Hospital facilities and the role of evidence‐based design

Preliminary Development of Items for a Nurses' Physical Environmental Stress Scale

RESEARCH PURPOSE

This study aimed to develop a preliminary Nurses' Physical Environmental Stress Scale (NPESS) that explores the relationships between the physical environment in the intensive care unit (ICU) and work-related stress among ICU nurses.

BACKGROUND

Working within the healthcare field is stressful and comes with a high level of responsibility for nurses, especially ICU nurses. The ICU work environment is associated with risk factors such as excessive workload, increased expectations, and long working hours that can lead to burnout among nurses. There is some evidence that environmental design has the potential to prevent or mitigate work-related stress; however, an adequate assessment tool to identify physical environmental stressors or supports for moderating stress is lacking.

METHODS

To develop the preliminary environmental assessment tool, an exploratory sequential methodology was used. The approach consisted of three distinct phases, including (a) a qualitative content analysis of existing focus group data, (b) a qualitative content analysis of pertinent literature related to environmental assessment tools in a healthcare context, and (c) the development and refinement of the NPESS assessment tool. Tool refinement was based on interviews with ICU nurses.

RESULTS

The resulting NPESS tool was comprised of seven sections (sounds, lighting, smells, staff respite spaces, staff workspaces, patient rooms, and aesthetic qualities) containing a total of and 81 items that address factors that were identified as potential moderators of environmental stress in ICU settings.

CONCLUSIONS

The resulting NPESS assessment tool provides a feasible approach for evaluating ICU settings to identify possible improvements to reduce stress among nurses. Future research will be conducted to assess the validity and reliability of the final tool by distributing it to a larger sample of ICU nurses.

Evaluating Therapeutic Healthcare Environmental Criteria: Architectural Designers' Perspectives

This study presents architectural designers’ perception of the importance of healthcare environmental criteria in the implementation of user-centered, therapeutic hospital design. Architectural designers with over three years of professional experience (N = 182) in South Korea were surveyed using an empirical questionnaire. The extensive interviews of 15 hospital design experts followed to interpret the survey results and discuss the barriers and suggestions for the successful delivery of therapeutic healthcare design practice. Among the 27 variables selected from the preliminary literature review, factor analyses revealed seven important therapeutic environmental criteria (i.e., management, interior design, spatial quality, service, nature and rest, ambient indoor comfort, and social program and space; χ2 = 1783.088, df = 300, p < 0.001). Analyses of variance revealed the level of importance among these criteria related to respondents’ personal and professional characteristics. Significant differences were found for the variables from the management, interior design, and spatial quality factors in relation to the respondents sex and age. For the successful delivery of therapeutic healthcare design, the design experts highlighted the implementation of evidence-based design practice that integrates local and international knowledge from various hospital users and multi-disciplinary specialists participating in the healthcare design process.

Specific Needs of Patients and Staff Reflected in the Design of an Orthopaedic and Rehabilitation Hospital-Design Recommendations Based on a Case Study (Poland)

This article presents results of the research conducted with the use of participatory methods by the Faculty of Architecture, Poznan University of Technology on architectural design of healthcare facilities. The studies concerned the needs of patients and hospital staff in an orthopaedic and rehabilitation hospital. Preferences and expectations of all the users of healthcare facilities should be considered as early as at the stage of planning and designing. The hospital profile and the type of its users predetermine the architectural design in the area of the building functions, its internal circulation and interior design. Participation of the user in the process of compiling design recommendations is a chance for a designer to confront the original assumptions with expectations and to adjust relevant solutions to factual needs of the users. This study, undertaken in a regional setting, provided an in-depth exploration of staff's experiences of hospital space to indicate possible spatial improvements.

METHODS

The research was conducted on the basis of a case study of a renowned regional orthopaedic and rehabilitation hospital in Poznan, Poland. Rapid assessment methods and questions were examined to describe current approaches and synthesize results. Semi-structured interviews and thematic analysis identified staff and patient's experiences.

RESULT

Participation of hospital staff and patients resulted in design recommendations of high utility value. It was found that the two groups to a certain extent proposed similar recommendations; however, certain proposals submitted by the two groups were totally opposite.

CONCLUSION

the research highlighted the importance of the active research methodology that engages the researcher/expert in the action and critical reflection process. Such a methodology can successfully underlie the formulation of accurate recommendations.

Evaluating building performance in healthcare facilities using entropy and graph heuristic theories

Designing a healthcare facility is one of the most challenging tasks due to the complexity associated with these facilities. The primary goal of healthcare facilities is to provide high-quality care; consequently, the design of healthcare facilities and their environments directly affects the facility's productivity, the organization's economic performance, the experienced clinical outcomes in the hospital, as well as patient and staff satisfaction. The redesign of a healthcare facility is essential for ensuring a serene healing environment for the patients and thus influences their healing rates, reduces the amount of time spent in the facilities, and impacts their level of satisfaction with the care provided. The evaluation methodology is a step in the redesign process that measures the performance of healthcare buildings according to international standards. In this study, the collected standards were weighted using an entropy algorithm to evaluate different departments in various hospitals. In addition, the layout score was measured using the adjacent algorithm as one of the graph heuristic methods to determine whether the department or the whole hospital can be redesigned to meet international standards. According to the results of our methodologies being used in one selected hospital in Egypt, the average of the satisfied standards was 43%, standards that could be satisfied were 24%, not applicable standards were 34%, and the average layout score was 25.

Enhancing Healthcare Project Definition with Lean-Led Design

Decisions regarding project definition have a significant impact on client value generation. However, although this phase is of utmost importance, traditional management practices are inadequate, as the focus is rather on budget and technical aspects leaving aside the functional ones. Neglecting the functional aspects could have serious consequences on the operation and thus quality of workspace, especially in complex projects including hospitals that involve multiple clients and with a high degree of uncertainty of change. The Lean-led Design approach provides a participative solution which involves the main project clients, namely the users (doctors, patients, etc.), project managers, and the government, with the intention of delivering facilities with a better fit for purpose and use. The main objective of the paper is to develop a framework that summarizes the steps leading to the implementation of such an approach during the project definition of a new hospital. The methodology chosen is a case study and the main contribution is to develop theoretical knowledge regarding its implementation. This may support managers in their decisions when coordinating project definitions.

An analytic network process model for hospital facilities management performance evaluation

Purpose

This study aims to establish a rigorous model that can pragmatically evaluate the facilities management (FM) performance of hospitals.

Design/methodology/approach

Among the applicable performance indicators that were identified from extant literature, a focus group study shortlisted ten key performance indicators (KPIs) in four categories (safety, physical, financial and environmental) and verified their practicality. Using the analytic network process (ANP) method to process the focus group’s responses yielded importance weightings for the KPIs and developed the intended evaluation model. This model was then validated by a case study.

Findings

From the empirical data collected, two types of FM performance data and two scenarios of KPI scores were identified. To process these data and scores, a robust calculation method was devised and then proved useful in obtaining an overall score for holistic hospital FM performance. The case study confirmed the appropriateness and validity of the model developed.

Research limitations/implications

Through illustrating how the ANP method could be applied to develop an FM performance evaluation model, the study contributes knowledge to the multi-criteria decision-making domain. Despite the geographical limitation of the model established (i.e. centered around a group of hospitals investigated in Hong Kong), the study can serve as a reference for developing performance evaluation models for other buildings or infrastructures globally.

Practical implications

The model constitutes a practical tool for evaluating the FM performance of hospitals. Using this model on a regular basis will enable performance benchmarking and hence, continuous improvement of FM services.

Originality/value

The ANP model established is the first of its kind tailored for evaluation of hospital FM performance.

Creating joy in the workplace

Creating a joyful workplace is not the same as dealing with issues of stress, fatigue, burn-out, and resilience. It requires a proactive approach to augment feelings of worth, appreciation, and well-being in the members of the team. The sense that one is pursuing worthwhile, valuable activities requires a wholesale commitment to the mission, vision and values of the organization. These tenets are often created through an organic consensus of collegial workmates and then put to action by a leadership team. Reassessing the goals and virtues of the organization at appropriate intervals leads to ongoing loyalty and commitment to the team and a positive attitude. Well-being is addressed through the creation of a bright and cheerful physical and psychosocial workplace that offers programs that encourage mindfulness, humor, playfulness, and fitful lifestyle choices. The sense that one's work is appreciated and valued stems from an attitude of gratitude on behalf of all levels of the organization including management and peers where such encouragement flourishes. Those expressions of appreciation may be in the form of celebrations in the workplace and/or compensation and benefits that appropriately value the contributions of the employee. The organization's executive team should be dedicated to crafting an environment that leads to delighted, healthy employees.

Implementing lean-led hospital design; lessons gained at a pioneer

PURPOSE

The aim of this study is to document and analyze experiences with building a new hospital guided by lean-led hospital design (LLHD) (Grunden and Hagood, 2012) and to investigate key mechanisms enhancing healthcare professionals' participation and collaboration in implementing this innovative approach.

DESIGN/METHODOLOGY/APPROACH

An in-depth case study of the implementation of LLHD in a Dutch hospital was performed based on multiple data sources. The case hospital presented a unique opportunity since there was embedded access to the data by the first author.

FINDINGS

Three mechanisms supporting participation and collaboration of staff for implementing LLHD were identified. (1) Freedom in translating a concept enables managers to balance it with variations in practice at the organizational level. (2) A set of key principles governing the design process appeared an important anchor on a managerial level in a changing environment. (3) Creation of a supportive attitude toward lean and lean facility design, with co-creation as a key element of LLHD.

PRACTICAL IMPLICATIONS

By using the emerging mechanisms, managers/change agents can enlarge collaboration and participation of hospital staff when implementing organization-wide innovations.

ORIGINALITY/VALUE

This case study delivers a unique inside view on the dynamics evolving in the complex change processes at organizational, managerial and personal levels involved in implementing LLHD.

The role of evidence-based design in informing health-care architects

Purpose

This study aims to trace the relationship between the evidence-based design (EBD) process and decision-making during the architectural design process, the barriers to informing health-care architects and possible methods to overcome these barriers.

Design/methodology/approach

This study aims to explore the barriers to the EBD process during the design process by reviewing the relevant literature and future steps to overcome these barriers and support design decisions.

Findings

The study shows that EBD is a relevant, useful tool for providing evidence that positively affects design decisions. This study divides EBD barriers into simple barriers and complex barriers, depending on the nature of the barrier. Additionally, methods to overcome these barriers are discussed to ensure the best use of EBD findings with a significant impact on health-care design decisions, as they are core elements in informing architects, especially when combined with the traditional design process. This study investigates how likely it is for the EBD to contribute optimally to design decisions depending on architects’ skills and cooperation with researchers.

Originality/value

This study can apprize health-care architects of the need to consider the role of EBD in improving the quality of design decisions, and the importance of combining EBD with the traditional design process to implement optimal design decisions.

The experience of patients in an outpatient infusion facility: a qualitative study

Purpose

As hospitals are now being designed with an increasing number of single rooms or cubicles, the individual preference of patients with respect to social contact is of great interest. The purpose of this study is to gain a better understanding of the experience of patients in an outpatient infusion center.

Design/methodology/approach

A total of 29 semi-structured interviews were conducted, transcribed and analyzed by using direct content analysis.

Findings

Findings showed that patients perceived a lack of acoustic privacy and therefore tried to emotionally isolate themselves or withheld information from staff. In addition, patients complained about the sounds of infusion pumps, but they were neutral about the interior features. Patients who preferred non-talking desired enclosed private rooms and perceived negative distraction because of spatial crowding. In contrast, patients who preferred talking, or had no preference, desired shared rooms and perceived positive distraction because of spatial crowding.

Research limitations/implications

In conclusion, results showed a relation between physical aspects (i.e. physical enclosure) and the social environment.

Practical implications

The findings allow facility managers to better understand the patients’ experiences in an outpatient infusion facility and to make better-informed decisions. Patients with different preferences desired different physical aspects. Therefore, nursing staff of outpatient infusion centers should assess the preferences of patients. Moreover, architects should integrate different types of treatment places (i.e. enclosed private rooms and shared rooms) in new outpatient infusion centers to fulfill different preferences and patients should have the opportunity to discuss issues in private with nursing staff.

Originality/value

This study emphasizes the importance of a mix of treatment rooms, while new hospital designs mainly include single rooms or cubicles.

Employee organizational commitment and hospital performance

BACKGROUND

There is widespread evidence of the purported benefits of employee organizational commitment (EOC) and its impact on both individual and organizational performance. This study contributes to this literature by providing a unique insight into this relationship, focusing on the interrelationship between EOC with hospital performance and the role of the provision of adequate facilities in eliciting EOC.

PURPOSE

The aim of this study was to introduce and empirically examine a new theoretical model in which it is argued that the performance of hospitals with regard to the provision of adequate facilities (medical facilities, support facilities, and staff resources) influences the level of EOC, which in turn influences hospital performance with regard to patient care and operational effectiveness.

METHODOLOGY/APPROACH

To examine the interrelationships between the provision of adequate facilities, EOC, and hospital performance, the study utilizes a survey of hospital managers.

RESULTS

The findings support the theoretical model, with the provision of support facilities and staff resources positively indirectly associated with both patient care and operational effectiveness through their impact on EOC.

CONCLUSION

The findings highlight the importance of providing adequate facilities and EOC within hospitals and suggest that CEOs and general managers should try to enhance the provision of such resources in an attempt to elicit EOC within their hospitals.

PRACTICE IMPLICATIONS

The findings suggest that managers should try to enhance their provision of adequate facilities in order to elicit EOC and enhance hospital performance. With regard to medical facilities, they should consider and incorporate the latest technology and up-to-date equipment. They should also provide adequate staff resources, including appropriate numbers of beds, nurses, and doctors, to prevent "fatigue" (West, 2001, p. 41) and provide adequate support facilities.

Layout Planning in Healthcare Facilities: A Systematic Review

This study presents a systematic review of the literature on layout planning in healthcare facilities. The review includes 81 articles from journals, conferences, books, and other documents. Articles were classified in two groups according to their main contents including (i) concepts and guidelines and (ii) techniques and tools to assist in layout planning in healthcare facilities. Results indicate that a great variety of concepts and tools have been used to solve layout problems in healthcare. However, healthcare environments such as hospitals can be complex, limiting the ability to obtain optimal layout solutions. Influential factors may include the flows of patients, staff, materials, and information; layout planning and implementation costs; staff and patients safety and well-being; and environmental contamination, among others. The articles reviewed discussed and often proposed solutions covering one or more factors. Results helped us to propose future research directions on the subject.

Identification of space management problems in public hospitals

Purpose

In the past decades, public hospitals in Thailand have developed gradually and been characterized by an incremental development of hospital facilities. First, this study aims to investigate the factors that have caused the incremental development and how such development has affected the hospital’s architectural layout. Second, the paper assesses the functional quality of nonclinical areas in the Maharaj Hospital to identify space management problems.

Design/methodology/approach

The first part of the study is based on a literature review of the Thai health-care landscape. The second part includes the functional quality assessment of nonclinical areas, walk-through observations and documentation. Obtained data were synthesized using building quality method and measurement criteria and analytical drawing techniques for design assessment.

Findings

The first part identified three factors: the lack of local general practitioners, the limited number of public hospitals and the implementation of Thailand’s universal coverage scheme. These factors have resulted in a dramatically high number of patients in public hospitals. The second part identified problems regarding poor accessibility, a low level of spatial flexibility and poor spatial orientation. These problems are related to a lack of appropriate strategic space planning and lack of integration of the Thai culture into hospital design processes.

Practical implications

An identification of space management problems is a prerequisite to the improvement of hospital facilities.

Originality/value

This paper presents the first study of space management problems concerning nonclinical areas in Asian hospitals.

The Influence of Spatial Design on Team Communication in Hospital Emergency Departments

OBJECTIVE

To identify spatial design factors that influence informal interprofessional team-based communication within hospital emergency departments (EDs).

BACKGROUND

Effective team communication in EDs is critical for interprofessional collaborative care and prevention of serious errors due to miscommunication. Limited evidence exists about how informal communication in EDs is shaped by the physical workspace and how workplace design principles can improve the quality of ED team communication.

METHOD

Two health services with four hospital sites in Victoria, Australia, participated. A multistage mixed-methods approach used (1) an anonymous online communication network survey ( N = 103) to collect data on patterns and locations of informal interprofessional team communication among ED staff, (2) focus groups ( N = 37) and interviews ( N = 3) using photoelicitation to understand the perspectives of ED staff about how spatial design influences team communication, and (3) validity testing of preliminary findings with executives and ED managers at the participating sites.

RESULTS

Informal communication with peers and within discipline groups on nonspecific areas of the ED was most common. Three key factors influenced the extent to which ED workspaces facilitated informal communication: (1) staff perceptions of privacy, (2) staff perceptions of safety, and (3) staff perceptions of connectedness to ED activity.

CONCLUSION

Our research supports the proposition that ED physical environments influence informal team communication patterns. To facilitate effective team communication, ED workspace spatial designs need to provide visibility and connectedness, support and capture "case talk," enable privacy for "comfort talk," and optimize proximity to patients without compromising safety.

A Study of Relationships Between Content in Documents From Health Service Operational Plans and Documents From the Planning of New Healthcare Environments

AIM

The aim was to investigate the content and quality of the governing documents created in the planning and design phase of new healthcare environments and in the related healthcare strategic and operational plans.

BACKGROUND

Quality deficits in buildings can often be traced back to the initial stages in the planning and design phase. Although large investments have been made to improve the process of planning new healthcare environments and linking the requirements to health service strategies, healthcare organizations rarely relate their strategy goals to the built environment.

METHOD

A retrospective review of documents created in the planning and design stages of new healthcare environments and the operational plans of the target organizations was conducted.

RESULTS

The organizational operational plans did not contain any statements or information about the built environment or how a building could or should support the organization's goals. Important information was frequently absent from the documents governing the planning and design of buildings. The documents lacked information about what and how to follow-up and what to measure once a construction project had been completed. There were no references to evidence.

CONCLUSIONS

Poor documentation might undermine the quality of the planning and design phase and ultimately the opportunity to create environments that support health outcomes. Therefore, more emphasis must be placed on the importance of documentation but above all to strengthen and clarify the relationship between the healthcare organization strategy to achieve an effective and efficient care process and the intention made in the planning and design process.

The Role of the Built Environment: How Decentralized Nurse Stations Shape Communication, Patient Care Processes, and Patient Outcomes

Increasingly, health communication scholars are attending to how hospital built environments shape communication, patient care processes, and patient outcomes. This multimethod study was conducted on two floors of a newly designed urban hospital. Nine focus groups interviews were conducted with 35 health care professionals from 10 provider groups. Seven of the groups were homogeneous by profession or level: nursing (three groups), nurse managers (two groups), and one group each of nurse care technicians ("techs") and physicians. Two mixed groups were comprised of staff from pharmacy, occupational therapy, patient care facilitators, physical therapy, social work, and pastoral care. Systematic qualitative analysis was conducted using a conceptual framework based on systems theory and prior health care design and communication research. Additionally, quantitative modeling was employed to assess walking distances in two different hospital designs. Results indicate nurses walked significantly more in the new hospital environment. Qualitative analysis revealed three insights developed in relationship to system structures, processes, and outcomes. First, decentralized nurse stations changed system interdependencies by reducing nurse-to-nurse interactions and teamwork while heightening nurse interdependencies and teamwork with other health care occupations. Second, many nursing-related processes remained centralized while nurse stations were decentralized, creating systems-based problems for nursing care. Third, nursing communities of practices were adversely affected by the new design. Implications of this study suggest that nurse station design shapes communication, patient care processes, and patient outcomes. Further, it is important to understand how the built environment, often treated as invisible in communication research, is crucial to understanding communication within complex health care systems.

Post-Occupancy Evaluation of a Mental Healthcare Facility Based on Staff Perceptions of Design Innovations

OBJECTIVES

This study was a post-occupancy evaluation (POE) to examine the effectiveness of three specific design innovations in a mental healthcare facility. In addition to collecting data about the impact of these specific designs, the study provides a model for the broader implementation of POE approaches in the mental healthcare context.

BACKGROUND

POEs in general healthcare settings have been shown to lead to better work environments and better outcomes for patients. Despite growing evidence of the value provided by POE studies, the industry has been somewhat slow to adopt their regular use, in part due to unfamiliarity with the POE process. This is particularly true in mental healthcare contexts, where POE studies remain virtually nonexistent.

METHOD

In-depth interviews and a widely distributed, anonymous survey were used to collect hospital staff perceptions and feedback regarding the impact of specific design features.

RESULTS

The hospital staff were quite enthusiastic about two of the design innovations studied here (a new wayfinding strategy and the use of vibrant colors in specific areas of the facility). The third innovation, open-style communication centers, elicited more mixed evaluations. The results include extensive hypothesis testing about the effects of each innovation as well as narrative discussions of their pros and cons.

CONCLUSIONS

The study generated new knowledge about three specific mental healthcare design innovations and provides a model for the practical implementation of a POE approach in mental healthcare contexts. The results are particularly relevant for designers who are considering innovative strategies in future mental healthcare facilities.

Coming Full Cycle

PURPOSE

This article illustrates a collaborative, full cycle diagnostic postoccupancy evaluation (POE) conducted in an emergency department (ED) to demonstrate methods of planning a POE, conducting research to capture meaningful data, and applying outcomes through the use of a design charrette.

BACKGROUND

POEs often end with the reporting of findings rather than suggesting how this knowledge feeds forward. A design charrette presents an opportunity to engage with POE evidence and integrate research into practice.

METHODS

Planning for the POE resulted in a multiphased, multimethodological study. Data collection and analysis utilized objective and subjective measures yielding both qualitative and quantitative data. The design charrette then served as an interactive method to assist design practitioners in both understanding and applying the research findings in the redesign of the entry/triage sequence of the ED.

RESULTS

POE findings revealed four key issues impacting the ED experience. These include workflow, communication, privacy and confidentiality, and safety and security. In analyzing the use of the charrette to link POE findings to design application, it was determined that the charrette should include an all-inclusive, collaborative process, easily interpreted evidence, active participant engagement, and feasible outcomes grounded in research.

CONCLUSION

Taking the POE process full cycle is a critical component in bridging the gap between research and its application to design. The charrette process offers a positive mark of completion to the POE and helps participants gain sensitivity to the importance of evidence-based decision-making.

Evidence-based design and transformative service research for the healthcare in hospitals

Purpose

The purpose of this study is to combine the two fields of transformative service research (TSR) and evidence-based design (EBD) to improve the healthcare service provided in hospitals. TSR and EBD are two separate research fields that aim to improve the well-being of consumers within the service sector. Research propositions for making changes in the hospital physical environment to improve the patient well-being are developed to link the two fields.

Design/methodology/approach

This work takes a theoretical approach to develop research propositions based on the literature. The research propositions guide the development of the framework developed for future studies under TSR and EBD.

Findings

The research propositions should be tested empirically in future studies to develop a methodology for transforming a hospital physical environment. The implementation of these propositions would allow hospitals to reach a new and more sustainable competitive advantage.

Originality/value

The relationship between the domains of TSR and EBD has not been explored before in the literature. This study presents an unprecedented work that is needed to improve patient well-being. It contributes to TSR and EBD by providing a research agenda for healthcare practitioners and researchers to pave the way for achieving improved healthcare services focusing on patient well-being and sustainability.

Space planners' perception of an assessment instrument for briefs in the pre-design phase of new healthcare environments

OBJECTIVE

The main purpose of the study was to investigate the usability of a newly developed instrument designed to assess the content and quality briefs (CQB-I) in programs for new healthcare environments. We studied the perception of using the instrument on a group of space planners.

BACKGROUND

The study is part of a larger project designed to ensure the quality of the planning of new healthcare environments with a focus on documents (programs or briefs) created in the early phases of the planning process. In this study, we used an instrument that measures the clarity of the mission statement for the project based on user needs and care activities that will take place in the new healthcare environment. The instrument further evaluates whether there are clear patient-related outcome measures specified and whether the information in the documents is person-oriented and evidence-based.

METHODS

The study used a mixed-method design where the relevance and usability of the instrument was estimated and a focus group interview was conducted.

RESULTS

The study showed that a CQB-I is perceived to be a relevant instrument primarily as a guide for programming, but also for monitoring the produced programs.

CONCLUSIONS

Instruments like CQB-I can help to bring research results into planning and contribute to dialogue and collaboration in the early phases of a planning process by orienting planning participants to user needs and facilitating the discussion and articulation of clear performance indicators.

Shared decision making in designing new healthcare environments-time to begin improving quality

BACKGROUND

Successful implementation of new methods and models of healthcare to achieve better patient outcomes and safe, person-centered care is dependent on the physical environment of the healthcare architecture in which the healthcare is provided. Thus, decisions concerning healthcare architecture are critical because it affects people and work processes for many years and requires a long-term financial commitment from society. In this paper, we describe and suggest several strategies (critical factors) to promote shared-decision making when planning and designing new healthcare environments.

DISCUSSION

This paper discusses challenges and hindrances observed in the literature and from the authors extensive experiences in the field of planning and designing healthcare environments. An overview is presented of the challenges and new approaches for a process that involves the mutual exchange of knowledge among various stakeholders. Additionally, design approaches that balance the influence of specific and local requirements with general knowledge and evidence that should be encouraged are discussed. We suggest a shared-decision making and collaborative planning and design process between representatives from healthcare, construction sector and architecture based on evidence and end-users' perspectives. If carefully and systematically applied, this approach will support and develop a framework for creating high quality healthcare environments.

Australasian Health Facility Guidelines: results of a user survey

Purpose

– The Australasian Health Facility Guidelines (AusHFG) project was initiated in 2005 by the Australian State and Territory Health Departments, and the New Zealand Ministry of Health to guide hospital development in the Australasian region. This paper shares the results of a 2010 survey of guidelines users in three of the health jurisdictions, conducted to understand whether the anticipated project benefits were being achieved and to seek suggestions for future improvements.

Design/methodology/approach

– AusHFG users were surveyed using an electronic survey instrument. Data gathered included demographic information regarding the users and their projects, user views on the achievement of the anticipated benefits and their suggestions for future improvements to the AusHFG.

Findings

– In total, 152 people commenced the survey, with fewer fully completing it. Responses were generally positive and supportive of the project. Useful commentary was received regarding possible improvements; some of this illustrated user confusion regarding the purpose and inherent limitations of guidelines of this type.

Research limitations/implications

– The survey was conducted in only three out of a possible nine health jurisdictions – it could be further extended to these other jurisdictions in the future.

Practical implications

– The research illustrated the need to identify, and to communicate clearly, regularly and effectively with key project stakeholders to ensure user feedback and support for using health design guidelines.

Originality/value

– This is the first survey to be conducted of Australian and New Zealand users of health design guidelines. It provides useful feedback to those developing and implementing health guidelines, especially regarding the format, content and delivery of guideline information.

Development of the Content and Quality in Briefs Instrument (CQB-I)

OBJECTIVE

The Content and Quality in Briefs Instrument (CQB-I) was designed to develop a valid and reliable audit instrument to examine the content and quality of information in documents (briefs) created in the early stages of designing healthcare environments.

BACKGROUND

The importance of effective briefing has been emphasized in many research studies during the past two decades. However, there is no developed instrument for auditing the content and quality of these documents.

METHODS

The study had a methodological and developmental design based on an established methodology for instrument development and validation. The development process consisted of three main phases: (1) item generation and scale construction; (2) assessment of face and content validity, and (3) testing of the reliability. To obtain face and content validity, expert panels reviewed the COB-I. Content validity was assessed using the Content Validity Index (I - CVI = item level, S - CVI = scale level). Reliability was tested by test-retest and inter-rater reliability.

RESULTS

CQB-I was found to have good content validity (I - CVI = 0.78 - 1.0 and S - CVI = 0.98). Inter-rater reliability was acceptable (Spearman's correlation = 0.62) and stability was considered high for both raters (83% and 88%, respectively).

Updating and normalization of the Nursing Management Minimum Data Set element 6: patient/client accessibility

Patient/client accessibility is one of 18 Nursing Management Minimum Data Set data elements developed to evaluate contextual factors at the nursing unit or service level of care. The Nursing Management Minimum Data Set 06 patient/client accessibility was developed to capture variability in time and distance required to access patients. Variability in access to patients, needed supplies, equipment, and information for patient care has an impact on the amount of time available for direct patient care. Limitations in time available to provide safe and quality care may negatively affect patient outcomes, nurse retention, and, as a result, a healthcare organization's accreditation and finances. Since 2005, the first five Nursing Management Minimum Data Set data elements have been incorporated into the publicly accessible healthcare data set Logical Observation Identifier Names and Codes, thereby making results derived from these nursing management data elements available for empirical use. A critical review of the literature and other healthcare resources was conducted to update patient/client accessibility. A consensus approach was used by an interdisciplinary panel of experts to finalize recommendations for revisions. The name, conceptual and operational definitions, and measures were updated. The revised data element is titled "client accessibility." The conceptual and operational definitions were expanded and measures changed to increase validity and reliability of data collection. The updated conceptual definition is "the time, distance, and method to connect the nurse/provider and client for an encounter and includes the information, supplies, equipment, and personnel required for the encounter." The Nursing Management Minimum Data Set can provide individuals responsible for managing and financing nursing resources with quantifiable data regarding the context of nursing care. At present, healthcare costs are rising at an unsustainable rate, and many national healthcare outcomes are worsening. More information is needed to identify potential areas of improvement in the management and funding of nursing care. The update and use of Nursing Management Minimum Data Set 06 data element client accessibility may help to identify problem areas associated with nursing time, distance traveled, and methods used to provide patient care. Such empirical evidence may support better informed decisions on caseloads in diverse settings, hospital designs, methods used to provide care, and fiscal requirements.

Integrating Evidence-Based Design and Experience-Based Approaches in Healthcare Service Design

Objective:

To investigate the connections between, and respective contributions of, evidence-based and experience-based methods in the redesign of healthcare services.

Background:

Evidence-based medicine (EBM) preceded (and inspired) the development of evidence-based design (EBD) for healthcare facilities. A key feature of debate around EBM has been the question of interpretation of the guidance by experienced clinicians, to achieve maximum efficacy for individual patients. This interpretation and translation of guidelines—avoiding a formulaic approach, allowing for divergent cultural and geographical exigencies, creating innovative, context-specific solutions—is the subject of this discussion, which examines the potential for integration of evidence-based and experience-based approaches in the development of creative solutions to healthcare services in England. This paper examines Practice-Based Commissioning (PBC) in England, which devolves responsibility for commissioning new services for patients to frontline clinicians, relying on their understanding of patient needs at the local level.

Methods:

An 18-month project, funded by the Health and Care Infrastructure Research and Innovation Centre (HaCIRIC), examined PBC frameworks in England, investigating the impact of different models of governance on the development of service redesign proposals to answer the following questions: How do clinicians interpret the multiplicity of guidance from government agencies and translate this into knowledge that can be effectively used to redesign patient care pathways aligned with local healthcare priorities? How can understanding patient and staff “experiences” and key “touch points” of interaction with local healthcare services be used to provide a creative, customized solution to the design of healthcare services in a local, community-based framework?

Technology and building design: initiatives to reduce inpatient falls among the elderly

This paper offers a narrative exploration of interventions for inpatient falls among the elderly with respect to the design of technology (equipment and furniture) and buildings. Most of the contributory risk factors for inpatient falls among the elderly were identified in the 1950s, but incident and injury rates remain relatively unchanged in the 2000s. Interventions have predominantly focused on staff and organizational changes, for example monitoring (observation) and communication, possibly in response to increased patient privacy (isolation) in single rooms. The clinical response has been to modify the patient by means of medication review, continence management, and impact protectors. This paper considers whether technology and building design have helped or hindered the newly admitted frail and/or confused elderly patient at risk of falling, assuming the provision of good nursing and medical practice (e.g., observation, treatment, and care).

Supporting patient safety: examining communication within delivery suite teams through contrasting approaches to research observation

OBJECTIVE

to explore the nature of intra- and interprofessional communication on delivery suites, with a particular focus on patient safety.

DESIGN

longitudinal study using contrasting forms of observation: ethnographic methods alongside the highly structured Interaction Process Analysis (IPA) framework.

SETTING

four contrasting delivery suites offering different models of care and serving different populations: two in the north of England and two in London.

PARTICIPANTS

the multidisciplinary delivery suite teams and visiting professionals from related areas.

KEY FINDINGS

the ethnographic observations and quantitative findings combine to highlight four principal areas relating to communication: communication underpinning collaboration; effects of workload pressures on communication practices; interprofessional communication; and the influence of architecture on communication. Contextual factors (e.g. case acuity, client throughput, model of care) underscore some inter site differences and attention is drawn to implications for safety.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

the use of complementary methods aided exploration of communication in the complex environment of the delivery suite. The findings reflect the complexity of communication patterns and the multiple influences on patterns and norms. Interprofessional tensions, workload pressures and the design of the environment can restrict communication, with implications for safety. As such, these findings have implications for policy in that safety solutions which focus efforts on standardising communication need to be located within wider strategies that also address structural and organisational networks and influences.

How work context affects operating room processes: using data mining and computer simulation to analyze facility and process design

The complexity of the operating room (OR) requires that both structural (eg, department layout) and behavioral (eg, staff interactions) patterns of work be considered when developing quality improvement strategies. In our study, we investigated how these contextual factors influence outpatient OR processes and the quality of care delivered. The study setting was a German university-affiliated hospital performing approximately 6000 outpatient surgeries annually. During the 3-year-study period, the hospital significantly changed its outpatient OR facility layout from a decentralized (ie, ORs in adjacent areas of the building) to a centralized (ie, ORs in immediate vicinity of each other) design. To study the impact of the facility change on OR processes, we used a mixed methods approach, including process analysis, process modeling, and social network analysis of staff interactions. The change in facility layout was seen to influence OR processes in ways that could substantially affect patient outcomes. For example, we found a potential for more errors during handovers in the new centralized design due to greater interdependency between tasks and staff. Utilization of the mixed methods approach in our analysis, as compared with that of a single assessment method, enabled a deeper understanding of the OR work context and its influence on outpatient OR processes.