Building Direct Connection to the Out of Doors

Modifying hospitals’ designs by humanizing spaces and reconnecting with nature offers therapeutic support that can positively impact the patient’s psychological and physical well-being; it can also measurably improve their ability to recover.¹⁹ International studies have confirmed that 95 percent of patients and families exposed to direct contact with nature reported lowered stress levels, more positive thoughts, and increased coping ability.²⁰ In addition, plants in rooms and rooftop gardens in hospitals improved patients’ psychological response to treatment, with lower levels of pain, anxiety, and fatigue.²¹

Stephen R. Kellert and Elizabeth F. Calabrese define Biophilic Design as “the deliberate attempt to translate an understanding of the inherent human affinity to affiliate with natural systems and processes—known as biophilia—into the design of the built environment.”²² There are many ways to incorporate biophilic elements into a building’s design – through a visual connection to the outdoors, incorporation of natural elements, or by directly expanding the boundaries of indoors to the outdoors. Rooftop and patio deck systems offer an exceptional opportunity to incorporate biophilic design elements and sustainability goals.

Including access to the outdoors, decks, or patios, can connect guests to the surrounding environment using natural materials, such as wood and stone, and foster the incorporation of vegetation and greenery into an individual’s regular routine through the use of planter cubes and pots. Regular interactions with the outdoors are proven to have positive health benefits for everyone—staff and patients alike—such as lower blood pressure, reduced stress, expedited healing, and improved mood and focus. These areas can also provide occupants with the opportunity to release tension through recreation, sport, and physical activity, thereby improving users’ focus, health, and morale. For staff, offering natural spaces onsite increases productivity, with lower illness and absenteeism, better staff retention, and job performance.

New products are helping to remove barriers and facilitate the development of natural spaces within healthcare settings. Adjustable pedestal deck systems provide a unique alternative to traditional deck building methods that deliver tremendous design flexibility, coupled with ease of installation. Pedestal deck supports are designed to elevate a variety of substrates, including granite or concrete pavers, wood tiles, composite materials, fiberglass grating, or conventional wood decking systems. These systems are available in a range of heights and weight-bearing capacities to suit a variety of applications. The pedestal system is one of the most labor- and cost-efficient methods of creating a flat, level deck over a sloped sub-surface. They also open the opportunity to use underutilized outdoor spaces, turning an otherwise wasted space into a functional outdoor amenity.

Modular pedestal decks create distinctive opportunities to capture nature in design. Pop-Up Parks can be used to reclaim car-designated zones in urban areas. Pop-Up Parks vary in size from a one-car parking space of about 150 square feet to many spaces linked together, to a whole block or lane. Installations include pedestal supports with wood tile, stone, or concrete paver surfaces covering the existing pavement. Popular accessories include attachment hardware, planters, railing, and benches. Some manufacturers offer all the built elements required for a Pop-Up Park installation. This creates a smooth installation as well as offering a consistent warranty for the entire system.

Modular decking transforms balconies and rooftops swiftly into outdoor decks, affording living space with a direct visual and material connection to nature and a peaceful refuge to rejuvenate the body, mind, and soul. A deck’s sweeping views of the encircling landscape allow patients and staff to visually survey and contemplate the surrounding environment. These broad landscape views inspire an emotional attachment to the building’s natural surroundings and promote positive interactions between the building’s users and the neighboring ecosystem.

Photo credit: Kyle J Caldwell; courtesy of Bison Innovative Products

A growing body of evidence suggests that certain design features, including access to daylight and nature, facilitate key benefits in healthcare.

Photo courtesy of Bison Innovative Products

Versatile pedestals, pavers, and site furnishings offer the design flexibility to create unique and beautiful rooftop environments. Independently tested, modular deck systems allow rooftop decks to be installed quickly and easily.

Deck support systems are impervious to water, mold, and freeze-thaw cycles. Pedestal systems can support decks over occupied space, allowing cavity space for electrical systems, ductwork, and irrigation. Pedestals also elevate the deck surface to meet the threshold, delivering an even and level transition from one space to another. This allows easy access for patrons with different levels of mobility. Being a gravity system, the supports do not penetrate the substrate, and therefore protect roofing membranes and waterproofing and do not damage or harm the surface below.

Modular deck systems contribute to sustainable design goals and may help projects earn certification through LEED, SITES, WELL, and other green building design initiatives. Pedestal decks can help to reduce a building’s carbon footprint through a reduction in a roof’s ambient temperature, potential for green space, rainwater collection initiatives, and reduced need for roof replacement, avoiding additional construction materials. Where wood tiles are specified, verify the availability of FSC-certified species. Paver trays provide simple, lightweight, and durable support for porcelain, natural stone, and concrete pavers. Paver trays made from galvanized steel meet the testing requirements for non-combustible surface materials. The paver support trays are designed to enhance the impact and wind uplift resistance and provide additional strength to paver surface materials. Paver trays can be adhered to the desired surface pavers on site before or during installation. Planter cubes integrate with walkways in a modular pedestal deck system, making it easy to design a beautiful outdoor environment. Available with standard irrigation sleeves and drainage holes, cubes can host plant life in the summer and be repurposed for seating and storage in the winter.

THE UNSEEN VARIABLES: ACOUSTICS, IAQ, SAFETY, AND HEALTH

There is now a significant body of evidence that shows the physical environment is a critical component in any program to improve safety and comfort for patients and provide a safer working environment for staff.²³ The physical environment in which people work and patients receive their care is one of the essential elements to resolving preventable hospital-acquired conditions. EBD demonstrates that the physical environment in which patients are cared for and in which caregivers work has a measurable and quantifiable impact on them.

Assuring safety is a must. Along with safety, hand-in-hand come the attributes of an enhanced indoor environment, including acoustics.

One of the most significant aspects of a healing environment is acoustic comfort. When considering a healthcare setting as a holistic whole, managing sound becomes extremely important. Noise affects patient safety and health and is an important part of the patient experience. The noise from equipment, patient intake and discharge areas, nurses’ stations, and common areas, plus the regulatory requirements for patient privacy, all point to the need for the mitigation of sound transmission as a critical aspect of design. Patients often complain about noise levels during their hospital stay, but there are many interventions, such as stone wool acoustic ceilings with high Noise Reduction Coefficient (NRC) ratings and high STC-rated partitions made using CLD gypsum panels, available to support a healthier and more comfortable environment.²⁵ EBD research indicates that proper sound control can increase patient sleep and recovery, increase patient and staff safety, improve patient privacy and dignity, and relieve caregiver stress while increasing job satisfaction.

Achieving optimized acoustics can be refined to three practices: first, selecting a ceiling system to optimize acoustic absorption, then, using walls, floor slabs, or plenum barriers to effectively optimize sound isolation between rooms. Finally, designs need to ensure that the background sound level is within the desired range. Soundscaping can also add positive and desired sounds to the care environment to aid privacy, wayfinding, positive distractions, and biophilia.

Photo: ©Michael O’Callahan; courtesy Rockfon

The material elements of a healthcare environment are just as critical to ensuring positive patient outcomes.

Photo: ©Kyle Jeffers; courtesy of PABCO Gypsum

When considering a healthcare setting as a holistic whole, managing sound becomes extremely important. Acoustic comfort is one of the most significant factors in healing environments.

New Options in Acoustic Control

The Facility Guideline Institute (FGI) provides recommendations for STC ratings and other acoustic criteria. STC ratings measure the effectiveness of walls in reducing sound transmission from one space to another. STC ratings for a specific space need to be determined before partitions are specified. Wall systems with an STC lower than 35 are considered poor sound barriers while those with an STC above 55 are considered very good. To meet these higher STC ratings, products such as gypsum board partitions require enhancements beyond what conventional products provide.

Constrained layer-damped (CLD) gypsum panels are an alternative product that provides excellent acoustic performance while integrating more easily into standard construction. CLD panels contain a viscoelastic polymer layer that allows the gypsum layers to independently shear, dissipating the acoustic energy of the sound wave. This results in less audible energy passing through the board, in essence, reducing the sound transfer between rooms. CLD panels achieve higher STC ratings at a lower installed cost than other sound reduction options such as resilient channels, sound isolation clips, and using multiple layers of gypsum. This also decreases the chance of improper installation that will negatively affect acoustic performance. STC performance with CLD panels also is not affected by headwall systems and mounted fixtures. Critically, CLD can achieve both tested STC performance and UL/ULC fire-rated walls in one design. Furthermore, specialized CLD panels can meet additional criteria, including high impact, mold-resistant, radio frequency (RF) shielding, and low-frequency control.

“CLD panels excel where it matters most, creating quiet environments conducive to healing and enhanced speech privacy in a simplified manner,” says Ben Shafer Sr. Acoustician, Research and Applications, PABCO Gypsum. In addition to designing for noise, architects need to address mold concerns. Breathing mold-contaminated air can cause severe health issues for hospital patients, personnel, and visitors. Because the campus buildings are equipped with HVAC units and plumbing running through plenums above ceilings, this may increase the risk of mold growth. Mold-resistant CLD panels are an option to treat areas above ceiling height and mitigate mold concerns.

CLD panels also save on installation time, reduce installation steps, and help control labor costs. Certain CLD panels also allow installers to easily score, snap, hang, and finish the drywall like standard gypsum wallboard. With no paper or metal in the center of the panel, the drywall delivers the desired acoustic performance with improved workability.

Photo courtesy of PABCO Gypsum

Specifying CLD panels not only secures better noise control, but these panels can also save on installation time and reduce installation steps.

Photo: © 2023 James Steinkamp Photography; courtesy Rockfon

Stone wool ceiling tiles designed for healthcare environments can meet ISO Class 4 standards for low particle emissions and exceed FGI guidelines. They can inhibit the growth of MRSA and are tested per ASTM D4828 for washability, ASTM D2486 for scrub resistance, and ASTM D1308 for chemical resistance. These tiles can also offer excellent sound absorption of up to NRC 0.90, promoting a healing environment.

Photo: Fotoworks/Benny Chan; courtesy Rockfon

Stone wool tiles perform for areas requiring high cleanliness, offering sealed edges to prevent particle ingress and maintain clean room standards. Stone wool tiles can also provide high light reflectance of up to 83 percent, contributing to brighter spaces and energy savings.