Designing to Heal

Patients and Their Families Weigh in on Evidence-Based Hospital Design

Background

In 2 landmark publications, the Institute of Medicine reported on significant deficiencies in our current health care system. In response, an area of research examining the role of the physical environment in influencing outcomes for patients and staff gained momentum. The concept of evidence-based design has evolved, and the development of structural guidelines for new hospital construction was instituted by the American Institute of Architects in 2006.

Objective

To determine perceptions of patients and their families of evidence-based design features in a new heart center.

Methods

Hospitalized patients and their families, most of whom were in intensive care and step-down units, were surveyed and data from the Hospital Consumer Assessment of Healthcare Providers and Systems were reviewed to determine perceptions of evidence-based design features incorporated into a new heart center and to assess patients’ satisfaction with the environment.

Results

Responses were reviewed and categorized descriptively. Five general environment topics of focus emerged: privacy, space, noise, light, and overall atmosphere. Characteristics perceived as being dissatisfying and satisfying are discussed.

Conclusions

Critical care nurses must be aware of the current need to recognize how much the physical environment influences care delivery and take steps to maximize patients’ safety, satisfaction, and quality of care.

Organizational Transformation: A Model for Joint Optimization of Culture Change and Evidence-Based Design

Healthcare organizations face continuous and accelerating external change and thus must be prepared to manage their own change initiatives proactively. Given that many believe that the U.S. healthcare system is broken and most healthcare organizations are dealing with pervasive problems, some organizations may choose to seek transformational change to achieve the six aims identified by the Institute of Medicine: healthcare that is safe, effective, patient-centered, timely, efficient, and equitable. Transformational change will almost certainly involve organizational culture. Culture change may be most effective when linked to other organizational change initiatives such as organizational strategy, structure, policies, procedures, and recruiting. Significant organizational change often requires accompanying facility change. There is an interdependent relationship between facility design and organizational culture. They affect each other and both impact organizational performance. Sociotechnical theory promotes joint optimization of the social (culture) and technical (facilities) aspects of an organization to achieve sustained positive change. To achieve organizational transformation and to sustain positive change, organizations must be prepared to adopt collaborative efforts in culture change and facility design. The authors propose a model for accomplishing joint optimization of culture change and evidence-based facility design.

A third place in the everyday lives of people living with cancer: functions of Gilda's Club of Greater Toronto

The purpose of this paper was to examine the therapeutic functions of Gilda's Club of Greater Toronto in the everyday lives of people living with cancer. Gilda's Club is a non-institutional setting, where people living with cancer join together to build physical, social, and emotional support as a supplement to medical care. Findings reveal members regarded Gilda's Club as an escape from the stressors of home and hospital, a place where they could meet others living with cancer, and a social environment in which they could confront or distance themselves from their health problems. The paper demonstrates the significance of "third places" for health and calls on researchers to afford such places greater attention.