Creating a Space for Spiritual Health in a Time of Healthcare Uncertainty – a Case Study

When circumstances are beyond our control, many find solace in connecting with the spirit. Through meditation, prayer, or reflection in a quiet place, healing the mind-body-spirit connection can bring peace during times of uncertainty. Earlier this year, Froedtert Hospital answered the call for soul healing and support by opening a renovated spiritual space nestled deep within the clinical maze. A small space squeezed between a noisy corridor and bustling offices, opened its new doors as an oasis of quiet meditation and self-reflection.

The design challenge was to transform the existing chapel within its current footprint. A sweeping curved wall was introduced to dissolve the sense of one’s orientation within the space and a wing wall was strategically placed to create a buffer to the main entry and aid in the transition to solemnity. The team took a strategic approach of incorporating little gems of reverence for diversity and various religious practices into the design matrix.

 

A very important goal was to maintain the multi-denominational inclusivity of the Chapel. The design team worked closely with the hospital chaplain on determining the content, the flow and the accurate visualization for all religious forms and functions of the space. Seven symbols of faith have been strategically placed to lead the way into the Chapel, unfolding this hidden room in front of visitors’ eyes.

In the heart of the Chapel – the Bible on the lectern and the sanctuary light on the wall; the Quran on its stand; the Prayer Wall with a floating shelf where words of thanks and pleas for healing are written – all received their appropriate space, orientation and iconography.

As the curved wall unravels in front of them, Chapel visitors get subtly cued in by several curated pieces of artwork and antiques from the donor’s personal collection. Four refinished antique kneelers bring the memories of old times and reinforce the importance of staying grounded in faith through prayer. The crystalline and weightless aquarelle painting of a canoe and its shadow pays tribute to the Native American way of life where religion is united with nature and landscape.

Anticipating the cue, Zimmerman designers took a biophilic design approach to bring natural materials and the sensation of natural light into the Chapel. The stained glass windows brightened the space and brought in the motifs of barley spikes as a homage to the heritage and the origin of the Froedtert Hospital trust, the Froedtert Malting Company.

Today, the Chapel is full of warm sun, bright blue skies, and fresh greens. The chosen glass colors blend nicely with light wood panels and soft fabrics, providing a needed atmosphere of calm and peace. A small stone wall, with candle-like integral lights and narrow slots for prayer notes, is now a place where prayers can be whispered or turned in. The ceiling oval provides tiny flickers of light for special occasions, while disguising the sound proofing above its wood grille. This acoustical blanket ensures for the moments of quietness in the worried life of a patient’s family, or in a stressed day of a staff member. Hidden behind the neighboring wall fabric finish is another layer of sound proofing – high efficiency acoustical panels, providing the shield from noisy offices beyond. All lights are LED, dimmable and programmable, enabling different settings for various uses of this space – for everyday public use, for special gatherings and ceremonies, for quiet nightly soul searching.  Smaller size stained glass panels are easily removable for LED ribbon lights replacement and maintenance. For larger size windows, back access to lights and wiring was provided with a goal of minimizing the disruption of Chapel services and reducing the risk of damage to large stained glass panels due to their removal.

The furniture has been carefully selected to be soft and comfortable, but at the same time sturdy and supportive. The chairs are light and movable, their rounded forms fitting the curvature of wood walls. Even though the benches appear airy and sculptural, they are bariatric grade and accessible to all.

In such a small space, every square inch was a premium. To provide for badly needed storage the design team made creative use of several residual spaces – a small storage room was carved out of the cavity behind the curved wall; the sacristy base cabinet was equipped with hidden hardware and magnetic locks to discourage potential thefts and make the storage function less obvious. To protect the privacy of prayer notes, a built-in collection box inside the stone clad wall was given a lockable access panel on the back side, accessible only to chapel staff.

The redesign of Kurtis R. Froedtert Memorial Lutheran Chapel came to life thanks to a generous donation to the Froedtert Hospital Foundation. Froedtert’s Facilities Planning and Development team partnered with Zimmerman Architectural Studios to lead the design effort, and with C.G. Schmidt as the general contractor. Stained glass windows were created in collaboration with Oakbrook Esser Studios in Oconomowoc.

Zimmerman Architectural Studios project design team is proud to have supported the creation of this precious retreat. We thank Froedtert Hospital for this opportunity, and we hope that the Chapel serves its noble purpose to the community for many years to come.

Team: Lisa Jansen ASID – Interior Design, Zorana Kostovic – Project Manager, Brian Nelson LEED AP – Architectural Designer

 

 

 

 

Zorana Kostovic

Zorana Kostovic

Senior Associate | Senior Project Associate

zorana.kostovic@zastudios.com

Ms. Kostovic, a project manager with more than 10 years of healthcare focused project management experience, participates in all stages of the healthcare design process, from schematic and design development, to construction documentation and management. Ms. Kostovic specializes in healthcare:  architecture project development; programming; planning; construction documents; construction administration, and specifications development. Zorana’s project portfolio includes physician’s suites, hospitals, clinics, and medical office buildings and she has completed both new construction and renovation and remodeling projects. Kostovic, whose career spans more than 20 years, has completed projects in the United States and abroad.  She is skilled in generation of project documentation in Architectural RE.

 

Why Go to Work? The Debate Between Traditional Office and Remote Work

Now that I am back in the office I have again hit my stride in productivity, am fully engaged with my team, and completely understand the “new normal” that I have been reading about.  I have all the answers.

 Said no one.  Ever.

 We will all agree that the exact opposite is true.  We do not have the answers as we adapt how we work and engage with one another.  We recognize that the “new normal” is a journey and not a destination, as cliché as that may sound.  The way we live and interact with one another and with place, may always be changing – a forced flexibility as part of our evolution.

 One of the tremendous victories coming out of the pandemic quarantine was our need to continue speaking with one another and seeing one another.  We leveraged technology to continue our work, meetings, and happy hours.  We demonstrated to one another how we can be productive while being remote.  The practice of working from home suddenly rivaled the traditional office culture in its effectiveness and value.

 Then why do we go to work?

Why then are we willing to accept that so much of our financial overhead is dedicated to our traditional work spaces?  As planners and designers, the answer to this question is essential to the services we provide, and in the interest of transparency an answer that runs the risk of putting us out of business.

Our belief is grounded in an understanding that as humans we need to connect personally and physically in environments that are shared, and that these environments frame and elevate our experiences.  Our spaces – our work spaces – have the ability to make us better at what we do.  In addition, the experiences we take with us from these spaces make us better individually at who we are.

 We work because:                                                                                                                

1.     We need cultural and social interaction.

2.     We need to collaborate with one another and be accountable to one another.

3.     We need to share ideas and be creative.

4.     We need to have purpose.

5.     We need to maintain a standard of living.

 But there is a subtle and very important distinction in this reasoning that cannot be overlooked.  The question “why do we work” is very different than “why do we go to work.”  Much of the value that we need from work is not tied to place.  Much of the value that we need from work is preserved – or even improved – in working remotely.  The reality, however, is that each model offers real benefits and certain advantages over the other.

 The traditional office

 Physical contact is an intangible that is only possible by bringing people together in the same setting.  Nextiva Marketing Manager and author Jeremy Boudinet offers that “face to face communication is something you really only get in an office space. It’s not only beneficial when planning for business, but it strengthens relationships and rapport with other employees. There’s something about relationship-building that happens when you sit next to someone or bump into each other at the coffee machine.”

 The workplace also affords greater access to technology, more impromptu interactions, and a stronger cultural connection.  It is also “simply where the magic happens.”  It is, quite frankly, difficult for employees to connect with co-workers when everyone is working from home.  One study suggests as many as 70% of employees view relationships with co-workers just as important as their jobs.  It is also well documented that in addition to separation, reduced communication, and even loneliness, working from home does not afford a clean break in leaving the office, making it hard to unplug after work.

 Working from home

 Working from home has its benefits, however, by eliminating commute, reducing stress, and resulting in better focus and increased productivity.  Working from home can boost productivity by 13% and significantly reduce interruptions.  A University of California Irvine Study found that a typical office worker is interrupted every 11 minutes, with it taking twice as long to then get back on track.  In addition to interruptions, discussion of non-work topics cuts into productivity.  Remote employees spend about 30 minutes of each day discussing non-work topics while their office counterparts spend more than an hour of each day socializing.

 Increased productivity, innovation, and level of engagement top the list of benefits to working from home.  This is well documented, as is the belief that remote employees feel more autonomous and empowered, and have a greater sense of work-life balance.

 Work-life balance

 Balance is key.

 In considering traditional office work versus working from home, we find that neither extreme is best.  Gallup surveys show that fully remote workers are among the least engaged of any worker, but so are employees who always come in.  Just 30% of employees in both groups are engaged.

So if we consider that there are benefits to working in a traditional office space and in working from home, we should also consider that the greatest value may come in striking a balance between these options.  Viewing this through the lens of socially healthy planning and design further reinforces this concept, and a hybrid solution emerges.

 If we crudely apply a split to a typical five day work week and arbitrarily suggest that an employee would be in the office for three days and working remotely for two days, there would be a 40% reduction of staff within the office at any one time.

 This is a 40% reduction in space usage.

A 40% reduction in interactions.

A 40% reduction in commuting.

I realize the actual percentages would be different.  There are still common, shared spaces that would be needed regardless of how many individuals are in an office.  Most interactions are with assigned team members and would be maintained.  Commuting is tough to gauge with public transportation and differences that tie more closely to urban density.  But the point is a good one – reduce the number of staff within the office and see reductions and improved outcomes elsewhere.  Research and opinion already support that work product and employee satisfaction would improve as well.

 The question becomes how to effectively implement this.  The solution – like most planning solutions – is part operational and part architectural.

 The solution

Operationally, one concept is to divide staff into different teams with these teams scheduled to be in the office at different times.  This could mean five different teams (A through E) with three day, staggered schedules for being in the office.  The result would be an overall occupancy of 60% at any time.  Scheduling would then rotate so one week team A would be in the office Monday through Wednesday, the next week Tuesday through Thursday, and so on.  This would equitably schedule the remote days relative to weekend time for all teams, and ensure that there would always be a different mix of teams within the office throughout the week.

 Architecturally, this concept could be translated to seating assignments within the office.  Admittedly, since the point of being in the office is to afford team interaction, teams would be assigned to dedicated work areas (well-planned and appropriately socially distanced).  This would enable staff to make eye-contact, ask questions, and just walk over to someone else’s desk.

 Collaborate.

 If not, why be in the office at all?

 The teams themselves however, could be separated, and supported by smaller common spaces for printing, supplies, coffee and breaks.  Instead of a single print and supply room, and a single staff break room, think of five smaller, decentralized areas dedicated to support each of the teams.

 Planning, like scheduling, would imply social firewalls to reduce unnecessary interactions while reinforcing those that are essential, and core to the life and success of traditional office environments.

 What is next?

 We are unsure what is next for the COVID-19 pandemic and are equally unsure how history will remember this time.  What seems a reasonable thought, however, is that if the COVID-19 pandemic has a lasting impact that extends into next year then our attempts to hurry out cardboard and duct tape solutions to promote social distancing will have been tragically short-sighted.  And similarly, if the impact is less than this then we are over-reacting.

 Why do we go to work?

The greatest benefit coming out of quarantine is asking this question, thinking about it critically, and adapting our work processes and planning of our spaces accordingly.  This should be a time of intelligent pause, taking stock in what we have, and developing a plan that balances the way our office schedules and spaces work together.

 Part traditional office.  Part working from home.

 Part operational.  Part architectural.

 

 

Troy Steege, AIA

Troy Steege, AIA

Vice President | Senior Project Manager Healthcare Team

troy.steege@zastudios.com

Mr. Steege is a Wisconsin Licensed Architect, Senior Project Manager and Project Architect, specializing in healthcare project management, planning and design. His experience includes management of integrated project teams, fast-track delivery, and target value design, with a project focus upon healthcare campus master planning, hospitals, surgical and diagnostic centers, medical office buildings, and senior living facilities. Troy continues to push for development in the profession, with a focus upon research, and outreach opportunities to connect healthcare systems, industry, and academic programs.  He has a proven record in developing and managing large scale, business critical design and construction projects.

Communication Within a Resilient Community: Understanding What We Have

Check-in, exam, surgery, and recovery flows are likely to be forever changed as a result of COVID-19.  But a larger concern might be how these routine patient flows have been silenced by the current pandemic.  The lack of clear and accurate information on inventory and resources forced much of our healthcare system to suspend elective procedures and scale back other service lines in preparation for surge volumes which have not yet been realized.  As an architectural firm often tasked with this level of inventory, assessment, documentation, and ultimately management of this information, we experienced this firsthand with different healthcare systems and architectural teams as part of the COVID-19 response.

Considerable effort has been put into documenting and understanding existing stock in order to repurpose and better manage this.  However, our healthcare system is at a disadvantage because we lack a comprehensive, shared understanding of our assets and resources, and do not have a common, standardized language to track and share this information.  Knowing what we have and standardizing the ways in which we communicate are essential to prepare for, and allow us to be flexible in response to, the next event.

When we get to the new normal, the COVID-19 pandemic will have redefined how we plan, design, and construct healthcare projects.  What changes should we expect?  Will the spaces and infrastructure of healthcare be significantly different than they are today?

Probably not.

The more likely and immediate changes that we will experience will be grounded in operations and communication.

Although nothing like the September 11, 2001 terrorist attacks, the pandemic is perfectly like these attacks in its unanticipated burden on our healthcare system.  New York City’s Downtown Hospital, now the New York-Presbyterian Lower Manhattan Hospital, was located just four city blocks from the World Trade Center and served as a base site in the emergency response to the September 11 attacks.  These events directly impacted changes that have since been made to the hospital.  Renovations have been made to expand the decontamination facilities, increase and better outfit the trauma room to perform a wider range of procedures, and extend medical gases into the cafeteria to enable use as an expanded emergency space in the event of another disaster.

But Antonio Dajer, then Interim Chief of the Emergency Department, believes the changes coming out of the September 11 emergency response is less about built space and more about staff response and process.

“I think my big takeaway from 9/11, as far as medical staff dealing with an emergency, is that if you give trained doctors, nurses, physician assistants, nurse practitioners, and all medical providers clear direction and adequate resources, they will self-organize and do a very impressive job. The key is to have clear direction and a clear allocation of space and resources.”

This was evident at other New York City hospitals as well.  For St. Vincent Hospital, staff in critical areas knew how to address surge capacities and which areas would be used for which purposes.  But only a few key people had sufficient knowledge on where equipment and supplies were stored.  This supports the need for disaster drills that now involve multiple areas within a hospital, conversion of space to critical care areas, and elements of chaos incorporated into the drills.  The objective is to test resources, and the flexibility and creativity of the response team.

Another significant breakdown was in the communications between police, firefighters, and healthcare staff.  This was not only a function of infrastructure that was destroyed but in the procedures in place for response to emergency events such as the attacks.

In times of emergency we want to answer questions.  We want to make it better and fix things.  We are emotional and reactionary.  Doing something, offering a built solution and changing what we have, is an easy course to follow but reactionary, costly, and inflexible.  This course of action is a response to a single event.  As a healthcare community we need to be more proactive in understanding what we have and how this can be adapted to the events that we have not anticipated and tomorrow’s unknown needs.

Similar lessons have come from Hurricane Katrina in 2005, Hurricane Sandy in 2012, and the Joplin, Missouri Tornado in 2011.  Each has strained the healthcare system and demanded a resilient response.  In 2017, John Palmer wrote an article for Patient Safety & Quality Healthcare that addressed this, identifying specific lessons-learned from these tragedies that can result in better preparedness for the healthcare system moving forward.  He speaks to value in communications, understanding resupply lines, knowing evacuation plans, and drills and preparedness.

“Emergency planning experts recommend that hospital staff train to communicate with each other and emergency responders using relatively primitive means, even pen and paper or two-way radios, in the event of a power outage.  Also, federal and local officials now work together to plan.  They go through the same disaster training and largely work from the same playbook, which means they speak a common language, use the same radio equipment, and can work together.”

Perhaps most importantly, Palmer offers advice that in times of emergency we know who our friends are to the extent of having “memorandums of understanding” in place with other facilities to sustain one another with patient care and supplies.

“You can’t always anticipate what your needs will be, but if you have partners you can count on, that will save the day in a big way,” says Paula Baker, president and CEO of Freeman Health System in Joplin, Missouri.

A common language to help us prepare is key.  This unlocks our abilities to respond during emergencies and enables us to be resilient and adjust to changing needs.  The other key – needs change.  In times of crises we need to be able to adapt what we already have.

This starts with knowing what we have.

COVID-19 surge planning efforts brought to light the value in understanding our inventories and the means of standardizing the language of these inventories.  We were actively involved with several healthcare systems and worked with many architectural firms in these planning, assessment and inventory efforts.  We noted obvious differences in the way different healthcare systems track information, but also saw these differences within the individual healthcare systems themselves.

Policy has attempted to standardize alignment and the ways in which we communicate.  Greater emphasis has been placed on joint response efforts and how different organizations are to work cooperatively.  The Hospital Preparedness Program has enacted such policy to require greater alignment across response organizations through joint patient surge, mass fatality and evacuation planning, and promoted better relationships, joint exercises, and the sharing of information and resources.

What is lacking, however, is policy to address standardized asset tracking and documentation.

The values of standardizing what is known are what is expected – savings in time and cost, and improved accuracy in gathering and sharing information.

Accurate, standardized inventories and asset tracking is not novel, and at the core is a simple concept.  BIM capabilities continue to pull us in the direction of fully developed, smart models.  But even with these capabilities we need to be judicious and efficient in use of the tools.

The new normal will likely rely more upon our resiliency, and abilities to adapt the environments that we have.  As with the current COVID-19 pandemic, September 11, and other natural disasters it is easy to look at an ideal built solution after the fact, but impossible to execute and implement this solution in real time when needed.  We need operational flexibility and creativity, spaces that allow for this, and a shared knowledge of what we have and how it can be used.

Standardized asset tracking and documentation across different healthcare systems – a common language and open coordination – are at the core of this need.  We need to be efficient and smarter with what we have.

The new normal starts with this.

 

Troy Steege, AIA

Troy Steege, AIA

Vice President | Senior Project Manager Healthcare Team

troy.steege@zastudios.com

Mr. Steege is a Wisconsin Licensed Architect, Senior Project Manager and Project Architect, specializing in healthcare project management, planning and design. His experience includes management of integrated project teams, fast-track delivery, and target value design, with a project focus upon healthcare campus master planning, hospitals, surgical and diagnostic centers, medical office buildings, and senior living facilities. Troy continues to push for development in the profession, with a focus upon research, and outreach opportunities to connect healthcare systems, industry, and academic programs.  He has a proven record in developing and managing large scale, business critical design and construction projects.