The pandemic has pushed new thinking in health and wellness to the forefront of design. Consumers, office workers, and patients are more keenly focused on healthy buildings, partly driven by the increased focus on advanced cleaning protocols and air handling systems to address COVID-19. But patients are also more aware of the importance of environments that provide plenty of access to daylight and views, use low-VOC emitting materials, and foster connections to nature and the outdoors. These changes are putting pressure on the design, development, and construction industries to deliver buildings that help people feel safe inside. Clients also expect designers to aid their understanding of the measurable impacts of design decisions, including indoor air quality, building performance, and access to the outdoors.

Existing credentialing and certification programs like WELL and Fitwel provide specific criteria for delivering healthy buildings and include post-completion monitoring. For example, all WELL projects are verified through on-site testing of building performance. The American Institute of Architects (AIA) also recently adopted The Framework for Design Excellence, a toolkit to aid in achieving greater building performance that ties its design programs to verifiable metrics. It’s a significant shift from a focus on aesthetics to building performance, human well-being, and social responsibility. Factors such as utilizing low-VOC materials and increasing usable daylight represent some of the defining principles of good design in the 21st century. Whether or not designers are seeking awards, these parameters provide an industry reference point for understanding building features that promote health, conserve resources, reduce emissions, and support communities.

As part of Duda|Paine Architects’ focus on wellness design, we’ve outlined some essential areas of focus:

Air quality: Mechanical systems, particularly HVAC systems, are getting new attention as mechanisms to keep patients, employees, and visitors safe from viruses and other air- and surface-born illnesses. Sustainable features that once seemed destined for the value-engineering dustbin, such as improved central air filtration, upgraded filters, zoned systems, increased levels of outdoor air in HVAC systems, and even operable windows are getting attention. These features improve indoor air quality and meet ventilation and filtration standards at levels that reduce movement of viral and bacterial particulate. Additionally, ionization and ultraviolet germicidal irradiation can be added to air systems to clean the air in commonly crowded spaces.

Verifiable performance: Investment in new technologies must be accompanied by rigorous design and construction quality assurance and performance verification. The scope of post-occupancy evaluations can vary dramatically, but all ask fundamentally whether a building has performed as intended.

For example, Duke University’s Student Wellness Center in Durham, N.C., wanted to move from a more clinical model of student care to an open and welcoming facility for students that would provide a comfortable environment while encouraging healthy behaviors. The design of the open two-story entry pavilion, strategically located on a primary circulation route, was conceived as a large, multistory living room with sunlight, views, privacy screens, and natural stone and wood materials. Data gathered in the year after the opening of Duke Student Wellness Center show that The Oasis meditation space, which was designed specifically to be adaptable to the needs of students, was used by 10-15 students per day. Attendance of wellness programs increased 40 percent and care appointments increased 6 percent, while no-shows decreased 10 percent.

Experiential strategies: The firm has long-advocated for the inclusion of outdoor spaces, elevated gardens, and interior greenery across a variety of markets, from office towers to university campuses to buildings for wellness, to benefit the experience of users. A growing body of research, supports the success of biophilic design in improving occupant well-being, including increased productivity, decreased stress, and lower rates of illness. What is a measurable place to start? In temperate climates, such as the southeast, devote a percentage of building area to plazas, roof terraces, and interior gardens. Another consideration is using fold-away exterior doors, which are already in use in hospital waiting areas and cancer centers, to transform an interior space with direct access to sunlight and fresh air.

As occupants continue to be sensitized to personal health and safety issues in the built environment, standards and certification systems will become the norm for facilities that provide health and wellness services to their patients.

Jeffrey Paine, FAIA, is a founding principal at Duda|Paine Architects (Durham, N.C.). He can be reached at