Design Of Healthcare Facilities Research Articles

Проблемы проектирования и строительства объектов здравоохранения в Анголе

Проблемы проектирования и строительства объектов здравоохранения в Анголе

The evolving role of evidence-based research in healthcare facility design competitions

The architectural design competition remains a widely accepted method to advance design innovation, creativity, theoretical discourse, and the profession. In the realm of healthcare facility design, by contrast, clients and their sponsoring organizations seldom utilize this method. The reasons for this are many, and continue to stand in stark contrast to a growing body of evidence-based research and design (EBR&D)that is potentially of value in improving performance-based dimensions—esthetic and otherwise—of healthcare facilities globally. A comparative analysis of the entrants to a recent U.S. completion was conducted. Based on the results of this analysis, a two-phased healthcare facility design competition paradigm is put forth that is premised on the assumption that the intuitive dimensions of design creativity can be further advanced by means of a well timed and thoughtful injection of quantitatively based knowledge pertaining to patient, family, staff, and organizational concerns and priorities. This proposal׳s limitations, and future opportunities, are discussed.

Using an EBD Approach for Healthcare Design

Those of us who work in the world of evidence-based design (EBD) are often under the illusion that everyone believes as strongly about using an evidence-based approach in healthcare design as we do. Apparently this is not the case-for some, EBD is still merely a marketing strategy rather than a solid approach to use in the design of healthcare facilities. This became clear to me at the 2013 Healthcare Design conference in Orlando. While riding the bus from the conference site back to my hotel one evening, I overheard three gentlemen with me on the bus discussing a session about EBD that they had attended. Without introducing myself as the co-editor of HERD, I joined their conversation and asked them if they an evidence-based approach in their They all answered with an enthusiastic yes. I asked how they found the evidence to guide their design projects. After a few moments of silence, one stated that he simply asked the client what they wanted in the and another answered that he used experience from past projects to guide his work. Next, I asked what journals they read to guide them in their project decisions. One answered that he occasionally read Healthcare Design. Since none of them mentioned HERD, I asked them, Do you ever read HERD? I was saddened to discover that one of my fellow passengers had never heard of HERD. The other two gentlemen explained that they had seen HERD but felt that it was too technical for them to use for their everyday practice.Of course this wasn't what I wanted to hear, being completely enthusiastic about HERD and EBD. Remember, all three gentlemen had said they EBD, but they didn't read any journals. This conversation validated my suspicion that some people will tell you that they use an evidence-based approach to healthcare design, when in fact they may do little to search for credible evidence to guide their project decisions. The conversation also caused me to reflect on factors that architects and designers at the grassroots level may consider to be barriers to using an evidence-based approach in their design. Therefore the aims of this editorial are to discuss frequently cited barriers to EBD and demystify the EBD process, making it easier for design practitioners (my buddies on the bus) to actually use evidence in their practice.Barriers to EBDThere are several aspects to an evidence-based approach in design that some may perceive as barriers. Some may believe that EBD is too costly, that they must add extra steps in the design process to accomplish EBD, yet there are few design firms who add extra charges for an EBD approach. Perhaps the notion that EBD adds costs to a project stems from the misconception that EBD implies a pure research methodology, when in fact EBD is the use of and application of existing evidence (research findings, observations, expert opinions, past experiences) to guide decision making in the design process. Working with the pure definition of EBD, no additional costs should be incurred in the process. On the other hand, if a formal research study is being conducted for a project, it is possible that additional costs may be incurred with the hiring of a research consultant (if necessary), the data collection process, the data analysis, and the dissemination of the research findings at national conferences or in professional journals.Another commonly cited barrier was mentioned by my fellow bus passengers, who indicated that research articles were too technical or too intimidating to read. Unfamiliarity with the research process, statistical analysis, and research terms can certainly be a barrier to those who have not had the opportunity, experience, or education in the research process. HERD has attempted to minimize this barrier by adding the Implications for Practice section to every article and will soon be adding a new feature, the Executive Summary section, which can be quickly perused by any reader for a quick synopsis of the purpose and findings of the article. …

Current Trends in Health Facility Planning, Design, and Construction

It is critical now more than ever for today's healthcare facilities to serve as more than just a backdrop to the care provided--they can, and should, be an integral part of that care. In addition to promoting efficacy, delighting the senses, and placing patients and families at ease, facilities need to be high-performing, sustainable, and healthy environments. Creating today's healthcare facilities requires breaking through barriers in unexpected ways, and it often requires looking outside the healthcare profession for guidance. In this article, we explore current trends in health facility planning, design, and construction. Our focus is on the buildings that serve as venues for the provision of healthcare services across the full continuum, from prevention to critical care. In particular, we discuss four current broad trends and conclude with thoughts on future developments.

The future hospital – implications for acute care

The future hospital – implications for acute care

Towards Capturing the Silent Emotional Experience within Healthcare Design

Objective:The aim of this exploration was to develop a technique of capturing the inner emotional experience and private conversations existing within architectural design of two healthcare facilities through the art of poetry. Can this unique emotional journey within healthcare be captured? Background: Healthcare design has begun focusing on user environment and satisfaction. This shift draws attention to healthcare’s interiority, the spirit of a place, and its ability to create individual’s emotional experiences. This paper recognizes design as an art and language. Several studies show that healthcare facility design and created spaces affect patient wellness and their support system. Methods: A checklist was created and used as a tool in a sensual exploration of listening to healthcare interiors, the emotional experience, and the silent conversation. The checklist was applied during a two day listening observation of public spaces at two hospitals in Indianapolis, Indiana University Health and St. Vincent Hospital and Health Center. On the last day,all observations were compiled into narrative poems for each of the spaces. Results: Using the checklist allowed the emotional experiences within the hospitals to be captured during the observations. The narrative poems provided an avenue to capture and encompass healthcare’s interiority. Conclusion: This study confirmed that art can be used as a tool to listen and capture the spirit, aesthetics, and emotions created within healthcare facilities.Capturing one art with another can be incorporated into the design process to ensure designers are creating emotional experiences in healthcare that aid in user wellness.

Lessons Learned: Clinicians' Post-Occupancy Perspective of Facility Design Involvement

The research was conducted to determine clinician knowledge needs for competent involvement with the facility design process as well as to gather lessons learned on building stronger design teams. As clinical stakeholders are invited to the healthcare facility design table, the question arises as to the ability of professionally diverse team members to translate each other's comments and ideas accurately. In the past, hospitals were designed by a handful of hospital leaders and architects. More recently, multiple players have become involved throughout the design and construction of new healthcare facilities. Clinical consultants from two international healthcare companies observed that many clinicians were unprepared to effectively translate their needs to the architectural community or to competently utilize architectural tools and documents. A qualitative, post-occupancy cross-case study was conducted to understand how clinicians could increase their competencies for successful involvement in facility design. Focus group interviews were held with teams from healthcare facilities occupying their new facility for more than 6 months and less than 2 years. Curriculum topics were validated and additional areas recommended based on the interviews. Open-ended questioins on lessons learned provided several new dimensions to the research. Although validating the curriculum was the initial intent, the feedback from the focus groups on lessons learned provided rich concepts for practice implications and further research on post-occupancy. Decision-making, design process, interdisciplinary, planning, post-occupancy.

Hospital ward design and prevention of hospital-acquired infections: A prospective clinical trial.

Renovation of a general medical ward provided an opportunity to study health care facility design as a factor for preventing hospital-acquired infections. To determine whether a hospital ward designed with predominantly single rooms was associated with lower event rates of hospital-acquired infection and colonization. A prospective controlled trial with patient allocation incorporating randomness was designed with outcomes on multiple 'historic design' wards (mainly four-bed rooms with shared bathrooms) compared with outcomes on a newly renovated 'new design' ward (predominantly single rooms with private bathrooms). Using Poisson regression analysis and adjusting for time at risk, there were no differences (P=0.18) in the primary outcome (2.96 versus 1.85 events/1000 patient-days, respectively). After adjustment for age, sex, Charlson score, admitted from care facility, previous hospitalization within six months, isolation requirement and the duration on antibiotics, the incidence rate ratio was 1.44 (95% CI 0.71 to 2.94) for the new design versus the historic design wards. A restricted analysis on the numbers of events occurring in single-bed versus multibed wings within the new design ward revealed an event incidence density of 1.89 versus 3.47 events/1000 patient-days, respectively (P=0.18), and an incidence rate ratio of 0.54 (95% CI 0.15 to 1.30). No difference in the incidence density of hospital-acquired infections or colonizations was observed for medical patients admitted to a new design ward versus historic design wards. A restricted analysis of events occurring in single-bed versus multibed wings suggests that ward design warrants further study.

Making sense of future uncertainties using real options and scenario planning

Healthcare across the world is facing many uncertainties. In Dutch healthcare, a recent policy change is forcing health organizations to deal more efficiently with their real estate, and this increases the need for real estate strategies that are more flexible. In order to support managers in incorporating flexibility in their decision-making over the design of new healthcare facilities, we have developed a method that combines scenario planning and real options. Scenario planning enhances sensemaking over the consequences of future uncertainties, and real options should help in addressing flexibility in decision-making through weighing the pros and cons of flexibility measures. We illustrate the sensemaking process by applying the method to a hospital, to a forensic clinic and to a care organization for vulnerable citizens. Data collection took place through interviews and workshops. We found that the identity and characteristics of the workshop participants influenced the sensemaking process. The method proved a useful means of making sense of abstract uncertainties that influence an organization, aspects that are normally outside the scope of real estate managers. The real options approach offered a more structured way of balancing the costs and benefits of strategies in dealing with future uncertainties.

Translating Quality Care Factors to Quality Space: Design Criteria for Outpatient Facility

This paper is concerned with the design aspects of an Outpatient Facility, in terms of how to translate quality care concept, to space and interior design characteristics. The paper argues that making explicit aspects of the interior space design that are responsive to the concept of quality care is crucial for the benefit of improving existing facilities as well as future design. There is no locally drawn guideline for the design of healthcare facilities. This paper reviews foreign guidelines with the aim to consolidate key aspects of space design characteristics to support the quality care concept for outpatient facility.

New healthcare safety risk assessment toolkit includes acoustics and noise control design measures for error prevention in medication safety zones

The Facilities Guidelines Institute (FGI) manages the Guidelines for Design and Construction of Hospitals and Outpatient Facilities, which is used by the Joint Commission, many federal agencies, and authorities having jurisdiction in 42 states. The forthcoming 2014 edition calls for completion of a Safety Risk Assessment (SRA) to guide healthcare facility planning and design teams through systematic evaluation of safety issues in the built environment. In 2012, FGI and the federal Agency for Healthcare Research and Quality commissioned The Center for Health Design to oversee a three year effort to develop, test, and disseminate an SRA toolkit. The toolkit will consist of an online facility design questionnaire, supporting whitepapers and guidelines, and education for the healthcare community. The Acoustics Research Council was invited to contribute by integrating noise control language into the medication safety segment of the online questionnaire tool. The result is a question that specifically addresses acoustics and noise control design for error prevention in medication safety zones. In May 2013, the questionnaire content was finalized, and it will be validated, integrated, and evaluated during the subsequent two years. The co-authors are project participants.

Why alarm fatigue is a pivotal issue that affects the acoustical design of healthcare facilities

The U.S. FDA and Joint Commission designated “alarm fatigue” the “#1 priority in healthcare technology” in 2011–2012, acknowledging that this acoustical problem results in hundreds of patient deaths and thousands of injuries. The healthcare facilities industry has been slow to recognize that “alarm fatigue” is partly a facility design issue: i.e., a cacophony of recurrent noises from myriad uncorrelated medical devices, set at maximum loudness, occurring in hard-walled, reverberant spaces (such as patient rooms, ORs, and ICUs) produce elevated stress, sleep impairment, disorientation, and dangerously irrational, potentially deadly behavior. “Alarm fatigue” has been addressed as a human factors problem elsewhere: e.g., nuclear plant control rooms (after Three-Mile Island) and aircraft cockpits. In healthcare, it is imperative to engage architects, designers, acoustical engineers facility engineering staffs, and clinicians, who represent the “first line of defense” as the medical device industry requires 5–10 years to implement solutions. The presenter co-led a delegation of 12 distinguished members of the acoustics profession to the national summit on “alarm fatigue,” Washington DC, 2011 and has co-authored peer-reviewed medical journal articles and a forthcoming FGI white paper on the subject. This presentation focuses on solutions, challenges, and the research roadmap needed to address “alarm fatigue.”

Value based education for healthcare design

Accelerating the understanding and adoption of the FGI Guidelines is an essential part of the continuous improvement process—especially at a time when healthcare is coping with so much rapid change, and while the FGI Guidelines are becoming more accepted internationally. As part of the process to improve the acoustical environment in healthcare facilities, there is also the continual need to educate architects and designers concerning sound and vibration design criteria included in the FGI Guidelines. Designers need to understand how to apply the criteria, proposed changes to the guidelines, and how the changes will benefit the hospital by improving the patient experience. Using professional social networking, electronic, and face-to-face continuing education combined with research based design, professionals and the public can be educated on the merits of improvement in the acoustical design of healthcare facilities. Web-based education will attract a much wider audience worldwide and further international acceptance. Project case studies where FGI Guidelines were applied will identify the cost impact while increasing awareness and understanding.

The Role of the Hospital Environment in Preventing Healthcare-Associated Infections Caused by Pathogens Transmitted through the Air

OBJECTIVE: To assess and synthesize available evidence in the infection control and healthcare design literature on strategies using the built environment to reduce the transmission of pathogens in the air that cause healthcare-associated infections (HAIs). BACKGROUND: Air can serve as a route for transmission of important HAI pathogens, including Mycobacterium tuberculosis and influenza, and may play a role for others typically transmitted by contact, including Staphylococcus aureus and Clostridium difficile. TOPICAL HEADINGS: Four primary interventions can be used interrupt the transmission of pathogens in air: ventilation, filtration, decontamination, and isolation. Many studies demonstrate that unidirectional airflows, when combined with very clean air and frequent air changes, reduce bacterial counts in the air, though mostly focused on the operating room. A high-efficiency particulate air filter removes almost all particles from the air and is used in protective environments such as the operating room, but little evidence supports its broader application. Ultraviolet germicidal radiation can augment the performance of heating, ventilation, and air conditioning systems. Isolation with negative pressure ventilation prevents spread of airborne pathogens such as tuberculosis. CONCLUSIONS: Current evidence is limited by the complexity of the interactions between pathogens and potential hosts, and in the methods used to assess impact of these strategies. Because the factors that affect transmission of the pathogens are complex and transcend disciplines, a collaborative approach among the key stakeholders in healthcare facility design should be actively pursued from planning to completion of construction and in rigorous research to best determine how design can reduce HAIs.

Expert Opinions on the Role of Facility Design in the Acquisition and Prevention of Healthcare-Associated Infections

OBJECTIVE: To assess expert knowledge, perceptions, and experience on the role of the built environment in the acquisition and transmission of healthcare-associated infections (HAIs), facility design decision-making considerations, and strategies for intervention through facility design and technologies. BACKGROUND: Healthcare-associated infections pose a serious and costly threat to public health in the United States. A growing evidence base suggests that the built environment can play a role in interrupting the chain of infection. METHODS: Semi-structured individual interviews and triads were conducted with 26 experts in hospital administration, architecture, interior design, infection control, and air and water quality. A grounded theory approach was used for interview coding and interpretation. RESULTS: Participants characterized the shift in thinking about the relationship between the built environment and HAI transmission as a “progression,” as accountability for infection prevention has expanded beyond clinicians. Organizational leaders aim to make informed design decisions, but this can be challenging due to the paucity of efficacy and return on investment data. Emerging interventions include copper impregnated materials, seamless flooring, and chilled beams. CONCLUSIONS: No single intervention is entirely effective in mitigating HAI risk; multiple interventions are needed. In addition to the built environment, human behavior must be considered, as noncompliance can render even the best designs ineffective. Increased multidisciplinary collaboration is needed to improve the application of evidence and experience in healthcare facility design. In the absence of conclusive evidence regarding interventions aimed at reducing HAI transmission, a combination of research data and practical experience should be used to inform design decisions.

치유환경의 행태지원성과 지속가능성 개념에 관한 연구 - 저층 친환경 의료시설 사례 중심으로 -

The purpose of this study is to suggest a direction for eco-friendly healing space design for healthcare facilities in the future. Theoretical review and case study on the concept of sustainable design, spatial expression and behavioral affordance were used as research method. Through these reviews, the 3 elements of the total healing environment -physical, psychological and social- have correspondence with elements of spatial expression; Refuge, Flow, Prospect and Void. And these are related to the eight kinds of Behavioral affordance which are subdivided into WORKS Natural system, People, Place, The cycle of life, Energy & natural resources and Process. Through correlation analysis of behavioral affordance and 6 principles, the result of this study presents that the physical elements of the total healing space was mainly associated with the principles of people, place and the cycle of life. Psychological element was related to principle of natural system, human, place and process. And social element was associated with the principles of human, place and process. According to this analysis, the case study of four low-rise eco-friendly medical facilities was undertaken. Sustainability was evaluated in total healing environmental through this case study.

Knowledge of medication use and factors influencing the utilisation of public health clinics

This study aimed to determine knowledge of medication use, to investigate the treatment-seeking pattern and to identify factors affecting the use of public health clinics among the study population. A survey was conducted in Mantin Town of Malaysia using a structured questionnaire based on a literature review. Households were recruited through a three-stage sampling technique. Of 183 respondents (mean age 44.6 [±16.9] years; 115 [62.8%] women), 157 (85.8%) did not know about the term 'generic name' and 159 (86.9%) were not sure about the difference in price between a generic medicine and a branded medicine. The majority sought healthcare from the public health clinics (102/183; 55.7%). In the multivariate analysis, higher education level of respondents (p = 0.028), good quality of services in public health clinics (p = 0.001) and short distances between their residences and the public health clinics (p<0.001) were the significant variables for predicting the use of a public health clinic. This study highlights that health education on the use of generic drugs needs to be scaled up. These findings are important to the health policy makers who may need to consider addressing factors such as quality of care and physical distance to the clinic in the design and implementation of health facilities and the selection of the catchment areas.

The Question of Knowledge in Evidence-Based Design for Healthcare Facilities: Limitations and Suggestions

To help designers and researchers and other proponents of evidence-based design (EBD) overcome limitations concerning knowledge categorization and acquisition of evidence-based design (EBD). The evidence-based design (EBD) approach for healthcare facilities has been widely embraced by both designers and researchers in recent years; however, there are some limitations concerning knowledge categorization and acquisition of EBD. These limitations include an overemphasis on empirical knowledge gained by experimental research, a narrow focus that excludes design knowledge generated outside healthcare and allied fields, and a lack of interest in empirical knowledge gained by qualitative studies. In order to overcome these limitations, the proponents of EBD must acknowledge that design knowledge relevant to healthcare design can be found in disciplines unrelated to healthcare; that design knowledge does not always need empirical validation; and that design knowledge of the semantic kind can be more easily accessed and understood through qualitative studies. To reassess the foundations of knowledge of EBD with moderated skepticism is necessary because there are philosophical and analytical problems yet to be overcome in delivering on the promises of EBD. To question and reassess the foundations of knowledge base of EBD is not necessarily to deny its value, but rather to stimulate a judicious and balanced appraisal of its limitations so that, in future, we are able to take necessary steps to overcome these limitations. Design process, evidence-based design, methodology, theory, interdisciplinary.

A study protocol for performance evaluation of a new academic intensive care unit facility: impact on patient care

BackgroundHealthcare facility construction is increasing because of population demand and the need to replace ageing infrastructure. Research suggests that there may be a relationship between healthcare environment and patient care....

Lost in space

Purpose – Psychological and epidemiological literature suggests that the built environment plays both causal and therapeutic roles in schizophrenia, but what are the implications for designers? The purpose of this paper is to focus on the role the built environment plays in psycho‐environmental dynamics, in order that negative effects can be avoided and beneficial effects emphasised in architectural design. Design/methodology/approach – The approach taken is a translational exploration of the dynamics between the built environment and psychotic illness, using primary research from disciplines as diverse as epidemiology, neurology and psychology. Findings – The built environment is conceived as being both an agonist and as an antagonist for the underlying processes that present as psychosis. The built environment is implicated through several means, through the opportunities it provides. These may be physical, narrative, emotional, hedonic or personal. Some opportunities may be negative, and others positive. The built environment is also an important source of unexpected aesthetic stimulation, yet in psychotic illnesses, aesthetic sensibilities characteristically suffer from deterioration. Research limitations/implications – The findings presented are based on research that is largely translated from very different fields of enquiry. Whilst findings are cogent and logical, much of the support is correlational rather than empirical. Social implications – The WHO claims that schizophrenia destroys 24 million lives worldwide, with an exponential effect on human and financial capital. Because evidence implicates the built environment, architectural and urban designers may have a role to play in reducing the human costs wrought by the illness. Originality/value – Never before has architecture been so explicitly implicated as a cause of mental illness. This paper was presented to the Symposium of Mental Health Facility Design, and is essential reading for anyone involved in designing for improved mental health.