Tag Archives: The Center For Health Design

Helping Hand

By Debra Levin | April 30, 2018

It’s hard to watch the news these days. Although there’s more good than bad in this world, when bad things do happen, causing substantial loss and leaving sadness in their wake, we might feel overwhelmed and helpless. But as healthcare design professionals who contribute to shaping our communities and buildings, there are ways we can help prevent devastating events from occurring.

One area where we may lend our expertise is the mental health arena. Far too frequently we’ve watched people of all ages go on violent rampages that leave innocent people dead. We look for answers as to why these tragedies happen and ways they might have been prevented. In some cases, the person was acting out of hatred to create terror and fear. But in others, it’s about people hitting a breaking point—and there are opportunities along that person’s path where intervention could have made a difference.

The Center for Health Design believes that creating appropriate environments for those interventions is critical. To that end, we’ve launched a new toolbox with a library of behavioral health design resources. With generous sponsorship from industry partners, this toolbox is open and free for all to access and use.

During our year of work creating this toolbox, we found there’s still little research on the impact of the built environment on mental health despite the great need for investment in it. Behavioral and mental health conditions affect one in five adults in the U.S. each year and are even more common among patients receiving care for medical conditions. Up to 45 percent of patients admitted to the hospital for a medical condition or presenting to the emergency department with a minor injury also have a concurrent behavioral or mental health condition. These comorbidities increase the risk that psychological harm may occur during care.

Providing these patients with a healing, therapeutic environment should be an important goal for this industry, with design interventions aimed at improving the psychological well-being of patients. These efforts may be more cost-effective than they initially appear, too, because they can be leveraged to support improved well-being for all building users, including staff.

More than 20 resources are available in The Center’s open-source toolbox, from a deep-dive issue brief and executive summary prepared by our research team to interviews with topic experts. There are also project briefs that
illustrate what others have done, as well as a tool titled “Design for Behavioral and Mental Health: A Universal Approach & Benefit Analysis,” which helps project teams consider the broader impacts of design and incorporate them into an evidence-based design process. Plus, there are eight webinars relating to this topic that can be used for AIA/EDAC continuing education units.

Behavioral and mental health isn’t always an easy subject to talk about, but it’s important that we have these conversations to identify the best ways to take care of our communities, keep members safe, and help people thrive and be well. The Center is deeply invested in these issues and will continue to build out this toolbox with resources to help you be an effective advocate in your area.

Debra Levin is president and CEO of The Center for Health Design. She can be reached at



Posted on 03/29/2018Jane Rohde


Evidence-based design was developed and supported by The Center for Health Design (The Center), which is currently celebrating its 25th year as a non-profit organization. The Center is based on promoting research, education, and advocacy for the design of successful healthcare environments and has developed various “toolboxes” and issue briefs as resources for using EBD principles for innovative solutions.


The Center has recently released a Behavioral & Mental Health (BMH) Toolbox, which has been developed because 45 percent of patients admitted to a hospital for a medical condition or who visit an emergency department also have a concurrent BMH condition. This toolbox is complementary to the addition of a chapter on substance abuse treatment centers included in the 2018 Guidelines for Design and Construction of Residential Health, Care, and Support Facilities.


  • A homelike, de-institutionalized environment supportive of patient autonomy and control over a personal environment
  • An environment that is well-maintained and well-organized
  • Noise control
  • Support of privacy
  • Access to daylight and views of nature
  • Physical access to the outdoors
  • Support of personal safety/security
  • Support for social interaction
  • Positive distraction

This listing of design strategies is applicable to all types of healing environments and can work for emergency rooms, outpatient settings, and hospitals. These approaches continue to be successfully utilized in senior living settings including memory care facilities, providing not only positive outcomes for residents but also staff, family members, and visitors. It is time for the crossover and integration of all environments that provide care, support, and services to consider the complexities of the care populations being served and person-centered approaches for all constituents and stakeholders. 

Intimacy is not typically a term utilized when describing healthcare settings. However, an individual’s health and well-being are extremely personal. If design was approached from an intimate level—looking at each personal human interaction from the entry sequence through meeting with care providers, being admitted, family visits, and subsequent follow-up—it would provide context for developing smaller-scaled spaces with good acoustics, lighting levels to support various personal or group tasks, wayfinding systems, and the needs for respite in a quiet outdoor space or a sun room.


During programming and planning, we talk about the function of what occurs in an area or room but often do not address actual examples of personal interactions that may occur within a certain space. For example, let’s take a waiting room with tables, chairs, maybe a TV and possibly vending machines. Consider a scenario in which a couple arrives and is directed to a waiting room and a doctor comes out with sad news: a diagnosis of cancer for a loved one, a death of a friend, or the loss of a child. That waiting room is now a place where sad information must be delivered. An adjacent private space, an opportunity to have a glass of water, and access to the outside for a breather should be considered based upon the human interaction.

The waiting room isn’t just a waiting room—it is a place where a full spectrum of emotions from sadness to joy is delivered. It is a place where family members come together. It can offer overnight accommodations or it can be a place where a meal is consumed. Identifying the personal interactions allow for the design to be so much more than a waiting room but a place of comfort scaled to accommodate the privacy needs of patients’ family members and friends.

If this framework were utilized as a health and wellness overlay in a BIM model, think of what could be identified as conflicts; this could affect the size and scale of lobbies and amenities offered, the sizing of patient rooms, and simplifying point-of-service operational flows to accommodate staff. We think of BIM models as identifying conflicts with building systems but what if it were expanded to identify places of human interaction? This is a tool that helps address person-centered design based upon the research that establishes the framework for decision making and relevant design strategies to fulfill the intimate needs required of a space.

The Terasaki Research Institute, completed by Atelier Hitoshi Abe in Los Angeles near UCLA’s campus, exemplifies the need to address human interaction and caring. The institute focuses on organ transplants and wanted an innovative and engaging space. The beautiful interior atrium provides access to daylight supporting human interaction—learning, working, and holding public events within the space. Acoustics and seating arrangements were addressed to accommodate the various uses while supporting human comfort.

The utilization of openings throughout the two stories of mezzanines provides wayfinding landmark placements and opportunities for daylighting and engagement, giving the spaces a sense of place while connecting to the outside and vice versa.

To coin a new phrase, the “environmental program for human interaction” could become another way to support person-centered healthcare projects with human-to-human interaction being the evaluation and overlay in planning and designing healthcare environments of the future. 

Jane Rohde is the founding Principal of JSR Associates, Inc. located in Catonsville, Md.  The firm celebrates 22 years of consulting services in 2018. She champions a global cultural shift toward de-institutionalizing senior living and healthcare facilities through person-centered principles, research and advocacy, and design of the built environment. Clientele includes non-profit and for-profit developers, government agencies, senior living and healthcare providers, and design firms.  Rohde was the recipient of the 2015 Environments for Aging Changemaker Award and speaks internationally on senior living, aging, healthcare, evidence-based design, and sustainability.  For more information or comments, please contact Jane Rohde at or “Chat with Jane” at

Photography: Roland Halbe
Architect: Atelier Hitoshi Abe


A New Aim

In 2007, the Institute for Healthcare Improvementlaunched the Triple Aim initiative to tie specific actions for change to improved outcomes in healthcare environments. The result was a set of design concepts that supported a team-based approach to care and focused on improving the patient experience, improving the health of populations, and reducing the per capita cost of healthcare. A decade later, the Quadruple Aim was introduced, factoring the caregiver into the equation. It sought to restore a sense of joy and purpose to the work of being a caregiver, especially in an environment that’s traumatic at times.

Continue reading A New Aim

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