Walk into a well-designed surgery center, and you might have trouble believing that you're actually in a healthcare facility. Cheerful, comfortable waiting areas, tasteful art and even elaborate indoor gardens and waterfalls have taken the place of colorless, sterile-looking interiors in many facilities, giving them the appearance of high-end spas.

These features aren't just for show. The interior design of your facility, which includes lighting, wall and floor finishes, artwork and furnishings, speaks volumes to your patients, according to Anthony Pings, AIA, NCARB, a Fresno, Calif.-based architect. "The design of a facility is something that patients can easily understand," he says. "It answers two key questions that patients have about their caregivers: ?Do they care about me?' and ?Do they have the ability to care for me?'" Also, many research studies have indicated that the design of a facility affects patient outcomes and staff productivity (see "The Evidence-based Design Movement" on page 97).

Interior designers can help you ensure that your facility provides a warm, welcoming environment for your patients. They can also incorporate features that help you make the most of your space and promote surgeon and staff satisfaction. If you're working with a surgery center development firm to build or renovate your surgery center, chances are you'll already have an interior designer with healthcare experience on the team. If you decide to hire one on your own, here are some tips.

Check credentials and experience
Here are four qualifications you'll want in a designer.

• Make sure your designers have the basic qualifications to practice in your state. Twenty-three states, the District of Columbia and Puerto Rico require interior designers to fulfill certain requirements to become registered or licensed, including passing a national qualifying exam. The American Society of Interior Designers lists each state's requirements on its Web site (www.asid.org) and also has a referral service.
• Hire a designer with healthcare experience. "The biggest mistake you can make is choosing a residential designer who has no experience with healthcare facilities," says Mr. Pings. "If you look at the designer's portfolio, and the firm isn't doing what you're looking for, don't assume it can."
• Look for variety in the designer's portfolio. Healthcare designers who've worked with hospitality clients, such as restaurants and hotels, might have fresh ideas - "especially since those buildings are designed with customer satisfaction in mind," says Margo Komplin, manager of interior design services with Marshall Erdman & Associates in Madison, Wis.
• Make sure your architect and interior designer have worked together before. "Architects and interior designers love to fight, and many architects will try to do their own interior design, even though having a separate interior designer adds a lot of creative input," says Mr. Pings. You can help ensure a non-contentious collaboration by asking your architect for referrals.

Seek early input
Interior designers can start working on your facility in the initial planning stages, says Becky Chambers, ASID, principal of Chambers Lorenz Design Associates in Fresno, Calif. Her firm often works with architects to design the overall envelope of the facility. She points out that interior designers can often suggest details that architects might pass over: "For example, an architect might plan a large window but forget to allow for a solid place to attach a window treatment. An interior designer would catch those types of things."

Randal Kiemnec, ASID, president of RMK Design Associates, Inc., in Colorado Springs, Colo., agrees. "An interior designer can also suggest accent detailing that the architect might not have gotten to - things that make the facility more efficient, as well as more pleasant to be in," he says.

Even if your interior designers won't be involved in drawing up the design, it's still important to bring them on board early on, says Ms. Chambers. "Designers can contribute important information as far as budgeting and scheduling tasks, as well as design concepts, early in the process," she says. "When you bring in the designer too late, you end up with spaces that don't accommodate furnishings properly, lighting and finishes that are not ideal and window coverings that are not the best choice."

It's important to set up a clear schedule for how the work will progress in these early planning meetings, says Ms. Komplin. "Set clear expectations as far as the scope of the project and the interior designer's role, and set up a clear decision-making process with a single point of contact for the designer," she says.

Key design elements
We asked our experts to discuss some of the design elements that can make a facility more pleasant for patients and more functional for staff. Here's what they said:

• Clear wayfinding. Attractive, prominently placed signage helps your patients get their bearings when they enter your facility and shows them where to go, says Ms. Komplin. "Wayfinding elements reduce stress by helping patients get to their appointments on time - if they're late, their nervousness has a ripple effect throughout the rest of their stay," she says.
• Color considerations. "Color is amazingly important," says Mr. Pings. "Warm colors and textures can help put patients at ease." Ms. Komplin agrees, noting that earth tones and other colors that occur in a natural environment are especially popular in healthcare facilities.

Experts recommend using more intense colors sparingly. "We favor neutral, light colors in the background (walls and carpets), with color accents in the art and upholstery," says Ms. Chambers. "When you provide too much color in the background, it's harder to adapt and change the facility," she says.

• Lighting. An interior designer with expertise in lighting can create various lighting levels throughout your facility. In waiting areas, for example, Mr. Kiemnec uses indirect lighting, such as table lamps and wall sconces, which provide a warmer environment than overhead fluorescent lights.

Ms. Komplin points out that it's important to think about how lighting affects staff productivity. "There are numerous studies that show that light levels contribute to eye fatigue," she notes. A designer can create lighting schemes that minimize glare and ensure that everyone has the optimal level of light to perform effectively.

• A welcoming waiting area. Start with the basics, such as warm lighting and generous, supportive seating that can accommodate different-sized parties. "We like to include individual chairs for unrelated individuals, as well as settees or lounge-type chairs for a mother and child or for larger people," says Mr. Kiemnec.

Experts say that the waiting room and reception areas are where you can add the most design flourishes, such as plants and artwork. However, Mr. Kiemnec warns against spending your entire design budget on these areas. "Try to keep the quality of design in your facility the same throughout," he says.

• Unintimidating patient care areas. In exam rooms and patient care areas, a designer can add touches that don't compromise sterility and functionality. Wood-grained cabinetry, for example, or patterned cubicle curtains can provide some positive distraction and give these areas a less sterile look. Mr. Kiemnec also recommends keeping stackable chairs (upholstered in an easily cleanable material) in exam rooms and recovery areas for family members.
• Positive distraction. Features such as interesting artwork, aquariums and plants provide patients with something interesting to look at and help reduce stress. Experts recommend choosing representational nature art over abstract pieces - landscapes and floral pieces seem to have a calming effect.

Artwork and other design touches don't have to be expensive or high-maintenance. "There's lots of affordable, original artwork available in many communities," says Ms. Chambers. "We get together with local artists to find original art that fits the facility's aesthetic." Mr. Kiemnec mines local art colleges for original pieces or uses framed poster art, as well as high-quality silk plants that don't need to be maintained.

If your budget allows it, you could give your interior designer license to incorporate natural materials and other design elements to create stunning effects. For example, at a facility called The Center: Orthopaedic and Neurosurgery Care and Research, in Bend Ore., Marshall Erdman & Associates incorporated a 24-foot waterfall, an elevated timber atrium and waiting areas identified by regional themes (desert, mountain and rivers) to enhance wayfinding.

Design says a lot
Taking the time to find the right designer for your facility and paying attention to design details is an important step toward ensuring its ultimate success.

"It's important for designers to examine ways in which the atmosphere of confidence, comfort and respect for the individual will be conveyed by the interior and furnishings of the setting," says Ms. Chambers.

Design can also do a great deal to enhance staff performance, she adds, by creating work spaces that are well conceived, logically planned, flexible, adequately equipped with storage, power and technology, and furnished not only to suit the task, but the individual as well.