Assessing child satisfaction and expectations for developing a child-friendly environment at the pediatric department in a general hospital in Qatar

Background

"Patient-centered" care positions the patient at the core and emphasizes fulfilling their unique needs, preferences, and values. This approach is particularly significant in the context of children. Although widely recognized as necessary, this approach is not universally implemented. The children find themselves in hospital wards where they are required to follow protocols and systems designed primarily for adults. In the appropriate atmosphere, children often express themselves more effectively through words, body language, and play, leading to a richer understanding of their needs. There is growing recognition of the importance of addressing children's concerns regarding hospital environments.

Aim

This study investigates children's satisfaction with the physical aspect of the hospital environment. Insights from this exploration could provide valuable input for creating hospital environments centered around children's needs and preferences.

Methods

This mixed-methods study involves children aged 6-14 years with parental consent from a premiere healthcare provider in the state of Qatar. The survey used nine items to gauge satisfaction with the existing hospital environment as a "child-friendly hospital" and another nine items to explore their expectations for such environments. The Mann-Whitney U and Kruskal-Wallis tests as well as thematic analyses were employed to assess the statistical significance of differences in satisfaction levels and children's expectations of the hospital's physical environment.

Results

A total of 398 children participated in the study. Of them, 40.3% were aged 6-8 years; 60.3% had experienced two to five hospital visits; 55.8% of children participated during their outpatient service visit; and 31.7% were Asian. Children's satisfaction levels with various aspects of the hospital environment-including its physical appearance, signage, lounge, consultant rooms, corridors, bedrooms, TV content, toys, and staff uniforms-were in the range of 42.9%-59%. The children expressed a desire for a hospital environment that is spacious, colorful, attractive, and filled with cartoon characters and toys in the children's hospital from the front lounge to the inpatient units.

Conclusion

The findings underline the importance of considering the perspectives of children in evidence-based healthcare design. The study reveals that children's satisfaction with the hospital environment is generally average or below average. Ultimately, a "child-friendly hospital environment" integrates children's rights into healthcare to significantly improve outcomes.

A Systematic Literature Review on Healthcare Facility Evaluation Methods

To present a systematic literature review on predesign evaluation (PDE), postoccupancy evaluation (POE), and evidence-based design (EBD); to delimit the concepts and relationships of these terms and place them in the building life cycle framework to guide their application and indicate a common understanding and possible gaps. The preferred reporting items for systematic reviews and meta-analyses protocol was used. Inclusion criteria cover texts that present a concept, method, procedure, or tool and use the example in healthcare services or other environments. The reports were excluded if there was no evidence of a relationship between the terms, if cited rhetorically, duplicated, or if an instrument was not related to at least one other term. The identification used Scopus and Web of Science and considered reports until December 2021 (search period). When extracting the evidence, formal quality criteria were observed and sentences and other elements were collected as evidence and tabulated to segment topics of interest. The searches identified 799 reports with 494 duplicates. In the selection, 53 records were selected from 305 obtained in 14 searches. The classification extracted concepts, relationships, and frameworks. Results indicate a consistent understanding of POE and EBD and a diffuse understanding of PDE. A summary of the three concepts including two frameworks is proposed. Situations are contextualized where these frameworks are used in specific areas of research. One of these frameworks provides a basis for classifying building assessment methods, procedures, and tools but does not detail the classification criteria. Thus, more detailed adjustments should be considered in specific studies.

Developing a Measurement Scale of Gender-Friendly Hospital Environments: An Exploratory Study of Customer Perceptions in Taiwan

According to the United Nations, males and females should be given equal treatment in physical and psychological services, and healthcare institutions should exert greater efforts to reduce the gap in gender equality. However, this issue has been largely ignored in previous literature on healthcare environments. Designing a hospital environment that focuses on gender differences is critical to academic researchers and practical managers in all healthcare institutions. Thus, as an exploratory effort, this study aims to develop a measurement to assess customer perceptions of gender-friendly hospital environments. To identify and refine the structure of the instrument, two studies are conducted at different hospitals in Taiwan. The exploratory evidence shows there are five factors (i.e., physical design, functional design, marking design, gender perception, and gender-friendly services) and 28 items in the measurement scale of gender-friendly hospital environments. Results also show that gender-friendly hospital environments affect customers' loyalty and willingness to pay. Based on our findings, hospital practitioners and researchers can adopt the measurement instrument used in this study to deal with the gap of gender equality in healthcare environments.

Making the Case for Practice-Based Research and the Imperative Role of Design Practitioners

The purpose of this article is to justify the need for evidence-based design (EBD) in a research-based architecture and design practice. This article examines the current state of practice-based research (PBR), supports the need for EBD, illustrates PBR methods that can be applied to design work, and explores how findings can be used as a decision-making tool during design and as a validation tool during postoccupancy. As a result, design professions' body of knowledge will advance and practitioners will be better informed to protect the health, safety, and welfare of the society. Furthermore, characteristics of Friedman's progressive research program are used as a framework to examine the current state of PBR in design practice. A modified EBD approach is proposed and showcased with a case study of a renovated inpatient unit. The modified approach demonstrates how a highly integrated project team, especially the role of design practitioners, contributed to the success of utilizing baseline findings and evidence in decision-making throughout the design process. Lastly, recommendations and resources for learning research concepts are provided for practitioners. It is the role of practitioners to pave the way for the next generation of design professionals, as the request and expectation for research become more prevalent in design practice.

Kids' Perceptions toward Children's Ward Healing Environments: A Case Study of Taiwan University Children's Hospital

This paper summarizes the opinions of experts who participated in designing the environment of a children's hospital and reports the results of a questionnaire survey conducted among hospital users. The grounded theory method was adopted to analyze 292 concepts, 79 open codes, 25 axial codes, and 4 selective codes; in addition, confirmatory factor analysis and reliability analysis were performed to identify elements for designing a healing environment in a children's hospital, and 21 elements from 4 dimensions, namely, emotions, space design, interpersonal interaction, and pleasant surroundings, were determined. Subsequently, this study examined the perceptions of 401 children at National Taiwan University Children's Hospital. The results revealed that, regarding the children's responses to the four dimensions and their overall perception, younger children accepted the healing environment to a significantly higher degree than did older children. The sex effect was significant for the space design dimension, and it was not significant for the other dimensions.

An Evaluation of Operating Room Safety and Efficiency: Pilot Utilization of a Structured Focus Group Format and Three-Dimensional Video Mock-Up to Inform Design Decision Making

Objective:

The purpose of this investigation was to identify safety and efficiency-related design features for inclusion in operating room (OR) construction documents.

Background:

Organizations are confronted with an array of challenges when planning an OR, including inefficiencies in operations, adverse events, and a variety of innovations to choose from. Currently, techniques that can be used in design practice and to inform design decision making for implementable OR solutions are limited.

Methods:

The project team used a structured focus group format with mixed methods to solicit 19 varying surgical team members' reactions to a three-dimensional video mock-up of a proposed OR. Data from the 19 participants were analyzed using stepwise multiple regression and content analysis of open-ended responses.

Results and Discussion:

Results demonstrate that several features of the proposed OR design predict meaningful outcomes, including flexibility and satisfaction with the OR setup, adverse event prevention, team performance, and distractions and interruptions. Participants' suggested solutions include universal booms to support anesthetic and perfusion capabilities, a fixed circulating nursing workstation that faces the patient and is at the foot of the operating room table, a wall-mounted monitor across from the surgeon, and wiring to support a touch-screen control arm in OR surgical fields.

Conclusions:

Findings from structured focus groups with mixed methods lead to implementable design solutions for construction documentation. The expeditious qualities and objectivity of the format are value-adds to the design decision-making process. Future research should use various techniques such as virtual technologies and building information modeling.

Mock-Ups as “Interactive Laboratories”: Mixed Methods Research Using Inpatient Unit Room Mock-Ups

Objective:

To establish evidence-based design (EBD) guidelines for inpatient rooms at Department of Veterans Affairs (VA) facilities.

Background:

Simulation allows clients, designers, and researchers to visualize how users might interact with a proposed design before actual construction of the design. This study used mock-ups as a simulation technique during a study of the VA inpatient room standards. The participants used the inpatient room mock-ups as “interactive laboratory” environments to maximize opportunities for participatory design, qualitative research, and quantitative research of project-specific EBD solutions.

Methods:

The research used questionnaires, scenarios, on-demand modifications, and observations to evaluate and confirm EBD solutions for inpatient room mock-ups. A total of 71 participants responded to a questionnaire administered across five mock-up work sessions. These 71 participants consisted of administrators, nurses, physicians, support staff, environment and maintenance staff, and patient and staff safety representatives from throughout the VA healthcare system.

Results and Discussion:

EBD solutions were tested, evaluated, and modified for each inpatient room type and were applicable to two or more of the inpatient room types. The latter included the location of patient beds and standard headwall position, technology and spaces for nurse charting activities, clearances (e.g., equipment, wheelchair, and bariatric patient), universal rooms, and patient and family amenities. Also, EBD solutions were tested, validated, and modified to the needs of each inpatient room.

Conclusion:

The mock-ups allowed researchers and designers to evaluate and confirm EBD solutions and strategies for the development of VA inpatient room standards. When used as a means for mixed-methods research, mock-ups can successfully integrate research and design during project-related work. EBD research using mock-ups not only addresses project- or organization-specific concerns, but it may contribute to the knowledge base of the healthcare design community.

Humane Design for Hospital Landscapes: A Case Study in Landscape Architecture of a Healing Garden for Nurses

Objective:

The overall goal of this study was to design a beautiful garden to provide a spatial experience of renewal for hospital nursing staff and for their ecologically- and culturally-specific healing. The first objective of this study was to identify the physical, social, and spiritual attributes of an existing courtyard to determine which features encouraged or discouraged use. A site-specific design concept and user-specific survey instrument were developed to gather data directly from the nursing staff on campus.

Background:

There has been growing evidence that landscapes for renewal have measurable characteristics. Physical, social, and spiritual characteristics of the landscape interrelate to determine the appropriateness of a landscape for a particular health outcome. Increasingly, evidence demonstrates that contact with the living world around us is an important part of healing and recovery. This design project created a natural opportunity to research the effect of landscape improvements on renewal.

Methods:

The method combined standard landscape architecture ecological site design process with a qualitative empirical study of staff characteristics and landscape preferences. The transparency of the landscape design process provided the basis for a post-occupancy evaluation in the future.

Results:

Sixty-one nurses participated in the qualitative phase of the design process. Preferences for contact with nature and privacy were significant among the staff. The spatial structure of the concepts was revised to include private table-and-chair places for one or two people and features that would encourage a contemplative pedestrian walk along existing shortcuts. To encourage the benefits of the typical staff's very short exposure to the garden, archetypal landscape features—thresholds, contemplative paths, garden benches, a symbolic creek, and sacred springs—were arranged to shift the spiritual dimension of the place from that of an exposed, dry gulley ravine to a green, fertile oasis.

Conclusions:

The courtyard was designed based on survey results. The final design was reviewed and found to satisfy the preferences of the nursing staff. Currently, the design is being detailed for construction, and a post-occupancy evaluation is being developed to ascertain the quality of the outcome for the nurses.