The trend away from large institutional buildings is almost complete, said HASSELL in a 2014 paper titled ‘Future Directions in Design for Mental Health Facilities’. When you dig deeper, this statement is not too dissimilar from Lyons Architecture director Corbett Lyon’s keynote presentation at this year’s Health Care / Health Design forum, where he noted that healthcare design was “moving beyond the functionalist model” to display demonstrable benefits to the healing process.

That healthcare projects should be designed to maximise the well-being of patients and staff is not new, although this ideal has become clearer in recent years as more practices ensure their designs have a positive effect on a person’s ability to recover. HASSELL’s Shoalhaven Cancer Care Centre in Nowra, NSW for instance, swaps the institutionalised healthcare diagram for a more informal and personalised space.

The Centre’s direct engagement with its landscape will create a positive healing environment, while a simple facility floor plan orientates people towards an outdoor central courtyard. Photography by Michael Nicholson

The Fiona Stanley Hospital Mental Health Unit in Perth, another project by HASSELL, Silver Thomas Hanley and Hames Sharley, also features a design that seeks to provide a calm sense of normalisation. According to HASSELL’s Mark Black, this guiding aim prompted the team to create “safe, secure and usable courtyards with effective connection to the surrounding natural landscape”.

Left and above: Fiona Stanley Hospital Mental Health Unit by the Fiona Stanley Hospital Design Collaboration is in the race for the Australian Institute of Architects' WA Architecture Awards. Photography by Peter Bennetts.

"These spaces were draped in a single, large and gently undulating curved roof which floats over the whole facility to unify the plan form, with openings cut out in direct response to the need for courtyards, daylight and planning," said Black.

But what does ‘good design’ in the healthcare setting really look like? Canadian architect Tye Farrow equates ‘good’ to ‘cause health’, which he says can be unlocked with five vital elements that can be translated to all building aspects, such as nature and vitality.

A large but often forgotten part of this equation is flooring, which contributes as much to a centre or facility’s aesthetics as its walls, lights and furniture. For Angela McGregor, Marketing Communications Manager at Shaw Contract Group, these benefits include helping to provide comfort for those being treated as well as those operating and working within the facility.

“Flooring through design also assists with designating areas and provides way-finding within a healthcare facility,” she says. “In the case of a mental health facility the use of certain colours can guide patients from one area to another calmly. These colours can also be used to designate high traffic and low traffic areas – signifying areas of activity, quiet and stillness.”

Left: Quakers Hill Nursing Home by Jen White Design uses Shaw Contract Group's broadloom carpets. Right: Olivia Newton John Cancer & Wellness Centre by Jackson Architecture & McConnel Smith Johnson featured different flooring types for different spaces. Images: Shaw Contract Group

Of course, functionality cannot play second fiddle to aesthetics, and an understanding of the demands that would be placed on the finishes utilised in a particular environment is just as important. Slip resistance, durability and hygiene are essential qualities in health applications, where flooring must be able to withstand the push and pull of equipment and soiling without requiring tedious maintenance.

According to the Australasian Health Facility Guidelines’ (AusHFG), an initiative of the Australasian Health Infrastructure Alliance (AHIA) that sets the specifications for the base elements of health facilities, these elements should add up so that flooring for healthcare is ‘fit for performance’.

The 2009 TS7 ‘Floor Coverings in Healthcare Buildings' proposes that this definition covers both the physical and functional performance of the product and design, as well as factors like acoustic control, level of toxicity, colour, texture and comfort.

“The use of colour, pattern and texture for practical purposes is particularly relevant in flooring, and is used for the following outcomes,” the Guide says:

maintain appearance and improve service life by reducing the unwanted effects of staining and marking
provide an interior environment that assists the intended outcomes, e.g. healing, ‘home like’, stress reduction.
create designs that identify, unify or separate spaces, and add aesthetic and functional value
serve as a way finding device for general use or for specific user profiles, e.g. patients with dementia.

“You could think of the [healthcare] building as a small community with its reception area, staffing areas, treatment areas, food and beverage areas, high care and low care areas,” advises McGregor. “For each of these areas the key considerations can be broken down into these different categories:

Area function
Patient and visitor safety requirements– slips, trips and falls
The needs of special user groups
Acoustic and aesthetic considerations
Infection and odour control
Staff safety – OHS and manual handling
Maintenance

“Working through these key considerations for each area will ensure the flooring selected is fit for purpose.”

Key aesthetic considerations in selecting the right flooring

Looking specifically at how the look of a floor can affect patients, architects and designers must first understand the effect different flooring patterns can have, particularly in mental health or rehabilitation facilities. High contrast colours for instance, combined with strong graphic patterns, may be visually disorienting to some patients, and can create feelings of confusion, unsteadiness or instability. Free-flowing, organic patterns however, may contribute to feelings of well-being and reduce uneasiness.

In general, light colours reflect more light, but could deteriorate in appearance more rapidly. Darker colours can absorb downward lighting, while pure or bright colours will show staining more than their duller counterparts.

“Colour and pattern selection appropriate for a patient bedroom area or a corridor would be unsuitable for an operating room where sharp visual contrast is required for the rapid identification and recovery of small dropped items, such as micro surgical needles,” the NSW Health guidelines note.

“Inappropriate patterning and floor patterns can create a risk for some users by causing disorientation, dizziness or impeding movement and can adversely affect intended outcomes or the tolerance of occupants, to the point of requiring early replacement. The successful use of colour and pattern is a design skill requiring the services of professionals with healthcare experience in collaboration with appropriate healthcare staff. An unsuccessful design or selection can result in costly and disruptive replacement.”

Polyflor's Horizon Blue 5208 used in a treatment room

UK Market Manager John Mellor of Polyflor suggests in an opinion piece that using flooring with a matte appearance could cut down on glare. He also says that designers in dementia or aged care environments should stay away from glossy surfaces that could be perceived to be ‘slippery and wet’, which could lead to anxiety and change the gait of patients. Shaw Contract Group’s McGregor adds that carpets can also absorb light, cut down on glare and ease eye stress and patient anxieties, while offering noise reduction.

What products are to be selected, in what designs, patterns and colours, and at a deeper level, with particular appropriate fire hazard properties, methods of joining, and dirt retention and control, are dictated by a space’s purpose. Surfaces with a raised profile or heavy texturing, for example, should not be used in areas where wheeled traffic is expected, but is recommended for floor safety in areas such as central kitchens and wet areas.

“Consider the lifestyle, the overall feel you want in your project, research products that are fit for purpose and that they will provide sustainable slip resistance where required, the abrasion level of the flooring and wear layers, the ease of cleaning and ongoing cleaning and maintenance costs,” concludes Polyflor’s National Technical Manager, Damien Ryan.

“The best way to approach these design areas is to decide on a style i.e. clinical or relaxed environment and research colour trends and how colours effect emotion especially within mental health.”

To find out more visit the Australasian Health Facility Guidelines.

Geraldine Chua

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