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Evaluation of Functional & Environmental Factors in Spanish Acute-care Hospital Design "Evaluación de los factores funcionales y ambientales en el diseño de hospitales de agudos españoles"
The aim of this doctoral thesis is to explore the evaluation of functional and environmental factors in acute-care hospital design that might have an impact on healthcare outcomes. Despite the progress of the evidence-based design process in North-European and North American countries, in Spain it still has not been fully developed. The purpose of this design process is to establish a link between design variables and health-related outcomes. Acutecare hospitals are buildings in constant change to cope with the evolving demands of clinical progress and the social context. Thus, acknowledging the functional and environmental factors that impact on the care process and evaluating them in existing acute-care hospitals becomes of paramount importance. This dissertation follows a mixed-method methodology based on four perspectives: 1) the field, with an ethnographic study during a three-month placement in an acute-care hospital; 2) the theory, with literature analysis; 3) the future, with an ethnographic study of sixteen acute-care hospital visits considered as best practice, and 4) the present, with the evaluation of four acutecare hospitals in Spain. The primary result of this work is the tool CURARQ. The purpose of this tool is, on the one hand to provide a first diagnostic of the functional and environmental quality of the studied unit, and on the other hand to guide in the design decision process of a new development. This tool has been created for seven units in the acute-care hospital and has been tested in four acute-care hospitals in “Comunidad Valenciana”. Secondary results include: 1) feedback and scripts from users during the acute-care hospital placement; 2) evaluation through architectural layouts and photographs of the acute-care hospital visits; and 3) evaluation of CURARQ scores of the four evaluated acute-care hospitals. This document provides a current overview of functional and environmental factors in acutecare hospitals, which evidence: 1) the need for refurbishment to promote clinical innovation; 2) the need to update national standards, 3) the usefulness of CURARQ tool to identify priority buildings to intervene, and 4) the usefulness of CURARQ tool to generate synergies between healthcare staff, patients, researchers, and architects to promote the potential of the evidencebased design process in Spain.