Huelat Parimucha Ltd. is leading the way in helping caregivers understand the value of creating spaces where all aspects contribute to a patient’s recovery.

Premier Business Partners:

Herman Miller

Caregivers are beginning to understand that one of the most important features of a healthcare facility can’t be held in the hand like a scalpel or administered to a patient like a drug. Nonetheless, it can make a demonstrable contribution to the health of patients. The interior design and architecture of a healthcare facility has taken on a greater role in the planning of most modern facilities in recent years. Huelat Parimucha Ltd. is one of the firms leading the way in helping caregivers understand the value of creating spaces where all aspects contribute to a patient’s recovery.   

Co-founder and Principal Barbara Huelat has written two books on the subject of evidence-based healthcare interior design, and says the firm’s expertise in this area has made it a partner in the ER One project. ER One is an initiative funded by the federal government to design an emergency care facility for the 21st century.   

Huelat says the Virginia-based firm’s origins began in 1991, when she and her husband left their executive positions with major healthcare design firms to start their own practice focusing on a more complete view of design. “We really wanted to focus on healing environments, not just healthcare design but, more specifically, healing designs that are a more holistic way of healing the whole body, and that’s not always possible with the large firms,” she says.

People-Centered Medicine
Huelat says the firm’s concept of a healing environment is based in the philosophy that medicine should be people-centered, no matter what the procedure or situation. “The holistic design really focuses on the patient and the person of the patient,” she says. “So, that would be the person’s physical condition, but also their emotional, their spiritual and their cognitive conditions.”   

Huelat Parimucha’s holistic approach considers not only the functional needs of the healthcare facility, but also the experience a patient has while receiving care. “It’s really a journey for the patient, whether they’re just coming in to have their appendix out or if it’s a more-serious journey,” Huelat says.    

Making patients feel comfortable and confident are the two major goals of this holistic design philosophy, and Huelat says they can go a long way toward helping a patient recover. “What the patient experiences has a lot to do with the environment and what they see in the environment,” she says. “For instance, a cluttered environment leads to the patient’s stress.”   

Taking away from patients’ stress are elements typically found in environments such as shopping malls and corporate lobbies. “We call them in the healthcare industry ‘positive distractions,’” Huelat says. “That can be anything from aquariums to art programs to music.”   

In terms of the practical side of design, Huelat says the holistic approach takes the need for easy navigation into consideration, and creates spaces where patients, family and staff can find their way around easily. She says creating landmarks out of elements like nurses’ stations goes a long way to accomplishing this goal. Cleanliness is another important element, and holistic design prefers materials that are durable and can be cleaned easily.

A New Way
The overall aim, Huelat says, is to make the healthcare experience “more human” for everyone involved. This is evidenced perhaps most prominently in Huelat Parimucha’s work on Project ER One. 

Project ER One is a government-funded initiative to develop a prototype emergency department that is “all-risks ready.” According to the ER One Institute, this means an emergency room that can be scaled to handle normal hospital ER traffic as well as mass casualties caused by a terrorist attack, an outbreak of disease or other catastrophic event. “This was an experiment to understand what an emergency room needs to be in the nation’s capital to respond to such events,” Huelat says.    

As part of that initiative, Huelat Parimucha participated in the Bridge to ER One program, a 10-bed prototype of the concept at Washington Hospital in Washington, D.C. Here, the firm was able to experiment with ideas that were untested in an emergency department setting, such as the use of silver ions in paint to prevent the spread of contagions. In the event of a biological attack, Huelat says, such measures will be necessary.   

“We know that when we had that anthrax situation in the Washington, D.C., post office, we had to shut that down for 18 months,” she says. “We can’t shut down the emergency room for the metropolitan area for 18 months.”

Reducing Stress
Huelat says the Bridge to ER One project incorporates many other holistic design elements, many of which are designed to cut down on one of the most counterproductive aspects of an emergency room – stress. Reducing the amount of stress patients and their families experience is especially important during catastrophic events, she says.   

“How do you get people who are in the midst of a crisis to be able to cooperate with the institutions if you’re terrified that you can’t find your loved one?” Huelat says.    

Dr. Michael Pietrzak was the initial director of phase one of the ER One project, and says Huelat Parimucha understood its goal thoroughly. “In an emergency department, you have a completely different concept than you do in a hospital where the healing environment has an impact on healing,” he says. “In the emergency department, it’s really about how much we can reduce their anxiety about being in an emergency environment.”   

The space’s color palette includes both warm and cool natural colors arranged in organic fractal patterns.  

Lighting in the ER has been designed to serve as both functional and mood lighting, with a special emphasis on preserving patients’ privacy, Huelat says. Other features designed to protect patients’ privacy include breakaway glass doors and special glass doors that become opaque at the flip of a switch.    

“We also specifically planned our lighting in conjunction with what needs to be seen, like hand-washing sinks,” she says.   

Reducing the amount of noise in the ER was another goal for Huelat Parimucha, one that Huelat says went a long way toward creating a less-stressful environment. “In emergency rooms, you hear everything, from the beeping monitors to the ambulance drivers’ radios,” she says.   

Although much of this noise is necessary for the benefit of doctors and nurses, Huelat says the firm could still take steps to cut down on the unnecessary noise that only adds to the feeling of anxiety and uneasiness. She says Huelat Parimucha associates spent a night in an ER to map out the noisiest areas. In the Bridge to ER One, a research prototype, poured rubber floors were used to cut down on the sound of footsteps, and acoustic ceilings were installed over the noisiest areas.   

Pietrzak says creating a more calming environment with better flow of activity has a positive impact on the caregivers, as well. “That will also have an effect on patient care,” he says. “If the workers are not feeling stressed from the fact that the environment is too enclosed and they are functioning better, typically the patients will also feel better and improve better.”   

Even though the interior design made up only a fraction of the work that went into designing the Bridge to ER One prototype at Washington Hospital, Pietrzak says Huelat Parimucha proved that “you could still create a calming and soothing environment at the same time you were putting a lot of protective features in it.” The Bridge to ER opened in March, and is currently in the research phase, headed by registered nurse Ella Franklin, as data about its efficacy is collected, Huelat says.

The Holisitic Process
Huelat says the design process at Huelat Parimucha begins with brainstorming. “The first thing we do is have what we call a visioning session, and this is a meeting with all of the stakeholders in the property,” she says.   

The initial brainstorming sessions can take multiple days, Huelat adds, because the firm believes it’s important to bring everyone together on the same page with the same goals.    

“This helps identify the vision and the mission for the project,” she says.    

Where Huelat Parimucha differs from other firms is its use of known evidence models to create design prototypes, Huelat says. This approach incorporates known visual cues staff is used to so they are not confused by new layouts. Designers and owners go through a design review checklist during reviews to ensure the designs are intuitive for staff, Huelat says.    

In the future, Huelat says the firm will always have to be looking to the cutting-edge of technology and consider how advances in medical science will affect its work. “Keeping up with all of this is a must, it’s not an option,” she says. “One of the things that helps us do that is that we continually educate ourselves and reeducate ourselves.”   

Even so, the firm’s holistic approach will likely remain its chief focus in the years to come. No matter how advanced technology becomes, Huelat says, healthcare is still all about healing people. “It seems like technology is the driver, but it is really people who are the driver,” she says.