Initiating the process
Hiring a qualified health care interior designer is the single most important determinant to achieving a successful interior design program. The process of selecting the right firm starts with defining the project requirements through a request for qualifications (RFQ) document. Criteria for assessing a design firm’s capabilities may include the following:

• Education. Look for a candidate with a degree from among the 148 professional programs accredited by the Council for Interior Design Accreditation, formerly the Foundation for Interior Design Education Research (FIDER), or an interior designer with an equivalent college degree from a four- or five-year program.
• Training and experience. Actual health care design experience is the best kind of preparation for a hospital interior designer. A minimum of five years of health care interior design experience should be the standard requirement. Since there are virtually no interior design educational programs specializing in health care, on-the-job experience is critical. While there are professional development opportunities, such as several continuing education units (CEUs) in health care interior design, practical experience is a necessity.
• Certification. The American Academy of Healthcare Interior Designers (AAHID) recently offered its first advanced health care certification examination. The examination, which recognizes the distinct challenges and skills required in designing interiors for health care, is conducted in conjunction with the National Council for Interior Design Qualification (NCIDQ) exams for minimum competency. Because the NCIDQ exam does not specifically address health care interior design, an interior designer with only an NCIDQ certification is not necessarily qualified to provide health care interior design services. Seeking firms with employees who have successfully completed the AAHID exam will help to ensure a successful interior design program.
  • Licensing. Keep in mind that many states require licensing for interior designers. Be sure to check with your state and include licensing as a prerequisite in the RFQ, if appropriate. Once responses to the RFQ have been evaluated, send a request for proposal (RFP) that clearly defines the expected scope of interior design services to a short list of prequalified firms. The RFP should provide information such as an overview of the entire construction or renovation project, a list of the other major aspects and expectations (e.g., architectural, engineering, etc.), as well as specific responsibilities of the interior design firm. At this stage, the facility should designate a project owner or manager to oversee the various outside entities involved in the project.

Setting expectations
Once an interior design firm has been selected, the project owner should hold regular meetings with the professional services providers, medical planners, vendors and other key team members to discuss the importance of partnership and communication. For example, interior designers must collaborate with architects on the selection and implementation of furniture, finishes, millwork and lighting. They also must coordinate with mechanical, electrical and plumbing (MEP) engineers on many of these decisions, such as how electrical and lighting components need to support furniture or workspace choices.

The project owner and interior design team proceed with developing a work plan and deliverables. This stage is identified as the schematic design phase. At this juncture, the crucial task of defining terms and expectations—also known as visioning—takes place.

An exercise that matches words with visuals is a way for the interior designer and project owner to agree on how a facility should look upon completion. From a long list of descriptive words and phrases like “high-tech,” “warm and inviting,” “friendly” or “comforting,” the owner selects several options that best address the facility’s needs and his or her vision of the project’s end result. For each selection, a picture corresponding to how the interior designer “sees” it is shown to the project owner. This ensures, for example, that both parties have the same interpretation or definition of what the shared vision looks like.

Another schematic design phase activity could include visiting other facilities that reflect the owner’s concept. Visioning should also consider the characteristics of the local community to ensure that is reflected in the design.

Once the design and project management teams have reached an agreement on how the completed project will look and feel, preliminary design concepts and budgets are developed for approval. Based on owner feedback, budgets are then finalized and developed as the agreed-upon initial design concepts start to take shape during the design development phase.

Deciding on furniture
At this point, interior designers turn their attention to the product category that influences virtually every practical and aesthetic consideration in health care interior design: furniture. Initial questions to be answered include: How many people must be accommodated? What types of patients must be accommodated? How much square footage is available in each space requiring furniture? Are there special furniture sizing or upholstery requirements?

Interior designers generally start by considering numerous furniture companies and their products. Because of furniture’s centrality to every aspect of an interior design program, manufacturers should be carefully reviewed. Qualifying criteria to address with potential furniture vendor-partners include:

• Warranty evaluation. What does it cover and for how long?
• Ownership and financials. Who owns the company, and is it financially strong?
• Commitment to health care. Does the company have a team dedicated to the health care market? If so, how many years has it been in the health care market? What is the breadth of the company’s health care product line? Does it have ongoing design and development initiatives for health care? Does the company conduct market research with health care facilities? Does the manufacturer hold contracts with major health care group purchasing organizations?
• Product quality and reliability. Is the company able to support furniture that is structurally safe for health care and high-traffic use? Do products meet local, state and federal health care codes and flammability requirements?
• Manufacturing and distribution. What is the manufacturing capacity for health care products? What is the average manufacturing lead time? Does the supplier have a plan to ensure continuity of manufacturing in the event of a disaster? Is its manufacturing operation International Organization of Standardization (ISO) certified? Is infrastructure in place to support national distribution of products and services?
• Customer service and support. What are the company’s customer satisfaction ratings? Is information available 24/7, online or over the phone? Does the company provide training on its products? Is on-site support readily available? What is the average service response time? Does the company provide product liability insurance? Can it provide product samples and literature?
• Flexibility. Are there minimum order requirements? What leasing options are available? Based on these considerations, health care interior designers will typically select three companies to provide furniture samples for the project team, and potential users such as nurses and staff, to evaluate. Furniture layouts are now ready to be coordinated with architectural and electrical plans.

Bringing vision into focus
During the design development phase, interior designers continue to take steps to set expectations and minimize surprises. A mock-up room provides the most effective way for the project owner to see what to expect upon completion.

Developed in an open room at the facility or an off-site location, mock-up rooms display different configurations of patient rooms, nurses’ stations and waiting areas, for review of both aesthetic and practical considerations. Mock-up rooms show, for example, if a patient room provides adequate privacy or the travel distance for a patient to move from the bed to the toilet.

The best way to analyze the mock-up rooms is to completely apply all proposed finishes and furniture. Depending on the mock-up size, the cost for full implementation can range from $25,000 to $75,000. However, mock-up rooms can be inexpensively constructed with cardboard and sheetrock to define the space without the cost of actual finishes. In either approach, it is imperative that all furniture, patient bed and equipment be placed in the mock-up room to allow the owner to evaluate patient flow and clinical processes.

The interior design process is so foreign to most health care staff that review of plans and elevations is difficult and confusing. A mock-up room is the best method of ensuring an understanding of the volume of space, room configuration, application of finishes, furniture size and function, lighting placement and function, and how the space will support medical procedures.

Lower-cost alternatives to mock-up rooms include computer-animated design (CAD) “flybys” or hand-drawn or computer-generated perspective renderings.

Once decisions have been made about all the interior design details—including furniture, lighting, electrical systems, and medical equipment—the construction documentation phase begins. Bids are prepared, solicited and evaluated in a process often handled by an independent project or construction manager. The project or construction manager oversees the coordination and procurement of construction, furniture, medical equipment, graphics, artwork and more to ensure the project is completed on schedule and on budget.

Final schedules and plans are then written and bids are accepted for final review and approval by the project manager. The process up to this point, depending on the size and scope of the job, can take from three months up to three years.

Moving to completion
The interior design program now transitions to the construction administration stage. Designers focus on responsibilities like managing furniture status reports, attending construction meetings and developing punch lists of necessary corrective actions. Other activities include responding to architects’ requests for information about finishes, lighting and other interior design issues, making periodic site visits, and overseeing the installations of furniture, soft goods, plants and art.

Finally, the project is complete. Within several weeks of completion, the interior design and project management teams should conduct a post-occupancy evaluation. There are three primary questions to be answered during this meeting:

• Does the interior design function well in every regard?
• Did the project meet the owner’s expectations? And, if not, why and how can it be improved?
• Are there any changes necessary to achieve desired function and aesthetics?

Over the next several months, designers should periodically check with users to ask how the space works for them and if any modifications are necessary.

A successful interior design program contributes to the vitality and viability of a health care facility. By conducting a thorough search for a qualified, professional interior design firm that specializes in health care projects, developing a comprehensive interior design plan and selecting the right vendor partners, health care facilities can help ensure their interior design program maximizes benefits to their patients and families, employees and their bottom lines.

Louise Nicholson Carter, AAHID, IIDA, is principal and founder of Carter Design Associates, Houston, and a founding member of the American Academy of Healthcare Interior Designers. She can be reached at louise@carterdesignassociates.com. Deborah J. Breunig, R.N., is vice president, health care market, for KI, Green Bay, Wis. She can be reached at debbie.breunig@ki.com.