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

July 14, 2017

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Boost Your Cold Calling Results in Commercial Real Estate

July 17, 2017

To make your prospecting system work for you in commercial real estate, you really do need to systemise it and set some priorities. Systems help build the future; random undirected action does little for you as a commercial real estate agent.

When you set the priorities you will not be wasting your time on things that don’t matter or perhaps have little results and conversions for you. It’s tough enough finding the time to prospect every day, let alone spending time on things that are not good converters of business opportunity for you.

So what can you do here? You can set a plan up that keeps you focused on the highly converting prospecting processes. You need new business to make your career work for you and prospecting is the key to pulling it all together.

Here is a priority model used by salespeople that I have helped in shaping their market share.

  1. Practice your call pitch for 30 minutes at 8:00am every day. This single one fact will help you convert more people faster to opportunities.
  2. Start the day with cold calls to new people. This should happen for a period of 2 hours. Start your calls at 8:30am.
  3. It will take you 30 minutes to build momentum as part of the call contact process. After 30 minutes you will be comfortable with what you are doing and the conversations will flow. The calls will get easier.
  4. Remove any meetings from the start of a business day. That includes team meetings. Focus on prospecting before anything else. Don’t let other people waste your prospecting time.
  5. Any follow up calls to established contacts should happen later in the day outside of your prospecting time. Create a habit of prospecting for new business. Don’t let existing customers or contacts derail your prospecting system.
  6. Towards the end of the day you should enter the results of the calls into your database. Perhaps you can do that as you are making the calls; the data does however have to be entered and you must take responsibility for that.
  7. End the day with research related to new prospects that you are to call tomorrow. Who are they and why are you calling them. You will need to know those facts as part of the process.

So these are some very rigid rules. When you stick to them you will find that opportunities develop. In any market and at any time the business is out there; it is just a matter of opening up the relationships with the right people.

Peter Pan Costumes for Kids Who Never Grew Up

June 12, 2017

You can fly, you can fly, you can fly! Let your imagination fly to new heights with one of a variety of quality Peter Pan costumes this year. Whether you’d like to dress as Peter himself (and remember that Peter Pan on Broadway was always played by a woman!), Tinkerbell, Captain Hook, or Tiger Lily, it doesn’t matter if you’re looking for a costume for a man, woman, children, or baby, you’ll be able to find just the Peter Pan outfit and accessories that will make Neverland come to life for you.

A man or boy’s Peter Pan costume comes with an olive green tie-up shirt, brown pants, wide brown belt, and pointy green hat with a feather. It’s one of those costumes suitable for all ages, because, after all, Peter Pan was the boy who never grew up. As we all know, there’s still a lot of boy inside of every man, and this can be your chance to get in touch with it. Accessories that you can purchase extra in order to really capture the Peter Pan look include green felt elf shoes, pointy ear tips, and a fencing sword that will come in handy for fighting with pirates.

Another great costume for men and boys is Captain Hook. With the boys’ model you get the red jacket with sash, black pants, and a white dickey. To further accessorize the outfit, a hat with a plume, black boots, a hand hook, and a fencing sword are all options. The man-sized costume features a long red coat with gold trim, a white ruffled jabot, and a hook. Other accessories can be purchased which include a Captain Hook Wig, a hat, sailor’s pants, and high black boots. A word to the wise to anyone wearing this costume, though – watch out for crocodiles!

Women and girls have a lot of different Peter Pan costume choices. They can choose to be Peter in a feminized version of the traditional outfit or select from many different Tinkerbell costumes and accessories. A typical Tinkerbell outfit includes the traditional green petal-skirt dress and a pair of sheer wings. Optional accessories include silver Tinkerbell shoes, a glitter wand, and a faux diamond tiara. Costumes for her have never been so sparkly or so feminine. Tinkerbell outfits are also available for infants. If they’d like something a little different, they can also opt to dress as Tiger Lily, the Indian princess.

Wading Into Internet Marketing

June 23, 2017

Internet marketing has the great advantage of low barriers/cost for entry. For as little as $50 and about 15 minutes you can be serving up pay per click (PPC) ads, with very little effort. This makes it very attractive for companies to try it out.

But you can’t really just try it out – not if you want to make it work. You’ve got to make a commitment; Internet marketing is similar to traditional marketing in that it is difficult to predict what will work in your target markets and what won’t. As with anything else in business, there are no guarantees of success.

Broaden Your Approach

As well, you don’t want to pin your hopes on the one Internet marketing activity you chose to try, because if the results are not as you expected, you’ll be disillusioned. Just like traditional marketing, communicating your message in more than one medium and multiple times will increase the probability of making the sale. Thankfully many online and offline elements work well together to achieve this. Along with a commitment, investment in a number of upfront activities will greatly improve success:

1. Research into keywords and user behaviour – These are staples in all Internet marketing activities; know them well.

2. The advice of experts – You don’t need them on your payroll and you don’t need them on every campaign, but an expert can help you choose the right Internet marketing tactics and ensure everything is set up correctly. As well they can interpret the campaign results. Click throughs (number of clicks to an advertisement), bounce rates (number of visitors who leave your site after viewing one page) and exit pages (pages that users are leaving your website from) can be a bit daunting. You may be able to judge if results are good or bad but more importantly, do you know what action to take next in order to improve?

3. Correct set up of analytics tools – To properly set up filters and segment your website traffic statistics to get at the data that is most important to your business is not straightforward, especially if multiple websites are involved. Many businesses don’t set up tracking correctly and work with inaccurate data.

4. Landing page templates – These are pages on your site specific to a campaign or promotion that people arrive at when they click from a PPC ad, online ad or a print campaign. A template based approach lets you reuse your investment for future campaigns.

5. Email template – If email is on your roster- and it should be since it’s cost effective and can be highly targeted – invest in 1 or 2 great templates. With a base template, all you need to do is swap in new content each time you want to send to your list. All of your emails will be consistently branded and polished if you take the time to do it right.

Your Return on Investment

These set-up activities will pay off in the long run. Yes, it’s more upfront cost, but once it’s all in place, subsequent campaigns will be mostly execution and reporting. And you don’t have to include their full cost in the Return on Investment (ROI) calculation – you can amortize them over a year or more to more accurately represent the value of your campaigns.

Approach Internet marketing with the knowledge that it is a cost-effective, flexible set of options to reach your market. But know that just because you can measure results, there is no guarantee of good results. By making an investment in the foundation activities and taking advantage of the intelligence that measurement provides, each campaign teaches you about the market and your user’s behaviour so subsequent campaigns can be that much stronger – every time.

Economic Recession Blues – Hospitals Aren't an Exception

July 3, 2017

In its most recent update, the International Monetary Fund (IMF) announced that world growth is forecast to fall to its lowest level since World War II. And with the US being one of the worst hit, the hospital business, an integral part of the medical marketplace, and often regarded as recession proof is beginning to feel the heat.

Despite the fact that hospitals aren’t hit the way the way the automotive sector or the retail has been, and that people will continue to fall sick irrespective of the economy, it seems that the number of people seeking medical care and the profitability of hospitals don’t walk hand-in-hand.

Growth stunted & patients decreasing

A recent report by the American Hospital Association (AHA) finds that the sputtering economy has already led to 45% of hospitals to postpone forthcoming capital projects, with about 13% being forced to completely stall any expansion projects already underway. The AHA report included 639 hospitals in the study.

Further, experts believe that even though people continue to fall sick they’re postponing, most treatments if not all, which can be classified as elective. The credit for the prevailing scenario goes to all the layoffs and the slowing economy. As per the Bureau of Labor Statistics the month of December saw some of the worst layoff figures, as there were 2,275 mass layoff actions, involving 226,117 workers.

What seems worse is that aside from foregoing elective treatments, patients seem to be avoiding essential drugs, with many actually abusing prescription drugs, such as narcotic painkillers , sedatives and tranquilizers and stimulants.

As a consequence, hospitals are reeling under delayed hospital equipment and supply purchases, declining patient visits, reduced staff with no fresh hiring, unpaid medical bills, in addition to ceasing any construction projects. The AHA survey, released in November last year found that patient visits were static or had decreased during the third quarter of 2008, and the cases of unpaid medical bills for hospitals registered a hike of 8%.

The government’s role in uplifting the spirit of hospitals is being thought to be instrumental as Medicare and Medicaid account for about half of the hospital business industry.

Home Based Business Trends In A Fragile Economy

June 20, 2017

Home based businesses are many with some that are truly legitimate and others that are out to put a deep hole in your wallet. With today’s fragile economy, millions of people out of work and a shrinking middle class, there are those of us seeking ways to increase our financial means to make ends meet or to simply keep food on the table for our families. I’ve been a victim of the scams and have invested hundreds (if not thousands) of dollars seeking out the latest home business trend. But I have also learned a lot along the way and have acquired some tools to success that I would like to share with you to avoid any pitfalls you may experience in your search for the right opportunity.

#1. Product. You need to choose a product that literally most everyone needs. Think long and hard about this. Not everyone needs or likes healthy chocolate (I personally know someone who is allergic to it). The market is also flooded with many nutrition supplements claiming to be the next big trend. There is liquid form, pill form, shake form, juice form, etc. So which do you choose? Not to mention the expense and investment in such a venture. Don’t get me wrong. There are many fine health and wellness opportunities out there but they require a large financial commitment and again isn’t necessarily something most everyone wants or needs (we are in fact one of the most obese nations in the global market). Consider something such as cell phones. Nearly everyone has them everywhere you look and nearly everyone needs them. Even my 10 year old son is begging me to get him one since many of his friends already have them. The cell phone industry is exploding and more and more companies are popping up on the market.

#2. Affordability. As I mentioned earlier there are many legitimate home based business opportunities but they require a large financial commitment on your part and with a fragile economy this just isn’t an option. So along with the right product you need to have the right price. Opportunities that are too inexpensive (such as an opportunity for only $97) require hundreds of people in your downline just to make a few hundred dollars. Home based business opportunities that are too expensive are simply that-cost prohibitive and you don’t stand a chance at seeing a return (such as those opportunities that cost $1995-$3995). I’ve found that the latest legitimate home based business trends are priced between $300-$500. These are reasonably affordable even in a fragile economy and can get you up and running in no time. It will have you seeing a return on this investment within a few weeks to a few months.

#3. Team. I can’t stress enough how important it is to have a strong support system in place. Too often we are left to fend for ourselves after signing on with an opportunity and spend months trying to figure everything out ultimately ending in failure. A duplicatable, automated selling process, turn-key system that can run on auto pilot is vital to being successful with a home based business opportunity. These duplicatable systems can be achieved through websites and lead capture pages (which are generated by the company and given to each of their reps to build their business), DVDs explaining the opportunity and most importantly a way to market your business through offline methods (such as postcards and sales letters) in addition to online methods such as pay per clicks or cost per clicks. There are other online methods such as blogs, social media, articles and more but these systems are not easily duplicatable by everyone and requires a great deal of research, practice and trial and error to be successful with these methods. With the flood of online advertising, offline old-school mailbox methods such as postcards promoting an opportunity are becoming the trend among home based businesses.

#4. Leverage. The fourth and final point is leveraging a powerful system with the right opportunity that allows you to:

1. Make a lot of money

2. Make a lot of money quickly (and I don’t mean within 48 hours-let’s be reasonable here). You could with the right system be making money within a few weeks to a few months.

3. Be able to work from home only a few hours a week on a schedule that YOU decide

4. Have a business working for you even when you are not-translates to a 100% automated sales process from the moment your prospect sees your offer. This means:

-No personal selling
-No phone calls
-No hotel meetings
-No emails
-No sharing with friends and family

There is a lot to consider when seeking out the next home business trend. What I can tell you is from my experience, by using the tips I have mentioned as tools for researching and crafting a home business opportunity that’s right for you, it will greatly increase your chances for success.

Is an electronic cigarette the best way to quit smoking?

June 14, 2017

For more than fifty years now, physicians have tried to raise people’s awareness regarding tobacco related illness and death, but even with all the anti-smoking ads and the increased excises, a lot of people continue their nicotine addiction. Trying to quit is not an easy process and there have been many ways suggested and praised, from nicotine patches to the newest electronic cigarette. However, giving up smoking is just about strength of character and will, as it is about finding the right method for you. Determination is certainly a factor here, but one should also keep in mind that every body is different and what worked just fine for your friend or relative, may not work for you. The recent invention of the electronic cigarette, however, seems to be enjoying a lot of popularity, although lately, the e-cigarette industry was hit by an FDA report, calling them dangerous.

Taking first things first, supporters of the elektronisk cigaret are claiming that it is the best tool in one’s efforts of giving up smoking. It has the feel and look of the real thing, but without any of the harmful substances. The e cigaret does contain nicotine, but none of the other chemicals, such as tar or carcinogens. So basically, it has three main components: the cartridge, which is the part you put in your mouth, an atomizer, being the heating element, through which the liquid is being vaporized and a battery, which works as a power supply. The elektronisk cigaret also makes use of a flavouring component, which, believe it or not, was one of the aspects for which it has been criticized. The FDA report stated that young people, who are not yet smokers, can be attracted by the different flavours of the e cigaret and thus tempted to try the real thing.

However, the electronic cigarettes industry has a lot to bet on, considering the benefits that opting for an e cigaret brings. Apart from the fact that it has none of the dangerous and extremely harmful substances of real tobacco, such as carcinogens or cancer causing agents, tar and second-hand smoke, the innovative product also eliminates other disturbing elements like smell, the bad breath or the discolouration of teeth. Furthermore, they had such a good start-off and were so well received by people, as a healthy alternative to smoking, that a couple of airlines even allowed their use during flights.

Health campaigners on the other side have argued that going from a tobacco cigarette to an elektronisk cigaret is not a solution. The only solution is giving up smoking in all of its forms, otherwise, sooner or later, people will go back to tobacco or just alternate between the two. Others stated their concerns with propylene glycol, which is a main ingredient in an electronic cigarette as it helps create the illusion of smoke, and how it had not been tested thorough enough.

All things considered, one can try many ways to quit smoking, such as a nicotine patch or gum or even the application of medication, but if the invention of such a device as an electronic cigarette was needed and it works, then it may as well be regarded as a very good, if not best, method.

First Date Clothing Suggestions For Men

June 18, 2017

Dressing smartly and suitably for a date is an area which some men unfortunately overlook and feel they don’t need to make an effort dressing for a date. This is the first mistake a man can make when going on a date. Having said that, not all men overlook this area; there are some men who spend hours getting ready for a date but wouldn’t admit it. Wherever you decide to go on a date, regardless of the class, it is vital that you appear to have made an effort and turn up looking your best wearing a freshly washed and ironed outfit.

First impressions can make or break a date, so the importance of looking smart cannot be underestimated. Along with being washed and ironed, clothes must fit properly, be stain free, be hole free, not too tight, not too baggy, not garish and not old and faded. It is also important that the outfit you choose to wear on a date is suitable for the date location plus matches your age. Dressing older or younger than your actual age will only make you stand out. By dressing too young you may appear like you are trying to recapture your youth resulting in your date believing you have other personal issues going on. Alternatively dressing too old could be off putting for your date. You want your date to look at you and feel happy to be on a date with you, not to wonder what they have got themselves into.

The easiest date to dress for is a casual date. This may include going for a drink in a bar, going out for fast food or a visit to the cinema. For any casual date, it is perfectly acceptable to wear jeans. It does not mean that you can dress down or wear jeans that have seen better days. Jeans should be in good condition and have a perfect fit, especially around the bottom area, which is where most women tend to have a good look at. You can choose between a variety of tops to accompany jeans, such as a t-shirt, a poloshirt, a casual shirt or a sweater. Poloshirts are ideal if you have a good physique and you wish to show it off. If the weather is cold, then a casual jacket is suitable. If you decide to wear a t-shirt, it is best to avoid garish colours and stay away from novelty t-shirts, at least for the first date anyway. If you decide to tuck your top into your trousers, remember to wear a belt to add a finishing touch to your look.

You can get away with wearing jeans on a casual date, but if you are going on a classy date, then they are not appropriate. A more formal look is required for a classy date, such as a visit to the theatre or a meal at a fancy restaurant. It’s a good idea to own a suit, ideally in a dark colour such as charcoal grey or navy, as you can create a number of different looks using just one suit. You can wear a variety of different shirts and ties with a suit or you can change your look entirely by wearing the suit trousers with a casual shirt, or even wear the suit jacket over a casual outfit to create another great look. If you choose to wear casual attire on a classy date then all you will achieve is showing your date that you couldn’t be bothered to make an effort, plus you will stand out especially if your date is wearing a stylish dress. Once you have chosen your outfit, don’t ruin the look by wearing inappropriate shoes. Formal footwear should be worn when going on a formal date. Trainers, sandals, pumps and boots are not appropriate. Formal shoes must be clean, match the outfit and comfortable to wear. If you are wearing a belt with your trousers, then ideally your shoes should be the same colour as the belt. Footwear is an area that women tend to notice, so great footwear can leave a great lasting impression on your date.

An active date, such as playing a game of tennis, or going walking together, requires a different look. It is necessary to wear sports gear and not forgetting supportive footwear. Clean modern jogging bottoms or shorts are appropriate, just as long as shorts aren’t too small and tight and jogging bottoms aren’t baggy at the knees. A t-shirt, long or short sleeved is suitable and if the weather is cold, then a sports jacket or a sweatshirt can be worn. Dressing for a sporty date is not a time to put fashion before comfort. You need to dress in clothes that won’t restrict your movement plus feel comfortable to wear; remembering to check that they are clean before you put them on, including your footwear.

If your date has arranged the date and you don’t know where you are going, then you need to wear an outfit that is suitable for a range of date locations. A good suggestion is a pair of smart trousers accompanied with a fashionable shirt and a stylish jacket. A stylish jacket, such as a suit jacket will be appropriate if your date has booked a table at a fancy restaurant, and a fashionable shirt is sufficient for any casual date and even a slightly classier date. There is no need to wear a tie, but if you prefer, you could always conceal a tie in your jacket pocket in case you find yourself going to an upmarket venue. If you feel overdressed, you can remove the suit jacket to reveal your casual shirt. It is always better to be slightly overdressed than underdressed, which will show that you have made an effort.

Along with clean, ironed, fresh smelling and well fitted clothes, it is a good idea to turn up for a date clean shaven, showered and smelling great. Smelling good is very attractive to women, just don’t overdo the aftershave or body spray. Don’t leave your decision making to the last minute. Think in advance about what you wish to wear and take your time getting ready. The last thing you want is to turn up for a date feeling flustered and worried because you forgot to shave or put on deodorant. Planning your outfit in advance and looking like you have made an effort are the two main keys to dressing well for a first date.

What Makes Wellington Boots Such a Very British Item of Footwear?

June 15, 2017

Looking back through history, it all seems to have started in the eighteenth century when a boot called the Hessian boot, initially used by the military, became widely worn by everybody else. Hessian boots had a low heel, quite a pointed toe (useful for mounted troops for ease of using the stirrups) and were knee high.

This style of boot became popular amongst the British aristocracy in the nineteenth century and it was the first Duke of Wellington that popularised it. The Duke had his own version of the Hessian boot made. There were many alterations and the resulting style is nothing like the wellington boots we know today, but his new boot was dubbed “The Wellington” and the name lives on today.

“The Wellington” was still made of leather and remained very fashionable in Britain until the mid nineteenth century. Then in 1853 a man called Hiram Hutchinson started making them out of rubber and established his company Aigle who are of course still going today in France. The new waterproof rubber wellington was very popular among agricultural workers in France.

Then it was the two World Wars that dramatically inflated a need for waterproof knee high boots, and lots of them! Soldiers were in need of suitable footwear for the flooded trenches and it was the North British Rubber Company (now Hunter Boot Limited) that came to the rescue. When the wars were over, the Wellington had become very popular among men, women and children as the best footwear for wet weather.

What makes them so British is of course the influence of the weather, they really were and still are essential footwear for outdoor life on a rainy island.

Aside from the two World Wars and the weather, the other big influence was by a member of the aristocracy again. It was the Duke of Wellington in the eighteenth century and the Princess of Wales in the twentieth. When the Princess was photographed wearing Hunter wellies, a brand new welly craze began all over again.

So they really are a very British type of footwear. Waterproof footwear that is expected to be inexpensive, durable (lasting at least twenty years!), comfortable and easy.

British people nowadays buy little canvas houses for their beloved wellies and children positively think they are alive. Every child has at least five books in their collection that feature wellies. Children also love them because they can put them on themselves from a young age and can splash in puddles without being told off for getting their shoes or clothes wet.

Planning and Design of Behavioral Healthcare Facilities

July 6, 2017

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

Right-sizing

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.

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