chronic conditions.

These shifts will ease the burden on the large urban medical center facility. The design field will need to help influence these shifts into thoughtful, patient-centered, family-focused, staff-supportive urban solutions.

Rosalyn Cama, FASID, EDAC, is The Center for Health Design’s board chair and president, and principal interior designer of CAMA Inc., in New Haven, Conn. For more information on The Center for Health Design, please visit www.healthdesign.org.