C H I L DR E N ' S H O S P I TA L O F P H I L A DE L P H I A MEDICAL BEHAVIORAL UNIT
C H I L DR E N ' S H O S P I TA L O F P H I L A DE L P H I A MEDICAL BEHAVIORAL UNIT
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F O R W A R D
With the highest standards of safety and dignity, this project set out to provide innovative, collaborative, integrated care that supports medical, emotional, and behavioral wellness with best-in-class patient, family, and staff experience.
The new Medical Behavioral Unit (MBU) at Children's Hospital of Philadelphia (CHOP) is the first of its type in the country. With no known precedent, CHOP pursued a vision to develop this new pediatric patient care unit—one that would meet the requirements and licensure of an acute care unit, and provide a safe and supportive environment for patients with a comorbid developmental, behavioral, or psychiatric diagnosis. The MBU is staffed by practitioners who specialize in treating this specific patient population, who range in age from age 3 to 18, and were previously treated in a general medical surgical unit. A multidisciplinary team led by ZGF worked together to envision, plan, and design a prototypical environment that would support a new model of care. The new 10-bed MBU is housed within a remodel of an existing unit on CHOP’s
main campus in Philadelphia. It provides a supportive environment with programmed spaces not typically found in an acute care unit, such as places for activities, relaxation, recreation, and sensory stimulation. It also includes safety and security features that will provide a more therapeutic and dignified environment for the patients.
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P R O G R A M
The new MBU is designed to create a welcoming and calming experience for patients and families.
Families are greeted at a reception desk, flanked by a floor-to-ceiling glass mural of trees, backlit with natural light penetrating in from the skylight in the family lounge beyond. The sculptural desk, recessed from the corridor, provides privacy at checkin. The 10-bed unit is organized into two neighborhoods with a playroom at the intersection. An open care team station in each neighborhood and decentralized care team porches between rooms provide visibility of the patient rooms and corridors. The neighborhood concept provides a way to aggregate patients by age or clinical
assessment. Each neighborhood has a meditation room for patients to self-soothe. Understanding that unexpected noises or visitors can be stressful for patients, an on-stage  / off-stage approach separates the service and staff areas from the patient room corridors. An existing skylight in the center of the unit was leveraged by locating the dining room, which also doubles as a multi-purpose activity room, and the family lounge beneath it.
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UNIT PLAN
CLINICAL
SPECIALTY 0’ 2’ 4’
8’
CLINICAL SUPPORT OFFICE
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10’
CIRCULATION BUILDING SUPPORT
TOP Open care team stations in each neighborhood offer visibility of the patient rooms and corridors, while a wood canopy and surround at care team porches adds warmth and interest to the hallways. RIGHT Patient rooms featuring nature-themed graphics and abundant natural light provide a sense of calm and connection to the outside world. A light source in the overhead canopy projects colored light—selected by the patient—at the footwall to change the room's appearance and mood. 9
RIGHT Each patient room depicts a unique natural element—a mix of leaves, flowers, and trees—that appears both as a large-scale photograph at the entrance and as a customized silhouette within. These graphics also serve as wayfinding elements to help patients and families easily differentiate between the rooms. 10
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P R O C E S S
The planning for the unit included a Lean process, shaped around an initial kick-off and visioning meeting followed by three integrated design events (IDEs).
ZGF worked directly with a diverse crosssection of the CHOP community, including their project management team, facilities team, medical directors, nurse managers, and specialists. Over the course of the IDEs, the team analyzed the current state, envisioned the future state, and tested macro- and micro-design concepts for the unit. The result of these workshops was a clear commitment to patient, family, and staff safety, as well as the development of a new model of care for this special patient population. Families and patients provided valuable insights regarding the planning and the details of the MBU, from public spaces to patient rooms. Through participation on the Youth Advisory Council, children helped define the nature theme for the unit—based on the notion that nature heals—and helped select the final graphic images. Mock-ups
provided the opportunity to modify the design in real-time with the contractor. The mock-up rooms were refined throughout the design process and used to test furniture and equipment, and resolve questions as they came up during construction. For the development of the circadian lighting system, the team collaborated with lighting designers, engineers, manufacturers, and researchers from Rensselaer Polytechnic Institute and Drexel University to determine the sequence of operations—the timing of color temperature and illumination levels—that would best reinforce patient and staff body clocks.
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LEAN PLANNING
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VISION AND GUIDING PRINCIPLES
To kick-off the Lean process, ZGF brought together CHOP facilities leadership, clinical leadership, and project management to identify the vision, goals, and principles that would drive the project.
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C U R R E NT STATE A N A LY S I S A N D F UTU R E STATE CONCEPTS The first of three integrated design events (IDEs) analyzed the current state and explored concepts for the future steps—identifying what works well and where opportunities exist for refined adjacencies, flows, and processes.
S C H E M ATI C: MACRO-DESIGN IDE 2 involved a macro-design of the overall MBU. Operational concepts and design requirements were tested in simulations and mock-ups.
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MOCK-UP Mock-ups of patient rooms as well as corridor care team stations, were developed early on to test the room sizes, layouts, and features. Mock patient events were also conducted— with team members acting the role of patient, family, and staff— to ensure that safety, patient, and staffing needs were being addressed.
D E TA I LE D : MICRO-DESIGN IDE 3 considered the micro-design of patient rooms at a micro-level. Design ideas were simulated in greater detail in order to refine and standardize concepts, and a patient safety workshop was conducted.
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E N V I R O N M E N T
A goal of this project was to find a way to make the unit safe and therapeutic, while also creating a calming environment for patients, families, and staff.
Recent research has identified a connection between the built environment and the health outcome of patients. Evidence shows that thoughtful design of the healthcare environment and connections to nature can promote and improve health and wellness for patients, staff, and families. This research formed the basis for the development of the program, planning, and interior design of the MBU. Single patient rooms and small patient neighborhoods provide privacy and reduce stress and feelings of aggression. Quiet corridors and natural light provide a sense of calm and a connection to the outside world. Throughout the space, color and environmental graphics with a nature theme provide a sense of optimism. The photographs used in the environmental graphics—relatable across cultures, genders, and age groups—help differentiate the
rooms, support intuitive wayfinding, and provide patients with a sense of ownership over their space. The colorful silhouettes of flora within the patient rooms are crafted from acrylic materials that subtly shift in hue depending on the viewing angle—a feature that adds playfulness without overwhelming patients who may have a hypersensitivity to sensory stimulation. Large silhouettes of trees also adorn the glass walls throughout consult rooms, multipurpose rooms, and playrooms. The translucency of the graphics applied to these rooms provides staff with the visibility to monitor patients, but enough opacity for patient and family privacy.
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RIGHT Biophilic elements are reinforced in staff spaces, including the staff lounge where care team members have the opportunity for respite.
FAR RIGHT A translucent glass-walled conference room features large silhouettes of trees—a graphic element that reinforces the nature theme and creates a sense of privacy for staff. 18
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Family Lounge
Patient Meditation Room
Dining Room / Multi-Purpose Activity Room Patient Playroom 20
RIGHT Family members and visitors wait in the family lounge, with its skylight and graphics depicting nature, prior to entering the patient rooms.
Patient Meditation Room
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E V I D E N C E - B A S E D
The connection to daylight is one of the most important characteristics in a hospital, particularly for patients who are often in their room for days, and sometimes weeks or longer.
When under medical care, patients can readily lose track of time and place. Timed and tuned lighting solutions can help right the body clock, as well as reinforce the passage of time. Research shows that daylight has particular biophilic benefits because of the natural variability of sunlight, based on solar position and atmospheric conditions. The circadian response to the changing light in humans affects body temperature, heart rate, and the production of melatonin and serotonin. The balance between them is linked to sleep quality, mood, alertness, depression, and overall health. Within the MBU, a specialized lighting system was developed and implemented in all patient and staff areas, and the corridors, to support circadian rhythms. The goal of this lighting system is to mimic the solar day and provide routine lighting exposure to
reinforce a body’s natural 24-hour cycle. The intensity and color temperature of fixtures automatically shift through a programmed and controlled time clock, which also features user override for maximum flexibility. Additionally, electrochromic—or electronically tintable— glass windows were installed in one of the patient rooms as a prototype, to provide custom control on the amount of daylight and glare coming into the room. Target metrics were established at the project’s onset to identify both clinical and experiential outcomes related to the new unit design and the new care model. Post occupancy evaluations are occurring as part of the ongoing research efforts, to analyze the health benefits that both the circadian lighting and electrochromic glass are having on patients and staff.
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LIGHTING ZONES
STAFF ZONES The majority of the MBU care team have daytime schedules. Staff interviews were conducted to understand a typical day; after which, lighting color and intensity values were aligned to match their work pattern.
PATIENT ZONES Lighting values in the patient zones mimic the solar day to reinforce the body clocks.
CORRIDOR ZONES Lighting values in the corridors mimic the solar day to reinforce the body clocks.
PATIENT STAFF CORRIDORS
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CIRCADIAN RHYTHM
S C H E D U L E
Specialized lighting combines dimming with color-shifting fixtures to support circadian rhythms for patients and staff. The lighting system seeks to remedy the disconnect between our natural upbringing and the novel environment in which we reside. We receive too much light at night and too little during the day. With the help of dimmed warm lighting in the evenings and cooler brighter daytime interior lighting, the design team sought to restore this balance.
2400 K 3000 K 3500 K 4000 K 4500 K 5000 K 5500 K 6000 K
6:00 AM
6:30 AM
7:00 AM
Overnight in the patient rooms, lighting is turned off to allow for restful sleep. Beginning at "sunrise," the lighting system turns on at a dim, warm level.
Midway through "sunrise," the intensity and color temperature of the lights slowly increased to mimic the beginning of the solar day.
By 7:00 AM, the lighting rises to peak brightness and color temperature values. This reinforces the connection between the body's clock and the solar day.
11:00 AM
3:00 PM
8:00 PM
Throughout the morning, the intensity and color temperature of the lights remains at a bright white value, as the lighting system continues to mirror the solar day.
Both intensity and color temperature decreases slowly in the "midday" and "evening" hours. These changes in intensity are gradual and nearly imperceptible.
At the end of the day, the lighting shifts to "sunset" to prepare for "nightime" settings.
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SAGEGLASS
SUNLIGHT SOLAR HEAT
SageGlass’ electrochromic coating consists of five layers of ceramic material. Applying a low voltage of electricity darkens the coating.
VISUAL + THERMAL COMFORT
SageGlass tints automatically or on demand to protect occupants from the sun's heat and glare while remaining transparent.
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E N E R GY S AV I N G S
Electrochromic glass can reduce cooling loads by as much as 20% and peak power demand by as much as 30%. HVAC systems can be up to 25% smaller in buildings where electrochromic glass is used.
GL ARE REDUCTION
SageGlass darkens to 1% of visible light transmission, blocking out 99% of glare-producing light. Thus, patient rooms can be darkened while maintaining the view to the outdoors.
TOP LEFT In one of the patient rooms, electrochromicglass was installed as a prototype, to allow control of daylight entering the room without requiring shades or blinds, thus maintaining the patient's connection to the outdoors.
LEFT In this second image, the electrochromic glass is activated, resulting in a tinted window that provides relief from glare without disrupting the view.
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S A F E T Y
The goal was to find the right balance between making the patient rooms and social spaces inviting, friendly, and "normalized," while following best practices for safe environments for behavioral health facilities.
The primary goal for developing this new prototype patient unit was to provide a safe, healing environment for this unique patient population and the staff that cares for them. These patients have behavioral tendencies that can pose safety risks to themselves and to staff. Planning, design, and material selections for the unit were all influenced by patients’ needs and with awareness of their sensory experience from the moment of arrival, through the transition spaces, and to the patient rooms and activity spaces. Using several patient scenarios, floor plan configurations were tested and planned to optimize effective care and efficient operations. Casework detailing, door hardware, toilet room accessories, and window treatment solutions were designed to protect patients and staff from harm. Examples of safety features in
the patient rooms include secured cabinets for medical equipment—including monitors and medical accessories, monolithic ceilings, tamper-resistant light fixtures, anti-barricade doors with ligature-resistant hardware, ligature-resistant air diffusers and plumbing fixtures, and tamper-resistant fasteners. Built-in family space with a family sofa that converts into a sleep space and a safe for securing personal belongings, was created so families feel welcome and relevant to the care team.
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SAFETY AND SECURITY LEVEL Ligature-Resistant Casework Hardware
Safety Windows w ith Polycarbonate Glazing
Wall Base Secured to Wall with Tamper Resistant Screws Impact-Resistant Gypsum Board Pick-Resistant Sealant or Caulk Tamper-Resistant Electrical Outlets with AFI & ARC Fault Protection
Monolithic Ceiling & Tamper -Resistant Light Fixtures Anti-Barricade Doors with Ligature-Resistant Hardware
Integrated Artwork and Graphics
Medical Equipment in Secure Cabinet
TV and Clock in a Secure Cabinet
TamperResistant Outlets & Fire Alarms
LigatureResistant Plumbing Fixtures
Integrated Blinds
TamperResistant Fasteners
LigatureResistant Air Diffusers
HIGH MEDIUM LOW
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TOP Because the patient population has behavioral tendencies that can pose risks to themselves and staff, room detailing—from materials and casework to selection of tamperproof hardware and ligature-resistant plumbing fixtures—was developed with safety in mind. 33
PROJECT TEAM
OWNER
C O N S U LTA N T S
L I G H T I N G R E S E A R C H A F F I L I AT E S
Children's Hospital of Philadelphia
architecture+
Drexel University Rensselaer Polytechnic Institute Lutron Electronics USAI Lighting
ARCHITECT / INTERIOR DESIGNER
BEHAVIOR AL HEALTH PL ANNING / SECURIT Y CONSULTANT
ZGF Architects LLP
Wick Fisher White
G ENER AL CONTR AC TO R
Keast & Hood
E L E C T R O C H R O M I C G L A S S R E S E A R C H A F F I L I AT E
L.F. Driscoll Company
STRUC TUR AL ENGINEER
SageGlass
MEP ENGINEER
AKF Group LIGHTING DESIGNER
PH OTO G R APHER
Metcalfe Architecture & Design
Todd Mason © Halkin Mason Photography
SIGNAGE / ART CONSULTANT
Jensen Hughes CODE CONSULTANT
Acentech ACOUSTIC / VIBR ATION CONSULTANT
C. Archer & Associates LOW VOLTAGE SYSTEMS ENGINEER
Corporate Security Services SECURIT Y
Healthcare Building Solutions MEDICAL EQUIPMENT PL ANNER
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