Construction Of Healthcare Facilities Research Articles

Urban transformation and population decline in old New Towns in the Osaka Metropolitan Area

In shrinking cities, old New-Towns have emerged as an urban issue in recent years as the population ages. New-Towns were quiet residential areas that flourished as neighborhoods that provided housing during the population boom from 1960 to 1990. New-Towns were developed on the design principle of Perry's neighborhood unit model. However, New-Towns have become “old New-Towns” with many older adults. The aim of this study is to examine the nonlinear relationship between population decline and urban transformation by using the urban transformation of houses in old New-Towns. This study analyzed the Osaka metropolitan area as a case study. The XGBoost algorithm was used to analyze the nonlinear relationship between urban transformation and population change. In conclusion, population decline correlates with the urban transformation of houses into health care facilities in old New-Towns in Japan. This means that the neighborhood unit model, which focuses on children, has changed to one that focuses on older adults. However, there have been fewer old NTs that transformed from housing to health care facilities than changes to other land uses. Therefore, urban planners need to develop policies to encourage the construction of health care facilities and mixed land use in old New-Towns.

Manajemen Organisasi terhadap Efektivitas Kinerja Ponkesdes

One of the community-based health initiatives (UKBM) that actively incorporates the community in the construction of healthcare facilities is Ponkesdes. According to evaluation data from the Kediri City Health Service (Dinkes), the Ponkesdes program encountered a number of technical difficulties and a lack of coverage of targets. Analytical descriptive research was used in the study, which was carried out in Kediri City and Bondowoso Regency. The cross-sectional approach is the methodology employed. These include organizational structure, work schedule, work program, goal setting, coaching and supervision, and evaluation, all of which are based on organizational aspects found in this research. The analysis's findings indicate that the program variable (α=0.032) and assessment variable (α=0.003) of the health center are the organizational characteristics associated with how well its performance is carried out. Meanwhile, organizational variables (α=0.517), work schedule (α=0.383), compensation system (α=0.101), goal setting (α=0.618), supervision and coaching (α=0.837), and organizational structure variables (α=0.517) are unrelated to the village health center's efficacy. This is due to the fact that, although occasionally ignoring the established organizational structure and work schedules, the Islamic boarding school officers take seriously the need to carry out the programs at the school in order to meet predetermined targets.

Construction of Healthcare Facilities Using Energy Efficient Technologies

Introduction. According to the Low-Carbon Development Strategy of the Russian Federation 2050, the special attention is allocated to cities, to evaluation of the quality and comfort of population life-activity, taking into account the implementation of energy-saving measures and other technological solutions, as well as to design and construction ensuring zero carbon dioxide emissions. The quality of people’s life is characterized by the availability of social infrastructure and adjacent spaces including: educational and healthcare institutions, as well as sports, recreation and cultural facilities. Planning the optimal development of healthcare institutions network with respect to the energy efficient measures, requires the integral system of urban territory evaluation, which is the main aim of the present study.Materials and methods. A complex task requires a multifaceted approach to systematizing the information about the state of urban territory in the following spheres: energy efficiency, green technologies, healthcare facilities network and its condition, development and character of the urban territory, environmental stability etc. In the context of low-carbon development the optimization of the healthcare network provided the use of energy-saving technologies becomes possible thanks to the use of the geographic information system.Results. As a result of the study held with application of the systemic approach to the phased planning of the healthcare institutions network optimization and using the geographic information system as a tool for territorial and spatial analysis, there were identified the main districts that require expansion and development of social infrastructure, namely healthcare institutions, and the urban territory features — infrastructure indicators (transport) and comfort of living indicators (urban greening evaluation). The basic opportunities and ways to improve energy efficiency of healthcare buildings were determined.Discussion and Conclusions. The long-term development of the healthcare institutions network in the city is fulfilled by means of the phased planning method implicating the differentiated normative-target approach, multi-criteria evaluation, which allows to organise sufficient medical care under conditions of the specific residing system. The implementation of the information modeling technologies, green and energy saving technologies will ensure improvement of the comfort of staying level, reduce energy consumption and ease the load on the municipal infrastructure of the city.

Strategies to evaluate the quality of hospital design with clinical data.

Strategies to evaluate the quality of hospital design with clinical data.

Evaluating Mortality and Hospital Room Design after High-Risk Inpatient Surgery

Introduction: Each year in the US we spend more than $48 billion on the construction of healthcare facilities and unfortunately rarely evaluate the performance of their design after occupation. Nonetheless, certain design features— including occupancy (single vs double), distance from nursing station, direct lines of site, and a window view— likely influence patient care and outcomes but have not been adequately evaluated. Methods: We linked two complementary datasets - Michigan Medicine’s 1.) Facilities of Operations Building Information and 2.) Research Database Warehouse- and identified a cohort of 13 different surgery procedures that have known rates of high complication (colectomy, pancreatectomy, kidney transplant, etc.). Admissions to the 5th or 8th floor of a University Hospital during 2016-2019 provided a sample of 3,964 inpatient surgeries. Patient rooms were coded based on their features and patient encounters were linked by room number to identify clinical outcomes (mortality, length of stay) related to room design. A logistical and Poisson regression were used to evaluate inpatient and 30-day mortality. Results: Inpatient mortality was significantly higher for rooms without a window view, when adjusting for patient demographics. 30-day mortality was higher for rooms without a window view or direct line of site. Mortality did not vary by room type when accounting for patient days. Conclusion: Mortality for high-risk procedures varies widely across room design features and room type. Risk adjustment methods can alter the estimate of mortality and more research should be dedicated to isolating additional room design features.

Peculiarities of the reflection of the cost in the accounts of the developer in the construction of health care facilities

The modern tendencies of the real estate market and also the basic aspects of formation and reflection of the cost price of real estate objects sold in the field of medicine and health care on the accounts of bookkeeping are considered in the present work. The author raises the question of the accounting of the expenses accumulated when carrying out investment activity in construction and considers the order of their distribution on finished objects of real estate. The author also emphasizes the importance of the recognition of the cost of sales of the development company in the correct period and, guided by professional judgment, offers typical accounting entries for the reflection of the cost of production in the accounting.

Psychologically supportive healing environment for sustainability in healthcare facilities: A case study

The design and construction of healthcare facilities are some of the significant foundations for the survival and healthy living of a happy society. In terms of the sustainable quality aspect in healthcare facilities, the structural safety and functional efficiency were primarily analyzed. In the further development, it turned into the healing healthcare centers together with the inclusion of aesthetic and cultural values as well as psychological and physical needs of individuals. With such developments, the concept of psychosocially supporting design has come into prominence through improving as a connection to nature, social support enhancement, stimulating design features, complexity, and coherence factors. Our article analyses the subject based on the indoor space planning elements for user’s psychological positive experience upon defining the factors with their spatial characteristics in consideration with the study regarding a conceptual model of the supportive healing environment. A hospital project, which is in the pre-design phase and still under development in the Near East University, was analyzed as the case study under this study.

Hospital Redesign Based on International Standards

This article reviews the regulations for redesigning a hospital facility to the international levels. It evaluates the different building guidelines such as Guidelines for Design and Construction of Health Care Facilities by the American Institution of Architecture, Facility Guidelines Institute, Joint Commission, American Society of Heating, Refrigerating, and Air-Conditioning Engineering, Health Technical Memorandum, National Fire Protection Associations, Housing and Building National Research Center, and American Society for Healthcare Engineering. These organizations offer guidance and set standards for the construction of healthcare institutions by making them patient friendly and as safe as possible.

Evidence-Based Design in Hospital Renovation Projects: A Study of Design Implementation for User Controls.

The purpose of this article was to investigate and report the implementation of evidence-based design (EBD) principles relating to user controls into hospital renovation projects. Progress requires the application of the most recent knowledge and technology. When it comes to the design and construction of healthcare facilities, the latest knowledge comes in the form of EBD research. EBD is the process of basing decisions about the built environment on credible research to achieve the best possible outcomes. The desired outcomes of EBD recommendations include improvements to enhance user control. User control factors include the individual control over bed position, air temperature, lights, sound, and natural light. A list of recommendations from existing EBD literature related to user controls was compiled. Construction documents from 30 recent healthcare facility renovation projects across the United States were obtained and analyzed. Implementation levels for the EBD categories of user controls were reported. The findings indicate relatively extensive industry use of EBD principles relating to user control of temperature, lights, and natural lighting. The findings indicate that EBD recommendations related to user controls are being adopted in practice at consistently high levels. These findings also reveal that there are still areas of potential improvement which could inform those who influence or determine building design, codes, standards, and guidelines. The results are helpful to owners, designers, and contractors by providing a glimpse into how well the industry is recognizing and implementing known best practices. The findings likewise introduce new opportunities for further research which could lead to additional improvement in the healthcare facilities of the future.

Recommended guidelines for the implementation of evidence-based design in healthcare construction

Implementation of verified research to improve the human environment is a process known as evidence-based design (EBD). Research on EBD has been ongoing at universities for the last 27 years. While previous research on EBD has sparked debates and created substantive knowledge on the effects of EBD in healthcare construction, the practical question of how best to implement EBD in healthcare construction has been overlooked. Developing guidelines for the implementation of best EBD practices in healthcare facility construction through consensus from a panel of healthcare, construction, engineering and architecture professionals was the focus of this study. The conceptual framework of the study included the theory of evidence-based practice, knowledge creation and triple-loop learning to support the modified Delphi research. The study generated nine responses that established group consensus for guidelines for the implementation of EBD in healthcare construction and their significance to each project. The findings in three rounds of the study stand alone in current research as a means and methods approach for teams to use ranked guidelines to focus leadership in healthcare, design and construction on the implementation of evidence from past projects to create innovative approaches to current projects.

Identifying Success Factors of Healthcare Facility Construction Projects in Iran

Building of healthcare facilities are considered to be complex owing to uncertainty attached to the nature of these types of projects. Feasibility study through design and construction figured out that many intricate factors should be considered by project managers to make healthcare projects successful. Multiple building components and systems, diverse stakeholders’ needs, progressive healthcare technology, specialized functions, different financing methods, and particular building codes and regulation make managing of healthcare facility construction a challenging tasks for project managers. Therefore, understanding the criteria for successful delivery of these types of projects is critical for project managers. Although, evaluating success factors of general construction projects has attracted attentions in recent years, no research has addressed specific nature of healthcare construction projects. This paper aims to identify success factors of healthcare facility projects by interviewing practitioners who have substantial experience in construction of health care facilities in Iran. The qualitative nature of the study gives an opportunity to experts to reveal their insights about projects success factors through open-ended interviews. The result can be used by project managers as a guideline to handle healthcare construction projects successfully.

Evolving leadership in healthcare design.

Nurses and other healthcare professionals have always had opportunities for diverse careers. Healthcare professionals can advance into management, education, specialized clinical practice, schools, sports teams, and even the movie industry. This issue of HERD discusses how healthcare professionals and those involved in healthcare design are using their art, expertise, and critical thinking skills improve both patient care and the built environment.Billions of dollars have been spent in the design and construction of healthcare facilities since the building boom of the 1990s. As a result, the healthcare design industry has had several opportunities evaluate the effectiveness of the built environment improve the patient experience and enhance the work environment for healthcare professionals. Perhaps a result of this building boom, or perhaps because of the pioneering spirit it engendered, nurses and other healthcare professionals began enter the design and construction industry integrate their perspective and expertise into the design and of healthcare facilities. Today, many healthcare professionals, especially nurses, are long-standing employees of architectural firms.A survey completed by the Nursing Institute of Healthcare Design (NIHD) found that nurses have been employed by architectural firms or the design industry since the early 1980s. The roles of physicians, nurses, and others have included visioning, strategic planning, operational improvement, space programming, team liaison, and conceptual thinking. Their roles have evolved include advising on the healthcare facility guidelines, technology and equipment development, interior design, architecture, product development and implementation, simulation modeling, and research.Those of us who work in the healthcare design industry may think of a building or a specific environment when we hear the word design. However, healthcare design encompasses so much more. The word design means to plan and fashion artistically or skillfully. Nursing is both an art and a skill. Nurses work artfully develop rapport with their patients and their families, design solutions motivate patients who are uninvolved in their care, creatively schedule analgesia manage a patient's pain, find solutions for the patient who cannot sit up by him- or herself, and create workarounds when the proper equipment or supplies are not available. Skill is related the knowledge base, training, and critical thinking required care for a myriad of disease processes that a nurse faces over the course of a day, week, or year. The right combination of art and skill cannot be readily observed or taught and the value of this insight in the design process is irreplaceable. The nurse and other healthcare professionals possess a combination of skill, knowledge, awareness, and experience that has a positive impact the design of the care delivery model as well as the design solution for the supporting environment.Today, that art and skill is being used lead the design of the future healthcare delivery model. The leadership opportunities in the domain of design are plentiful. The Spheres of Influence in Figure 1 illustrate how the healthcare professional's expertise permeates the patient care environment. The influence may or may not have a direct correlation an end-product within the environment; however, all dimensions require leadership, clinical knowledge, and advocacy for both patients as well as other staff members. The concentric circles demonstrate how the strength and influence of the clinician's leadership, knowledge, and advocacy can impact the end result of the project, both the clinical aspects as well as the design of the built environment.The first sphere (orange) demonstrates how healthcare professionals have the opportunity use their knowledge influence strategic planning within the healthcare system, collaborate with the development of patient access solutions, lead safety and quality initiatives, impact the future care delivery model, and identify and implement process improvement strategies. …

Heart Rythm Society expert consensus statement on electrophysiology laboratory standards: process, protocols, equipment, personnel, and safety.

ABBREVIATIONS CIED = cardiovascular implantable electronic device; CT=computed tomography; EP=electrophysiology; FDA= U.S. Food and Drug Administration; ICD=implantable cardioverterdefibrillator; MRI = magnetic resonance imaging; QA = quality assurance; QI = quality improvement; RF = radiofrequency; VT = ventricular tachycardia (Heart Rhythm 2014;11:e9–e51)

Integrated design experience and post-occupancy acoustic performance of medical office building of the future

This case study discusses the experiences working within this integrated design team with architects, engineers, and contractors from day one, which included mock-ups and physical models of proposed systems. This project was completed in 2013, and was designed and evaluated compared to the 2010 Facilities Guidelines Institute Guidelines for Design and Construction of Health Care Facilities. During construction, we evaluated some acoustic construction defects and addressed these impacts, and completed a full acoustic evaluation of the space prior to occupancy. This building was a paradigm shift for the doctors and nurses, and required additional testing and analysis to interpret some of the feedback from users about the acoustic function of the spaces.

Interprofessional practice: magic at the intersection.

Reflecting back on my career as a nurse, I am amazed at how the various positions I have held have shaped my perspectives on so many issues. After a great career in clinical nursing and hospital management, with involvement in the planning and design of a large specialty hospital, I was invited to join an architectural firm as a nurse consultant. The role included teaching less experienced architects about healthcare operations, care delivery processes, and patient and staff needs that might influence design decisions, and to accompany the design team when interfacing with the healthcare clients. In essence, I was an interpreter between the two languages in the worlds of healthcare and architecture. I must confess that the first few months in the architectural firm were a bit rugged for me. I was a pioneer in a new role with minimal skills, little orientation to the architects' world of thinking, and toolkit full of the wrong tools... or so I thought. Feeling like a fish out of water, I decided to surround myself with nursing memorabilia in my new avant-garde design office (what was a nurse doing in an office like this?). Still not comfortable in my new role, I re-read Florence Nightingale's Notes on Nursing, and then I knew why I was embedded in an architectural firm. Florence Nightingale was not only a nurse, but the first to bring attention to the need for changes in the design of healthcare facilities to ensure an environment that facilitated healing.After the first few client visits and work sessions, the importance of a nurse embedded in the design world was very apparent. Nurses and physicians could relate to me in ways that they could not relate to architects. They trusted me, because I was one of their own, and they were certain that architects didn't understand them or know how they were from all other hospitals in the world. Hospital leaders also trusted me, because I was experienced in hospital operations, finance, and patient care-what do architects know about that? was the general question. In hospital meetings, I was in my comfort zone, but back in the office, it took some time for me not to feel that I was in foreign ter- ritory. I made it my personal goal to prove my worth and to be a value-added asset to the firm.There is a purpose for my revealing such personal information. I hope to demonstrate in this editorial that there is magic at the intersection, where true interprofessional practice intersects and positive outcomes can be achieved as a result of the synergy that occurs among different professionals who come together with a common purpose and goal.Recognizing the Intersections in Healthcare DesignEven the term healthcare design indicates the intersection of two different disciplines that have merged into a new discipline with its own language, guidelines, and standards; science with rigorous research to guide practice decisions; and even certification examinations to recognize individuals who have mastered a body of knowledge that can be translated to quality decisions, service, and outcomes in healthcare design. All of these have come together at the intersection of two worlds; however, each of these distinctly different worlds has subsets of disciplines within them, making the intersection all the more complex. As an example, in healthcare the subsets of disciplines include healthcare administration, nursing, medicine, all the therapies, and numerous other disciplines that shape and support patient care. On the other hand, the design discipline also comprises subsets, including architecture; interior design; environmental psychology; structural, electrical, and mechanical engineering; and a host of other disciplines that support the planning, design, and construction of healthcare facilities. Clearly the healthcare design discipline is a complex system and can be best understood and explained using the theory of quantum science and complexity theory, which describe the world as one of complexity and chaos with multiple constantly moving and often unpredictable parts that comprise the structure of a whole system (Plsek & Greenhalgh, 2001). …

Guidelines for safety in the gastrointestinal endoscopy unit

In 2009, the Centers for Medicare and Medicaid Services (CMS) Conditions for Coverage eliminated the distinction between a sterile operating room and a non-sterile procedure room. Hence, GI endoscopy units are now held to the same standards as sterile operating rooms by CMS1 without evidence demonstrating that safety or clinical outcomes in endoscopy are thereby improved. Although the ASGE has previously published guidelines on staffing, sedation, infection control, and endoscope reprocessing for endoscopic procedures (Multisociety guideline on reprocessing flexible gastrointestinal endoscopes: 2011; Infection control during GI endoscopy; Minimum staffing requirements for the performance of GI endoscopy; Multisociety sedation curriculum for gastrointestinal endoscopy)2, 3, 4, 5 the purpose of this document is to present recommendations for endoscopy units in implementing and prioritizing safety efforts and to provide an endoscopy-specific guideline by which to evaluate endoscopy units. As a general principle, requirements for safety ought to be rooted in evidence that demonstrates a benefit in outcomes. Where data is absent, these requirements may be derived from experts with experience in the safe delivery of care in the GI endoscopy setting. Additionally, consideration should be given to the promotion of efficient care and cost containment with avoidance of requirements unsupported by evidence that then contribute to rising healthcare costs. Over the past 2 years, surveyors have called into question accepted practices at many accredited endoscopy units seeking re-accreditation. Many of these issues relate to the Ambulatory Surgical Center (ASC) Conditions for Coverage set forth by CMS and the lack of distinction between the sterile operating room and the endoscopy setting. The following is a summary of issues that have been faced by endoscopy units throughout the country along with ASGE’s position and accompanying rationale. Issue: Structural requirements for 40-inch doors and room sizes >400 square feet required of sterile operating rooms. Position: Standard 36-inch doors, if they accommodate patient transport mechanisms, and room sizes 180 square feet are adequate and safe for endoscopy units because they do not use the same large equipment or number of staff as in the operating room.6 Issue: Requirement for a written policy on traffic patterns in the endoscopy unit. Position: The unit should define low-risk exposure and high-risk exposure areas and activities within the endoscopy unit, and describe the attire and personal protective equipment that should be worn in each area. Endoscopy staff can move freely throughout the unit provided that there is appropriate use and changing of personal protective equipment. Issue: Requirement for endoscopy personnel to don full sterile operating room personal protective equipment including new scrubs, hair covers and booties. Position: It is recommended that staff directly engaged in GI endoscopy or in processes where splash or contamination could occur should wear gloves, face/eye shields, and an impervious gown. Units should develop policies that are consistent with OSHA and state-mandated recommendations for wearing face/eye shields or masks.7 Scrubs or other attire may be worn from home because endoscopy is not a sterile procedure. Likewise, there is no need for hair covers or booties. Staff must remove and appropriately discard used PPE before leaving the procedure area. Issue: Supervision of moderate sedation. Position: Moderate sedation may be administered safely under the supervision of a non-anesthesia physician who is credentialed and privileged to do so. Issue: Role of capnography. Position: There is inadequate data to support the routine use of capnography where moderate sedation is the target. Issue: Requirement that 2 nurses (one monitoring, one circulating) are present when moderate sedation is performed. Position: When moderate sedation is the target, a nurse should monitor the patient and can perform interruptible tasks. If more technical assistance is required, a second assistant (nurse, licensed practical nurse, or unlicensed assistive personnel) should be available to join the care team. Issues: Staffing requirements when sedation and monitoring is provided by anesthesia personnel. Position: When sedation and monitoring is provided by anesthesia personnel, a single additional staff person (nurse, licensed practical nurse, or unlicensed assistive personnel) is sufficient to assist with technical aspects of the procedure. Issue: Technical capabilities of technicians. Position: Unlicensed technicians, who have received initial orientation and ongoing training, and are deemed competent by their unit, can assist with and participate in tissue acquisition during the endoscopic procedure, including but not limited to the opening and closing of forceps, snares, and other accessories.

Two Decades (1993-2012) of Adult Intensive Care Unit Design

In 2006, Critical Care Nursing Quarterly published a study of the physical design features of a set of best practice example adult intensive care units (ICUs). These adult ICUs were awarded between 1993 and 2003 by the Society of Critical Care Medicine (SCCM), the American Association of Critical-Care Nurses, and the American Institute of Architects/Academy of Architecture for Health for their efforts to promote the critical care unit environment through design. Since 2003, several more adult ICUs were awarded by the same organizations for similar efforts. This study includes these newer ICUs along with those of the previous study to cover a period of 2 decades from 1993 to 2012. Like the 2006 study, this study conducts a systematic content analysis of the materials submitted by the award-winning adult ICUs. On the basis of the analysis, the study compares the 1993-2002 and 2003-2012 adult ICUs in relation to construction type, unit specialty, unit layout, unit size, patient room size and design, support and service area layout, and family space design. The study also compares its findings with the 2010 Guidelines for Design and Construction of Health Care Facilities of the Facility Guidelines Institute and the 2012 Guidelines for Intensive Care Unit Design of the SCCM. The study indicates that the award-winning ICUs of both decades used several design features that were associated with positive outcomes in research studies. The study also indicates that the award-winning ICUs of the second decade used more evidence-based design features than those of the first decades. In most cases, these ICUs exceeded the requirements of the Facility Guidelines Institute Guidelines to meet those of the SCCM Guidelines. Yet, the award-winning ICUs of both decades also used several features that had very little or no supporting research evidence. Since they all were able to create an optimal critical care environment for which they were awarded, having knowledge of the physical design of these award-winning ICUs may help design better ICUs.

Achieving the acoustical credit within the Leadership in Energy and Environmental Design (LEED®) for healthcare green building rating system and changes within the forthcoming 2014 Guidelines

The 2009 LEED® for Healthcare green building rating system includes a total of two possible points to be earned by satisfying the requirements of the Indoor Environmental Quality Credit 2 (IEQ Credit 2: Acoustic Environment). This credit references criteria that are defined by the Facility Guidelines Institute's 2010 Guidelines for Design and Construction of Health Care Facilities (2010 FGI Guidelines). The acoustical design requirements of the 2010 FGI Guidelines will be summarized, as well as a brief history of the FGI document itself. The FGI Guidelines document is currently being revised for the 2014 edition. Proposed changes in the 2014 edition will also be briefly discussed, as we anticipate that future versions of the LEED® rating system will reference the 2014 FGI Guidelines. The presentation will be made in English by Mr. Horan, secretary of the FGI's Acoustical Working Group (AWG). Mr. Latour, a French-Canadian member of the AWG, will be available to help respond to any French-speaking audience members during Q&A.

Rethinking Efficiency in Acute Care Nursing Units: Analyzing Nursing Unit Layouts for Improved Spatial Flow

This paper introduces a new design tool to increase efficiency in acute care settings. This visual tool facilitates matching spatial flow with caregivers' workflow to reduce waste and redundancies, as recommended by Lean thinking. Providing work environments that protect caregivers from fatigue, interruptions, and redundancies can contribute to quality patient care. By studying the Guidelines for Design and Construction of Health Care Facilities and reviewing the literature, the authors identified the main clinical spaces supporting nursing care and their important linkages. Space syntax, a diagrammatic analysis of relationships, was used to decode spatial relationships among the clinical spaces in five case studies. The movement distributions were measured and possible conflicts with focus-demanding tasks, such as noise and interruptions, were identified. The information was summarized in a visual diagram providing the "syntactic anatomy" of the most important work spaces. The main clinical spaces were the following: (1) patient corridor; (2) nurses' station; (3) medication area; (4) clean room; (5) soiled room; (6) physicians' dictation area; (7) report room; (8) restricted nourishment area; (9) equipment storage; and (10) unrestricted nourishment area. The report room, nourishment area, and physician workspace showed strong linkages to the patient corridor and nurses' station, although such spaces were not clearly discussed in the design guidelines. The most caregiver movement occurs in the patient corridor and nurses' station. These areas pose the greatest possibility of interruptions by persons. The results were translated into a visual design efficiency checklist. Illustrating the spatial order of the support spaces-and comparing that to use patterns-enables designers to reduce the movement sequences nurses undertake when accessing resources and identify where the flow is disrupted by "displaced" functions.

Collaboration in public sector projects: unearthing the contextual challenges posed in project environments

Collaboration is seen as an essential business trait in the construction industry for effective project delivery. Collaboration occurs in two stages: stage one is the development of a collective identity engaged through discursive practices, followed by stage two, where the collective identity translates the conversations into synergistic action. The antecedent dimensions that foster collaboration are: shared direction, collective action, competence of the members, power distribution and equality, and trust and communication. The research methodology employed ethnographic interviews within a single case study of a healthcare facility construction project. The findings of the case study suggest that contextual issues arising from the public project set-up had profound negative impact on collaboration; specifically the development of a collective identity and discursive practices. It was identified that the approach to the service provider selection, hierarchical governance mechanisms and the political land...