Forward Tilting

Lee Falck and Bobby Holt, Gen­eral Electric refugees, were sitting in their Harvard Business School class one day in 1997 when they started longing for…something more. “We realized that we wanted to do something that has social value,” Falck recalls. “Bobby and I wanted to do something ‘great,’ something meaningful, that went beyond just a better widget. Meaningful in that it’s done some good to the people using it—and maybe that can be instrumental to the long-term welfare of this country.”

Ten years, a few million dollars, a cross-country odyssey, and a move to Seattle later, the two, now 38, believe they’re on the verge of introducing just such an achievement to the world. Named Centé, it is an unprecedented attack on an array of patient-care problems besetting the health-care industry. “This Centé is a big step for our company,” Falck says. “And it’s taken us a long time to get here, but we’re right at the doorstep.”

It’s safe to say that you’ve never seen anything like the Centé in any hospital room anywhere: a tall, thin chair, with polyester-elastomeric mesh fabric stretched over a metal-and-plastic frame, it sits on four metal legs, with optional casters on the back two, allowing for a caregiver or room cleaner to tilt the chair back and move it with virtually no effort. Approximately 4 feet high by 24 inches wide and deep, and only 50 pounds, it appears scrawny—an effect heightened by its skeletal presentation; the metal legs and arm framework are exposed, and the interstices left open rather than covered with fabric. At first glance it looks like a combination of a Herman Miller Aeron and an emaciated Barcalounger.

The Centé story begins late in 2000, when Falck and Holt bought the Seattle company Brandrud, which specializes in furniture for public spaces. (The two are now copresidents of the company.) Brandrud is best known for its smart health-care-industry furniture—chairs and other pieces for waiting rooms, doctors’ offices, and patient rooms combining pleasing design with functions that meet the needs of the health-care world.

Founded in 1955 by Harold Brandrud, and sold in 1976 to Larry Green, the company has always been a small operation known for careful craftsmanship and a distinctive Scandinavian look. A Brandrud piece—with its clean lines, austere appearance, and ability to take a beating—is almost immediately recognizable. “Green,” Falck says, “was looking for a buyer who could protect the company’s legacy, grow and enhance its role in the community, and give it a chance to expand.”

And grow it did: Brandrud now produces approximately three times as much as it did in 2000 yet still looks like a mom-and-pop operation, working out of a large warehouse in Auburn, south of Seattle. Here Falck and Holt have done on a smaller scale what Howard Schultz did with Starbucks: take over a small Seattle company known for exquisite work and apply modern management and marketing principles to it, turning it into an industry presence. Once famous primarily as the company that supplied the first suite of furniture for the Space Needle in 1962, Brandrud is now known for a vast array of health-care furniture, including waiting-room armchairs, daybeds, bariatric chairs, incliners, sleep benches, chairs for hip-surgery patients, and treatment chairs. An alliance partnership with Herman Miller gives Brandrud distribution throughout the world, through the Michigan-based company’s health-care-products division. The year Falck and Holt bought the company, it shipped 14,000 units; this year Brandrud will ship approximately 46,000. Averaging nearly 20 percent growth over the last seven years, it grew 25 percent in 2006, will grow 35 percent this year, and projects expansion of 50 percent per year if Centé takes off.

Since taking over Brandrud, Falck says, they have intended to “look for gaps between what the market wanted and what companies could deliver.” And the health-care market, it turns out, is riddled with such gaps. When hospitals, for example, began shifting to a care model whereby relatives were encouraged to stay with patients, Brandrud introduced a daybed that offered guests a place to sleep while taking up a minimum of the hospital room’s precious space. The company went to work developing a new patient chair when it saw how difficult it was for caregivers to get patients back and forth from bed to chair. Herman Miller’s director of health-care consulting, Janet Zeigler, notes, “The chair has typically taken a backseat to everything else in the industry. There just hasn’t been a focus on it at all.”

Which brings us to the Centé project: Brandrud assembled a team that included Herman Miller, Maharam, furniture-design consultants 5D Studio (which worked with Bill Stumpf on the ergonomics of the Aeron chair), engineering consulting firm Fredricks Design, and infection-control consultant Debra Harris. Now, after more than a year in research and development, costing nearly $1 million, the chair is on the verge of release to the market. Centé represents not only the culmination of Falck and Holt’s grad-school daydream but also a sign of things to come in the health-care industry, as it gears up to take on the aging (and widening) baby-boom generation. Between that and the general advance of Americans into obesity, there is a soaring demand for useful health-care furniture that can sustain the weight of 300-pound-plus people without taking up critical space in a hospital room.

Centé’s progenitors began by researching the uses of the chair in a hospital room by bedridden patients as part of their therapy. Patients are typically moved from bed to chair and back as caregivers help them recover from surgery or other treatments. The more time a patient spends in a chair rather than a bed, the speedier his or her recovery.

The problem with traditional hospital-room chairs is that they’re bulky, get in the way of caregivers, and they’re hard to move around when you’re trying to clean the room. If they are covered in vinyl for easy cleaning, the chairs also promote sweating and are slippery; thus weakened patients often slip into uncomfortable positions, sometimes out of the chair entirely. Chairs that recline or are angled back too steeply are difficult for caregivers to lift patients out of. “You have to pull them forward,” Zeigler says, “and that’s when caregivers hurt their backs.”

This brings up an important point about patient chairs: their end users are not only patients but also the people who care for them. Caregivers help patients get in and out of their chairs, and spend a lot of time bending over them administering treatment, adjusting tubes, and fixing bandages. So a chair must be designed not just for patient comfort but for “caregiver ergonomics” since the leading cause of injury to nurses is patient handling. “You have all these different users you’re considering: the caregiver, the patient, the facility manager, the environmental-services person who’s cleaning the room,” says David Simon, Brandrud’s director of research and design. “And if you’re thinking of ergonomics, it really takes you to the caregiver.” Falck adds, “We’re thinking more specifically about the patient room as an ergonomic environment. I don’t know that it’s been talked about in that way. The literature tends to be patient-centric. We want to look at how the caregiver uses that space, ergonomically how it works for that person. That’s where the blood boils a little bit, going back to our original kind of vision. It has great social value as well as good economic and business value.”

So among the long list of solutions Centé is designed to provide are these: a breathable fabric (Brandrud settled on an Aeron-like mesh) that doesn’t promote overheating and sweating, and that isn’t slippery; an easily cleanable material, inhospitable to infectious agents; movable arms allowing caregivers to reach around patients to assist them in and out of the chair; arms open enough to accommodate the passage of tubes and other attachments between patients and their care machinery; tiltability and reclinability without electric power; as small a footprint as possible while still accommodating patients that weigh up to 350 pounds; easy portability when empty, and stability when occupied; and the ability to restrain patients without making them feel restrained. “The whole thing was demanding from a design aspect,” 5D Studio’s David Ritch says. “We had to prioritize a lot of needs in ways that made the most sense.”

From the very beginning of Centé’s development, Brandrud solicited input from all manner of health-care experts. “We were involved in this effort early on,” Zeigler says. “They’ve been very conscious about connecting with the caregivers—the people who will use the chair.” Ever since Centé was in prototype form, it has been through a tremendous amount of what Simon calls “beta testing,” not only at Herman Miller but also at hospitals. Its design began with research at the University of Virginia School of Nursing’s Health Care Product Evaluation Center. Simon is quick to credit Herman Miller both for the work of Zeigler’s team and for engineering advice on the chair’s lever mechanism, which tilts the chair forward three degrees and back ten—the back position for the patient at rest, the forward for getting a patient in and out—with very little effort. It’s a deceptively simple-looking mechanism that is highly complicated in the way it delivers mechanical advantage to the operator without giving discomfort to the occupant in the form of sudden jolts or stops. (The shape of the lever—roughly that of a wedge of pie—is one of the most attractive features on the chair, as well as one of the most difficult design problems the team faced.) “We collaborated with the Herman Miller for Healthcare division to evaluate the potential of our solution,” Simon recalls, “and with the head of their seating product development to critique our mechanical tilt and arm solutions to identify the areas that could be problematic based on their prior experience. That extended to the use of these different materials, particularly the mesh and suspension materials. And we collaborated with some of their dealerships—people close to the end user.” The alliance partnership is beneficial to both sides: Brandrud gets access to Herman Miller’s research, suppliers, and technical experts, and the furniture giant can add the product line to its health-care furnishings and seating segment. (A less formal partnership with Maharam aided Brandrud in refining its fabric for Centé.)

There is one more thing worth noting about the chair: it is almost supernaturally comfortable. The stretch fabric under your seat and against your back practically embraces you when you settle in and tilt it back. It feels as if the chair is molding itself to your body—which is exactly what it’s doing. “We chose fabric with a four-way stretch,” Ritch says. “Most chairs have only a two-way stretch. We wanted the chair to ‘hammock,’ so as to eliminate pressure points”—which are the cause of bedsores in patients too weak to move around. The overall feeling of luxurious comfort is so intensely pleasurable that it almost makes you yearn for the kind of infirmity that would qualify you for Centé chair privileges.

At both Brandrud and Herman Miller there is a sense that the small company has hit a home run. Yet everybody involved knows the Seattle group is taking a risk—the chair is, to say the least, an unusual new direction for the health-care industry, which is somewhat insular and out of touch with what might be called high fashion in furniture design. “It is quite different-looking,” Zeigler says. “A lot of people who look at it have never seen an Aeron chair.”