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Fable Hospital 2.0: The Business Case for Building Better Health Care Facilities

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Abstract

Evidence shows that changes in the architecture, design, and decor of health care facilities can improve patient care and in the long run reduce expenses. These essays detail the state of the research, look inside two hospitals and put some of these innovations into practice, and consider how design fits into the moral mission of health care.

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... This living lab will have substantial benefits for society, because it can decrease healthcare costs. Costs related to poor designs can be avoided by introducing better designs of spaces, such as design properties that reduce patient falls, patient transfers, adverse drug events, health careacquired infections, length of stay, nursing turnover, and staff injuries (Sadler et al., 2011). Application of established evidence-based innovations (e.g. ...
... Application of established evidence-based innovations (e.g. Sadler et al., 2011;Ulrich et al., 2008) contributes to knowledge development and valorisation in the design world and medical world. Table 1 below shows effective design factors and respective healthcare outcomes. ...
... Thanks to studies on the ideal healthcare environment, like the "Fable hospital" (Sadler et al., 2011), new insights on the relationship between spatial design, patient health, and economic benefits have emerged. This living lab will have substantial benefits for society, because it can decrease healthcare costs. ...
Conference Paper
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Background and aim-The objective is to develop the redesign of patient clinics by a living lab consisting of a multidisciplinary group of designers (interior design, facility design, organization design) and art students in participation with end-users and health care professionals at a Dutch university hospital. Methods-Participatory research was conducted in multidisciplinary communities within the context of the hospital. Spatial design ideas are based on observations, site visits and interviews with various stakeholders. Results-Four different themes or atmospheres have been created that can form the basis for further redesign of hospital wards. The spheres were: creating recharging possibilities for patients, creating delight at patients, seducing patient movements (inside out), and stimulating independency. Originality-The living lab combines integrality, multidisciplinarity, and participation with evidence-based design in a real-life context at a Dutch university hospital. Practical or social implications-New designs, capable of having positive impact on patient health, are interesting for other hospitals and healthcare institutions. This allows them to combine prevention with cost reduction. Moreover, better buildings are also relevant for innovation and commercial purposes of the construction industries and for cost benefits for insurance companies.
... 1,2 Shortcomings in facility design contribute to these lingering challenges. 3 Facility design endeavors often violate the cardinal principle of system coproduction, whereby users actively participate in the design process. Without that participation, trust and the delivery of safe, value-driven care are undermined. ...
... Nurturing, reflective spaces often reduce stress for patients, families, and staff-and emotionally rejuvenate them. 3,5,6,[17][18][19] Another way to improve the visit experience is to offer multiple small waiting areas along the flow of services: check-in, blood draws, lab testing, physical examination, and infusion or radiation. This approach can reduce congestion and the sense that the center is impersonal and institutional. ...
... 27 An integrated approach to high-efficiency air ventilation and filtration, hand hygiene, water systems, and choice of material finishes has been shown to reduce the risk of infection from the hospital environment. 3,28 Placing sinks and disinfecting stations where staff and family find them easy to routinely sanitize hands before contact with patients can increase adherence to infection-control protocols. 5 Clearly separating the flows for clean and soiled materials-and having adequate space to hold both-also reduces risks for contamination. ...
Article
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The nuts and bolts of planning and designing cancer care facilities—the physical space, the social systems, the clinical and nonclinical workflows, and all of the patient-facing services—directly influence the quality of clinical care and the overall patient experience. Cancer facilities should be conceived and constructed on the basis of evidence-based design thinking and implementation, complemented by input from key stakeholders such as patients, families, and clinicians. Specifically, facilities should be designed to improve the patient experience, offer options for urgent care, maximize infection control, support and streamline the work of multidisciplinary teams, integrate research and teaching, incorporate palliative care, and look beyond mere diagnosis and treatment to patient wellness—all tailored to each cancer center’s patient population and logistical and financial constraints. From conception to completion to iterative reevaluation, motivated institutions can learn to make their own facilities reflect the excellence in cancer care that they aim to deliver to patients.
... Items are also related to having relaxing music surrounding patients, receiving good food, and having a nice window view (cf. Hancock, 1999;Sadler et al., 2011). All items create possibilities for distracting patients from their pain (LaHood & Brink, 2010). ...
... Mollerup (2009) The signage system has not been given high attention in service firms. Sadler et al. (2011) Without a clear and well-designed signage system, patient and staff stress increases within hospitals. Dellinger (2010) Handrails should be found in hospitals. ...
... McCullough (2010) Handrails should be placed within patient rooms. Sadler et al. (2011) Hospitals should have safe processes when handling patients. Patient single rooms Henriksen, Isaacson, Sadler, and Zimring (2007) Single rooms that have an area for a family member to stay and assist the patient is regarded as an important feature within hospitals to have a more patient-centered care. ...
Article
Wellbeing of end-users is a growing concern in services research. The growth of Transformative Service Research (TSR) and Evidence-Based Design (EBD) highlights the need to focus on hospital patients to improve their wellbeing state. This study combines the two fields to propose a conceptual model for the perceived servicescape of hospitals with focus on in-patient wellbeing. The effect of the servicescape on wellbeing is tested using a survey conducted with 372 in-patients from Egyptian private hospitals. Results indicate that servicescape designs should focus on art and visuals; plants and greenery; safety and hygiene; patient single rooms and atmosphere; and signage and way-finding. This study offers a theoretical contribution to research focusing on wellbeing by showing the effect of servicescape design on patient wellbeing. Results offer practitioners a sustainable competitive advantage through the servicescape design improvements.
... Furthermore, the importance of the green/natural environment within healthcare facilities has been shown to increase patients' perception of care, satisfaction with medical care and loyalty toward the healthcare provider [14,38,40,41]. For instance, Park and Mattson [38] showed that patients who were exposed to plants during hospitalization had higher levels of satisfaction with the healthcare establishment compared with the patients who were not exposed to such green items. ...
... Moreover, the dimensions used in the present research (i.e., green items, natural light, self-rated mental health value, and satisfaction) and their significant relationships were shown to be critical drivers of patients' loyalty that has not been previously investigated. Our findings are consistent with studies that highlight that green spaces within a healthcare setting are important drivers of patient satisfaction (e.g., [39,41,76]) or loyalty (e.g., [33,77]). From a practical point of view, our findings can be utilized by healthcare managers to implement efficient biophilic design strategies within healthcare establishments that contribute to increasing patients' self-rated mental health value, which in turn determine an increase of their satisfaction with medical care and loyalty toward the healthcare provider. ...
Article
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Background: Existing studies revealed that exposure to green spaces within healthcare establishments has multiple physical and mental health benefits to patients. In this context, the concept of biophilic design has received growing attention among environmental psychology researchers. Several studies indicated that the positive effect of green environment may be different for males and females. Therefore, the present study sought to investigate the influence of biophilic design elements (i.e., green items and natural light) on patients'self-rated mental health value, satisfaction with medical care, and loyalty toward the healthcare establishment. The study also investigated the possible influence of gender differences in the relationships between the variables. Methods: A structural equation modeling was employed as a data analysis technique. Results: Our empirical result indicated that biophilic design elements significantly improved the patients' self-rated mental health value, and this dimension had a positive effect on their satisfaction with medical care and loyalty toward the health care facility. Our findings indicated that the relationships among biophilic design elements, self-rated mental health value, satisfaction with medical care, and loyalty toward the healthcare establishment were substantially different across male and female groups. Moreover, self-rated mental health value and satisfaction with medical care acted as significant mediators between bio-philic design elements and loyalty. Conclusions: Results of this study offer healthcare practitioners and researchers valuable strategies to effectively incorporate biophilic design elements into the interior spaces of a healthcare establishment. Keywords: biophilic design; healthcare facility; gender; self-rated mental health value; satisfaction; loyalty
... This is important because the design features of the physical facilities in terms of the buildings, equipment, furnishings, signage, colors, art, landscape, and other sensory stimuli offer an outpouring of clues about the organization and impact the users' evaluation of service ( Berry et al., 2004). Hospital physical facilities design features can create and enhance the moods of clients and employees (Sadler et al., 2011). Another importance of the hospital design features may contribute to the creation of a ''healing environment'' (Joseph, 2006;Sternberg, 2009). ...
... Another importance of the hospital design features may contribute to the creation of a ''healing environment'' (Joseph, 2006;Sternberg, 2009). In addition, the quality of design of the physical facilities can positively influence well-being, satisfaction, and intention to recommend to others (Sadler et al., 2011;Steinke, 2015). This study will the examine the effects of the hospital design features on hospital users which is perceived to be the determinants for hospital performance in Southwest, Nigeria and similar contexts. ...
Article
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This study examined the effects of design features on the user as a determinants for hospital performance in Southwest, Nigeria. The design features to proactively improve the hospital environment should be put in place to increase the hospital performance and users ’satisfaction. This study was carried out at the first generation Federal University Teaching Hospitals (FUTH) in southwest, Nigeria. Methodologically, it employed mixed methods of data collection. The primary source involves the use of multiple-choice structured questionnaire to collect data from the sample population. Also, semi-structured interview (SSI) was used to support the information gathered through the questionnaire in the study area. Sample size which amounted to 575 respondents and were randomly taken from the staff, inpatients and outpatients across the FUTH. However, Respondents were asked to rate the design features such as cleanness of the healthcare environment, natural lighting and ventilation, design for regular hygiene and handwashing policy, noise level within the environment and ward spaces, adequate air quality within wards, offices, and treatment spaces, location of the nursing station to oversee patients without obstructions and design for spatial flexibility and adaptability in order of preferences as a major determinants for hospital building performance.
... Table 1 outlines the eight-step evidence-based design process (8). Many studies have shown that decisions about architecture, interior design, and mechanical systems can help to reduce rates of infection, respiratory-related illness, medication errors, injuries from falling or lifting, stress, and anxiety (9)(10)(11)(12)(13). The Center for Health Design's Research Repository currently has more than 4,600 research citations on design-related outcomes, features, and processes that help to guide decision-making (14). ...
... The return on investment of a healthy building can be substantial. Using hard data from hospitals, Sadler et al. (9) analyzed and estimated the influence of evidence-based design interventions in a new hospital building on outcomes and operating costs. Improved outcomes included reduced rates of patient falls, transfers, adverse drug effects, and healthcare-associated infections-and shorter lengths of stay. ...
... 17 Patient outcomes vary between rehabilitation facilities, 17 and there is growing recognition of the interaction between the health care environment and clinical outcomes. 1,18 It would be timely to investigate whether there are relationships between the variations in rehabilitation facility design and patient outcomes. ...
... Acute health care building designs that follow the latest evidence-based design research have been shown to improve clinical outcomes and provide return on investment. 18,20,21 Half of the rehabilitation facilities in our survey were not purpose-built for rehabilitation and were refurbished as clinical demands changed over time. Evidentially, as well as being purpose-built for their intended purpose, health care buildings should also be designed to be adaptable should their purpose change. ...
Article
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Objective To identify all the services that offer inpatient rehabilitation in Victoria, Australia, and to describe the buildings in which these services are housed, including their size, age, whether or not they were purpose-built, whether or not they are colocated with a tertiary hospital, the proportion of single-bed rooms, and ward layout. Design Cross-sectional survey of inpatient rehabilitation buildings. Data were collected via telephone questionnaire and websites. Participants Sixty-four rehabilitation facilities were identified and all participated in the survey (37 public, 27 private). Results Results revealed heterogeneity on most variables measured, including size (number of beds ranged from 2-104), age (oldest building built in 1860, and 26% built since 2010), purpose-built status (48% purpose-built), freestanding status (34% freestanding), percentage of single-bed rooms (ranged from 0%-100%), and layout. All facilities had a therapy gym, and most had a communal area (96%). Conclusion Since 2010, the proportion of buildings being purpose-built and colocated with a tertiary hospital has increased. The proportion of single-bed rooms has also increased and is especially high in privately funded facilities. Results suggest that rehabilitation design is influenced by norms and evidence from acute medical health care despite the purpose of care being different: acute care (short-term, medical illness) and rehabilitation (longer-term, recovery, relearning).
... Many tenets of EBD were incorporated into the design of the study site (Sadler et al., 2011;Ulrich et al., 2008). Inpatient units follow a decentralized nursing model with charting stations between alternating patient rooms. ...
Article
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Objectives The purpose of this study was to understand how specific evidence-based design strategies are related to aspects of nurse wellness. Background Addressing burnout among the healthcare workforce is a system-level imperative. Nurses face continuous and dynamic physical and emotional demands in their role. Greater insight into the role of the physical environment can support efforts to promote nurse wellness. Methods This exploratory qualitative study was conducted at new Parkland Hospital in Dallas, TX. We conducted five focus groups with nursing staff in July 2018. These sessions covered five topics related to nursing work in the facility which had been redesigned nearly 3 years earlier: (1) professional and social communication, (2) workflow and efficiency, (3) nurses’ tasks and documentation, (4) ability to care for patients, and (5) nurses’ overall health. We conducted a thematic analysis and first identified different aspects of wellness discussed by participants. Then, we examined how nurses related different design elements to different aspects of their wellness. Results Participants included 63 nurses and nurse managers. They related environmental factors including facility size, break rooms, and decentralized workstations to social, emotional/spiritual, physical, intellectual, and occupational aspects of wellness. Conclusions It is critical to inform and integrate nurses at all levels into planning, design, and activation of new healthcare environments in order to ensure the well-being of nurses and, therefore, their ability to effectively support patients.
... Due to the small number of patients who acquired ESBL-E, we were unable to correct for these factors. An additional benefit of the reduction of transfers could be a reduction in workload, a decrease in cost, and a decrease in medical errors [8,[21][22][23][24]. As a result of the decrease in intra-hospital patient transfers, patients were exposed to less square meters of hospital environment in the new hospital building. ...
Article
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Background Extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E) are a well-known cause of healthcare-associated infections. The implementation of single-occupancy rooms is believed to decrease the spread of ESBL-E. Additionally, implementation of single-occupancy rooms is expected to reduce the need for intra-hospital patient transfers. We studied the impact of a new hospital with 100% single-occupancy rooms on the acquisition of ESBL-E and on intra-hospital patient transfers. Methods In 2018, the Erasmus MC University Medical Center moved from an old, 1200-bed hospital with mainly multiple-occupancy rooms, to a newly constructed 522-bed hospital with 100% single-occupancy rooms. Adult patients admitted between January 2018 and September 2019 with an expected hospitalization of ≥ 48 h were asked to participate in this study. Perianal samples were taken at admission and discharge. Patient characteristics and clinical information, including number of intra-hospital patient transfers, were collected from the patients’ electronic health records. Results Five hundred and ninety-seven patients were included, 225 in the old and 372 in the new hospital building. Fifty-one (8.5%) ESBL-E carriers were identified. Thirty-four (66.7%) patients were already positive at admission, of which 23 without recent hospitalization. Twenty patients acquired an ESBL-E, seven (3.1%) in the old and 13 (3.5%) in the new hospital building ( P = 0.801). Forty-one (80.4%) carriers were only detected by the active screening performed during this study. Only 10 (19.6%) patients, six before and four during hospitalization, showed ESBL-E in a clinical sample taken on medical indication. Fifty-six (24.9%) patients were transferred to other rooms in the old hospital, compared to 53 (14.2%) in the new hospital building ( P = 0.001). Intra-hospital patient transfers were associated with ESBL-E acquisition (OR 3.18, 95%CI 1.27–7.98), with increasing odds when transferred twice or more. Conclusion Transitioning to 100% single-occupancy rooms did not decrease ESBL-E acquisition, but did significantly decrease the number of intra-hospital patient transfers. The latter was associated with lower odds on ESBL-E acquisition. ESBL-E carriers remained largely unidentified through clinical samples. Trial registration This study was retrospectively registered in the Dutch National Trial Register on 24-02-2020, with registration number NL8406.
... Examples of such design strategies include improving acoustics and eliminating environmental distractions, reducing healthcare-associated infections (HAIs) by eliminating surface air and water points of infection transmission, reducing patient falls by employing nonslip surfaces, and changing unit configurations to improve clinical staff visibility and monitoring of the patient. 86 Healthcare workers can also benefit from EBD practices: reconfiguring the organization of patient rooms has been able to reduce the amount of walking for nursing staff and increase their visibility of patients, and ceiling lifts in patient rooms have decreased staff injuries from lifting patients. All of these interventions have not only healthrelated benefits but also economic benefits for the consumer and for the healthcare and insurance industries. ...
Chapter
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Overwhelmingly, evidence shows that health is directly correlated with the environment. It is thus imperative for integrative medicine practitioners to incorporate information about optimal environments in their toolkits for disease prevention.
... 7 Analogous to evidence-based clinical practice, hospitals designed following best research evidence garnered from EBD processes have better safety, patient outcomes, staff retention, and operation costs. 8,9 The Center for Health Design, established in 1993 to advance EBD, now maintains a repository of over 5,000 articles on healthcare design (https://www.healthdesign.org). ...
Article
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Healthcare facilities are among the most expensive buildings to construct, maintain, and operate. How building design can best support healthcare services, staff, and patients is important to consider. In this narrative review we outline why the healthcare environment matters and describe areas of research focus and current built environment evidence that supports health care in general and stroke care in particular. Ward configuration, corridor design, and staff station placements can all impact care provision, staff and patient behaviour. Contrary to many new ward design approaches, single bed rooms are neither uniformly favoured, nor strongly evidence-based, for people with stroke. Green spaces are important both for staff (helping to reduce stress and errors), patients and relatives, although access to, and awareness of, these and other communal spaces is often poor. Built environment research specific to stroke is limited but increasing and we highlight emerging collaborative multi-stakeholder partnerships (Living Labs) contributing to this evidence base. We believe that involving engaged and informed clinicians in design and research will help shape better hospitals of the future.
... Such features improve the overall experience of all users of the facilities, bolster safety and efficiency, and reduce waste d while cutting operational costs, especially for hospitals. [80][81][82][83][84][85][86] Princess Margaret Cancer Centre in Toronto, for example, has created serene, calming spaces for hospitalized palliative care patients and their families by using evidence-based designeinformed selections of color and wood for interior spaces, as well as carefully designed outdoor and indoor meditation gardens, which stand in stark contrast with the hectic atmosphere of many in-patient facilities. 87 Designing for trust takes this kind of creative approach, one that conceives of clinical care in its fullest context. ...
Article
When people think about trust in the context of health care, they typically focus on whether patients trust the competence of doctors and other health professionals. But for health care to reach its full potential as a service, trust must also include the notion of partnership, whereby patients see their clinicians as reliable, caring, shared decision-makers who provide ongoing “healing” in its broadest sense. Four interrelated service-quality concepts are central to fostering trust-based partnerships in health care: empathetic creativity, discretionary effort, seamless service, and fear mitigation. Health systems and institutions that prioritize trust-based partnerships with patients have put these concepts into practice using several concrete approaches: investing in organizational culture; hiring health professionals for their values, not just their skills; promoting continuous learning; attending to the power of language in all care interactions; offering patients “go-to” sources for timely assistance; and creating systems and structures that have trust built into their very design. It is in the real-world implementation of trust-based partnership that health care can reclaim its core mission.
... 16 A third study calculated that it can take as little as three years to gain back a $29 million construction investment in evidence-based design of healthcare facilities, thanks to reduced operating costs. 17 Despite these advantages, architectural services rarely include funds for conducting research about the effectiveness of design decisions. In an example from one of the authors' POE consulting practices (Core Space Planning), a senior architect from a global architecture firm stated they design the same courtyards and gallery spaces everywhere because they apply the same approach to these spaces assuming they will work in predictable ways to direct people to move in certain directions or to increase informal communication. ...
Article
Post Occupancy Evaluation (POE) is a research method that examines how buildings function; when the functions include social life, social science methods must be employed. This paper advocates using POE social research both in architectural practice and in architectural education to promote evidence‐based design. Based on four decades of experience teaching POE to undergraduates at the University of California Berkeley, we show how POE can be conducted and taught: gather the research questions, set up teams to collect data using different data collection techniques, and analyze the results by comparing and contrasting the findings of each team. We discuss the importance of POE research to architectural practice, education, and accumulated institutional knowledge.
... As stated by the European Observatory on Health Care Systems, hospital design plays an essential role because one of the first steps in achieving the desired outcome of high-quality, cost-effective care is ensuring that the right physical structures are in place (McKee et al., 2002). Several studies have been carried out to identify a good hospital design's key features (Berry et al., 2004;Sadler et al., 2011). Within the scientific debate, an increasing number of studies have found links between design strategies (i.e., layout, views, wayfinding) and users' well-being (i.e., patients, staff, visitors), or organizational outcomes improvements Ulrich et al., 2008). ...
Article
Aim The research sheds light on the challenges and limitations of Spanish and Italian hospital design by looking at the gaps between education and practice. Background Hospital design plays an important role in providing high-quality and cost-effective facilities for any healthcare system. Spain and Italy face contemporary challenges (i.e., elderly population, staff retention, and obsolete healthcare facilities) and have similar issues of life expectancy, health expenditure, hospital beds provision, and decentralized tax-financed healthcare systems. Method A cross-sectional, mixed-method study was used. This involved two different data collection strategies and analysis for each area of investigation: (i) education and (ii) practice. For the former, educational programs were reviewed via a web search; for the latter, an online survey of 53 architectural/engineering offices involved in hospital design was conducted. Results Hospital design education is limited to 0/58 in Spanish and 2/60 courses in Italian universities, although each country offers three postgraduate courses. The practitioners’ survey shows that even though their offices have a long history of healthcare design, only 48% in Spain and 60% in Italy have received specific university training. Office staff lack employees with medical backgrounds, which hinders any partnership between health and design fields either for design practice or the education fields. Laws, national regulations, technical guidelines, and previous experience are the most useful information sources, while international scientific publications appear underused by practitioners. Conclusions Italian and Spanish healthcare architecture could be improved by promoting multidisciplinary teams (in practice and education) and improving the education offer by tailoring it to national needs.
... A multidisciplinary author team introduced the "Fable Hospital" in 2004 (Berry et al., 2004) and an updated version in 2011 (Sadler et al., 2011) to demonstrate a strong business case for using the best-available evidence in building a new hospital. By investing in design elements such as sound-absorbing materials; larger, well-placed room windows to expose more natural light; single-bed patient rooms; and family support spaces, the 2011 version of Fable Hospital paid back its cost premium of 7.2% within three yearsstrictly on the basis of operational cost reductions. ...
Article
Purpose The purpose of this article is to highlight the importance of the foundational construct of “connection” in linking design and service in performing vital functions in the healthcare sector. “Connection” facilitates patients receiving life-saving and life-improving care at the right time, in the right place, in the right way. Design/methodology/approach This article discusses various design-improvement initiatives making clear that healthcare, like any labor-intensive service delivered to people, is a human endeavor whose systems and features can be materially and cleverly enhanced once their intricacies are analyzed, understood and then redesigned to move closer to excellence. Findings By designing connection into healthcare and thinking holistically about the needs and preferences of users (patients), the functionality and the appeal of healthcare services can be enhanced. Originality/value The gap between the service that healthcare aims to deliver – and what it actually delivers – is unacceptably large. This article calls for incorporating connection through design into healthcare as a way to bridge this gap.
... There is a substantial amount of quality EBD research relevant to general or somatic hospitals and other medical buildings, to the point that the design of nearly all hospitals in Sweden and other countries with advanced healthcare systems is strongly influenced by EBD knowledge and design concepts . These evidence-informed design approaches for hospitals have been shown to increase patient safety, clinical quality, patient and staff satisfaction, and reduce costs of delivering care (Ulrich, 2012;Ulrich et al., 2008;Berry et al., 2004;Sadler et al., 2011). A general conclusion supported by this research is that improving the design of healthcare buildings is integral to improving healthcare quality and controlling costs. ...
... The healthcare industry can promote health while conserving energy and related costs in many ways including architectural initiatives designed to increase proximity of patients and staff to green spaces which is in hospital settings to facilitate physical activity, accelerate recovery, and reduce pain, aggression, mental fatigue, and staff burnout (Sadler et al. 2011). Large amounts of energy and landfill waste can be safely reduced by modifying procedures for hospital-based cannulation and intravenous antibiotic preparation (Bajgoric et al. 2014), disposal of unused pharmaceuticals (Maughan et al. 2014), recycling of medical equipment (Kwakye et al. 2010), and other approaches (Health Research and Educational Trust 2014). ...
Article
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Health promotion involves social and environmental interventions designed to benefit and protect health. It often harmfully impacts the environment through air and water pollution, medical waste, greenhouse gas emissions, and other externalities. We consider potential conflicts between health promotion and environmental protection and why and how the healthcare industry might promote health while protecting environments. After probing conflicts between promoting health and protecting the environment we highlight the essential role that environmental resources play in health and healthcare to show that environmental protection is a form of health promotion. We then explore relationships between three radical forms of health promotion and the environment: (1) lowering the human birth rate; (2) transforming the food system; and (3) genetically modifying mosquitos. We conclude that healthcare and other industries and their institutions and leaders have responsibilities to re-consider and modify their priorities, policies, and practices.
... Several years later, the premise was updated as Fable 2.0 in a paper that provided new calculations to elaborate on the original idea (Sadler et al, 2011). The authors were promoting a premise that one could interpret credible evidence as a way to improve design decisions. ...
... Researchers demonstrated that physical healthcare environment is an important factor in the overall health care performance outcomes. Architecture and physical space are considered an important component that contributes to the creation of a high-quality health service to promote health and well-being (11)(12)(13). Indeed, the Donabedian's quality assurance model states that the quality of healthcare is related to three domains: process, outcome and, lastly, structure, which is defined as the "physical and organizational characteristics where health care occurs" (14). ...
Article
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Background and aim of the work: World Health Organization states that is possible evaluating projects' qualities via Health Impact Assessment (HIA) but there are not specific HIA tools on hospital buildings assessment. Researchers show significant relationships between built environment and health. The research purpose is investigating how existing tools for healthcare building assessment are encouraging the development of possible hospital HIA evaluation. Methods: Based on previous works, 13 assessment tools have been included and a comparison of the criteria has been conducted to understand which the most prevalent topics are. The tools have been analyzed through literature, technical manuals and official websites. The authors identified 12 thematic categories where criteria from different tools have been clustered and discussed. Results: The most prevalent criteria are related to Indoor Environmental Quality (IEQ) (20%). In the oldest tools the evaluation was mainly on technical features while in recent instruments several indicators are related to Architectural features and innovation (48%), Education (23%) and Food (11%). Conclusions: There is growing interest in tools capable of addressing healthy hospitals encouraging IEQ, physical activity and healthy food provision related to occupants' health outcomes. This preliminary study set the basis for further development on hospital facility HIA tools.
... 5 In 2011, the authors updated the analysis, using new evidencebased design innovations and construction cost estimates to describe Fable 2.0. 6 The business case was even stronger. This is hardly surprising, since the cost of harm to patients and staff has grown and will continue to do so. ...
... 5 In 2011, the authors updated the analysis, using new evidencebased design innovations and construction cost estimates to describe Fable 2.0. 6 The business case was even stronger. This is hardly surprising, since the cost of harm to patients and staff has grown and will continue to do so. ...
Article
As healthcare leaders look to the future, they are becoming increasingly aware of the vitally important connection between the quality of care delivered and the physical environments in which that care takes place. In addition, they are beginning to recognise the powerful connection between health care organisations and the environment, the very planet itself. These 10 new rules can provide a template to accelerate improved health, health care, and lower costs. They can serve as guideposts to designing truly healing environments today and tomorrow. The worlds of health care, architecture, the arts and the environment are coming together in new and profoundly powerful ways. Let's have the courage, creativity, and compassion to embrace this new world together.
... This analysis, conducted for a hypothetical hospital called the "Fable Hospital," showed a return on investment within three years. 34 Exhibit 1 ...
Article
There is a lack of awareness regarding the pervasive influence of the built environment on caregiving activities, and how its design could reduce risks for patients and providers. This article presents a narrative review summarizing key findings that link health care facility design to key targeted safety outcomes: health care-associated infections, falls, and medication errors. It describes how facility design should be considered in conjunction with quality improvement legislation; projects under way in health systems; and the work of guideline-setting organizations, funding agencies, industry, and educational institutions. The article also charts a path forward that consolidates existing challenges and suggests what can be done about them to create safe and high-quality health care environments.
... 40 The cost-benefit of the built environment has most often been represented through theoretical papers based on the literature and experiences of individual facilities. These can act as a narrative for discussion in health care settings, 41,42,43 but these types of narratives should be reviewed in the context of any stated assumptions (for example, cost avoidance, interpretation of research) that might warrant adjustment. 44 ...
Chapter
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Chapter 1 discusses the infection control risk assessment (ICRA), a process by which infection risks are taken into consideration during the design and construction of a health care space. This process results in specific design, construction and commissioning recommendations and risk mitigation measures. The spread of HAIs has been associated with both health care facility design and construction activity. Ongoing cycles of facility renovation and construction present continual risks for environmental contamination and subsequent infection transmission. The ICRAs are required by jurisdictions that acknowledge or adopt the Facility Guidelines Institute (FGI) Guidelines for the Design and Construction of Hospital, Outpatient and Residential Facilities (three separate resources), which provide minimum standards for the design and construction of health care facilities. The current Guidelines describe the ICRA as a proactive and integrated process for the planning, design, construction and commissioning activities to “identify and plan safe design elements, including consideration of long-range infection prevention; identify and plan for internal and external building areas and sites that will be affected during construction/renovation; identify potential risk of transmission of airborne and waterborne biological contaminants during construction and/or renovation and commissioning; and develop infection control risk mitigation recommendations (ICRMRs) to be considered.
... 24 Suggested disadvantages of single rooms for staff/ organisations include an increase in staff walking distances (reducing time for direct care) 25 and workload 3 ; potential need for an increase in staffing levels and/or adjustments to staff skill-mix 8 9 24 ; increase in staff stress 26 27 and potential risks to staff through working in isolation. [26][27][28][29][30] The international healthcare literature on the advantages and disadvantages of single-room accommodation for patients and staff is of variable quality, and some aspects have been studied more closely than others. Research on the impact of single-room accommodation on staff experiences of work and care provision is limited, the evidence does not clearly point to a preference for single rooms among patients and little is known about patient preferences across different age and cultural groups. ...
Article
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Background and objectives There is little strong evidence relating to the impact of single-room accommodation on healthcare quality and safety. We explore the impact of all single rooms on staff and patient experience; safety outcomes; and costs. Methods Mixed methods pre/post ‘move’ comparison within four nested case study wards in a single acute hospital with 100% single rooms; quasi-experimental before-and-after study with two control hospitals; analysis of capital and operational costs associated with single rooms. Results Two-thirds of patients expressed a preference for single rooms with comfort and control outweighing any disadvantages (sense of isolation) felt by some. Patients appreciated privacy, confidentiality and flexibility for visitors afforded by single rooms. Staff perceived improvements (patient comfort and confidentiality), but single rooms were worse for visibility, surveillance, teamwork, monitoring and keeping patients safe. Staff walking distances increased significantly post move. A temporary increase of falls and medication errors in one ward was likely to be associated with the need to adjust work patterns rather than associated with single rooms per se. We found no evidence that single rooms reduced infection rates. Building an all single-room hospital can cost 5% more with higher housekeeping and cleaning costs but the difference is marginal over time. Conclusions Staff needed to adapt their working practices significantly and felt unprepared for new ways of working with potentially significant implications for the nature of teamwork in the longer term. Staff preference remained for a mix of single rooms and bays. Patients preferred single rooms.
... High-quality care that is safe, efficient and person-centered requires a high standard for the physical environment (architecture or built environment) (A. Anåker, Heylighen, Nordin, & Elf, 2016;Clancy, 2008;Sadler et al., 2011). A recent study on a new stroke unit showed that the environment negatively affected patients' activity levels (Anåker, von Koch, Sjostrand, Bernhardt, & Elf, 2017). ...
Article
Aim: To explore and compare the impact of the physical environment on patients’ activities and care at three newly built stroke units. Background: Receiving care in a stroke unit instead of in a general ward reduces the odds of death, dependency and institutionalized care. In stroke units, the design of the physical environment should support evidence-based care. Studies on patients’ activities in relation to the design of the physical environment of stroke units are scarce. Design: This work is a comparative descriptive case study. Method: Patients (n=55) who had a confirmed diagnosis of stroke were recruited from three newly built stroke units in Sweden. The units were examined by non-participant observation using two types of data collection: behavioral mapping analyzed with descriptive statistics and field note taking analyzed with deductive content analysis. Data were collected from April 2013 to December 2015. Results: The units differed in the patients’ levels of physical activity, the proportion of the day that patients spent with health professionals, and family presence. Patients were more physically active in a unit with a combination of single and multi-bed room designs than in a unit with an entirely single room design. Stroke units that were easy to navigate and offered variations in the physical environment impacted patients’ activities and care. Conclusions: Patients’ activity levels and interactions appeared to vary with the design of the physical environments of stroke units. Stroke guidelines focused on health status assessments, avoidance of bed-rest and early rehabilitation require a supportive physical environment.
... Design changes. Using architectural design to increase proximity of patients and staff to green spaces can accelerate recovery; reduce pain, aggression, mental fatigue, staff burnout, and health care costs; and increase cognitive function [30][31][32][33]. Other sustainability initiatives safely and effectively reduce large amounts of energy and landfill waste by modifying procedures for hospital-based cannulation and intravenous antibiotic preparation [31] and for disposal of unused pharmaceuticals [32] and medical devices, which, when replaced with reprocessed devices, saved over 24 million pounds of waste and $1 billion over 20 years at 1,700 health care facilities nationwide [34]. ...
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Climate change threatens health, health care, and the industries and resources upon which these depend. The growing prevalence and severity of its health consequences and economic costs are alarming health professionals and organizations as their professional obligations, grounded in the core value of health, include protecting against these harms. One means of fulfilling these obligations is to lead or support sustainability initiatives that are built upon current, reliable, accurate, and unbiased evidence and collaboratively tailored to meet specific needs and respond to specific contexts. We consider why and how health professionals and organizations should lead or support such initiatives.
... The most important argument for a singleroom design is the reduction of airborne-and contact-transmitted infections [12]. Single rooms are also associated with reductions in noise [12], the number of harmful and costly patient transfers [34,35], and improved communication between staff and patients because of enhanced patient privacy [12,36,37]. All these advantages are undoubtedly important for patients with stroke; however, when early rehabilitation is a central aspect of the care in stroke units, the design of the environment should also support and encourage activity and interaction. ...
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Early mobilization and rehabilitation, multidisciplinary stroke expertise and comprehensive therapies are fundamental in a stroke unit. To achieve effective and safe stroke care, the physical environment in modern stroke units should facilitate the delivery of evidence-based care. Therefore, the purpose of this study was to explore patients' activities and interactions in a stroke unit before the reconstruction of the physical environment, while in a temporary location and after reconstruction. This case study examined a stroke unit as an integrated whole. The data were collected using a behavioral mapping technique at three different time points: in the original unit, in the temporary unit and in the new unit. A total of 59 patients were included. The analysis included field notes from observations of the physical environment and examples from planning and design documents. The findings indicated that in the new unit, the patients spent more time in their rooms, were less active, and had fewer interactions with staff and family than the patients in the original unit. The reconstruction involved a change from a primarily multi-bed room design to single-room accommodations. In the new unit, the patients' lounge was located in a far corner of the unit with a smaller entrance than the patients' lounge in the old unit, which was located at the end of a corridor with a noticeable entrance. Changes in the design of the stroke unit may have influenced the patients' activities and interactions. This study raises the question of how the physical environment should be designed in the future to facilitate the delivery of health care and improve outcomes for stroke patients. This research is based on a case study, and although the results should be interpreted with caution, we strongly recommend that environmental considerations be included in future stroke guidelines.
... Potential future uses of the model include investigating the impact of varying certain inputs, such as the infectiousness rate and the severity mix of patients, and whether or not managing routine demand to better complement the variations in unscheduled demand would provide the kind of benefits noted by . Another possibility is to use the model to estimate the benefits of treating all patients in private rooms in pediatric hospitals, an emerging trend in new hospital design (Sadler et al. 2011). BAPTSM could also be employed to quantify how further reductions in the discharge-ready delay could improve efficiency, i.e., what if all ancillary services could be provided in the evening so that pediatric patients who are medically cleared for discharge during evening rounds could actually be discharged that night? ...
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Hospital patients often move from one bed to another for both medical and nonmedical reasons. In a highly utilized quaternary inpatient pediatric unit we have studied, bed and nursing resources are stressed not only by frequent movement of patients but also by the unit’s patient discharge policy. We present a discrete-event simulation model for examining how the unit’s efficiency may be improved by a better discharge policy. In particular, we use the base version of the model to investigate the impact of sending various percentages of discharge-ready patients to a discharge holding area where they can safely wait for a few hours until being picked up by their parent or guardian. Doing so frees up inpatient beds, allowing the unit to serve many more pediatric patients per year. In a revised version of the model we quantify the benefits of helping some patients achieve discharge-ready status a few hours earlier than under current operations. In both cases, our cost analysis shows that the unit could realize...
... The team also identified a need to quantify the benefits (in terms of patient throughput and revenues) of treating all pediatric patients in private rooms, an emerging trend in new hospital design. 11 To execute the project, the team built a discrete event simulation (DES) model. The DES was felt to be a good choice as a vehicle for this project because various patient characteristics can be evaluated and modified. ...
Article
Objective: The objective of this project was to use an interdisciplinary approach to analyze strategies through simulation technology for improving patient flow in a pediatric hospital. Background: Various statistics have been offered on the number of children admitted annually to hospitals. For administrators, particularly in smaller systems, the financial burden of equipping and staffing pediatric units often outweighs the moral desire to maintain a pediatric unit as a viable option for patients and pediatricians. Methods: Discrete event simulation was used to model current operations of a pediatric unit. Cost analysis was conducted using simulation reflecting various percentages of patients being referred to a discharge holding area (DHA) upon discharge and of the use of all private rooms. Results: Both DHA and private rooms resulted in increased patient volumes. Conclusions: Administrators should consider the use of a DHA and/or private rooms to ease the census strains of pediatric units and the resultant revenue of this service.
... Functional planning for a new hospital starts with a critical review of current processes in order to modify and develop them so that they will function effectively in the new facilities [4]. There should also be goals for improving the quality, safety, and cost-efficiency of treatment and the work environment [5], as well as the wellbeing and satisfaction of users [6]. ...
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Introduction: Old hospitals may promote inefficient patient care processes and safety. A new, functionally planned hospital presents a chance to create an environment that supports streamlined, patient-centered healthcare processes and adapts to users' needs. This study depicts the phases of a facility planning project for pregnant women and newborn care processes (beginning of life process) at Turku University Hospital. Materials and methods: Project design reports and meeting documents were utilized to assess the beginning of life process as well as the work processes of the Women's and Children's Hospital. Results: The main elements of the facility design (FD) project included rigorous preparation for the FD phase, functional planning throughout the FD process, and setting key values: (1) family-centered care, (2) Lean thinking and Lean tools as the framework for the FD process, (3) safety, and (4) cooperation. Conclusions: A well-prepared FD project with sufficient insight into functional planning, Lean thinking, and user-centricity seemed to facilitate the actual FD process. Although challenges occurred, the key values were not forgone and were successfully incorporated into the new hospital building.
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Introduction: Green supply is defined as the range of processes by which green products and services can be acquired. The adoption of green supplies in hospitals includes the following seven key elements: hospital food, water and energy consumption, waste generation and related building design, energy efficiency and transportation within and around the hospital. Purpose: The main purpose of this paper, through the Greek and international literature, is to highlight the contribution of green supplies in the field of health, as a means of providing optimal health services, taking into account the advantages of green supplies. Material and Method: The study was conducted through a review that included research, review articles and papers related to hospitals in Greece and the USA, mainly published during the last twenty years. The research data derive from the bibliographic review of articles in Greek and English language related to the topic in the electronic databases “Med net”, “Google Scholar”, “Pubmed”, “Scopus” with index words: "Green supplies", "Green Products", "Environment", "Green Hospitals". Results: Greek Hospitals could apply for green supplies by adopting a series of practices from other hospitals that have previously implemented them. Via the adoption of green practices, many foreign hospitals are able to reduce energy bills, waste and achieve a healthier indoor environment for patients and staff. Conclusions: Because of the adoption of green supplies by Greek Hospitals, good practices can be found both domestically and internationally. The multiple benefits of their implementation and adoption constitute a key incentive for Greek Hospitals to shift to a green and sustainable direction. However, this shift requires investment and capital that will pay off in the long run from the above mentioned benefits. This search constitutes a serious matter, due to the economic crisis of recent years and the financial situation of public hospitals and on the whole country’s abilities.
Chapter
The intrinsic aim of delivering healthcare service is strictly related to patients’ wellbeing and quality of life. As the Transformative Service Research (TSR) suggests, successful interaction among several entities and users is crucial to realize wellbeing outcomes, such as access, literacy, decreasing disparity, and enhancing health and happiness.In the healthcare setting, value co-creation and physical environment affect psychological, existential, support, and physical components of wellbeing, including the eudaimonic and hedonic spheres.Digitization contributes in several ways: intensifying value co-creation activities by creating more opportunities for interactions outside the physical environment; moreover, technologies can reduce the sufferings on human lives and society through prevention, early detection, diagnosis, remote care, telehealth, and real-time communication. The chapter proposes a conceptual framework to enlighten the linkage between wellbeing, value co-creation, and physical environment.KeywordsWellbeingTransformative service researchAgenda 2030Quality of life
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Med net, Google Scholar, Pubmed, Scopus με λέξεις ευρετηρίου ευρετηρίου: «Πράσινες προμήθειες», «Πράσινα Προϊόντα», «Περιβάλλον», «Πράσινα Νοσοκομεία». Αποτελέσματα: Τα Ελληνικά Νοσοκομεία θα μπορούσαν να εφαρμόσουν τις πράσινες προμήθειες υιοθετώντας μια σειρά πρα-κτικών από άλλα νοσοκομεία που τις εφάρμοσαν παλαιότερα. Με την υιοθέτηση των πράσινων πρακτικών πολλά νοσοκομεία στο εξωτερικό καταφέρνουν να μειώσουν τους λογαριασμούς ενέργειας, τα απόβλητα και να επιτύχουν υγιέστερο εσωτερικό περιβάλλον για τους ασθενείς και το προσωπικό. Συμπεράσματα: Οι καλές πρακτικές για την υιοθέτηση των πράσινων προμηθειών από τα Ελληνικά Νοσοκομεία μπορούν να βρεθούν τόσο εγχώρια, όσο και στον διεθνή χώρο. Τα πολλαπλά οφέλη Υποβλήθηκε:
Thesis
The following research, carried out in the field ICAR/12 Technology of Architecture, aims to promote the application of the ex-post evaluation methodology in the national sector of healthcare buildings. Among the most accredited methodologies for the detection of feedback on the performance of a building, we find the Post Occupancy Evaluation (POE), defined as the act of evaluating the buildings in a systematic and rigorous way, after they have been built and occupied for some time. Over the last decades, the POE methodology has become an internationally accredited, evidencebased approach, which gives quantitative and qualitative data, through the involvement and detection of users’ feedback. This methodology has been successfully applied to hospital buildings, as they involve a series of specificities due to the variety of users and the different complexity of functional activities, that involves a different request for performance from an architectural point of view (adequacy of spaces in relation to activities to be performed), logistic, organizational/ management for the different functional areas. The aim was at first to develop a general framework for the application of POE methodologies to the Italian context for hospital buildings, starting from an analysis of the evolution of the method, the techniques and its possible applications. By studying the international context, a simplification of the application procedures and a systematization of criteria and sub-criteria for evaluating the performance of the hospital building has been carried out. For reasons related to the timing of the research, a model has been defined for the ex-post evaluation with respect to the sub-criterion of visual comfort. The detection of feedback from users, alongside the “expert” survey of technicians, must take place in an effective and systematic way, therefore specific tools have been developed for data collection. The application to the case studies has thus had the purpose of evaluating the first outcomes of the use of such methodologies for the evaluation of the visual comfort of the clinics’ waiting rooms of three hospitals of Rome (Ophthalmic Hospital, Nuovo Regina Margherita Hospital, S. Spirito Hospital). The analysis carried out has confirmed the effectiveness of the use of POE, which is particularly functional for managers and designers in order to identify preferential lines and methods of interventions, in relation to the needs identified by users and the requirements necessary for achieving performance goals. The “direct” communication between users, designers and building managers allows to intercept/catch/understand the real needs, increasing the efficiency and effectiveness of the interventions once they have been realized.
Article
Purpose Healthcare service is a process that comprises a series of touchpoints underlying the key facets of service delivery, collectively shaping the users' (i.e. patients, hospital staff, and visitors) experiences. Departing from most sensory studies dedicated to understanding the retail environment and hedonic service, this study focuses on how sensory knowledge can contribute to understanding the sensory-based experiences of hospital users and their interactions with healthcare services at multiple touchpoints. Design/methodology/approach This study employs a multi-method approach comprising two studies involving semi-structured interviews and a qualitative online survey of past patients. Findings Drawing upon the user-centered theory, the authors (1) consulted healthcare experts on hospital service touchpoints and standards around medical protocol; (2) explored users' needs, experiences, expectations, and evaluations of healthcare services; and (3) identified the issues and challenges faced by healthcare service users at various service touchpoints. Based on these insights, the authors proposed sensory tactics across healthcare service touchpoints that promote the well-being of major hospital users. Research limitations/implications The proposed sensory tactics require follow-up empirical evidence. Future research could adopt robust methodological designs on healthcare environmental interventions and progress with a transdisciplinary approach to advance this research area. Practical implications The authors' experience-based framework forms the basis of a valuable toolkit for healthcare service management. Originality/value This study advances services literature by integrating sense-based marketing knowledge with healthcare service research to understand the dynamic and interactive relationship between hospital users and the environment.
Article
Background: The design of the physical environment is a critical factor in patient care and is known to influence health, well-being, clinical efficiency, and health-related outcomes. To date, there has been no general review of the physical environment of modern Swedish stroke units. Aim: To explore the physical environment of inpatient stroke units in Sweden and describe the design and structure of these units. Methods: This was a cross-sectional study. Data were collected in Sweden from April to July 2021 via a survey questionnaire. Results: The layout of the stroke units varied broadly, such as the number of single-bed and multi-bed rooms. More than half the stroke units comprised spaces for rehabilitation and had an enriched environment in the form of communal areas with access to computers, games, books, newspapers, and meeting places. However, they offered sparse access to plants and/or scenery. Conclusions: Healthcare environments are an essential component of a sustainable community. From a sustainability perspective, healthcare facilities must be built with high architectural quality and from a long-term perspective. Research on the physical environment in healthcare should contribute to improved quality of care, which can be achieved through building healthcare facilities that support the performance of care and recovery. Therefore, mapping of areas of interest for further investigation is crucial.
Article
Sustainable development has become one of the major objectives in building and operating healthcare facilities, as they exert a major impact on the environment and society. It is also critically important for modern healthcare facilities to adapt to an aging population, rapid technology upgrades, and the increasing demand for quality health care. In this background, sustainable healthcare facilities (SHFs) have attracted growing attention from researchers in the past decade. However, there has not been a clear scope of SHFs, which undermines the theoretical foundation of SHFs evaluation. This study identifies, aggregates, and analyzes the existing body of knowledge to address such issue. We attempted to reveal the dimensions of sustainability in the context of healthcare facilities, the links among the dimensions of sustainability, and the framework of SHFs themes based on a systematic scoping review. A four-dimensional model of sustainability was discussed and a framework of SHFs themes is proposed, consisting of core business, supporting service, and organizational environment layers. We suggest future research to focus more on the core business and organizational environment layers and the links among the different attributes of sustainability in the SHFs field.
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Objectives To identify, appraise and synthesise existing design evidence for inpatient stroke rehabilitation facilities; to identify impacts of these built environments on the outcomes and experiences of people recovering from stroke, their family/caregivers and staff. Design A convergent segregated review design was used to conduct a systematic review. Data sources Ovid MEDLINE, Scopus, Web of Science and Cumulative Index to Nursing and Allied Health Literature were searched for articles published between January 2000 and November 2020. Eligibility criteria for selecting studies Qualitative, quantitative and mixed-methods studies investigating the impact of the built environment of inpatient rehabilitation facilities on stroke survivors, their family/caregivers and/or staff. Data extraction and synthesis Two authors separately completed the title, abstract, full-text screening, data extraction and quality assessment. Extracted data were categorised according to the aspect of the built environment explored and the outcomes reported. These categories were used to structure a narrative synthesis of the results from all included studies. Results Twenty-four articles were included, most qualitative and exploratory. Half of the included articles investigated a particular aspect of the built environment, including environmental enrichment and communal areas (n=8), bedroom design (n=3) and therapy spaces (n=1), while the other half considered the environment in general. Findings related to one or more of the following outcome categories: (1) clinical outcomes, (2) patient activity, (3) patient well-being, (4) patient and/or staff safety and (5) clinical practice. Heterogeneous designs and variables of interest meant results could not be compared, but some repeated findings suggest that attractive and accessible communal areas are important for patient activity and well-being. Conclusions Stroke rehabilitation is a unique healthcare context where patient activity, practice and motivation are paramount. We found many evidence gaps that with more targeted research could better inform the design of rehabilitation spaces to optimise care. PROSPERO registration number CRD42020158006.
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The Health Promoting Hospitals (HPH) networks, founded by the World Health Organisation, support the introduction of health promotion in healthcare. This development involves the creation of a health promoting built environment. However, few studies have explored the HPH in relation to the built environments, and it is unclear how HPH-networks incorporate the built environment in their work. The study therefore examined the Swedish HPH-Network in relation to the built environment. The mixed-method study included data from (i) key online material from the Swedish network, (ii) a survey with open-ended questions of representatives of the networks' workgroups and (iii) semi-structured interviews with the built environment workgroup. The study showed that the built environment is unevenly and incoherently incorporated in the network. Moreover, there is more attention for healing and healthy rather than health-promotive strategies, indicating a knowledge gap. Descriptions of the health promoting built environment are diverse, and address design features, design strategies or indicate places for health promotion interventions. The descriptions of the built environment are combined with various HPH goals and population groups. To utilize the built environment as a resource for HPHs, the networks should consider incorporating the built environment in documents and action plans at all organizational levels.
Article
Health care-based negative production externalities, such as greenhouse gas emissions, underscore the need for hospitals to implement sustainable practices. Eco-certification has been adopted by a number of providers in an attempt, for instance, to curb energy consumption. While these strategies have been evaluated with respect to cost savings, their implications pertaining to hospitals’ financial viability remain unknown. We specify a fixed-effects model to estimate the correlation between Energy Star certification and 3 different hospitals’ financial performance measures (net patient revenue, operating expenses, and operating margin) in the United States between 2000 and 2016. The Energy Star participation indicators’ parameters imply that this type of eco-certification is associated with lower net patient revenue and lower operating expenses. However, the estimated negative relationship between eco-certification and operating margin suggests that the savings in operating expenses are not enough for a hospital to achieve higher margins. These findings may indicate that undertaking sustainable practices is partially related to intangible benefits such as community reputation and highlight the importance of government policies to financially support hospitals’ investments in green practices.
Article
Objective This research aimed to evaluate the quantitative effects of new hospital design on adult inpatient outcomes. Background Tenets of evidence-based healthcare design, notably single-patient acuity-adaptable and same-handed rooms, decentralized nursing stations, onstage offstage layout, and access to nature were expected to promote patient healing and increase patient satisfaction, while decreasing adverse events. Methods Patient healing was operationalized through length of stay (LOS) and patient safety through three adverse events: falls, hospital-acquired infections (HAI), and medication-related events. Standard patient surveys captured patient satisfaction. Patient records from 2013 through 2017 allowed for equivalent time periods surrounding the move to the new hospital in August 2015. Stratified by hospital division where significant, pre/post comparisons utilized proportional hazards or logistic regression models as appropriate; interrupted time series analyses afforded longitudinal interpretations. Results Observed higher postmove LOS was due to previously increasing trends, not increases after the move. In surgical and trauma units, a constant increase in falls was unaffected by the move. Medication events decreased consistently over time; medication events with harm dropped significantly after the move. No change in HAI was found. Significant improvement on most relevant patient satisfaction items occurred after the move. Call button response decreased immediately after the move but subsequently improved. Conclusion Results did not clearly indicate a net change in adult inpatient outcomes of healing and safety due to the hospital design. There was evidence that the new hospital improved patient satisfaction outcomes related to the environment, including comfort, noise, temperature, and aesthetics.
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Many nursing home design models can have a negative impact on older people and these flaws have been compounded by Coronavirus Disease 2019 and related infection control failures. This article proposes that there is now an urgent need to examine these architectural design models and provide alternative and holistic models that balance infection control and quality of life at multiple spatial scales in existing and proposed settings. Moreover, this article argues that there is a convergence on many fronts between these issues and that certain design models and approaches that improve quality of life, will also benefit infection control, support greater resilience, and in turn improve overall pandemic preparedness.
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As the wave of sustainability is sweeping across the major countries and cities of the world, the effect of the inevitable change is finding its way through to the health sector as well. Since the main functions of the hospital include healing the patient, it aims to provide adequate health services to people. Hospitals managers should strive to realize facilities that meet a certain level of demand. This study aims to present the interior environmental quality (IEQ) of bedrooms in Jordanian hospitals and propose a solution to improve indoor environment quality using sustainable design principles. A qualitative research methodology is used in this study. A comparative analysis is made between the original set up of the hospital buildings and the present conditions in which they are in. During the research, it was found that the design to be applied for a hospital should be following the healing environmental characteristics. Besides, the design of hospitals should be made with the climatic conditions of the area in mind. In the advanced countries of the world, hospitals are generally built with extensive research and important factors such as temperature, wind direction and humidity are taken into consideration. The design for a hospital building should be assessed according to the German Green Building Assessment (DGNB) criteria. It has been found that the one-bedroom is ideal for patients because it provides the necessary privacy and also greatly reduces the spread of the disease. In hygienic practices, there should be a first-class healing environment with evidence-based medical research. It was concluded that the practices involving the use of sustainable designs can be followed with the hints received from hospitals in the advanced countries of the world.
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Introduction: Healthcare facilities are complex infrastructures where different features from technological, social, clinical and architectural field interact. In modern healthcare systems there is a growing attention to the need of quality in terms of process and outcome, while the structural (physical) aspects are not often considered. Since the Nineties the theory of the Evidence Based Design (EBD) states that there is significant relationship between built environment and health related outcome. Objective: Aim of this paper is to investigate, in the recent scientific literature, which are the most important occupants' and organizational outcomes influenced by EBD hospital built environment qualities. Methodology: A Literature Review based on Scopus and PubMed databases has been run in order to understand the existing situation in terms of hospital quality evaluation from the physical and architectural point of view and to highlight the current trends. The results of the different reviews, empirical studies and post Occupancy Evaluations have been analyzed according to Ulrich's EBD conceptual framework. Results: 35 peer reviewed papers from the last 2 years were included. The methodologies adopted are very different and data are mainly collected through structured interviews or observations and elaborated with qualitative (33%), quantitative (26%) or mixed (41%) methodologies. The topic is mostly investigated in USA, Australia, Canada, UK and in the Scandinavian region; few contributions come also from Italy. Built environment variables that affect user's or organizational outcomes are mainly the Visual Environment (29%), the Audio Environment (20%) and the Patient Room Design (20%). Discussion and conclusion: The most recurrent outcomes found to be affected by the built environmental qualities are staff job satisfaction (n=11), patients' stress reduction (n=9), patients' satisfaction (n=6) and patients' fall reduction (n=6). Organizational outcomes are mentioned only two times. Although EBD is an old theory, the topic is both contemporary and relevant. Due to the diversity of the contributions and the limitations of the research, a deep comparison is challenging. Further investigation is necessary to deepen each of the variables identified.
Article
The volume and rigor of evidence-based design have increasingly grown over the last three decades since the field’s inception, supporting research-based designs to improve patient outcomes. This movement of using evidence from engineering and the hard sciences is not necessarily new, but design-based health research launched with the demonstration that post-operative patients with window views towards nature versus a brick wall yielded shorter lengths of hospital stay and less analgesia use, promoting subsequent investigations and guideline development. Architects continue to base healthcare design decisions on credible research, with a recent shift in physician involvement in the design process by introducing clinicians to design-thinking methodologies. In parallel, architects are becoming familiar with research-based practice, allowing for further rigor and clinical partnership. This cross-pollination of fields could benefit from further discussion surrounding the ethics of hospital architecture as applied to current building codes and guidelines. Historical precedents where the building was used as a form of treatment can inform future concepts of ethical design practice when applied to current population health challenges, such as design for dementia care. While architecture itself does not necessarily provide a cure, good design can act as a preventative tool and enhance overall quality of care.
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Healthcare facility retrofit projects are among the most challenging types of construction. Such projects are often disruptive to patients and can cause significant patient safety issues. The aim of this study was to investigate current practices of retrofitting healthcare facilities, with a particular focus on patient safety and energy efficiency. To achieve this, the study followed a systematic approach to investigating the issues involved with retrofitting healthcare facilities. Three case studies were conducted, and data were collected through interviews, shadowing, site visits, and cognitive walkthroughs. Direct observation of retrofit projects was also undertaken to acquire firsthand knowledge of the retrofit process and to explore possible solutions associated with current practices. As more facilities consider the decision to retrofit, it is essential to provide a practical rationale for pursuing retrofit projects that are energy efficient and safe for patients.
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Health care leaders are continually seeking ways to optimize their care services, become financially viable, and retain quality caregivers. Such goals seem impossible in today’s intensely competitive environment. The incorporation of a healing environment into the health care setting not only optimizes clinical care and outcomes, it also optimizes staff satisfaction, morale, retention, and fosters repeat business. It has been shown that views of nature, natural light, soothing colors, therapeutic sounds, and the interaction of family members can enhance healing. These elements must be balanced with staff needs when designing critical care environments.
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These medication errors have occurred in health care facilities at least once. They will happen again—perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them at your inservice training programs. Your assistance is required to continue this feature. The reports described here were received through the Institute for Safe Medication Practices (ISMP) Medication Errors Reporting Program. Any reports published by ISMP will be anonymous. Comments are also invited; the writers' names will be published if desired. ISMP may be contacted at the address shown below. Errors, close calls, or hazardous conditions may be reported directly to ISMP through the ISMP Web site ( www.ismp.org ), by calling 800-FAIL-SAFE, or via e-mail at ismpinfo@ismp.org . ISMP guarantees the confidentiality and security of the information received and respects reporters' wishes as to the level of detail included in publications.
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Objective: To explore the implications of the single family room (SFR) care environment of neonatal intensive care units (NICU) compared to Open-bay, Combination and Double-occupancy configurations, focusing on family experience, neonate outcomes, staff perceptions, cost and environmental design. Study design: This study uses a multimethod design with 11 Level III NICUs. Space allocations, construction costs, staff preferences and perceptions, and occupant behaviors were evaluated. Results: SFR NICU design provides solutions for increasing parent privacy and presence, supporting Health Insurance Portability and Accountability Act compliance, minimizing the number of undesirable beds, increasing staff satisfaction and reducing staff stress. Conclusion: The analysis of this study suggests that there are benefits to SFR NICU. This study is an initial, comprehensive effort, the purpose of which is to spawn future, narrower, in-depth studies focused on SFR NICU design.
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The Lean Project Delivery System emerged in 2000 from theoretical and practical investigations, and is in process of on-going development through experimentation in many parts of the world. In recent years, experiments have focused on the definition and design phase of projects, applying concepts and methods drawn from the Toyota Product Development System, most especially target costing and set based design. These have been adapted for use in the construction industry and integrated with computer modeling and relational forms of contract. Although by no means a finished work, the Lean Project Delivery System has developed sufficiently to warrant an updated description and presentation to industry and academia, incorporating processes and practices that have emerged since earlier publications.
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This report surveys and evaluates the scientific research on evidence-based healthcare design and extracts its implications for designing better and safer hospitals. It builds on a literature review conducted by researchers in 2004. Research teams conducted a new and more exhaustive search for rigorous empirical studies that link the design of hospital physical environments with healthcare outcomes. The review followed a two-step process, including an extensive search for existing literature and a screening of each identified study for the relevance and quality of evidence. This review found a growing body of rigorous studies to guide healthcare design, especially with respect to reducing the frequency of hospital-acquired infections. Results are organized according to three general types of outcomes: patient safety, other patient outcomes, and staff outcomes. The findings further support the importance of improving outcomes for a range of design characteristics or interventions, including single-bed rooms rather than multibed rooms, effective ventilation systems, a good acoustic environment, nature distractions and daylight, appropriate lighting, better ergonomic design, acuity-adaptable rooms, and improved floor layouts and work settings. Directions for future research are also identified. The state of knowledge of evidence-based healthcare design has grown rapidly in recent years. The evidence indicates that well-designed physical settings play an important role in making hospitals safer and more healing for patients, and better places for staff to work.
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After establishing the connection between building well-designed evidence-based facilities and improved safety and quality for patients, families, and staff, this article presents the compelling business case for doing so. It demonstrates why ongoing operating savings and initial capital costs must be analyzed and describes specific steps to ensure that design innovations are implemented effectively. Hospital leaders and boards are now beginning to face a new reality: They can no longer tolerate preventable hospital-acquired conditions such as infections, falls, and injuries to staff or unnecessary intra-hospital patient transfers that can increase errors. Nor can they subject patients and families to noisy, confusing environments that increase anxiety and stress. They must effectively deploy all reasonable quality improvement techniques available. To be optimally effective, a variety of tactics must be combined and implemented in an integrated way. Hospital leadership must understand the clear connection between building well-designed healing environments and improved healthcare safety and quality for patients, families, and staff, as well as the compelling business case for doing so. Emerging pay-for-performance (P4P) methodologies that reward hospitals for quality and refuse to pay hospitals for the harm they cause (e.g., infections and falls) further strengthen this business case. When planning to build a new hospital or to renovate an existing facility, healthcare leaders should address a key question: Will the proposed project incorporate all relevant and proven evidence-based design innovations to optimize patient safety, quality, and satisfaction as well as workforce safety, satisfaction, productivity, and energy efficiency? When conducting a business case analysis for a new project, hospital leaders should consider ongoing operating savings and the market share impact of evidence-based design interventions as well as initial capital costs. They should consider taking the 10 steps recommended to ensure an optimal, cost-effective hospital environment. A return-on-investment (ROI) framework is put forward for the use of individual organizations.
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This paper explores the role of the chief executive officer (CEO) in evidence-based design (EBD), discussing the internal and external challenges that a CEO faces, such as demands for increased quality, safety, patient-and-family-centeredness, increased revenue, and reduced cost. Based on a series of interviews and case studies and the experience of the authors as researchers, consultants, and CEOs, this paper provides a model for EBD and recommends actions that a CEO can undertake to create an effective project over the life cycle of a building. TOPICAL HEADINGS: Evidence-Based Design: A Performance-Based Approach to Achieving Key Goals; Key Approaches to Executing Evidence-Based Design; Overcoming Barriers to Innovation: The CEO's Vital Role in Implementing Evidence-Based Design The CEO bears special responsibility for successful facility project implementation. Only the CEO possesses the responsibility and authority to articulate the strategy, vision, goals, and resource constraints that frame every project. With the support of their boards, CEOs set the stage for the transformation of an organization's culture and fuel clinical and business process reengineering by encouraging and, if necessary, forcing collaboration between the strong disciplinary and departmental divisions found in healthcare systems.
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In crowded hospital markets, hotel-like amenities for patients play an increasing role in the competition for market share. This development raises important questions about the definition of hospital quality and its benefits and costs to patients and society.
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To investigate the effect of a specially selected music sound environment on the feeling of wellbeing of adult, lightly sedated patients in a Cardiac Catheter Laboratory undergoing invasive procedures. Patients (n=193) were randomly assigned to either a music group, who listened to music during the procedure (n=99) or to a non-music group (n=94). Immediately after the procedure all patients were interviewed by a questionnaire about their opinion of the sound environment in the room and about their feeling of wellbeing. In the music group 91% of the patients defined the sound environment as very pleasant/pleasant - compared to 56% in the non-music group. The number of patients with 'no opinion' on the sound environment was lower in the music group than in the non-music group (8% vs. 42%). In the non-music group only 34% of the patients would have liked to listen to music, if possible, whereas 82% of the patients in the music group were very pleased/pleased with the music. Both groups noticed basic sounds and noises with similar frequencies. In the music group 62% of the patients noticed the music spontaneously. Sixty-eight patients (68%) reported that music was of major positive importance to their feeling of wellbeing. These patients expressed that music made them feel less tense, more relaxed and safe. The results were not related to age, sex or procedure. Specially selected music had a positive effect on the wellbeing of patients and their opinion on the sound environment during invasive cardiac procedures. Based on the negative expectations and the positive experience of the patients with regard to music environment, we suggest that specially selected music should be a part of the sound environment in the Cardiac Catheter Laboratory.
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To explore the use of virtual reality as a distraction intervention to relieve symptom distress in women receiving chemotherapy for breast cancer. Crossover study. The outpatient clinic of a midwestern comprehensive cancer center. 20 women 18-55 years of age. Using a crossover design, 20 subjects served as their own controls. For two matched chemotherapy treatments, one pretest and two post-test measures were employed. Participants were assigned randomly to receive the virtual reality distraction intervention during one chemotherapy treatment and received no distraction intervention (control condition) during an alternate chemotherapy treatment. An open-ended questionnaire elicited each subject's evaluation of the intervention. Symptom distress, fatigue, anxiety. Significant decreases in symptom distress and fatigue occurred immediately following chemotherapy treatments when women used the virtual reality intervention. The distraction intervention decreased symptom distress, was well received, and was easy to implement in the clinical setting. Nursing interventions to manage chemotherapy-related symptom distress can improve patient quality of life and increase chances for survival by reducing treatment-related symptom distress and enhancing patients' ability to adhere to treatment regimens and cope with their disease.
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To evaluate the effectiveness of mechanical patient lifts in reducing musculoskeletal symptoms, injuries, lost workday injuries, and workers' compensation costs in workers at a community hospital. Pre-post intervention study. Three nursing units of a small community hospital. Patients or Nursing personnel. Mechanical patient lifts were made available and nursing staff trained in their use between August 2000 and January 2001. Workers completed symptom surveys at baseline and six months after lift training. Pre-intervention and post-intervention rates of injuries and lost workday injuries using Occupational Safety and Health Administration logs of the three study units, from the period July 1999 through March 2003 were analyzed. Injuries potentially related to lifting patients were included in the analyses. Using workers' compensation data from the same time period, the compensation paid ($ per full time equivalent [FTE]) due to injuries during the pre-intervention and post-intervention period was calculated. Sixty one staff members were surveyed pre-intervention; 36 (59%) completed follow up surveys. Statistically significant improvements in musculoskeletal comfort (p<0.05) were reported for all body parts, including shoulders, lower back, and knees. Injury rates decreased post-intervention, with a relative risk (RR) of 0.37 (95% confidence interval (CI) 0.16 to 0.88); decreased injury rates persisted after adjustment for temporal trends in injury rates on non-intervention units of the study hospital (RR = 0.50, 95% CI 0.20 to 1.26). Adjusted lost day injury rates also decreased (RR = 0.35, 95% CI 0.10 to 1.16). Annual workers' compensation costs averaged $484 per FTE pre-intervention and $151 per FTE post-intervention. Reductions were observed in injury rates, lost workday injury rates, workers' compensation costs, and musculoskeletal symptoms after deployment of mechanical patient lifts. Strengths of this study include the community hospital setting and the inclusion of a variety of different outcomes. Limitations include the pre-post study design and the small sample size.
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Stress, strain, and fatigue at the workplace have previously not been studied in relation to acoustic conditions. To examine the influence of different acoustic conditions on the work environment and the staff in a coronary critical care unit (CCU). Psychosocial work environment data from start and end of each individual shift were obtained from three shifts (morning, afternoon, and night) for a one-week baseline period and for two four-week periods during which either sound reflecting or sound absorbing tiles were installed. Reverberation times and speech intelligibility improved during the study period when the ceiling tiles were changed from sound reflecting tiles to sound absorbing ones of identical appearance. Improved acoustics positively affected the work environment; the afternoon shift staff experienced significantly lower work demands and reported less pressure and strain. Important gains in the psychosocial work environment of healthcare can be achieved by improving room acoustics. The study points to the importance of further research on possible effects of acoustics in healthcare on staff turnover, quality of patient care, and medical errors.
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... And analysis of this body of research is at least suggestive that a cause-ef- fect relationship exists between some health - care environmental factors and therapeutic ... xx An Investigation to Determine Whether the Built Healthcare Environment Affects Patients&apos; Medical Outcomes ...
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Aim of the study: To evaluate the possible role of room acoustics on patients with coronary artery disease and to test the hypothesis that a poor acoustics environment is likely to produce a bad work environment resulting in unwanted sound that could adversely affect the patients. Methods and results: A total of 94 patients admitted to the intensive coronary heart unit at Huddinge University Hospital for evaluation of chest pain were included in the study. Patient groups were recruited during bad and good acoustics, respectively. Acoustics were altered during the study period by changing the ceiling tiles throughout the CCU from sound-reflecting tiles (bad acoustics) to sound-absorbing tiles (good acoustics) of similar appearance. Patients were monitored with regard to blood pressure including pulse amplitude, heart rate and heart rate variability. The patients were asked to fill in a questionnaire about the quality of the care, and a follow-up of rehospitalization and mortality was made at 1 and 3 months, respectively. There were significant differences between good and bad acoustics with regard to pulse amplitude in the acute myocardial infarction and unstable angina pectoris groups, with lower values during the good acoustics period during the night. The incidence of rehospitalization was higher for the bad acoustics group. Patients treated during the good acoustics period considered the staff attitude to be much better than during the bad acoustics period. Conclusion: A bad acoustics environment during acute illness may have important detrimental physiological effects on rehabilitation.
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An ongoing US research and demonstration project, the Pebble Project, uses a transdisciplinary evidence-based design process for assessing and informing design decisions on a diverse array of new and existing healthcare facilities. The Pebble Project measures the outcomes of the innovations and shares these results with the larger healthcare community. The emphasis is on understanding the linkage between the physical environment (as one of many parameters) and health outcomes and overall performance. It provides an opportunity to assess and understand how hospital design can help reduce staff stress and fatigue and increase effectiveness in delivering care, improve patient safety, reduce patient and family stress, and improve outcomes and improve overall healthcare quality. The combined research and innovation process provides a framework for organizing research projects and assists with the formation of an emerging health facility body of knowledge. Evaluations from completed projects suggest that the evidence-based design process is better for patients and staff in hospitals. Hospitals that have carefully considered and incorporated these value-driven evidence-based design features have benefited in terms of improved quality of care, increased satisfaction, and financial savings.Le projet Pebble est un projet de recherche et de démonstration mené actuellement aux États-Unis, qui utilise un processus transdisciplinaire de conception basé sur l'évidence et dont l'objectif est d'évaluer et de fournir des informations permettant de prendre des décisions de conception portant sur un large choix diversifié d'installations de soins de santé, nouvelles et existantes. Ce projet mesure les résultats des innovations et les partage avec la communauté des soins de santé prise au sens large. L'accent est mis sur la compréhension des liens entre l'environnement physique (l'un de nombreux paramètres) d'une part et, d'autre part, les résultats en matière de santé et les performances globales. Il donne l'occasion d'évaluer et de comprendre comment la conception des hôpitaux peut contribuer à réduire le stress et la fatigue du personnel et à améliorer l'efficacité des soins donnés ainsi que la sécurité des patients, à réduire le stress des malades et des familles et à améliorer les résultats de la qualité globale des soins de santé. Ce processus combiné de recherche et d'innovation fournit un cadre permettant d'organiser des projets de recherche et contribue à la formation d'un ensemble de connaissances nouvelles sur les installations de santé. L'évaluation de projets achevés laisse à penser que le processus de conception basée sur l'évidence convient mieux aux patients et au personnel des hôpitaux. Les hôpitaux qui ont considéré avec soin et incorporé ces caractéristiques de la conception basée sur l'évidence et motivée par la valeur en ont bénéficié en termes d'amélioration de la qualité des soins, d'une plus grande satisfaction et d'économies financières.conception basée sur l'évidence, retour d'information, conception des soins de santé, hôpitaux, innovation, évaluation après occupation
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Private patient rooms have become the industry standard in the United States based on the assumption that they reduce the rate of hospital-acquired infections, facilitate patient care and management, and afford greater therapeutic benefits for patients. The objective of this article is to reviewand analyze the existing literature to identify the empirical evidence related to the advantages and disadvantages of single versus multiple-occupancy patient rooms in hospitals. Three substantive areas were identified for synthesis of the review: (a) first and operating cost of hospitals, (b) infection control, and (c) health care facility management and hospital design and therapeutic impacts. The analysis reveals that private patient rooms reduce the risk of hospital-acquired infections, allow for greater flexibility in operation and management, and have positive therapeutic impacts on patients. This review highlights the need to consider room occupancy issues along with other patient care issues and environmental and management policies.
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This Statistical Brief presents data from the Healthcare Cost and Utilization Project (HCUP) on infections due to medical care during medical and surgical hospital stays in 2007. These cases were based on the criteria for AHRQ’s PSI #7. Patient and hospital characteristics, including age, gender, expected payer, length of stay, and hospital size, are compared between hospital stays with infections due to medical care and all other hospital stays that meet the same inclusion criteria. The most common principal diagnoses among stays with infections are described and their incidence among the infected is compared to those without infections. Additionally, rate trends, adjusted for age, gender, DRGs, and comorbidities, are illustrated. An eight year trend in the adjusted rate of infections due to medical care among hospital stays is shown from 2000 to 2007. Trends in the adjusted rate of infection are also illustrated from 2004 to 2007 by age group, region of the country, and expected payer. All differences between estimates noted in the text are statistically significant at the 0.05 level or better.
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This study assesses the extent of "first-cost green building construction premiums" in the healthcare sector based on data submitted by and interviews with 13 current LEED-certified and LEED-registered healthcare project teams, coupled with a literature survey of articles on the topics of actual and perceived first-cost premiums associated with green building strategies. This analysis covers both perceived and realized costs across a range of projects in this sector, leading to the following conclusions: Construction first-cost premiums may be lower than is generally perceived, and they appear to be independent of both building size and level of "green" achievement; projects are using financial incentives and philanthropy to drive higher levels of achievement; premiums are decreasing over time; and projects are benefiting from improvements in health and productivity which, although difficult to monetize, are universally valued.
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This journal is dedicated to the concept of design based on the use of credible evidence from research. The very term evidence-based design and its fashionable currency suggest that architects and design professionals only recently may have come to use evidence in their work. Nothing could be further from the truth. Architects have certainly always applied evidence from structural and civil engineering, mathematics, geometry, physics, material science, fluid dynamics, real estate economics, and so forth. It seems to me that the current emphasis on designing with evidence is a recognition that architects are now being asked to turn to unfamiliar domains of knowledge, domains for which customarily they have no educational foundation.This issue features a much-anticipated paper that updates the important 2004 work of Roger Ulrich and his colleagues in which a meta-analysis of the research literature documented more than 600 citations linking environmental design and clinical outcomes. Ulrich and Xiaobo Quan of Texas A&M University collaborated four years ago with Craig Zimring and Anjali Joseph of the Georgia Institute of Technology to compile this important paper. It has been widely circulated and downloaded from the Robert Wood Johnson Foundation and The Center for Health Design websites many thousands of times. It seems that nearly everyone interested in evidence-based design for healthcare has encountered the original groundbreaking paper. Some irreverently have described it as the Bible for evidencebased practitioners.The editors of HERD are delighted to publish the sequel to this 2004 work by Ulrich et al. Readers will find the unusual length of the piece in this issue to be well worth the time invested in its reading. The paper was again supported by a grant from the Robert Wood Johnson Foundation through Georgia Tech. This time Ulrich, Zimring, and their new collaborators have documented more than 1,000 papers relevant to the relationship of design to outcomes, including topics such as patient safety and stress reduction for patients and staff.The study follows the basic premises of Ulrich's theory of supportive design (1997) in which he offered a summation of what was known in the literature at the time and made recommendations to designers. These suggestions addressed the concepts of stress reduction, sense of control, social support, positive distraction, and the role of nature. Many healthcare architects and designers have been influenced by this theory and actively follow the recommended model. The theory of supportive design is now well established in the mainstream canon of healthcare design best practice. …
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The healthcare construction boom requires evidence for effective design of nurse stations, including evidence supporting workflow processes, computerization, integration of technology, communication of caregivers, and optimal patient outcomes. This article describes the examination of a traditional centralized nursing station using a total patient care delivery model and minimal computerization and a highly computerized, decentralized nursing station using a team nursing model. Results specific to communication activities, time with patients, number of patient visits per registered nurse, and patient satisfaction with response time are reported.Key WordsPatient care unit design, ergonomics, healthcare workflow, medical-surgical unit, registered nurse work activities.
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Back injuries are increasing among health care providers and are related to a multitude of factors, including repetitive tasks related to patient handling, the aging of the nursing workforce, higher patient acuity levels, and an increased prevalence of obesity in patients, as well as limited workspaces in patient rooms. An estimated 12% of nurses leave the profession annually because of back injuries, and more than 52% complain of chronic back pain and injuries. Implemented in response to rising costs of health care providers' injuries, a safe patient handling program resulted in decreased injuries from staff performing work-related duties, and decreased workers' compensation claims, which resulted in significant cost savings and improved patient satisfaction.
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Telemedicine technology, which can enable intensivists to simultaneously monitor several intensive care units (ICUs) from an off-site location, is increasingly common, but there is little evidence to support its use. To assess the association of remote monitoring of ICU patients (ICU telemedicine [tele-ICU]) with mortality, complications, and length of stay (LOS). Observational study conducted in 6 ICUs of 5 hospitals in a large US health care system to assess the use of tele-ICU. The study included 2034 patients in the preintervention period (January 2003 to August 2005) and 2108 patients in the postintervention period (July 2004 to July 2006). Hospital and ICU mortality, complications, and hospital and ICU survivors' LOS, with outcomes adjusted for severity of illness. Local physicians delegated full treatment authority to the tele-ICU for 655 patients (31.1%) and authority to intervene only in life-threatening events for the remainder. Observed hospital mortality rates were 12.0% (95% confidence interval [CI], 10.6% to 13.5%) in the preintervention period and 9.9% (95% CI, 8.6% to 11.2%) in the postintervention period (preintervention to postintervention decrease, 2.1%; 95% CI, 0.2% to 4.1%; P = .03); observed ICU mortality rates were 9.2% (95% CI, 8.0% to 10.5%) in the preintervention period and 7.8% (95% CI, 6.7% to 9.0%) in the postintervention period (preintervention to postintervention decrease, 1.4%; 95% CI, -0.3% to 3.2%; P = .12). After adjustment for severity of illness, there were no significant differences associated with the telemedicine intervention for hospital mortality (relative risk, 0.85; 95% CI, 0.71 to 1.03) or for ICU mortality (relative risk, 0.88; 95% CI, 0.71 to 1.08). There was a significant interaction between the tele-ICU intervention and severity of illness (P < .001), in which tele-ICU was associated with improved survival in sicker patients but with no improvement or worse outcomes in less sick patients. There were no significant differences between the preintervention and postintervention periods for hospital or ICU LOS. Remote monitoring of ICU patients was not associated with an overall improvement in mortality or LOS.
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Nurse turnover is a recurring problem for health care organizations. Nurse retention focuses on preventing nurse turnover and keeping nurses in an organization’s employment. However, decisions about nurse turnover and retention are often made without the support of full and complete knowledge of their associated costs and benefits. This article identifies common nurse turnover and retention costs and benefits, discusses the use of benefit-cost and cost-effectiveness analysis relevant to nurse turnover and retention, and calls for the construction of a business case for nurse retention. It also provides a foundation for including the costs and benefits of nurse turnover and retention in estimating the economic value of nursing.
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The relationship between the level of illumination and the prescription-dispensing error rate in a high-volume Army outpatient pharmacy was investigated. The prescription error rate was determined by direct, undisguised observation and retrospective prescription review under three levels of illumination (45, 102, and 146 foot-candles) during 21 consecutive weekdays. Illumination was controlled in the prescription-checking area of the pharmacy by using additional fluorescent lamps and filters. The three levels of illumination were randomly assigned to the 21 days to provide a total of 7 days of observations per level. The final sample consisted of 10,888 prescriptions dispensed by five pharmacists. The overall prescription error rate (including both content and labeling errors) was 3.39% (369 prescriptions). An illumination level of 146 foot-candles was associated with a significantly lower error rate (2.6%) than the baseline level of 45 foot-candles (3.8%). There was a linear relationship between each pharmacist's error rate and that pharmacist's corresponding daily prescription workload for all three illumination levels. The effect of the observer was minimal. The rate of prescription-dispensing errors was associated with the level of illumination. Ergonomics can affect the performance of professional tasks.
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Retrospective surveys were carried out on two groups of patients who had survived a stay of at least 48 h in an Intensive Therapy Unit. One group had been kept in a unit without windows, and the other in a similar unit with translucent but not transparent windows. Survivors from the windowless unit had a less accurate memory of the length of their stay, and were less well orientated in time during their stay. The incidence of hallucinations and delusions was more than twice as high in the windowless unit. The phenomenon of depersonalisation in the face of life-threatening danger is described and discussed.
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Bright light therapy is an effective treatment for seasonal affective disorder, an uncommon condition marked by mild winter depression. Bright lights have been used as adjuncts in the pharmacological treatment of other types of depressive illness. The rooms in our psychiatric inpatient unit are so placed that half are bright and sunny and the rest are not. Reasoning that some patients were getting light therapy inadvertently, we compared the lengths of stay of depressed patients in sunny rooms with those of patients in dull rooms. Those in sunny rooms had an average stay of 16.9 days compared to 19.5 days for those in dull rooms, a difference of 2.6 days (15%): P < 0.05.
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This paper describes the evaluation of a fall prevention protocol that combined the assessment of the mobility and confusion status of 2,023 patients aged 70 years and over and a toileting regimen for at risk patients who were both confused and having mobility problems. The six months' study was conducted in a 450 bed metropolitan teaching hospital and involved approximately 500 nursing staff in the hospital's medical and surgical wards. Almost five percent (4.7%) of patients in the study group fell; 13 patients fell more than once and the total number of falls was 112. Twenty-four percent of patients (n = 482) were assessed as being at risk of falling and 54% of falls (n = 61) occurred in the at risk group. Sixteen percent of these falls occurred in the sub-group who had been toileted according to the study protocol and 84% in the sub-group who had not been toileted according to the protocol. There were 53% fewer patient falls during shifts which complied with both the assessment and toileting protocol than during non-compliant shifts. Given the simplicity and effectiveness of the study protocol, the finding that it was not followed on 43% of shifts is of concern.