How To Get Traffic As An Internet Marketer

Becoming a successful internet market is no joke. To really make more money than the guy that work his heart out from 9am-5pm takes knowing how to do the right thing. Some people say you need to work hard to make it in internet marketing. But, I would say that you not only work hard but work smart.

Every info-preneur or internet marketer undoubtedly needs to get traffic to make it in the internet business. The internet business is very competitive and if you do not know how to gain traffic to win the heart of people surfing the net, you may eventually become a failure. I have seen and heard many information marketer with right passion and excitement, become frustrated and fail in this business. You could avoid being frustrated and having the believe that internet marketing does not work or it is a big scam. You only need to become smarter to make 4 or 5 digit cash with an effective traffic strategy.

There are 3 skills that you will need to cultivate if only you want to make big money selling information over the internet.

*Perfect the bait
*Target the right people
*Delivering the right solution quickly

When you think of getting or gaining traffic for your internet marketing business, you must keep three things in mind:

1. Who is my target audience

2. What do they want?

3. How can i motivate this target audience to act now?

Let look at these closely;

Who is my target audience:If you want to market products/services or information you must first find a group of people who are hungry for such information. I call this ‘finding hungry fish’. I prefer a school of fish in ‘feeding frenzy’. If you drop your bait, that is traffic into such a school of hungry fish, they will attack your bait.
The most important part of marketing is not the traffic you could drive to the product. It is targeting your traffic to the right audience.

2. Where do you find your right audience:You have 2 choices;you can either devise traffic from someone else medium or create your own traffic strategy and get your own customers. In other words, you could pay for it as in using pay per click(PPC) or buying classified ads slot/space. But, for starters it could be expensive.

A free and no-cost method of getting traffic is to build a list. You can write a 8-15 pages report or create an e- book and give it out for free in giveaway events or forums sites. People who opt-in for your report, leave their name and email address. With this, they become willing subscribers you manage for your marketing activities.

3. How do I motivate the target audience to buy Now:As a student of marketing, i have discovered some principle that work. There are 6 of them:

a. Consensus:Give people what they want. The ‘hottest’ thing that is in demand by a large number of people. It will induce a potential buyer to say yes easily to your product.

b. Reciprocity:You should give them bonus for buying your products. Give them a free ‘gift’. It creates a subtle obligation to them to buy your product.

c. Scarcity:Attach a time limited and quantity limit to the amount you have to sell. This create urgency in the potential buyers.

d. Authority:Talk like an expert. If you are a newbie, you can have a joint venture with experts. you should note that people like to deal with experts.
e. Commitment:Whatever you promise you will do, stick to your words. Give yourself to doing what you say.

f. Liking:Make them like you and your products. appeal to their sense of liking to you and your product.

Traffic is the hub of your marketing campaign in internet marketing. Do every thing you can to get traffic. Always remember, without it you are less likely to succeed online. I wish you success and see you at the top.

Ways To Stop Smoking Permanently by sigarette elettroniche

A lot of smokers want to stop and you might be looking for information on how to stop smoking having made previous unsuccessful attempts sigaretta elettronica.

It is not uncommon to be in this position as stopping smoking cigarettes electroniques is not easy and you need to really make a very firm decision to do so. It may help to write down why you to want to quit to remind you when the going gets tough.

The difficulty with stopping smoking cigarette electronique is there are both physical and mental addictions to beat and beating the physical addition is the easy part (relatively).

People smoke because:

• It is a pleasurable experience and relaxes the smoker.

• Smokers have developed an unconscious link between certain activities and environments and smoking elektronisk cigaret.

• They have an addiction to nicotine.

As an alternative to quitting smoking you might think about using electronic cigarettes(elektroniske cigaretter). People have used these to stop smoking although they are not marketed for this purpose but they do make smoking cheaper, cleaner and harmless to others. You can also choose how much, if any, nicotine they supply.

Some of the possible approaches to stopping smoking are:

Cold Turkey

This is the simplest and cheapest method but not the most successful. You pick a date and from that point you no longer smoke. The initial period is very difficult so you need to be very strong minded to be successful. The success rate is estimated to be between 5% and 10%.

Alternative Sources Of Nicotine

Products such as nicotine patches or gum are used to replace that previously received from cigarettes. They deliver a controlled dose into the body to relieve some of the withdrawal symptoms. There is a lot of variation in the claimed success rates but for nicotine replacement used on its own they vary from 7% to 35%.

Stop Smoking Medication

Medications (such as Zyban) help relieve withdrawal symptoms without the use of nicotine but are intended for short-term use only. There are also homeopathic remedies (such as Smoke Deter) which do the same thing.

Various Therapies

You can learn how to modify your behavior to break habits that lead to smoking and how to stay motivated to quit smoking. In fact it is very difficult to stop smoking without help and support and any sort of counseling or organized program will help considerably.

Quit Smoking Hypnosis

When considering how to stop smoking, hypnosis should be taken seriously as it has success rates of up to 50%. Quit smoking hypnosis is based on reprogramming the subconscious mind to stop associating smoking with pleasure and relaxation and to substitute some other behavior. It can also be used to remove conditioned responses so the smoker loses the urge to smoke when in the environments that used to trigger it.

Hypnosis will not work for everyone, but it is well worth trying.

Best Option

Trying to stop smoking on your own is very difficult and likely to fail. Support of some sort will increase your chance of success considerably and it may be that taking something to help with the nicotine withdrawal, combined with hypnosis or behavioral therapy to address the psychological addiction, is likely to give you the best chance to stop smoking for good.

Thrifty Car Rentals – Tripling Your Savings

Thrifty car rentals are becoming popular as an option for people who hardly drive their car except on extended trips. Then there are those people who would prefer not to use their own car on trips over uncertain roads for fear of the wear and tear in will cause. People also rent cars to upgrade or downgrade on the size of the car that they own. For instance, an architect might own a large SUV which he uses for bringing his materials to his projects. For non-business trips, the car has much more room that he requires and more engine power than he ever needs to avail of. So he visits a thrifty car rental to get a smaller car for his daily use. Again people might want to rent a car because they are interested in buying that exact same model but just want to try it out first for a week before actually making that purchase.

If you are thinking of a renting a car, you should know that they usually cost less than the up-front price. This is because thrifty car rental companies offer discount bonuses on most cars and at most times of the year. Discount bonuses can shave of from 10% to 50% of the amount you need to pay after renting it. Price shave-offs can be availed of if you rent on weekends or during off-peak season. You can also have price reduction on the average cost if you rent for a week or a month. The specifics for extended rental discounts may vary from company to company, but they are always there.

Right now, the going price for high-powered cars, has gone down with the recession. Due to the need to save, people are buying cars with less power and smaller build. The result is that cars like the SUV are rented out instead of sold. Now would be the right time to try out renting a SUV from a thrifty car rental. This car is ideal for outdoor adventures on virgin terrain, like camping in the wild or fishing out in a secluded lake. The SUV is also ideal for visiting friends who live in isolated areas.

Before renting for an extended period, you need to consider the amenities or accessories that are included or excluded for monthly or yearly rental plans. Before settling on a monthly rental plan, be sure to calculate whether renting daily for 28 days will cost more than an outright 30-day plan. There are some thrifty car rental companies whose price structure sets a higher basic rate for monthly plans. If such is the case, there may be amenities or add-ons for monthly rentals that you are not aware of. Ask the personnel about it.

Other than the basic discounts on the rental fees of thrifty car rentals, some offer discount coupons for tourist spots, hotels and restaurants. These discount coupons are issued by the establishments to encourage more visitors to their place. Among these establishments, you have Disneyland, Sea World and even Universal Studios. Holiday Inn and Grand Hyatt are two hotels that offer discount coupons for travelers.

Avail Short Term Cash Advances With Limited Legal Formalities

The unpredictable market condition has made it almost necessary for people to resort to various kinds of loans. However, earlier availing debts was very difficult because of their long formalities and complex terms and conditions. In contrast to this, a number of easy finance possibilities have cropped up to help the people to meet their immediate emergency monetary needs. In this context, the short term cash advances caters the needs of the middle class people and allow them to meet their immediate expenses. What is most impressive about these finances is the fact that they are easily available and can be availed without long formalities or complex terms and conditions.

Today such loans have become very common because of the rise in uncertainty in life. A number of middle class as well as upper middle class people have started depending on such debts to prepare themselves for the unforeseen circumstances. Earlier, people had this misconception that resorting to bank borrowings could often turned out to be risky venture due to the pressure of repayments. But with the introduction of such short term cash advances, one can easily avail necessary finances for the emergency situations like medical needs, educational needs, paying off outstanding debts and many more.

One of the most striking feature of these finances is that they are unsecured in nature and do not require any pledge of security in the form of car, house or other property. This has actually proved very advantageous for the middle class people, who can now avail such debts in spite of not having enough property to be pledged as security. Hence, such financial sources have become more exposed to the people in UK.

Another plus point of these advances lies in the fact that these borrowings can be availed even by those who have low credit history. This means that even if you have defaulted payments for a couple of times in the past, then also you can avail finances from banks as and when required. Now, since these short term loans do not require any security pledging, therefore, they takes less processing time. These debts are getting very popular, as they offer easy repayment schemes which do not affect the savings of the people and reduce the pressure from the borrowers. However, in spite of having favourable terms and conditions these borrowings also involve certain criteria to be fulfilled by the users.

First of all, anyone who wishes to avail such finances must be a citizen of UK and must be minimum 18 years of age. Other than this, the borrowers must have a valid bank account so that the bank can transfer the loan amount directly to their account. The borrowers should also be working for at least a period of 6 months and should earn a handsome salary in order to avail such debts.

These short term cash advances with its favourable terms and conditions have come as saviours for those who cannot afford to avail long term loans because of the legal formalities and security pledging. Therefore, these finances have become highly popular among all class of people, especially the middle class, due to their liberal terms and conditions.

Real Estate Services – Business Immune To Internet?

Real estate services business is one of those verticals with an overwhelming number of websites. There are thousands of websites with apartments and villa listings. But does it really mean that this internet model of business generate a proportionate amount of revenue? Well, not really!

By many ways real estate services is one of those businesses that are ideally suited for a net based model. On one side you have a seller who wants to sell his property and other side you have a buyer who wants to buy a similar property. The seller lists the property for sale on a website. Prospective buyers finds it on the site and if found suitable, the buyer and seller come to an agreement for sale. No searching for agent, no commission. It all looks so simple. But it seldom happens that way.

The sale of a property incurs an agent commission of 2.5 to 6% (depending on your country, region, agreement with agent etc) of the sale price. The above described scenario means only a small listing fee to be spent by the seller. Consider the online recruitment business where a similar situation exists. It has done very well unlike real estate websites and sites like monster.com and hotjobs.com have a high brand recall. But a similar success is not found for real estate services websites. Spare a few like loopnet.com and costar.com which has found success in the commercial real estate sector. The truth of the matter is that the real estate multiple listing service (MLS) and agents tightly guard the seller data and other information. However, some other reasons also exist.

A real estate listing, unlike a job listing, needs to provide more information to look credible for the buyer. Collecting the required data, pictures of the property, (even videos some times) recent sales data, above all removing outdated data from the database, all this needs money to be spent.

Not all those who buy and sell property are negotiators. The agent claims to be one and normally takes such a role. But on most cases, they just make both the buyer and seller feel good about the deal. Both parties feel they negotiated and got the best deal. Also, not everybody wants to publicize that their property is up for sale, especially for commercial properties. An agent is entrusted to find buyers for the property.

There can be a solution for most of these issues. A real estate website can still provide the first level of information to seller. At least it can narrow down the search to a few properties of ones choice. With a little effort one can get additional information necessary for deciding the suitability of that property against your requirements and budget. As for confidential listing of property, this can be incorporated in a website. For example, KeralaListings.com a property marketing company hides the seller data and other traceable information from a property listing if tagged ‘confidential’ by the seller. This listing appears in search results for the given parameters and the prospective buyer can email the seller of his interest in the property.

As real estate websites adopt steps, to provide information which is updated and verified, this business model will gradually pick up. Though the cost of maintaining such sites is slightly more, this should gradually increase public trust on this model. Even with all this, the cost of property transaction can reduced considerably. Not to mention about the time saved for finding a property.

Effective Bird Control For Healthcare Centers & Hospitals

It’s no secret that people who are already sick are more vulnerable to contracting diseases.And one potentially unhealthful source of disease is bird waste. As a hospital administrator, you are no doubt aware of the problems pest birds can cause. Many species of birds, including pigeons, starlings and sparrows, often gather to roost on a hospital’s roof, under parking structures, in receiving bays and loading docks, and around exterior employee lunch and snack areas. Without bird control, you soon have a noisy, smelly and potentially dangerous problem on your hands.

Keep in mind that a single pigeon can excrete up to 25 pounds of droppings per year. The bacteria, fungal agents and ectoparasites in bird droppings and nesting materials have been known to carry any of 60 diseases–including histoplasmosis, encephalitis, salmonella, meningitis, and toxoplasmosis, even the West Nile virus.

No less harmful is bird fecal dust carried into hospitals through rooftop heating, ventilation and air-conditioning ducts. Birds often build nests around air handling equipment, ducts, compressors and other vented pathways. Dried by wind and sun, this disease-infested dust gets sucked into HVAC systems. The fine particles can quickly spread diseases throughout a hospital or medical center.

Hospital administrators should also be aware of the negative visual impact bird droppings, nests and other debris can have on a hospital’s image. Finally, bird droppings can cause dangerous slip-and-fall hazards–a huge legal liability for any institution.

Today’s Bird Control Measures

Hospitals and healthcare centers are somewhat restricted in their use of pest bird control measures. They certainly can’t use firearms, noise cannons or fireworks. And poisons present too much of a liability. Besides, federal, state and local wildlife protection ordinances forbid the use of lethal or harmful bird control measures. Fortunately, there are several highly effective bird proofing solutions currently available that are safe, sane and humane.

Bird Spikes

The good thing about Bird Spikes is that they prevent many species of large birds from landing in the first place. Suddenly, rooftops, ledges, signs, light fixtures and other elevated areas are off-limits to birds. Bird Spikes come in rows of spiked strips. And you can get them in either rigid U.V.-resistant unbreakable polycarbonate or high strength, durable stainless steel. The stainless steel spikes come in 3-, 5- and 8-inch widths; the plastic spikes (which cost slightly less) come in 3-, 5- and 7-inch widths. Plastic spikes are ideal for use near antenna arrays since they won’t interfere with radiated RF energy. You can get bird spikes in a non-reflective metal finish or a variety of colors–like white, tan, gray, black, brown, brick red and crystal clear. There’s also a no-gap spike that’s easy to affix to curved surfaces.

If your hospital or healthcare center is being invaded by large birds like gulls, try the Mega Spike. Its 7-inch spikes made of marine grade stainless steel will make sure these birds get the point and leave. There’s also the Gutter Spike, ideal for keeping large pest birds out of gutters or drains. Look for gutter spikes that have adjustable clamps at the base; these allow the spikes to be easily attached to the lip of a gutter.

Lastly, Birds Spikes look dangerous, but they are harmless to birds or people. They have even been approved by a number of humane groups worldwide–including the U.S. Humane Society and PICAS (Pigeon Control Advisory Service).

Sonic Bird Deterrents

Ideal for use in certain areas of a hospital or healthcare center, Typically, Sonic Bird Deterrents emit predator and distress calls that frighten pest birds but are basically just Uncategorized sounds that are not unpleasant to humans. Some highly versatile sonic systems emit distress and predator calls for as many as 22 types of birds. The sounds are cycled every few minutes to convince pest birds that they best leave or risk being attacked. Sonic Bird Deterrents are an ideal bird control solution for deterring pigeons, crows, starlings, swallows, gulls, woodpeckers, sparrows, grackles, cormorants and many other birds.

Bird Netting

To keep pest birds out of certain specific areas–like eaves, overhangs, patios, and parking structure recesses–there’s Bird Netting. This barrier bird control measure is available in various cuts and mesh sizes. For large birds like pigeons or seagulls, use a 1-1/8-inch to 2-inch mesh size. Sparrows or starlings, on the other hand are best excluded using a 3/4-inch mesh net. The best bird repellent netting will meet ISO 1806 protocols, is U.V. stabilized, flame resistant and rot- and water-proof. In areas where electrical conductivity or radio frequency interference is a problem, non-conductive netting is often used. Also note that netting now comes in various colors– including white, stone and black–to match a structure’s color scheme.

Electric-Tracks
A great spot deterrent for ledges, rooflines, eaves, signs and most flat or curved surfaces, Electric Tracks impart a mild electrical shock when birds land on their surface. This is an ideal bird control device for use against a wide variety of pest birds–including pigeons, sparrows, gulls, starlings and crows. The best electric tracks feature a low-profile design that makes them almost invisible. The strips of electrified track are usually powered by an AC charger or solar charger. One manufacturer uses copper knitted wire mesh in a continuous tube-in-tube stocking design. This gives the track greater conductivity, strength and reliability. The copper mesh is resists corrosion and will stand up to alkali and acidic environments.
Bird Slope
These angled, slippery PVC panels known simply as Bird Slope, won’t allow pest birds enough of a grip to land. After a few unsuccessful attempts, they just slide off like water off a goose. Bird slopes are easily installed, tucking unnoticeably into ledges, eaves, beams and other 90-degree areas pest birds often nest. The best panels are U.V. protected and sun and weather resistant. They deter a wide range of birds, including swallows, starlings, pigeons and seagulls. Some panels have a “snap-on” extender, which allows them to adapt more easily to wider ledges and coverage areas.
Bird Scare Deterrents

These inexpensive bird control devices make pest birds too nervous to nest. There’s Flash tape, an iridescent material that shimmers and crackles in the sunlight and breeze to scare pest birds. And Bird Scare Balloons, which, emblazoned with lifelike reflective predator eyes, bob and weave menacingly in the breeze to make birds really uncomfortable.

Make Unforgettable Memories at Gold Coast With Cheap Car Rentals

The pride of Australia and undoubtedly, Queensland’s most popular holiday destination, Gold Coast can be your pick this summer vacation because this is where you can relish a peaceful time with the hustle bustle of urban living at the same time. You can choose from its vast options available for accommodation, which include scenic resorts, motels, and hotels. You can even drive straight to your rented apartment using car rentals at Airport or choose a caravan or a camp. Whatever you choose, you are sure to have an out of the world experience in this exotic seaside town.

Gold Coast has a number of exquisite beaches that are spread over 70 km of expanse. That gives you plenty of choices. If you are here with family, Rainbow Bay is befitting for you because it is a place kids love. It has surfers, other families, swimming areas and interesting food. In fact all beaches here are carefully patrolled, have shade spots and numerous eateries. Gold Coast even boasts of having the best of surfing beaches in the world. Whether you are a beginner or an expert, there is something for everyone. However, if you are looking out for a private patch, then you can drive straight towards Northern coastline using Gold coast car rental and find solace from the noise of the crowd.

In case you want to have a stroll on a calm beach side, you do have serene suburb of main beach where you can hear the wave’s dash against the rocks, truly a unique experience. If you don’t enjoy the excitement of surfing on waves, It has some enchanting still water spots. Drive straight to Broadwater and inland rock pools using car hire in Gold Coast and explore these places, which offer you picture perfect time whether with friends or all alone. If you are lucky, you would occasionally, find exotic colourful birds fly past you. You can carry your food with you or set up a bar-be-que to feed yourself some delectable hot chicken or vegetable as per your choice.

The Gold Coast has a longer whale-watching season than any other bay because of its geographical location, seeing whales swim is, by all means, an exhilarating experience. It also has the most interesting theme parks and parklands where you can enjoy a green treat. Hit the road at night availing cheap car rentals in this city to choose from its vibrant clubs. Do all this and more because this sizzling spot in Australia will surprise you with its offerings.

Commercial Real Estate – Checklist for Making Your Sales Pitch Convert More Listings

In this property market, your pitch for new business is likely to be up against other agents in the local area. This says that every sales pitch and listing pitch should be well crafted and well designed. As the local commercial real estate agent, you will normally have two or three agents competing against you with the same property and with the same owner or landlord.

In such a competitive market you have two choices available in making the pitch for the listing:

  • You can offer discounts in your services to attract the interest of the property owner. The discounts would normally be in your commission or marketing costs.
  • You can offer special points of difference which you believe are unique to your marketing and promotion strategy, and that can achieve a positive result for the property owner as soon as possible.

In pitching for the property listing, the reality of the situation is that the owner of the property really wants to resolve their property pain as quickly as possible at the best possible rent or price. Discounts will not normally do this. In fact they can be counterproductive. Think about it; why would you discount marketing of the property if it is going to limit the exposure to the target audience?

Some agents will discount the commission they will charge within small margins, and that may be satisfactory in your business model. Significant commission discounts should however not normally be given as they will provide real limitation on the time that you can devote to the campaign and the promotion of the property. Invariably you see the agents that discount commissions not staying in the business for very long.

Now some property owners certainly do push you on the commission survey can get some reduction or discount. In their opinion the commission will not impact the marketing of the property. The choice you make here on this matter is up to you but it is recommended that only small commission discounts are given. To do business as a real estate agent today, operational costs and support staff expenses prohibit major commission discounting.

The best way to pitch your services to a property owner can incorporate strategies similar to these:

  1. Show the property owner that you really understand the target audience to tap into in selling or leasing the property.
  2. Provide examples of the best available marketing method and price or rental range that will suit the target audience.
  3. Give the client three alternatives of marketing that provides some discount but still taps into the target audience most effectively. Invariably you will find that the client will choose the middle level marketing campaign.
  4. Show the client how your office database of prospects will suit the marketing of a property, and how you will then implement the database marketing campaign.
  5. Show the client just how many potential prospects exist in your database now, that can inspect prior to any advertised marketing campaign commencing.
  6. Use third party evidence when it comes to property prices and marketing strategies. This will make your sales pitch a lot easier.
  7. The client will usually choose the agent with the most significant market awareness and product knowledge. Your sales pitch should incorporate these details and facts.

The agents that win the listings and business in today’s market are usually confident and connecting. They have the ability to show the client how they can shorten the property pain and improve the price or rental in the process. Design your sales pitch around these facts and then start to practice.

A sales pitch is not about discounts; it is about solving a problem. That should be your focus.

Grow a Wealth Building System by Learning Internet Marketing Skills With a Free New Wealth Report

Well you may not know it but to build wealth you must use internet marketing strategies and techniques because Internet marketing is the lifeblood of any affiliate, network marketer or home based business. Therefore you need to understand that internet marketing may sound complex but it is a skill you can develop and learn. So if success is mandatory now in your business then getting web traffic is a must so here are some of the skills you need to master to build international wealth in your business.

When it comes to building wealth, especially international wealth, which is very possible on the internet, then you need to understand:

  1. The basics of internet marketing and the importance of it to your business.
  2. How to choose an internet marketing system to market your business.
  3. How to understand the marketing lingo and the many ways people use the same term to mean many things.
  4. The importance of an autoresponder selection so you can start to build a profitable list.
  5. That you need to discover how to get yourself into profitability sooner rather than later.
  6. The funded proposal system to support your initial business advertising costs.
  7. The selection process that helps you develops your affiliate programs as part of your funded proposal system.
  8. That you have to build the foundation of your business by working your way from the simple and easy to the complex.
  9. The necessity of daily business activity means you will have many monotonous,repetitive activities and you will need to become much more efficient.
  10. That these monotonous, repetitive activities require you to learn how the process of developing and using automated business solutions.
  11. That you will need to learn the nuances of your competition and what they are doing so you can stay one step ahead of them.
  12. How to perform the most important activity which is the advertising of your business because there are many, many different types of advertising and you need to master a number of them.
  13. That once you advertise you need to learn how to track and monitor all your activities to ensure you are performing profitable activities.

To gain international wealth, you should explore the internet marketing strategies and techniques that you can use to promote your business. You can create your prosperity marketing system that helps you develop your international wealth. These strategies will improve and shore up your business’s general marketing objectives.

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

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.