How paralysis forced Michael Graves to design a better wheelchair

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innovative wheelchair
The Prime TC.

Michael Graves has done chairs before. The architect and designer who almost single-handedly brought the concept of no-brow—high design for the masses—into American culture conjured teak patio chairs for Target; Arts and Crafts-inspired lounge chairs for Arkitectura; sleek stacking chairs for Kron USA.

But never has he made one like the Prime TC, with armrests that fold back and flip-up footrests and washable fabric and BackSmart ergonomics.

The Prime TC is not available at Target, or JC Penney, or the myriad other outlets in which the more than 2,000 products he’s designed have appeared. You’ll only find it in hospitals.

Graves and his team of product designers created the Prime TC to replace the x-frame wheelchair so pervasive in American hospitals, that symbol of disability emblazoned on bathroom walls and parking passes that is, according to Graves’ design group, a contributor to the entrenched problems of hospitals. In fact, Graves is dedicating the rest of his life to tackling what he called “the last frontier in hospital design:” the patient room and the products in and around it.

His shift in focus came in 2003, when Graves, busy with travel, had left a sinus infection untended until the pain in his back became unbearable. He went to the emergency room at 2pm. By the next morning, he was paralyzed from the chest down. The infection had spread to his brain and then his spine.

He spent three years recuperating in eight hospitals and four rehab centers, in each one learning more about the limits of the spaces in which he was expected to recover. Because the rooms weren’t built according to principals of universal design (in which elements are created to be both aesthetically pleasing and usable by the greatest number of people, including those in wheelchairs) he couldn’t reach the outlets to plug in his electric shaver (they were too low) or turn on the faucets to wash his face (they were too high). Portable toilets were stacked against the wall, the bedside tables dirty. “It doesn’t make you feel very good when everything around you says ‘sick,’” said Graves, 79.

In fact, hospitals often do make patients sick, whether that’s the 722,000 hospital-assisted infections (HAIs) that patients contract while in the hospital each year, or the depression and delayed healing associated with sub-par hospital design. It’s well documented that light and quiet and views of nature all improve patients’ health. According to an oft-quoted paper “Effects of interior design on wellness“: “the effects of supportive design are complementary to the healing effects of drugs and other medical technology.” But, said Lindsey Dunn, editor-in-chief of the industry publication Becker’s Hospital Review, “there’s been very little focus on the actual design of products and their relationship to overall patient health and experience.” And yet, as The Center for Health Design put it, “A visit to a US hospital is dangerous and stressful for patients, families and staff members.”

In some ways Graves’ typically horrendous experience had a silver lining. It inspired him to recover because, as he said, “It was far too ugly for me to die in there.” It also inspired him to shift the focus of his design business; healthcare now makes up 25% of his work.

For his research, Graves traveled to 44 hospitals to study the problems with the products and spaces within them. “I’ve been in enough rooms that are pretty close to Third World that I knew it wasn’t working but I didn’t know why,” he said. After three years of study with his design team, he discovered: “The equipment was old, the plans were bad, the chance for infection was great, the chance for falls was terrific.”

In 2009, Graves partnered with Stryker, a medical technology company, and went on to create nine products for hospitals including a bedside cabinet with a drop leaf top and a chair that helps patients with disabilities get in and out of it. He has also developed architectural plans for patient rooms; over a dozen more products are in the works.

In December, 2013, Graves released the Prime TC, an antidote to the ubiquitous hospital wheelchair, one which, according to Graves’ group, was only designed for home use anyway. The traditional x-frame folding wheelchair, created by a mechanical engineer named Harry Jennings and his disabled friend, Herbert Everest, is, to say the least, out of date. “The old model was designed in 1933,” said Graves. “FDR was president.” It certainly wasn’t designed to last. “When the seat gets old and tired it rests on that armature underneath. It’s extremely hard on the patients.”

While other wheelchairs have hit the market since then, including various electric models like the IBOT and a Permobil, which Graves himself uses, the x-frame chairs were most commonly used in hospitals nonetheless so hospital workers could both transport and park the patients. Technically the Prime TC is not a wheelchair but a transport chair, designed for hospital workers to push and to accommodate patients sitting for long stretches of time. “If you’re brought from your bed to radiology to get an x-ray, you might wait for an hour in that chair,” said Graves. “Comfort becomes a very important issue in your wellness.”

But it’s not just about the discomfort, it’s about the bedsores associated with those old wheelchairs. It’s about the infection spread by placing hands on those wheels spinning across the hospital floors; 1 in 25 hospital patients contracts at least one HAI, according to the CDC, many of them through furniture or surfaces. ”There’s a direct relationship between the environment and the spread of infection,” said Matthew J. Arduino, chief of the Clinical and Environmental Microbiology Branch in CDC’s Division of Healthcare Quality Promotion. Though the CDC and NIH don’t keep tabs on infections from specific products like wheelchairs, research from Stryker has found infections spread when hands touch never-cleaned wheels that constantly skate across hospital floors.

Then there’s the repetitive stress injuries that occur when caregivers push the oddly angled and totally un-ergonomic handle of the x-frame chairs. And the collapsing frame that makes it easy to steal from the hospital parking lot. According to Graves’ group, one third of the wheelchair fleet disappears from hospitals every year. Every three years, most American hospitals end up replacing the fleet entirely, according to what hospital administrators have told Graves’ team.

And then there are the falls. “If you’re 90 years old and you’re trying to get into the chair and you’re not very agile, you’d have to get over those footrests to get into the seat,” said Graves. “It’s a big tripping hazard.”

So the Prime TC includes footrests that can swing away; a design that nests to save space, rather than fold; handles that curve up to accommodate caregivers of all heights; a one touch central break system; an oxygen tank holder and chrome-plated IV pole. And, yes, it looks less institutional than its elderly x-frame cousin, in its soothing gray-blue or brick red fabric (which is, of course, power washable).

But even if caregivers prefer the Prime TC and hospital administrators recognize its eventual savings, it doesn’t mean that they’ll have the financial or political will to commit to a new vision of the hospital environment, even in the form of a chair. Hospitals across the country face budget cuts and hospital closings; last year, 10 hospitals filed for bankruptcy. “There’s certainly a lot more scrutiny in terms of more expensive products,” said Dunn.

Prime TC chairs start at $1,500 but have a three-year warranty, as compared to x-frames, which start around $500 and come with a 90-day warranty. It’s also a lot harder to break and to steal. Even if healthcare-associated infections can cost up to $45 billion a year, said Dunn, “You would have to be able to demonstrate pretty clearly that the higher cost is justified by better outcomes and patient experience.”

Dunn, however, is optimistic that designers can make an impact on the health and well-being of hospital workers and patients, even in these financially challenging times. “If something can be shown and demonstrated to have a good return on investment and that the patient experience ratings would be higher, I don’t think systems with healthier budgets are shying away from them,” she said.

Graves still has to convince buyers that a product like a transport chair can make a significant impact on the workings of the hospital. And admittedly, it’ll be hard to know if hospitals outfitted with Michael Graves products are significantly less prone to infection or bedsores or general environmental malaise. It still comes down to the hospitals’ workers using products properly and following cleaning and other environmental protocols. “There’s always a human factor, even with great design,” said Arduino. You can build a better mousetrap, he says, but inevitably there’s someone around who can break it.

Arduino points out that there are very few studies linking products, including those with antimicrobial materials, to decreased infection rate or improved health. But the Graves team is trying to make that link, at least as it relates to worker injuries. Two as yet unnamed universities are designing studies to evaluate the ergonomics of the Prime TC versus the x-frame wheelchair. In the meantime, Prime TC has won the accolades of the design community, and two awards:  2014 Red Dot Best of the Best Award in Life Science and Medicine, and another major design award to be announced in July.

But Graves isn’t in it for the rewards, he’s in it for the legacy, the chance to right a wrong that he has known so intimately himself. “I’m going to do as many of these as I can,” he says, “before I croak.”