Defragging the space of machines for PT at RWJ Somerset
+ Post-Occupancy interview with Deborah Fugaro, Director of Rehab Services.

Architectural defragmentation of Robert Wood Johnson University Hospital Somerset’s Physical Therapy Program improved spatial relationships and allowed for more program in a smaller space.

The Challenges:  Smaller Space + More Program
RWJ Somerset needed to make room for a new cardiology suite, which resulted in the displacement of the existing PT suite into a smaller space. The space that was available was their former Same Day Surgery Suite (SDS), and it was smaller. RWJUH Somerset’s facility leadership furthermore challenged the design team by asking them if they could help solve the problem of how to combine Physical Therapy (PT), Occupational Therapy (OT) and Activities of Daily Living (ADL) in this new reduced area. The charge was to synthesize these three spaces into one location.

The Solutions: 
I. Planning for the Machines

Intense front-end planning with the design team, PT leadership, and the equipment planner were critical contributing factors to the successful outcome of the project. Given the machine-driven nature of the project, Best Healthcare Planning played a vital role in the planning stages of the project, carefully documenting all the existing and new machines and equipment and working with the architects to assure a proper fit. Correcting relationships can result in a sense of more space.

After detailed programming and planning, the design team worked together to produce a fresh, finished environment with strong perceptual and organizing principles. Zones were defined without infringing the space with bulky walls. Balancing and invigorating the space for the clientele, who range from injured to elderly, allowed for both athletes as well as disabled seniors to co-exist in mutual comfort.   

Q&A Post-Occupancy Interview with Deborah Fugaro, Director, Rehab Services at Robert Wood Johnson University Hospital Somerset.

• Newton (NK Architects):
  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 (RWJUH Somerset):
  • 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.

• Newton (NK Architects):
  What is working for RWJUH Somerset in the final space?
• Deborah Fugaro (RWJUH Somerset): 
  • 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.

• Newton (NK Architects):
  Are there any elements in the new design/space that RWJ Somerset is particularly pleased with?
• Deborah Fugaro (RWJUH Somerset): 
  • (With a laugh and smile) 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.

• Newton (NK Architects): 
  Are there any items or things RWJUH Somerset thinks could have been better/done differently? Lessons learned?
• Deborah Fugaro (RWJUH Somerset): 
  • It was very helpful having someone on the design team that had deep knowledge from personal experience about PT environments. It added a greater level of understanding.  (One of the design team members had a disability and spent years in PT environments.)
  • 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. 

• Newton (NK Architects): 
  Has there been any feedback from users (either internal, or clients?)”
• Deborah Fugaro (RWJUH Somerset):
  • 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. Occupational Therapy (OP) is on one end of the suite, while on the other end is dedicated to pure Physical Therapy (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 1980’s!”
  • Patients and users like that the space is calming with a pop of color.

• Newton (NK Architects): 
  Did RWJUH Somerset learn anything in this process that would be helpful to share for those designing for PT environments?
• Deborah Fugaro (RWJUH Somerset):
  • 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.

• Newton (NK Architects): 
  What are the current trends in PT that have changed over time?
• Deborah Fugaro (RWJUH Somerset):
  • The delivery of PT is being affected and changed by impacts of the Covid-19 pandemic. 
  • The pandemic makes us rethink patients’ beginning point of entry and waiting areas.  Prior to this new space, there were issues with safe distancing and now with the new waiting room we are immediately able to meet the separation requirements.  Furthermore, having two reception windows allows us to process two patients at a time.
  • In the new gym the treatment bays are properly distanced. Our red and green dot cleaning methods allow the therapists to tell right away if space has been sanitized or not.
  • Our Physical Therapy Unit has been very busy, even considering the Covid-19 pandemic, which says a lot about the services that former patients were receiving. It shows that they could not wait to come back. Now with the process of scheduling and screening by phone, and then carefully processed through the unit, patients have a real sense of safety.
  • Family-centered and patient-centered care has transformed PT. Once upon a time, they were told what was going to happen, and now they are asked to be involved with their own care. 
  • RWJUH Somerset has implemented an application where therapists send exercises and videos to patients’ cell phones to reinforce the work at home, giving them at-home exercise plans customized and personalized for them.

The Conclusion: 
Synthesis + Spatial Efficiency

Synthesizing the programs, correcting vicinities to create better efficiencies within space, organizing the equipment in detail, integrated by design solutions that clearly define space and walkways without using walls or enclosures, are key elements to the unique success of this project.

• RWJ University Hospital Somerset, Somerville, New Jersey
• Physical and Occupational Therapy
• Renovation Cost (per square foot): $145.75
• Project Completion: Spring 2020

Design Team:  

• NK ARCHITECTS Architecture, Design & Planning
• LKU Group MEP Engineers
• DCC Design Group Interiors
• Best Healthcare Planning LLC
• O’Donnell & Naccarato Structural Engineers

See also:

Healthcare Design Magazine - December 2020 Issue