Is your facility beginning to look its age? A little worn and torn, a little drab and dated? Not as cozy or as comfortable as it once was? We know that not everyone has the space or budget to mimic the custom woodwork and cathedral ceilings of today's bigger, grander and more luxurious surgi-palaces. But that doesn't mean you can't inject new life into your older facility. From landscaping to lighting, from fireplaces to fountains, get ready to explore some relatively simple and low-cost ideas to give your facility a mini makeover that patients, staff and surgeons will notice and appreciate.

Start at the beginning
The golden rule in hospitality management is that the first impression is paramount to ensuring a customer's satisfaction. Many new centers have adopted this principle by constructing entrances that are more four-star hotel lobby than community healthcare facility.

"We try to allocate much of our client's budget to the entry and lobby areas because it sets the image for the rest of the facility," says John Hrivnak, principal for Altus Architectural Studios in Omaha, Neb. "The key is to put the money you have to spend at the greatest area of impact in terms of setting an impression."

Entrance improvements - applied to whatever scales your space and budget allow - help instill a promise of quality care in a patient's subconscious. "If a patient comes into a facility that may not be up to par, it's not unlike seeing duct tape on a plane seat," says John Pangrazio, FAIA, president of the AIA for the Academy of Architecture for Health. "Seeing that, an airline passenger might think 'if the seats are treated like this, how well do they take care of the engine?' It's the same concept with a surgery center."

To get the biggest bang for your first-impression buck, consider the following upgrades to your outside and inside entrances.

1. Cover the patient pick-up area
Not only will this relatively simple addition change the entire look and form of your building, a covered entrance is now required under the Americans with Disabilities Act. "In covering your pick-up area, not only can you be very creative and make a huge impact, but you're also improving patient care and bringing yourself up to code," says Wade Taylor, AIA, of Wade Taylor and Associates in Milwaukee.

For a more affordable option to a permanent cover, Douglas Lindsay, AIA, CEO of Array Healthcare Facilities Solutions in King of Prussia, Pa., suggests the use of a customized canvas canopy over a metal frame.

2. Incorporate natural light

Almost every architect and designer we talked to emphasized the need to incorporate natural light into as many areas of your facility as possible. They cited numerous reasons; the most important being sunlight's soothing influences. The waiting room can be a place of high anxiety for the nervous patient about to undergo a procedure or for the concerned mother waiting to meet her daughter in the PACU.

If your waiting area is adjacent to an exterior wall, think about maximizing the inflow of natural light by adding or increasing the size of the room's windows or skylights. If, on the other hand, your anteroom is buried inside a structure, it's still possible to replicate natural light to a staggering level of authenticity. Customized ceiling panels - depicting essentially any natural scene you wish - can be installed and backlit to brighten even the dimmest room.

3. Create appealing masking noises
Aquariums and fountains are not only valuable soothing entities, the noise of an aquarium's filter or the cascading water of a fountain are also creative ways to mask private conversations.

"The speed of the water in one of the fountains we installed could be adjusted, depending on the noise level of the room," says Loren Lamprecht, principal and lead medical planner for Altus Architectural Studios. "Using the sound of the water is a great way to soften a room."

4. Plant a garden
A popular trend among facility designers is the construction of a landscaped courtyard. These healing gardens are being built indoors and outdoors, and offer a place of quiet reflection. "We refer to gardens as a positive distraction," says Ron Luskin, director of marketing for Marshall Erdman and Associates in Madison, Wis. "It provides a comfortable environment for patients and waiting family members."

5. Add a fireplace
A custom gas unit with internal combustion and stainless-steel heavy-metal gage flue can be installed into most existing spaces with very little physical adaptation necessary.

Much like the plant and water design concepts, a burning log works off the relaxing influences of earthen elements while also helping to transform the space's feel from surgical waiting area to cozy living room.

6. Provide food and beverages
Patients scheduled for surgery certainly can't eat or drink before a procedure, but those waiting for them sure can. While remaining sensitive to the plight of the patients, consider outfitting your waiting area with a small coffee bar, vending machines or food carts. Family members are essentially stuck in the waiting room when waiting for their loved ones. Having the option to grab a bite to eat or a quick drink can go a long way in making the downtime a little easier.

7. Analyze the flooring
Whether you have a tiled or carpeted entrance, double-check to ensure the flooring is intended for use in a healthcare facility. According to Randall Carns, director of interior design for HBE Corporation in St. Louis, carpet manufacturers should include a density factor in their product's specs; he insists on using carpet with a density factor of at least 5,000 - a suitable level to withstand a great deal of traffic with minimal wear and tear.

Another cost-saving idea to consider when deciding on carpet is the use of a modular system. "Installing carpet that can be replaced on a piece-by-piece basis is a good idea for a healthcare facility," says Mr. Lindsay. "If one area of the carpet is showing wear or has been stained, a new piece can be substituted without having to redo the entire room."

But with more and more facilities deciding to go with a hard surface in the waiting area, Mr. Carns suggests using ceramic porcelain pavers for an easy-care option in flooring. "The color and pattern is applied all the way through the tiles so they don't show wear," he says. "Plus they require no finish, wax or polish and can be easily cleaned with a damp mop."

8. Revamp the reception desk
A patient's first interaction with a member of your staff can be made a little more inviting and friendly by lowering the height of the reception desk. In his designs, Mr. Carns aims to keep the height at no higher than 42 inches to create a welcoming surface instead of a barrier-like communication obstacle.

Mr. Carns also likes to incorporate a wheelchair storage space into the reception desk design. This simple concept is a great way to maintain an appealing waiting room that is organized and clear of obstructions.

9. Overhaul the appointments
If your waiting room's color palate features mauve and beige, it's time for a change. Most designers recommend using warm, soothing colors and muted blends. Regardless of which color scheme you choose, use shades that accent both the sophistication and calming themes that should be present in any waiting room.

In addition to a possible color upgrade, look into replacing standard waiting room chairs with upscale couches and wood-based furniture to create a warmer, more hospitable feel.

Pre-op and post-op improvements
Experts say you should think about extending variations of the waiting room improvements into the core of your facility to ensure patient satisfaction throughout the pre-op and post-op stages.

10. Custom curtains
A simple aesthetic upgrade involves replacing institution-style dividers with custom curtains depicting various nature scenes. The curtains brighten pre- and post-op areas while also offering positive distractions to anxious patients.

11. Use interior windows
The importance of allowing natural light into a majority of your facility cannot be emphasized enough. Like its effects in the waiting room, natural light can calm nervous patients in pre-op as they inch closer to the OR. If the current design of your facility does not allow for the obvious use of conventional windows or skylights to brighten the pre-op area, consider an alternate solution.

"The use of fire-treated windows in interior doors or walls can really open up a facility," says Mr. Taylor. "Interior windows help borrowed light from a waiting room skylight or exterior window filter into the other areas of the center."

By using the same means, if necessary, consider letting natural light stream into your PACU.

"Outdoor light aids in a patient's orientation when waking from anesthesia," adds Mr. Taylor. "If they're able to look out of a window instead of at a ceiling grid, they become grounded that much quicker."

If interior and exterior windows or skylights are simply not an option, you can use custom ceiling panels or decorative lighting.

12. Use indirect- lighting strategies
Many trend-setting surgery centers are finding creative ways to soften a patient's exposure to artificial light.

"Patients spend most of their time in a facility reclined on their backs," says Nick Rehnberg, principal for Boulder Associates in Boulder, Colo., "so try to avoid having them stare straight up at a ceiling light. Instead of shining light directly down, bounce it off the ceiling by using lights mounted on the wall."

Wall sconces are a great investment; they serve the dual purpose of moving away from institutional forms of lighting while also providing a functional means for bouncing indirect light off a ceiling.

The use of sconces can be particularly effective in pre-op and post-op areas.

"Incorporating two levels of light is a good strategy," says Kristi Ennis, senior associate/sustainable design director for Boulder Associates. "In areas where patients might be waiting for surgery or recovering from a procedure, we like to use basic ambient light instead of a harsh overhead source. When an examination needs to be made, a toggle switch is then used to turn on a more powerful fixture."

13. Customize patient headwalls
A customized headwall is an ideal way to enhance a surgery center's overall presentation in the eyes of a patient's family. Other than the waiting room, the pre-op or PACU area is likely the only other area of a facility they will see. By covering medical equipment with a custom headwall, the perceived quality of a center is reinforced.

"We've encased all hoses, gases and related equipment behind a large wood cabinet," says the headwall's designer, Mr. Lamprecht. "Even when a patient is hooked up, the cabinet's doors can close to conceal the hoses and machines."

14. Don't forget the ceilings
Patients spend a majority of time in a surgery center on their backs. Keep this in mind when thinking of appearance improvements.

"Since patients spend a lot of their time in a center on their backs, we install colorful tiles or ceiling design elements in areas where a patient may be wheeled or resting in bed," says Patricia Malick, interior design principal with Array Healthcare Facilities Solutions. "It's important to consider the way a facility appears from the perspective of a patient."

"We worked on a surgery center that was in a basement," says Mr. Rehnberg, "and put luminous panels above the beds so the patients were not simply staring at the ceiling."

15. Soften the OR
Use soft muted colors instead of stark white to cover the walls and floors of your facility's ORs. According to Mr. Lindsay, plain white reinforces the feel of an institution and tends to make surgical equipment more prominent; and that in turn might make a patient more nervous.

In addition to using the proper colors on the walls, Ms. Malick recommends the use of a solid block design around the OR table to mask the ghosts of deep surgical stains. "The area where all the action takes place - even if completely scrubbed - tends to still be stained," says Ms. Malick. "Imagine the anxiety a patient would feel if they enter an OR and see stains under the table on which they are about to be operated on."

Staff amenity improvements
Once patient satisfaction has been taken care of, what about the needs of your staff? Until recently, staff amenities have been the forgotten piece of a facility design's puzzle. That is simply no longer the case.

Aside from big paychecks, a positive work environment is a key factor in your ability to recruit an all-star staff.

The new state-of-the-art facilities may have an advantage over older centers when it comes to staff amenities, but here are some affordable ways to keep up with the Joneses.

16. Upgrade the staff lounge
Installing satellite television, high-speed Internet access, a quality sound system, large-screen TV, custom kitchenette and comfortable upscale furniture (such as over-stuffed chairs and sofas) goes a long way in making the workplace more enjoyable.

17. Move the lounge
If at all possible, move the lounge to an exterior wall to incorporate natural light and views of the outside world. If such a physical change is impossible, consider artificial alternatives to natural light (such as the backlit custom ceiling panels and decorative light elements we've already discussed).

18. Build a landscaped courtyard
A private outdoor escape exclusively for staff use is an ideal place for lunch breaks or quick retreats to ease work-related stress.

19. Incorporate OR floor designs
In addition to easing a patient's stress around the OR table, a solid color design is also a creative way to define the sterile area for the perioperative staff. A design feature around the OR table will also create a contrasting background to help the OR staff locate dropped instruments.

20. Install telephones and dictation alcoves
To a surgeon, case throughput is a top priority. By making phones and dictation devices accessible outside each OR, a surgeon wastes little time in recording the important facts of the case or following up on the status of his patients. The time a doc saves by not returning to an office every time he needs to dictate or make a phone call can quickly add up to improve a facility's overall efficiency.

A competitive advantage
We've covered a lot of ground and hopefully given you ways to improve the look and feel of your facility without burning a hole in your scrubs. Keep in mind that a modern and visually appealing center has become essential in the battle for patients, nurses and surgeons.

"Through building design, you can get more beneficial outcomes in patient satisfaction, healing, and staff and physician productivity," says Mr. Luskin. "All these factors help staff recruitment and retention, which helps operational efficiencies, which in turn helps substantiate investment dollars in a facility."

Designers and owners alike are sensitive to the influence of a center's appearance on patient satisfaction and staff recruitment.

"You need to recognize physical clues that your facility is outdated from an image standpoint," says Mr. Pangrazio. "Your goal should be to make the patient and staff feel as comfortable as possible. These factors are just as important as the surgery space because it affects the potential of your facility as a whole."

"The commitment to physical improvement causes a momentum that shows a dedication to the staff and facility," says Ray Fox, principal, Raymond Fox and Associates in San Diego. "It shows you care about the surroundings, your patients and the people who work for you as opposed to just making money."