Meeting of the Minds

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January/February 2003

By C.A Wolski

The nourishment gazebo and Japanese bridge bring serenity to the center's atrium.

When the administrators at WakeMed, Raleigh, NC, decided to upgrade its rehab facilities, they scrapped conventional rehab models for something that looked less like a rehab center and more like a community center.

Deborah Friberg, MBA, PT, senior vice president and executive director of WakeMed Rehab, says part of the motivation for the new facility was to continue to develop inpatient and outpatient capabilities, but they also wanted to offer to the community state-of-the-art services “in settings that really did recognize the rehabilitation process, the dignity of the person in need of rehabilitation services.”

The resulting $8.9 million, 43,000-square-foot facility has banished health care’s traditional fluorescent light and white walls for skylights, plants, and a Japanese bridge, integrating beauty with a multipurpose, fully functioning rehab space.

The new space—an extension of WakeMed’s existing campus of buildings—was designed to fill a vacuum in its rehab services and motivate patients to continue their treatment, says Lisbeth Gierman, LCSW, CCM, director of administrative and therapy services.

“What we were lacking was a place for our patients, both inpatients and outpatients, to be able to experience not just simulated home environments or simulated community environments, but real home and community environments,” she says. Previously, WakeMed staff spent a lot of time taking patients out in the community to practice in “real” environments, she says. The new building has allowed them to give people the opportunity to practice very real scenarios without the same level of potential embarrassment, allowing them to “fail” in a very safe environment. Then, she says, when patients go out into the community, they have practiced exercises enough to feel confident in real-world settings.

The design process for the Health Park began more than 6 years ago, with trips to other rehab facilities that had a community-focused theme. It involved everyone who had a stake in the success of the private, nonprofit facility’s rehabilitation program, including medical staff, clinical staff, patients, families, and support groups.

During the brainstorming sessions, the building’s architects, from FreemanWhite Inc, received the inspiration needed to realize the project. Will Bethune, AIA, principal and senior health care designer at FreemanWhite, says that in one of the meetings, Raymond Champ, president and CEO of WakeMed, was asked what his vision was of the new facility. “Make it grand,” he replied. This response, Bethune says, “helped me get something in my mind that was bigger and different from what they were thinking about a year before.” What emerged from the various surveys and brainstorming sessions was a wish list of services and features from both staff and patients.

A key feature in the design philosophy was to make the building a multipurpose structure, while catering to patient needs for a long period of time. “We went after larger spaces, so that, if we have to convert something in the future, each one of our spaces is a very good size and can be modified to suit a different purpose,” says Friberg. She adds that the only space that will probably never change is the park space.

FORM FOLLOWS FUNCTION

When the project was turned over to FreemanWhite, the 220-person firm, which includes former hospital CEOs, administrators, and nurses, was aware that its design would be impacting people’s lives.

“We wanted to make sure that we were creating an environment that was noninstitutional, that was very pleasant and homelike and encouraging and supportive,” says Frank Brooks, AIA, ACHA, director of health care and managing principal of FreemanWhite. “So much of that has to do with finishes, colors, and light, and how you integrate [these aspects] into a comprehensive whole. We were able to take all of these diverse elements and put them in a context that integrates them into one thing—the Health Park.”

At the cooking cafe, patients can develop skills in dietary practices.

Aiding the design and, later, the 18-month building process was the fact that FreemanWhite has a long history with WakeMed, having developed the hospital’s master plan and designed the additions that ring the original core structure. The exterior of the Health Park pays homage to the rest of the buildings on the WakeMed campus, made of a combination of pale and dark red brick and glass.

The inside, which has little thematically to do with the exterior, presented Bethune with a more difficult problem. Because many patients have head injuries and other problems, he wanted to make the center easy to navigate. To do this, the architects created the central indoor park with other spaces “spinning off of it,” he says.

“Beyond that, I think the most successful thing we did was work functional [features] into this park in a pretty transparent way,” he adds. “It had to have ramps, it had to have different walking surfaces. It had to have a track, a clock.”

What challenged Bethune, he says, is incorporating features such as a bubbling brook, plants, a boat on springs, and a putting green, without them looking “silly.” He accomplished this by establishing a framework with columns, which gave the space some symmetry, and then he “let the inside just really play off my imagination,” he says. These imaginative turns are seen in the 45-degree cant of the skylight and elevator and free-form designs such as that of the edge of the putting green.

An added burden to the health care facility designer is that many people are usually involved in the design process. With WakeMed, however, Bethune says he had the best of both worlds because of the client’s interest in the project and the firm’s long-standing relationship with the hospital. “I used to trick [clients] into buying good design, but nowadays they’re pushing us as much as we’re pushing them,” he says. Bethune adds that one of the things he likes about health care design is that every project is a custom job.

The new Health Park reflects a change not just for WakeMed, but in overall institutional design. “When I started doing this, the design was the exterior of the building and the lobby for the most part and that’s where the intensity of the design stopped,” says Bethune. “And now it’s everything.”

The finished product has been not only a hit with staff and patients, but a point of satisfaction for the architects. “This is very customized, very specific to the patient’s needs,” says Brooks. “We’ve raised the bar with this particular addition to the rehab program, and [WakeMed] has every intention to meet that level of care throughout the rehab facility and the hospital.” The firm has also received professional accolades for the Health Park at WakeMed, winning this year’s Grand Prize Award for Modernization from Building magazine.

HEALING SPACE

Though the façade of the Health Park is thoroughly modern with its multicolored brick and metal columns, it is obviously the interior that is of prime importance. The core design element is the indoor central courtyard, which resembles a Norman Rockwell-esque park, open to the outside with a large skylight and complete with old-fashioned streetlamps, a rowboat in a small pond, and a Japanese-style bridge.

The park-like setting has a specific rehab function, with its walking track and bridge presenting different kinds of walking environments for patients. In addition, the new facility has a small general store; a cooking café, where patients can learn cooking skills and dietary practices; and a car to help rehab patients in real world environments.

“The park is the central focus,” says Friberg. “We basically told the architects, ‘Give me outside, inside,’ because even though North Carolina has very nice weather, we still don’t have 365 days of sunshine, and we needed to make sure that weather didn’t interfere.”

Health Park also includes a 68-bed inpatient unit and a health center, Healthworks, with state-of-the-art exercise equipment, a half-court basketball court, and a therapy pool. The center is available to both patients and employees, and includes changing areas designed so spouses or caregivers can help patients change clothing. Healthworks also offers numerous specialized programs in areas such as cardiac, geriatric, and multiple sclerosis wellness.

The space is also used by community support groups, for patients with conditions such as brain injury, stroke, and spinal cord injuries.

In addition, the Health Park has not forgotten children in the rehab equation. The children’s therapy area is disguised as a playroom with a playhouse shaped like a castle, mats and therapy balls in bright primary colors, and a climbing rope attached to a sky-blue ceiling.

The new space has not only expanded the structured activities available, but has inspired spontaneous rehab opportunities as well. For example, says Gierman, if patients say they like golf, “we can take them that minute to the putting green and practice their standing balance and eye-hand coordination. Those spontaneous things make it an interesting rehab experience for them, because it can become a little routine. Even though the repetition is important for getting your strength and your endurance back, if you can spice it up at all, that makes a huge difference.”

The Health Park offers rehabilitation to about 40 patients a day from the inpatient rehab unit. Patients run the gamut from small children to the elderly, with conditions ranging from orthopedic injuries to stroke paralysis to brain injuries.

MOTIVATING SPACE

Not only does the Health Park at WakeMed serve patients’ physical needs, but it caters to their psychological needs as well.

According to Gierman, the feedback from patients and staff has been very positive, with the Health Park fulfilling its design function of feeling like home to the patients. The psychological impact has been almost as powerful for patients as the physical one. “This building has allowed us to create environments that are beyond simulated ones, and that’s what we had to do in our heads when planning this building,” she says. “We don’t have to say, ‘Pretend there’s a car there and we’re going to transfer you from this chair to this chair.’ Instead we can say, ‘We have a real car, parked at a real curb, in a real street, so let’s go and do that. And let’s see how you would be able to transfer from your chair to the car, let’s see how you can make this automatic scooter in the grocery store work, so you don’t have to figure it out at the store.’ All of those things give people psychological power, because knowledge is power, and if they feel a little bit more comfortable, their psyche just gets that much stronger.”

The feedback from employees has been just as positive. “Our employees are very proud of our organization,” says Friberg. “They love it not only from the standpoint of their own personal gain, but they’ve been very proud of what WakeMed has been able to do in the arena of rehabilitation.”

PUBLIC SPACE

The central courtyard serves another purpose as well. It has become the face of the 568-bed hospital. “It’s a multifunctional space,” says Bethune. “If you just looked at it, you wouldn’t say, ‘There’s a rehab something or other.’ It’s specifically generic. I think we were very successful in disguising the therapeutic elements of that park.”

This has allowed the public to discover the needs and benefits of rehab in a non-threatening way. “We can bring people who don’t know anything about rehabilitation into the setting and we can walk them through and we can explain to them how someone with a disability might use this space to regain skills,” Friberg says. “The plus is that people start to recognize disability as a transition and a challenge, but not necessarily something you need to hide from. Rehab programs don’t get an opportunity very often to take their story to the general public.” Since the building opened a year ago, more than 6,000 people have toured the facility.

C.A. Wolski is associate editor of Rehab Management.

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January/February 2003