Uses of Car Detailing

Owning a car has now become a norm for middle class families in India. With the country showing good economic growth, the average middle class consumer has enough money to splurge on a car. With a wide range of models to choose from, the Indian consumer is pampered for choice. From going out on picnics to having a fun drive, a car has become a part and parcel of an Indian family’s growth, happiness and transportation needs.

Buying an automobile is always a daunting task. First one has to decide if one needs a new care or a used car based on one’s budget and needs. But whatever be the case, a car once bought needs good care and maintenance for peak performance and all round reliability. Given that a car is a utility, due care must be taken to ensure that there are no breakdowns at any time so as not to be caught unawares. Besides periodic maintenance of the engine, chassis, turbocharger and other technical aspects, the aesthetic aspect of things must also be considered. A car is a work of art and over time, it is subject to a lot of wear and tear. The initial lustre may be lost, scratches and dents may occur. Further, when the owner decides to sell a car, he must ensure that he can attract potential buyers and convince them that their potential investment is good value for money. A first impression is always the best impression at any point in the lifetime of a car and here is where car detailing comes in.

Auto detailing is a technical process where an automobile is thoroughly cleaned, waxed and polished both on the inside and the outside to produce show quality level of detail. Besides improving appearance, it helps to raise the resale value of a car. It is subdivided into three aspects- exterior detailing, interior detailing and engine detailing.

Interior detailing involves cleaning the passenger compartment, trunk, dash board areas, panels, windows and carpet. Vacuuming is the first step and this may be followed by steam cleaning, use of liquid cleaners and brushing to remove stains. Exterior detailing involves cleaning and bringing to shine all the parts of the visible exterior like wheels, paint, chrome trim, windows, wheels and other components. Cleaning, polishing and protection are the three steps in exterior detailing. Cleaning deals with the removal of all foreign matter from the exterior surface. Polishing involves the use of machines to remove scratches and other imperfections from the surface. This is done by removing a micrometre of paint from the surface by special pads. Waxing or protection involves the application of wax on the surface to prevent foreign matter from adhering to the surface. The third aspect of detailing is where steam, high pressure water, degreasers and all purpose cleaners are used to clean under the hood of a car. A lot of car dealers in India offer restoration services in addition to car detailing. The best way to shortlist a company will be based on reputation, service quality and cost effectiveness.

AED – Automatic External Defibrillator

How many chances do you have in your life to save another?

Purchasing an AED (automatic external defibrillator) may seem as simple as purchasing a copier machine, but the choices you make today, may be instrumental in more than just reducing your insurance policy-it may actually save a life.

Just a few short years ago, the very concept of a average person using a defibrillator on a person in cardiac arrest may have resembled a comedy movie. Fortunately today, the advancement of technology has transformed science fiction into everyday convenience. The modern Automatic External Defibrillator is safe to use, simple to operate and portable enough to go anywhere.

With rapid advancement of technology comes explosive opportunities for the marketplace. Entire companies now focus on the manufacturing and sales of this important, life-saving device. With a wide variety of choices, colors, models and prices the uninitiated buyer will most definitely be confused.

Here are the 7 key things you should insist upon when purchasing an Automatic External Defib.


Variety of models. A “one size fits all” isn’t a good strategy. You may only have a single need, but a distributor with a variety of options will be able to custom fit the right device with your organizational needs.

Other medical equipment. On the surface it seems that a company that specializes in AED units would be the logical choice. However, by working with a company that has other medical equipment available, you’ll be working with a supplier for all your needs. Customization with one-stop shopping!

24/7 Support. While shopping may be a daytime activity, your lifestyle may not. Be sure to work with a company that has 24/7 support either by phone or online where you can get your order fulfilled, product tracked and questions answered.


Charging of the unit. What is the shelf life of the unit? How long can it last without be charged? What is the expiration date of the unit?

Accessories. Does the product come with pads compatible for children? Is it wall mounted on in a kiosk? Does the unit come with signage for the unit? Is a storage container included?

Training. Is the unit easy to use. Does it come with English only instructions or can a non-English speaking user easily operate the device? Does it come with a DVD or manual for the owner? Are appropriate compliance documents included?

The value you seek in purchasing a life-saving device must be clearly defined. Getting a good price doesn’t mean the lowest price. There will be more than one good choice of an AED for your organization, but selecting the best one will require you to eliminate those options which don’t fit your needs and working with a company that thinks and acts like you. By purchasing your AED from a supplier with a variety of models, options and prices, you’ll now only be confident you’ve made the right choice for you, but you’ll know that the value you received is 2nd to none. Be wary of discounts in parachutes, insurance and defibrillator’s. The life you save, could be your own.

Commercial Real Estate Marketing Plan – Key Points to Win the Client

In giving a client a marketing proposal and strategy to sell or lease a commercial property, a number of things need to be well detailed in the proposal itself. Here are some of the main ones that should never be overlooked in your property proposal.

  • Why Should I Use Your Agency? It is an important question and hopefully you have a very clear idea of the advantages you bring to the sale or leasing process. Generic statements like ‘we know the market’, ‘we are the best agent in town’, ‘we have been here for 50 years’, and ‘we will serve you well’, just do not cut it in competitive markets. Consider why your real estate agency can stand clear and separate to other competitive agencies in promoting the property. Make sure that the client knows without any doubt why they should choose you as the agent of choice. Do not base your marketing point of difference on low commissions or agency paid advertising; that just does not work in this market and will put you out of business fast. Your agency must have something that is special and not copied from other agencies; it should also be so unique that you are the first choice as the real estate agent to take on the listing. If you do not have this clear mindset, then welcome to the world of the ordinary real estate agent that has to fight for every listing. Be separate than everyone else, create your point of difference and then market it well.
  • Happy Existing Clients & Recent Sales: Evidence of market activity and positive results will always come in handy as you attempt to advise the client on the right strategy to adopt for their property. In this property market with an abundance of available property stock, you should never take on overpriced listings. On average it is better to walk away from them and work with listings that are closer to the market price or rent. Your time is a valuable resource and must be protected from unrealistic vendors. A realistic property owner that works within the property market is far better than a property owner that is trying to set their own property market.
  • Prospective Buyer Activity on a Property: Telling the seller or landlord of your current and prospective sources of enquiry is a worthwhile part of your marketing plan. This lets the owner of the property know that you are really on the right ‘wavelength’ when it comes to locating tenants and or buyers. Some agents also adopt the strategy of getting a series of inspections done quickly with potential buyers from their database even at the early listing stage. It is surprising how many listings are sold or rented even before they reach the market officially.
  • What is Value? What is a Property really worth? Whilst exact prices and rents are hard to pinpoint, you should have a reasonable idea to within 5% as to what price or rent you could achieve with any given property. If you have no idea of the rent or the price then it is better to put the property to the market on the basis of ‘expressions of interest’. In that way the market will tell you what they think. With some very unique properties this is necessary given the limited pool of buyers that can participate in the purchase.
  • Methods of Sale and Timing: The main possibilities when selling a property are usually sale by auction, sale by tender, sale at a price, sale by negotiation, expressions of interest, trade or exchange. Knowing the best one to choose is the key to success. Putting the property on the market at a price is the less successful way of property marketing. The reason for this is the market will judge the property and try to reduce the price; if the property is too highly priced it will ‘kill’ any genuine enquiry before you even hear about it. One other fact needs to be remembered and respected here; a property will become ‘stale’ on the market after about 90 days. If it does not sell by then, it is better to remove it from the listing books for some reasonable time, to freshen the property for the next stage of marketing that you need to go to.
  • GANTT Model: For those of you that may not be aware, this is a way of graphically displaying activity. It is a common graphing process. It just so happens that it is a very powerful tool when you put it in a commercial property proposal for sale or lease. The display shows the client exactly what you are going to do for them and when.
  • Question and Answer: As part of your property marketing proposal, it is wise to have one or two pages that handle the concerns and questions of the client. From the preliminary meeting with the client you will have ascertained what matters concern them; you can merge these concerns and your answers into a Q&A format within your proposal.
  • Executive Summary: Always use an Executive Summary at the front of your document. It should be no longer than 2 pages, and bring all the main points to the front of the proposal. Adults generally do not want to read a lengthy document, so all your great work may largely go unread unless you can get the key points to a place that interests the client to read further.
  • An Exclusive Selling Agency Agreement: Why should you do one? The obvious answer is that you can best serve the listing and the client; you can also control the competition agents that may be chasing the same property. Open listings are not desirable and are essentially a waste of time unless you specifically have a purchaser that is a strong contender to take the property immediately. Occasionally I come across an agency that has a business approach of listing everything they can regardless of agency type; whilst this method can work, it does require you to have a very large number of listings and plenty of signs on properties. In only that way will you get the enquiry and conversion numbers that you need for KPI’s on commissions.
  • What are the advantages to a Vendor in having only one Agent when selling a Property? Tell the client why one agent is the best way to go. Multiple agencies working on the one property do not allow focused communication of offers and marketing coordination. Tell the client how you will connect with them on marketing, negotiation, due diligence, and property settlement.
  • Advertising: Yes advertising is expensive and it is still necessary, although you can be selective. You need to get the property message out to the market in the most efficient and direct way. How you do that is really property specific, although the conventional processes of newspaper marketing (expensive) are becoming less necessary. The internet is taking over as the main advertising channel in commercial real estate sales and leasing, and offers your client far better and cheaper ways of putting the property to the market. A key strategy for property marketing is to create 3 different levels of marketing for the client to consider (gold, silver, and bronze), as it gives them the feeling of control when it comes to spending on vendor paid advertising.

So these key points should be well handled in your property proposal. When you get the points clearly set out, the client knows what you can do and why they should choose you as the property agent of choice.

Most Common Cosmetic Dentistry Procedures

These days, technological and medicinal advancements have made many different cosmetic dental procedures possible. These procedures give patients a better-looking smile overall and can help to improve their self confidence as well. So if you are unhappy with the current state of your teeth, you may want to consider speaking with your dentist about the possibility of having one or more of the following common cosmetic dental procedures performed.

The most common type of cosmetic dental procedure that people get done involves whitening of the teeth. There are different specific procedures offered to achieve this goal, ranging from traditional tooth bleaching to newer laser whitening techniques. The effects of teeth whitening can last anywhere from a couple of years to decades, depending on how well the patient takes care of their teeth following the procedure. However, it is not uncommon for patients to return for further whitening procedures to get their teeth looking their absolute whitest.

Another common type of cosmetic dental procedure involves that of reshaping teeth. This is specifically common in situations where dental trauma has occurred. For example, a patient may seek teeth reshaping after being hit in the mouth, perhaps while playing a sport, and suffering from a chipped tooth. In many cases, a dentist can use special tools to file the tooth down or to otherwise reshape it so that it looks as normal as possible. In addition, having this procedure done reduces the chance of further injury, as chipped teeth can be dangerously sharp and lead to cuts and other mouth injuries.

Another common procedure that is similar to reshaping is known as bonding. This is often done as a way of replacing pieces of teeth that has been lost from chipping or gradual wear. In bonding, a dentist uses a special composite that resembles enamel and applies it to the surface of the afflicted tooth. Once it dries and hardens, the new enamel blends in with the existing tooth and gives it the correct shape and overall appearance.

The placement of veneers is also a very common cosmetic dental procedure. These are often done as a last resort, such as when a tooth will simply not take to teeth whitening procedures or the damage to a tooth is too severe to use bonding enamel or reshaping techniques. Veneers are a bit more of an involved dental procedure, as they involve inserting custom-made porcelain duplicates of teeth. These are adhered directly to an existing tooth, but it is usually necessary to file down the existing tooth almost entirely. Individual veneers are common, though people who have severe tooth decay or other problems may end up with several veneers.

Above are some of the most common cosmetic dental procedures these days. If any of these sound appealing to you, then you should speak with your dentist to find out whether you would be a good candidate for the particular procedure that you are considering. From there, you can take the next steps needed to achieve your ideal smile!

Home ElectronicsCigarette (cigarrillo electronico) Automated Protection You Need To Know

Electronic cigarette(cigarette electronique) is a safe thing to consider when the(sigaretta elettronica). Electronic cigarettes(cigarros electronicos) are a new and unknown computer, that should be reviewed and understand the use of the (elektronisk cigaret) for personal use. Security (cigarrillos electronicos) to be taken seriously and understood the use of the(elektronischen zigaretten).

Safety begins with the spray electronic cigarette(cigarrillo electronico). The spray is the small part that screws into the pile of electronic cigarettes(sigaretta elettronica) and connect the spray cartridge (elektroniske cigaretter). This sprayer is heated to convert the liquid nicotine cartridge into the water vapor that is inhaled. The electronic cigarette is safe in the knowledge that this warming and can be hot. Never drag a permanent or inhaling the, because this will make(cigarros electronicos) spray to keep warm and eventually melt the toner. You must be a burden when you feel the urge to smoke. The use of the is moderately good security and cartridges will actually last longer.

Another important safety does not hinder the too hard. When you take a drag of your, you should take a slow, deep pull in about 3-5 seconds. If you pull too hard on the cartridge, you can potentially suck some of the nicotine in the mouth. If this happens, the security of(cigarro) correct too quickly, rinse your mouth with water.

Cartridges are available in a wide variety of tastes and strengths of nicotine. For regular, menthol, also the apple and strawberry flavor cartridges and nicotine strengths come in full, a medium, light, and no. While(elektroniskas cigaretes) are technically “alternative to smoking”,rather than smoking cessation device, the range of nicotine strengths offers clear opportunities to support those trying to quit smoking, and seems to be proving to be popular in these markets.

The nice thing about that you say, nicotine patches, that give the same tactile sensation and oral fixation that the desire of smokers, while satisfying the desires of snuff as well. When you take a drag n really feel your lungs fill with smoke flavored snuff warm and the waves of smoke exhaled from your lungs as the regular snuff, however, as mentioned, the smoke is actually a lot more water vapor that evaporates quickly heals and not offend anyone in the vicinity.

A Guide To Redesigning Your Used Caravan's Interior

Have you ever spent a weekend or even a week travelling around the coast or countryside in a caravan, experiencing all the sights and sounds that our wonderful country has to offer? This is a fantastic way to travel – not only can you take along as many of your own possessions as you like, you will be able to prepare and cook your own meals (helping you to save some money). The only complaint that most travelers appear to have is that their used caravans have quite outdated interiors.

Fortunately, this is a problem that can easily be fixed, allowing you to get on with your travels as soon as possible. And, luckily for you, redesigning the interior of your used caravan could not be any easier. Using the following tips, you can rest assured that your van is perfectly suited to your needs and that you are able to travel in comfort.

  • As caravans only have a small amount of space, you should be aiming for as clutter free a design as possible. Make sure that there is plenty of cupboard space so that you can hide away all of the mess.
  • Opt for a darker colour scheme, as this won’t need to be cleaned as often and will not show up the dirt (especially with your carpet). Vinyl or laminate can be a good choice around the doorway for those muddier times of the year.
  • Add a mirror or two onto the walls, as this can help the space to feel much larger. This is especially useful if your used caravan is lucky enough to be fitted with a bathroom, which are notoriously small.
  • Consider covering your windows with roller blinds, as these have a simple design that won’t detract from the clutter-free appearance of your space and they are relatively maintenance free. Black out blinds are also a good choice if you like to sleep in.
  • Choose one brighter colour that you can use an accent, then begin using it in small amounts throughout the used caravan. A touch here and there is often enough to brighten the space up.
  • Give your caravan some small, home-y touches that will make your travels (especially long ones) much more enjoyable. Hang a clock on the wall over the kitchen area, for example, or put some photo frames on display. You could also use bedspreads instead of sleeping bags.

If you find the interior of your used caravan completely unsuitable for your needs, you might like to completely gut the space and start again. Not only will this enable you to update the space, it will enable you to design it according to your own needs. Perhaps you want some bunk beds for the kids or you want to make the living area smaller – it’s up to you.

A Check in Hand – Pay Check Cash Loans

It can be a distressing situation if you don’t have money in hand and some financial emergency suddenly looms large. Mid month it can be further more troublesome because by that time you’ve already spent a large part of your monthly salary. So what do you do? You can always go in for an overdrawing facility on your account or a cash advance on your credit card or apply for a loan at your bank. But then, you also have the option of pay check cash loans. Let us know more about these loans.

Details Of The Loan

You draw the loan for a short duration, up till you receive your next pay check. The interest rates on payday loans can range from $15 to $30 per $100 withdrawn. The ceiling on the amount that can be borrowed is usually $1000. Often as a security, lenders giving an emergency cash loan ask for a post dated check. If the check bounces, another fee is for charged. Though rolling over the loan is not advisable (as it may lead you to a debt trap), sometimes it becomes inevitable.

The Loan Procedure

A large number of these companies are electronic in nature. That’s what gives speed to the transaction of no fax pay check loans. A pay check cash loan can be applied for, by anybody who is above 18 years of age, full time employed and having a running bank account. A simple form is to be filled in and a proof of employment has to be provided in the form of the latest pay stubs. The application is then verified and processed. Since the repayment record of the applicant is not a consideration, hardly any paperwork is required. Quite quickly, your account is credited with the loan money.

Some Do’s

Always ask yourself whether your need is really dismal. If the urgency is inevitable then of course, pay check cash loans are a viable option. They are convenient in case of an emergency. However you can try to maintain a budget for contingencies. Even planning the repayment beforehand is a good idea; it’ll help in debt management. Though most of the companies are safe to deal with, it’s always advisable to go through their fine print properly. This will help avoid any misuse of your financial information of personal nature.

Though cash advances can be a boon in times of need, they can become a bane too if you rely on them too much. A pay check cash loan is intended for small amounts, so borrowing big amounts can become a further source of trouble. Avail cash advance conveniently by searching and comparing various companies on the Internet.

Planning and Design of Behavioral Healthcare Facilities

Behavioral Healthcare Facilities: The Current State of Design

In keeping with most districts of healthcare, the marketplace has seen a boom in the construction of Behavioral Healthcare facilities. Contributing to this increase is the paradigm shift in the way society views mental illness. Society is placing a heavier value on the need to treat people with serious addictions such as alcohol, prescription and elicit drugs. A large percentage of people suffering from behavioral disorders are afflicted with both mental and addictive behaviors, and most will re-enter communities and either become contributors or violators.

These very specialized facilities do not typically yield the attention from today’s top healthcare designers and their quantity accounts for a small fraction of healthcare construction. However, Behavioral Healthcare projects are increasing in number and are being designed by some very prominent architectural firms such as Cannon Design and Architecture Plus. Many are creating state-of-the-art, award-winning contemporary facilities that defy what most of us believe Behavioral Healthcare design to be.

Changing the Way We Design Behavioral Healthcare Facilities

As with all good planners and designers, A+D (along with facility experts) are reviewing the direct needs of patient and staff while reflecting on how new medicine and modern design can foster patient healing rates, reduce environmental stress, and increase safety. This is changing the face of treatment and outcome by giving the practitioner more time to treat because they require less time and resources to “manage” disruptive patient populations.

The face of Behavioral Healthcare is quickly changing. No longer are these facilities designed to warehouse patients indefinitely. And society’s expectations have changed. Patients are often treated with the belief that they can return to their community and be a contributor to society. According to the National Association of Psychiatric Health Systems (NAPHS), depending on the severity of illness, the average length of stay in a Behavioral Healthcare facility is only 9.6 days.

What has changed?

Jaques Laurence Black, AIA, president and principal of New York City-based daSILVA Architects, states that there are two primary reasons for the shortened admission period:

1. Introduction of modern psychotropic drugs that greatly speed recovery

2. Pressures from insurance companies to get patients out of expensive modes of care

To meet these challenges, healthcare professionals are finding it very difficult to effectively treat patients within the walls of antiquated, rapidly deteriorating mental facilities. A great percentage of these facilities were built between 1908 and 1928 and were designed for psychiatric needs that were principled in the belief to “store” not to “rehabilitate.”

Also impacting the need for Behavioral Healthcare construction is the reluctance of acute-care facilities to provide mental health level services for psychiatric or addiction patients. They recognize that patient groups suffering from behavioral disorders have unique health needs, all of which need to be handled and treated only by very experienced healthcare professionals. This patient population also requires a heightened level of security. Self-harm and injuring staff and other patients are major concerns.

The Report of the Surgeon General: “Epidemiology of Mental Illness” also reports that within a given year about 20% of Americans suffer from a diagnosable mental disorder and 5.4% suffer from a serious mental illness (SMI ) – defined as bipolar, panic, obsessive-compulsive, personality, and depression disorders and schizophrenia. It is also believed 6% of Americans suffer from addiction disorders, a statistic that is separate from individuals who suffer from both mental and addiction disorders. Within a given year it is believed that over one-quarter of America’s population warrants levels of mental clinical care. Even if these statistics were cut in half, it cannot be denied as a serious societal issue.

With a growing population, effectively designing in accordance with such measures is at the heart of public health.

Understanding the Complexity of Behavioral Healthcare Design

Therefore, like Corrections, leading planners and designers specializing in Behavioral Healthcare are delving deeper to better understand the complexity of issues and to be the activist to design facilities that promote treatment and healing – and a safer community.

The following is a list of key design variables that are being studied and implemented:

1. Right Sizing

2. Humanizing Materials and Color

3. Staff-Focused Amneties and Happiness

4. Security and Safety

5. Therapeutic Design Tenants


Today’s Behavioral Healthcare facilities are often one-story single buildings within a campus size. Often debated by Clients due to costs, this design preference is driven by the demand for Uncategorized light, window views to nature for all patient areas, and outdoor open-air gardens “wrapped” within. All of this provides soothing qualities to the patient, reduces their anxieties, counteracts disruptive conduct and helps to reduce staff stress.

“When you look at the program mix in these buildings, there’s a high demand for perimeter because there are a lot of rooms that need Uncategorized light. Offices, classrooms, dining areas, community rooms, and patient rooms all demand Uncategorized light, so you end up with a tremendous amount of exterior wall, and it forces the building to have a very large footprint.” – James Kent Muirhead, AIA, associate principal at Cannon Design in Baltimore

These design principles are also believed to improve staff work conditions. Unlike a multi-story complex, at any moment staff can walk outdoors and access nature, free from visual barriers, and within a building that more accurately reflects building types that both patients and staff would encounter in their communities.

In addition to right-sizing for the overall building footprint, is right-sizing for internal patient and staff support area. Similar to the move we have seen in Corrections to de-centralize support spaces, Behavioral Healthcare is moving to decentralized nursing/patient units called “neighborhoods.” With mental health facilities there is a large concern with distances and space adjacencies in relation to the patient room and patient support areas such as treatment and social spaces. Frank Pitts, AIA, FACHA, OAA president of Architecture Plus, Troy, NY, advocates neighborhoods that average 24-30 beds arranged in sub-clusters, called “houses”, of 8-10 beds. Thus, each neighborhood consists of three houses. Often these layouts will include a common area where patients congregate and socialize, with a separate quiet room so patients can elect to avoid active, crowded areas. In addition Pitts states, “There’s a move away from central dining facilities. So, while facilities will still have a central kitchen, it’s a whole lot easier moving food than it is patients.” However, it is important for the facility to mimic normal outside daily life routines, so patients are encouraged to frequently leave their neighborhoods to attend treatment sessions, and outdoor courtyards.

Humanizing Materials & Color

In all facilities that play a role in rehabilitation, design strives to create spaces that humanize, calm, and relax. Behavioral Healthcare patients need to feel that they are in familiar surroundings; therefore, the architectural vocabulary should feel comfortable and normal. Since these facilities are about rehabilitation (when possible) and encouraging patients to merge back into society, the facility should feel like an extension of the community. Their spaces should reflect the nature and architecture of the surrounding region and thus so, no two facilities should look too much alike.

“Our a
pproach to designing these facilities is to view the facility as an extension of the community where patients will end up when they’re released. Interior finishes also depend on geography because you want to replicate the environment patients are used to. You want to de-stigmatize the facility as much as possible.” – Tim Rommel, AIA, ACHA, OAA, principal with Cannon Design in Buffalo, NY.

Therefore, materials and colors within these spaces want to feel familiar to one’s region and everyday life. To soothe the psyche and rehabilitate, they want to feel soft and comfortable, yet visually stimulating. An interior that is overly neutral or hard in appearance is not appropriate. Materials should reduce noise, and colors should lift the spirit. This can help to create an environment in which the patient can learn, socialize, and be productive while easing anxieties, delivering dignity, and modifying behavior. As stated previously, behavioral studies advise the use of softer interior materials-like carpeting, wood doors and tile. Doing so translates directly to both patient and staff well-being, particularly staff safety, and makes for a nicer place to work. In addition, staff have more resources to “treat” instead of manage heated situations. When staff experiences are eased and satisfied, morale is boosted and life-saving rules and policies are more likely to be enforced.

Staff-Focused Amenities & Happiness

While reducing staff stress and fatigue through a healing supportive environment seems like an obvious goal, there are relatively few studies that have dealt with this issue in any detail. More attention has been given to patient outcomes. However, many leading hospitals that have adopted therapeutic tenants into their newly built environments have seen vast improvement through their “business matrixes” and financial reporting.

In one example, the Mayo Clinic, a national leader in implementing healing design in its facilities, has reported a reduction of nursing turnover from a national annual average of 20% to an annual 3%-4%. In another example, when Bronson Methodist Hospital incorporated evidence-based design into its new 343-bed hospital, they cited their 19%-20% nurse turnover rate dramatically dropped to 5%.

Now, both the Mayo Clinic and Bronson Methodist Hospital have had to initiate a waiting list for nursing staff seeking positions. This converts to better-trained and qualified staff, and a reduced error rate. Therefore, more health facilities are investing in staff support areas such as lounges, changing rooms, and temporary sleep rooms. Within these staff spaces and in the hospital throughout, facilities are also recognizing the need for upgrade materials, better day lighting, and an interesting use of color: One soon realizes that the need of patients and staff are interwoven, each impacting positively or negatively the other.

Security & Safety

Without debate, self harm and harm to staff is one of the biggest concerns mental health facilities manage. Often the biggest safety and security concern is the damage patients can do to themselves. “There are three rules I had drummed in me,” says Mark Hanchar; Director of Preconstruction Services for Gilbane Building Company, Providence, R.I. “First, there can’t be any way for people to hang themselves. Second, there can be no way for them to create weapons. Third, you must eliminate things that can be thrown.” Hanchar says that the typical facility is, “a hospital with medium-security prison construction.” This means shatter proof glass, solid surface countertops (laminate can be peeled apart), stainless steel toilets and sinks (porcelain can shatter), push pull door latches and furniture that cannot be pulled apart and used as a weapon. These are just to name a few.

Additionally, removing barriers between patients and nursing staff is a safety consideration. Frank Pitts, AIA, FACHA, OAA president of Architecture Plus, says what may be counter-intuitive for safety precautions, “Glass walls around nursing stations just aggravate the patients.” Removing glass or lowering it at nursing stations so patients can feel a more human connection to nurses often calms patients. There is also discussion of removing nursing stations altogether; decentralizing and placing these care needs directly into the clinical neighborhoods and community spaces. Pitt says, “The view is that [nursing staff] need to be out there treating their patients.”

Therapeutic Design Tenants

As medicine is increasingly moving towards “evidence-based” medicine, where clinical choices are informed by research, healthcare design is increasingly guided by research linking the physical environment directly to patient and staff outcomes. Research teams from Texas A&M and Georgia Tech sifted through thousands of scientific articles and identified more than 600 – most from top peer-reviewed journals – to quantify how hospital design can play a direct role in clinical outcomes.

The research teams uncovered a large body of evidence that demonstrates design features such as increased day-lighting, access to nature, reduced noise and increased patient control helped reduce stress, improve sleep, and increase staff effectiveness – all of which promote healing rates and save facilities cost. Therefore, improving physical settings can be a critical tool in making hospitals more safe, more healing, and better places to work.

Today’s therapeutic spaces have been defined to excel in 3 categories:

1. Provide clinical excellence in the treatment of the body

2. Meet the psycho-social needs of patients, families, and staff

3. Produce measurable positive patient outcomes and staff effectiveness

Considering the cost of treating mental illness, which is exceedingly high, and wanting facilities to have effective outcomes, a further practice of incorporating therapeutic design is increasing. The National Institute of Mental Health (NIM H) approximated in 2008 that serious mental illnesses (SMI ), costs the nation $193 billion annually in lost wages. The indirect costs are impossible to estimate.

The estimated direct cost to clinically treat is approximately $70 billion annually and another $12 billion spent towards substance abuse disorders. In addition to the increased need of care and the boom in Behavioral Healthcare construction, it becomes an obligation to make certain that we as facility managers, architects, designers and manufacturers therapeutically plan and design these facilities.

Notably, in 2004, “The Role of the Physical Environment in the Hospital for the 21st Century: A Once-in-a-Lifetime Opportunity,” published by Roger Ulrich P.H.D., of Texas A&M University, was released. In a culmination of evidence-based research, research teams found five design principles that contributed significantly to achieving therapeutic design goals.

The report indicates five key factors that are essential for the psychological well-being of patients, families and staff, including:

1. Access to Nature

2. Provide Positive Distractions

3. Provide Social Support Spaces

4. Give a Sense of Control

5. Reduce or eliminate environmental stress

Access to Nature

Studies indicate that nature might have the most powerful impact to help patient outcomes and staff effectiveness. Nature can be literal or figurative – Uncategorized light, water walls, views to nature, large prints of botanicals and geography, materials that indicate nature and most importantly, stimulating color that evokes nature. Several studies strongly support that access to nature such as day-lighting and appropriate colorations can improve health outcomes such as depression, agitation, sleep, circadian rest-activity rhythms, as well as length of stay in demented patients and persons with seasonal affective disorders (SAD).

These and related studies continue to affirm the powerful impact of Uncategorized elements on patient recovery and stress reduction. Thus, it is clea
r that interior designs which integrate Uncategorized elements can create a more relaxing, therapeutic environment that benefits both patients and staff.

Positive Distractions

These are a small set of environmental features that provide the patient and family a positive diversion from “the difficult” and, in doing so, also negate an institutional feel. These can be views to nature, water walls, artwork, super imposed graphics, sculpture, music – and ideally all of these want to be focused on nature and, when applicable, an interesting use of color. Therapeutic environments that provide such patient-centered features can empower patients and families, but also increase their confidence in the facility and staff. This helps with open lines of communication between patient and caregiver.

Social Support Spaces

These are spaces designed partially for the patient but mainly for the comfort and socialization of family members and friends of the patient; therefore, family lounges, resource libraries, chapels, sleep rooms and consult rooms all play a role. When family and friends play a key role in a patient’s healing, these spaces encourage families to play an active role in the rehabilitation process.

Sense of Control

In times when patients and family feel out of control, it is very healing for the facility design and staff to provide it back when appropriate. Although, this cannot always be done suitably in mental healthcare facilities. However, when applicable, these design features include optional lighting choices, architectural way-finding, resource libraries, enhanced food menus, private patient rooms and

optional areas to reside in. A few well-appointed studies in psychiatric wards and nursing homes have found that optional choices of moveable seating in dining areas enhanced social interaction and improved eating disorders. When patients feel partially in control of their healing program and that the building features are focused to them, an increased confidence of the quality of care enters and tensions lower.

As with all therapeutic design, this allows the caregiver to use their resources healing in lieu of “managing” patient populations.

Reduce or Eliminate Environmental Stress

Noise level measurements show that hospital wards can be excessively noisy places resulting in negative effects on patient outcomes. The continuous background noise produced by medical equipment and staff voices often exceeds the level of a busy restaurant. Peak noise periods (shift changes, equipment alarms, paging systems, telephones, bedrails, trolleys, and certain medical equipment like portable xray machines are comparable to walking next to a busy highway when a motorcycle or large truck passes.

Several studies have focused on infants in NIC Us, finding that higher noise levels, for example, decrease oxygen saturation (increasing need for oxygen support therapy), elevate blood pressure, increase heart and respiration rate, and worsen sleep. Research on adults and children show that noise is a major cause of awakening and sleep loss.

In addition to worsening sleep, there is strong evidence that noise increases stress in adult patients, for example, heightening blood pressure and heart rate. Environmental surfaces in hospitals are usually hard and sound-reflecting, not sound-absorbing causing noise to travel down corridors and into patient rooms. Sounds tend to echo, overlap and linger longer.

Interventions that reduce noise have been found to improve sleep and reduce patient stress. Of these, the environmental or design interventions such as changing to sound-absorbing ceiling tiles, are more successful than organizational interventions like establishing “quiet hours.”

Conclusion and Additional Information

The information contained in this excerpted report is intended as a guide for architects, specifiers, designers, facility planners, medical directors, procurers, psychologists and social workers which have a stake in providing improved facilities for behavioral healthcare patients. It is a portion of a report entitled “The Contributions of Color” authored by Tara Hill, of Little Fish Think Tank. Ms. Hill was commissioned by Norix Group Inc., in 2010 to research the role color plays in the safe operation of correctional facilities and behavioral health centers. More in-depth information specifically about the psychological influence of color and behavioral healthcare facility design can be found by reading the full report.