In Physical Therapy, Bigger Isn’t Always Better: A Post-Occupancy Q&A with RWJUH Somerset

Needing to make room for a new cardiology suite, Robert Wood Johnson University Hospital (RWJUH) Somerset displaced Physical Therapy (PT) into their former Same Day Surgery suite — a smaller space — and furthermore challenged the design team to combine Occupational Therapy (OT) and Activities of Daily Living (ADL) with PT in this new reduced area. In response, the design team synthesized the programs, corrected vicinities to create better efficiency and reorganized the equipment. To guide walking exercises and maximize the use of circulation space, the team also placed distance indicators in aisles flanked by large mirrors and used finishes to clearly define space without walls or enclosures.

Erin Sharp Newton, an Associate at NK Architects, spoke with Deborah Fugaro, Director of Rehabilitation Services at RWJUH Somerset, to understand what makes the new PT environment a success.

[Erin Sharp Newton:] As Director of Rehab Services at Robert Wood Johnson University Hospital Somerset, what would you say about the planning and design process for the new PT wing?

[Deborah Fugaro:] It was a collaborative process. Everybody was working on it all together right from the beginning. Equipment Planning, Architecture and Interiors were all sharing together and being free to comment outside of their discipline to make a truly collaborative successful outcome.

Having BHP (Best Healthcare Planning) very active in the front end in understanding and making sure that early in the process RWJUH Somerset’s PT had all the equipment they needed to do their jobs really helped.

What is working for RWJUH Somerset in the final space?

The new walking tracks are working very well because it gives therapists clear open space to ambulate their patients without any obstacles in the way. In the new space, when therapists enter the gym, it is very clear that someone is ambulating and that they need to stay out of the walking track.

The integration of ballet barre and mirrors throughout creates a nice large area for the therapists to give the patients the right environment to self-monitor with therapists close-by to provide instant corrections. When patients can see themselves exercise, they can self-correct. The prior space had mirrors on wheels that only allowed limited view.  Now with the new design, patients can monitor their full range of motion.

Are there any elements in the new design/space that RWJ Somerset is particularly pleased with?

We are very pleased with the clear walking tracks, ballet barres, mirrors and the windows. These elements create a very open environment and people are always commenting, “Oh my God, this space looks so great, there is so much brightness, so much light coming in…” It is a very open, calming and inviting space.

Are there any items or things RWJUH Somerset thinks could have been better/done differently? Lessons learned?

It was very helpful having someone on the design team that had deep knowledge from personal experience about PT environments. [One of the design team members had a disability and spent years in PT.] It added a greater level of understanding.

It is important in an equipment-heavy space to really look at the finishes, colors and the machines in the space and to make sure they fit visually because they become the furniture. All of the finishes, including those on equipment, need to work together. During construction the beds had to be changed to navy because the blue was a robin’s egg blue that did not work.

Has there been any feedback from users, either internally or from clients?

People are always saying “Oh you have so much more space here!” and I have to say, “no, not really.”

Staff likes that there are unspoken dedicated spaces. OT is on one end of the suite, while the other end is dedicated to pure PT, yet there are areas in between where staff can cross over invisible boundaries that are still understood by the perceptual organization of these zones, allowing for a hybrid shared space.

One patient came in and said, “OMG you are finally stepping out of the 1980s!” Patients and users like that the space is calming with a pop of color.

Did RWJUH Somerset learn anything in this process that would be helpful to share for those designing for PT environments?

I have been involved with a lot of construction and design projects over the years (more than I can count). My advice is: “Listen to what your architects and designers are saying.” Listen to the design professionals because they might have had an experience in another facility that you may not think will work in yours, though if you listen you may come out with a better outcome.

Allow yourself to think outside the box, and to share thoughts and ideas with the team because they will tell you if it can or cannot be done and may be able to find modifications to make it happen. For example, I did not ever believe we would be able to find space for ADL and storage. Also adding the barres and the mirror is an example of something I neither had thought of nor necessarily thought could work, though has become one of our favorite things in the space! This is a good example of how a very simple move can make a big difference for both treatment and space.

For more, see Newton’s Notes on Archinect.