bluuebunny/crossref_metadata_2025 huggingface dataset:
Buildings and Organizations: The Shaping and the Shaped
Authors: Gibson Susan FitzMaurice
Published: February 2015

The words of Winston Churchill, spoken in 1943, provide the philosophical basis for this study of the social implications of the built environment: “We shape our buildings and afterward our buildings shape us.” Using the work of ecological psychologists, sociologists, and organizational design theorists, this paper explores the reciprocal relationship between buildings and the organizations that create and occupy them. Although no comprehensive theory of the social implications of building design has been developed, these theorists provide concepts that are useful for understanding the organizational processes of shaping and being shaped by the built environment. Insights from the modernist, symbolic-interpretive, and postmodernist perspectives are applied to the experience of design and construction of a medical center in the creation of the Center for Advanced Healing.
Ambulatory Facility Design and Patients' Perceptions of Healthcare Quality
Authors: Becker Franklin , Sweeney Bridget , Parsons Kelley
Published: February 2015

Objective:

This research examines whether the physical attractiveness of an outpatient practice influences patients' perceptions of healthcare quality, including patient and staff perceptions of the quality of staff-patient interaction.

Background:

Despite the high and increasing percentage of healthcare dollars for care delivered on an outpatient basis, relatively little research has examined the relationship between the design of ambulatory facilities and patient outcomes. Few studies have examined how patients' perceptions of healthcare quality differ in the same outpatient practice before and after a move to a new facility designed to be patient-centered. This study is the second phase of a study comparing patients' perceived quality of care in ambulatory facilities that differ markedly in physical attractiveness.

Methods:

Using both a patient and staff survey, and structured interviews, this study compared staff and patient perceptions of healthcare quality (including staff-patient interactions) before and after a move to a new facility designed to be patient-centered.

Results:

Patients' perceived quality of care, and their perceptions of the quality of interaction with staff, was significantly better in the patient-centered facility. Few differences were found in actual patient-staff interaction behaviors.

Conclusions:

This study is consistent with other studies that examined the relationship among the physical attractiveness of healthcare settings, patient satisfaction, and perceived quality of care. For this reason, the results are more credible than they would be were they inconsistent with other research or were this the only study examining these issues. These results support the value of investing in the physical attractiveness of patient areas in the ambulatory care setting. Further research is needed to identify specific physical elements that contribute to positive attributions related to quality of care, as well as where the “tipping point” is in investments to improve physical attractiveness.
A Retrospective Evaluation of the Impact of the Planetree Patient-Centered Model of Care on Inpatient Quality Outcomes
Authors: Stone Susan
Published: February 2015

Objective:

This retrospective quasi-experimental study evaluated the Planetree patient-centered model of care on inpatient quality outcomes. The research questions to be addressed were: What is the impact of the Planetree patient-centered model of care (1) on patient satisfaction, (2) on clinical outcomes (length of stay and readmission), and (3) on the cost of providing care (cost per case and productive nursing hours per patient day)?

Background:

Patients and their families have described a more patient-centered approach as key to meeting their needs. The Planetree model of care provides a framework and operational guidance on how to implement programs targeting these key areas. The link between patient-centered care and quality outcomes such as patient satisfaction, length of stay, readmission, cost per case, and productive nursing hours per patient day has been postulated; however, to date little to no research has been conducted examining this issue.

Methods:

This was a retrospective, nonexperimental comparison study evaluating units with the same types of patients and the same skill mix, and with standardized organizational pay rates, supply costs, policies, procedures, contracts, and a regulatory compliance program. This provided a unique opportunity to evaluate the impact on inpatient quality outcomes of the Planetree patient-centered model of care as practiced in the Planetree unit. Data were analyzed using a 2 × 5 analysis of variance (ANOVA) and logistic regression (readmission only). This was a study of five separate cohorts grouped by calendar year rather than a study of repeated measures.

Results:

No differences in demographic profiles were noted between the two groups. The patient satisfaction composite mean score evaluation, length-of-stay evaluation, and the cost-per-case evaluation demonstrated that the Planetree group was different from the comparison group ( p = <.05 with Eta squared = >.01). This evidence validates that the Planetree patient-centered model of care had a positive impact on patient satisfaction, length of stay, and cost per case.

Conclusions:

This evaluation of 869 hospitalized adults undergoing elective total-knee or total-hip joint replacement surgery indicated that the Planetree patient-centered model of care positively affected patient satisfaction, length of stay, and cost per case. Nursing and hospital administrators seeking to improve the inpatient hospital experience should consider implementation of the Planetree patient-centered model of care. Hospitals and healthcare organizations seeking an evidence-based approach to the implementation of patientcentered care will benefit from the information in this study.
Analysis of Hospital Facility Growth: Are We Super-Sizing Healthcare?
Authors: Latimer H. Scott , Gutknecht Hillary , Hardesty Kimmey
Published: February 2015

A retrospective analysis of space planned for selected clinical areas in acute healthcare facilities between the years 1980–2008 was conducted. Findings revealed that, during the 28-year period, incremental growth occurred in both room size and departmental square feet in adult inpatient units as well as interventional services. This observed growth and—in many instances— super-sized or excessive growth may be attributed to various factors, depending on the year of construction, regional variability, or level of urbanization. However, at a macro level, growth may be attributed to changes in patient care and operational models; consumer-driven healthcare and market competition; demographics and patient acuity; technology; and regulations and building codes. In the future, forces including but not limited to capital availability, an increased desire for efficiency, and continued escalation in the cost of construction are likely to play an increasing role in offsetting the desire for sizing excess.
Searching for Evidence
Authors: Edelstein Eve A.
Published: February 2015

Purpose:

There is a clear call for a single-source knowledge base linking literature on architecture and human outcomes. However, this seemingly simple need relies upon a vast source of information from multiple disciplines, each with their own vocabulary, structures, and modes of disciplinary thought.

Background:

The “Information Age” provides an abundance of research from the sciences as well as the humanities. Despite unprecedented access via public and licensed databases, searching across knowledge repositories remains a labor-intensive and skilled task. It therefore behooves the design profession to collaborate with experts in research, and to seek new skills for searching, interpreting, and applying evidence to design.

Methods:

The pattern of database usage by 71 professionals involved with evidence-based design in healthcare facilities was studied. Respondents represented a range of interests including healthcare practitioners and executives, researchers, and design professionals.

Findings:

Survey analysis revealed that a large number of information repositories are used (45), though few sources were used in common among the respondents.

Recommendations:

Knowledge informatics strategies are reviewed, and concepts put forward advocating the design of an information source with multiple portals, vocabularies, and outputs to serve design, research, and healthcare practitioners alike.
Islam and the Healthcare Environment: Designing Patient Rooms
Authors: Kopec DAK , Han Li
Published: February 2015

Islam and the Muslim population are often the source of much misunderstanding and media-influenced misconceptions. Muslim patients who enter the healthcare environment are often weak and likely to experience feelings of vulnerability. Because of the complex and interwoven nature of culture and religion in a person's identity, it is important to consider patient belief systems and values when designing a patient's immediate environment. Through an exploration of literature related to culture and diversity and the beliefs and value system of the Muslim population, the authors were able to identify flexible design initiatives that could accommodate an array of cultural and spiritual practices. Islam and the Muslim population were chosen as the points of reference for this study because of the strong influence of religion on the culture, and because of the many nuances that differ from the dominant culture within the United States. From these points of reference, a hypothetical design was developed for a patient room that considers differing notions of privacy, alternatives for cultural and religious practices, and ways to include symbolic meaning derived from attributes such as color.
Reinterpreting the Hospital Corridor: “Wasted Space” or Essential for Quality Multidisciplinary Clinical Care?
Authors: Carthey Jane
Published: February 2015

The planning of New South Wales (NSW) and other Australian health facilities is guided by the Australasian Health Facility Guidelines (AHFG), which prescribe allowances for circulation (corridors and similar areas for movement between spaces) of between 10% and 40% of functional floor areas. A further allowance of up to 28% for Travel and Engineering is then assumed (University of NSW & Health Capital Asset Managers' Consortium, 2005). Therefore the “circulation” and “travel” space manifested as the corridors and similar movement spaces within health facilities is both extensive and expensive. Consequently, such space often becomes regarded as a necessary evil and, in the name of efficiency, is often minimized wherever possible. This paper revisits the view that corridor space allocations (circulation) must always be minimized to achieve design or functional efficiencies. Minimizing circulation or travel inevitably assumes that the realized space savings will then be reallocated to “more important” areas of the facility. Yet the corridors and other movement spaces also are very important to the functioning of multidisciplinary clinical teams and the quality of care delivery. Ultimately, inflexibly reducing the space allocated to such spaces may be regarded as a false economy.
Humane Design for Hospital Landscapes: A Case Study in Landscape Architecture of a Healing Garden for Nurses
Authors: Naderi Jody Rosenblatt , Shin Woo-Hwa
Published: February 2015

Objective:

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

Background:

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

Methods:

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

Results:

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

Conclusions:

The courtyard was designed based on survey results. The final design was reviewed and found to satisfy the preferences of the nursing staff. Currently, the design is being detailed for construction, and a post-occupancy evaluation is being developed to ascertain the quality of the outcome for the nurses.
Unit-Related Factors That Affect Nursing Time with Patients: Spatial Analysis of the Time and Motion Study
Authors: Hendrich Ann , Chow Marilyn P. , Bafna Sonit , Choudhary Ruchi , Heo Yeonsook , Skierczynski Boguslaw A.
Published: February 2015

Objective:

The primary goal of this study was to test the hypothesis that nurses adopt distinct movement strategies based on features of unit topology and nurse assignments. The secondary goal was to identify aspects of unit layout or organization that influence the amount of time nurses spend in the patient room.

Background:

Previous research has demonstrated a link between nursing hours and patient outcomes. Unit layout may affect direct patient care time by determining aspects of nurse behavior, such as the amount of time nurses spend walking. The recent nurses' Time and Motion study employed multiple technologies to track the movements and activities of 767 medical-surgical nurses. With regard to unit layout, initial analysis of the data set did not detect differences between types of units and time spent in the patient room. The analysis reported here applies novel techniques to this data set to examine the relationship between unit layout and nurse behavior.

Methods:

Techniques of spatial analysis, borrowed from the architectural theory of spatial syntax, were applied to the Time and Motion data set. Motion data from radio-frequency identification tracking of nurses was combined with architectural drawings of the study units and clinical information such as nurse-patient assignment. Spatial analytic techniques were used to determine the average integration or centrality of nurse assignments for each shift.

Results:

Nurse assignments with greater average centrality to all assigned rooms were associated with a higher number of entries to patient rooms, as well as to the nurse station. Number of entries to patient rooms was negatively correlated with average time per visit, but positively correlated with total time spent in patient rooms. The data describe two overall strategies of nurse mobility patterns: fewer, longer visits versus more frequent, shorter visits.

Conclusions:

Results suggest that the spatial qualities of nurse assignments and unit layout affect nurse strategies for moving through units and affect how frequently nurses enter patient rooms and the nurse station.
Exploring the Impact of the Physical Environment on Patient Outcomes in Ambulatory Care Settings
Authors: Gulwadi Gowri Betrabet , Joseph Anjali , Keller Amy Beth
Published: February 2015

Objective:

This report of empirical literature on ambulatory care centers (ACCs) addresses a gap in the healthcare field by exploring physical features of ACC settings that have been associated with favorable patient outcomes.

Background:

Growing numbers of ACCs correspond with an increasing shift from inpatient to outpatient services. As the focus of ACCs shifts from treating episodes of illnesses to comprehensive, longitudinal, patient-centered care, different types of ACC settings seek to accommodate a variety of patient groups from different demographics.

Methods:

Given the range of ACC settings and population types and the paucity of literature focused on any one of these settings, the literature search process was broad based to include not only peer-reviewed literature, but also “gray literature” on ACC design. The primary focus was on research studies and reports that centered on some aspect of the physical environment in ACCs and their relationship to outcomes in these settings.

Results:

The following patient outcomes were identified in different phases of ACC patient experience: improved access and wayfinding, enhanced waiting experience, enhanced privacy, enhanced physician/staff-patient communication, reduced patient anxiety, and reduced risk of infection.

Conclusions:

This article identifies physical design features of ACCs that can promote favorable patient outcomes. However, most literature reviewed adheres to a physician-centered model of episodic illness in which care ends with the experience in the exam room of the ACC. A more patient-centered approach has not been explored fully in the literature. The results indicate that there are many opportunities for future inquiry.
Using Task Analysis in Healthcare Design to Improve Clinical Efficiency
Authors: Lu Jun , Hignett Sue
Published: February 2015

Objective:

To review the functionality of the proposed soiled workroom design for efficient and safe clinical activities.

Background:

As part of a hospital refurbishment program, the planning team of a United Kingdom National Health Service hospital requested a review of a proposed standardized room design.

Methods:

A 7-day observational study was conducted in five clinical departments at three hospitals. Link analysis was used to record and analyze the movements among components, i.e., nursing staff, equipment/devices, and furniture.

Results:

Fifty-four observations were recorded for 18 clinical tasks. The most frequent tasks were the disposal of urine and used urine bottles, and returning used commode chairs. Minor recommendations were made to improve the proposed design, and major revisions were suggested to address functionality problems.

Conclusion:

It was found that the proposed design did not offer the optimal layout for efficient and safe clinical activities. Link analysis was found to be effective for plotting the movements of the staff and accounting for the complexity of tasks. This ergonomic method, in combination with observational field studies, provided a simple and effective way to determine functional space requirements for clinical activities and should be used in all healthcare building design projects.
Creating Healing Environments in Support of the U.S. Military: A Commitment to Quality through the Built Environment
Authors: Casscells S. Ward , Kurmel Thom , Ponatoski Ed
Published: February 2015

The U.S. Military Health System (MHS) provides care to 9.2 million beneficiaries with approximately 130 thousand military and civilian staff in 70 military hospitals, 411 primary care clinics, and 417 dental clinics around the world. In anticipation of nearly $11 billion of new medical construction planned for the next 5 years, this paper describes the commitment of the MHS leadership and its approach to creating healing physical environments across the system, employing a set of principles, projected outcomes, and design features to achieve world-class facilities for service members and the military “family.” The results of a survey of active duty personnel and spouses indicated a desire for MHS facilities to provide space for family members to be able to spend the night, to control environmental features such as lighting and temperature, and to communicate more effectively with family and friends outside the facility via e-mail and telephone.
Color Perception in Pediatric Patient Room Design: Healthy Children vs. Pediatric Patients
Authors: Park Jin Gyu
Published: February 2015

Objective:

The purpose of this study was to investigate the value of color as a component of a healing environment for pediatric patient rooms. Color preferences from pediatric inpatient, pediatric outpatient, and healthy children groups were investigated and compared for group and gender differences.

Background:

Positive environmental stimulation can promote patient well-being by reducing stress or negative feelings. If environmental colors can have positive influences, then those colors will make patients more comfortable, reducing their stress. Although previous color studies are suggestive, none has focused on pediatric healthcare environments. Patients' health status may affect their reaction to environmental stimulation. There was a gap in the body of knowledge regarding the consistency of color preferences with regard to patient health status.

Methods:

A simulation method was used because of its reliability and feasibility. It allowed for investigating the value of color in real contexts and controlling confounding variables. Previous color preference studies typically have been done with small colored squares of paper, which are visually different from seeing a color applied on wall surfaces. In addition, they failed to control confounding variables such as color attributes and light sources.

Results:

Group differences were not significant. This refuted the hypothesis that the color preferences of pediatric patients are different from those of healthy children. However, overall color preferences showed that the healthy children group had higher mean scores of color preferences than both pediatric outpatients and inpatients groups. Gender effects were identified across all three groups.

Conclusions:

All three groups showed similar color preference patterns, except for yellow. Both pediatric outpatients and inpatients preferred yellow less than healthy children did. Healthy children's mean scores of color preferences were higher than the pediatric outpatients; the pediatric outpatients group had higher mean scores of color preferences than the pediatric inpatients group. Although this observation was not statistically significant, it raised the question of whether the sickest pediatric patients respond differently to color than healthy children do. Gender effects indicated that girls preferred red and purple more than boys do. Regardless of gender effects, healthy children and pediatric patients preferred blue and green the most and white the least. These results can help healthcare providers and professionals better understand appropriate colors for pediatric populations.
Eco-Effective Design and Evidence-Based Design: Perceived Synergy and Conflict
Authors: Shepley Mardelle McCuskey , Baum Mara , Ginsberg Rachel , Rostenberg Bill
Published: February 2015

Eco-effective design (EED) and evidence-based design (EBD) are two powerful trends currently shaping healthcare architecture. EED addresses whether/how the design and operation of buildings improve ecological value and enhance human health. EBD addresses whether/how the design and operation of buildings support positive health outcomes in the built environment through a growing collection of solutions informed by research and practical knowledge. The primary hypothesis of this study was that EBD and EED are compatible approaches to health facility design, especially when addressing the impact of the environment on human health. To explore this hypothesis, healthcare facility administrators were surveyed regarding their perceptions of the relationship between EED and EBD. Input from focus groups and EED and EBD experts was used to formulate the administrator questionnaire. The study concluded that the relationship between EED and EBD typically was synergistic.
Preventing Chronic Disease among the Aged: A Call for Evidence-Based Design Research
Authors: Verderber Stephen
Published: February 2015

The quality of the built environment and the public health and well-being of its inhabitants are profoundly interwoven. Among all age groups, the aged are particularly susceptible to disengagement or avoidance of the built environment and the physical exercise options it affords; this can have a deleterious influence on personal health. In this discussion, concepts drawn from the fields of architecture, landscape research, urban and regional planning, and environmental gerontology are drawn together in the context of a hybrid conceptual and operative model. This model is put forth to assist in the acquisition of knowledge in the field to further understanding of how chronic diseases among the aged can be reduced through the provision and utilization of sufficiently supportive outdoor physical activity options in the everyday environment. This hybrid model, the Prospect-Refuge Competency Index (PRCI), combines key elements of prospect-refuge theory and environmental press-competency theory. It can be applied to diverse settings and user constituencies. The discussion concludes with the presentation of a set of hypotheses for the neighborhood/community level and the residential/exterior environs level of inquiry.
Demystifying First-Cost Green Building Premiums in Healthcare
Authors: Houghton Adele , Vittori Gail , Guenther Robin
Published: February 2015

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.
Hospital Design and Face to Face Interaction among Clinicians: A Theoretical Model
Authors: Rashid Mahbub
Published: February 2015

A growing body of literature suggests that face-to-face interaction among clinicians in hospitals affects patient outcomes. How can face-to-face interaction among clinicians be influenced positively to improve patient outcomes in hospitals? So far, most strategies for improving face-to-face interaction in hospitals have focused on changing organizational culture. In contrast, this paper proposes a theoretical model that shows how spatial program and structure can help face-to-face interaction fulfill its purposes in hospitals by controlling the interfaces among different communities of clinicians.
Incentivizing the Daylit Hospital: The Green Guide for Health Care Approach
Authors: Pradinuk Ray
Published: February 2015

Daylight is usually mentioned immediately after reduced energy use in conversations about sustainable building design, yet in North America, daylight remains the most-asked-for/least-delivered aspect of the caregiver work environment. In Europe, essentially the same care practices continue to be accommodated in daylit building configurations. Recognizing that the daylighting credits in Leadership in Energy and Environmental Design (LEED) for new construction (NC) are more difficult for large healthcare projects to achieve during the design process, and that two daylighting credits are probably not enough of an incentive to change North American healthcare design practice, the Green Guide for Health Care (GGHC) has both simplified the process of calculating daylight achievement levels and increased the number of daylighting credits available from two to five.
Healthcare Facility Benchmarking
Authors: Mulva Stephen P. , Dai Jiukun
Published: February 2015

Development of a national healthcare facilities benchmarking program is described. As the first effort of its kind, a framework of facilities is presented. The methodology and systems used to compare measures of capital project performance are discussed. These include the development of questionnaires, databases, data mining structures, and executive dashboards. The benefits of benchmarking healthcare facilities are discussed along with several lessons learned from other, similar efforts. Future extensions of this research are discussed.
Consultation Room Design and the Clinical Encounter: The Space and Interaction Randomized Trial
Authors: Almquist Julka R. , Kelly Caroline , Bromberg Joyce , Bryant Sandra C. , Christianson Teresa J. H. , Montori Victor M.
Published: February 2015

Objective:

The design of the consultation room remains largely unaltered despite major changes in clinical practice, such as the electronic medical record and patient-centered care. The value of redesigning the consultation room to accommodate these changes and the effect of a redesign on patient-clinician interaction are unclear.

Methods:

The authors randomly allocated 65 patient-physician dyads to consultations in a standard room ( n = 30) or in an experimental room designed with a semicircular table around which the clinician and the patient sat, with equal access to the computer screen ( n = 35). Participant responses to post-visit surveys, assessing patient experiences in these rooms, were compared in an intention-to-treat fashion.

Results:

The authors found no differences between the rooms in terms of patient satisfaction with the consultation, mutual respect, or communication quality. Compared to the standard room, patients in the experimental room were better able to interact with the computer monitor (24 [75%] vs. 17 [59%], P = 0.07) and had a greater ability to look at the screen at any time (22 [73%] vs. 8 [28%], P < 0.001); and they reported that clinicians allowed them to review the medical record on the screen (22 [71%] vs. 13 [45%], P = 0.012), shared information on the computer screen (24 [80%] vs. 18 [60%], P = 0.037), and reviewed information on the Internet with the patient (13 [43%] vs. 7 [26%], P = 0.010) more than those in the standard room.

Conclusions:

The design of the consultation room affects the clinical encounter. In particular, ready access to a computer screen using the electronic medical record and the Internet may enhance information sharing.
Adapting to Family-Centered Hospital Design: Changes in Providers' Attitudes over a Two-Year Period
Authors: France Daniel , Throop Patricia , Joers Barbara , Allen Lauran , Parekh Amruta , Rickard Dorsey , Deshpande Jayant K.
Published: February 2015

Objective:

The United States is currently in the midst of a hospital construction boom. An increasing number of hospitals are being designed using the principles of evidence-based design to improve patient safety and patient satisfaction. Few studies have examined the impact of new hospital design models on providers' attitudes or work performance. The goal of this study was to determine how providers' attitudes at one children's hospital changed over a 2-year period. It was hypothesized that clinicians' attitudes about their work environment would be significantly more positive 2 years after opening.

Background:

In 2004 a children's hospital within a hospital was replaced with a free-standing facility, which was designed on the theme of family-centered care. The hospital quality improvement team developed and administered the Environment of Work survey to measure providers' initial impressions of the hospital design on job function, patient safety, and personal well-being. The survey was readministered approximately 2 years later to measure changes in providers' perceptions about the same issues.

Methods:

A 25-item survey was administered to a convenience sample of clinical staff to measure their attitudes about the effects of family-centered hospital design on providers and patients. Chi-square tests were used to compare subjective ratings collected from the two surveys on pooled samples and on samples stratified by clinical unit.

Results:

Surveys were collected from 270 clinicians (a 25% response rate) in 2004 and 544 clinicians (a 51% response rate) in 2006. Nurses accounted for a higher percentage of total respondents (78% versus 57%). Most domain areas garnered improved and overall positive ratings from clinicians in 2006. Providers' ratings of elevated mental fatigue, physical fatigue, and walking burden remained high in 2006 despite improvements. Ratings of noise levels increased on all units except the neonatal intensive care unit. Fewer respondents rated the new hospital “somewhat to much better” than the former hospital.

Conclusions:

Moving into a new healthcare facility is a stressful event for healthcare providers and adapting to a new work environment requires a lengthy period of transition. Providers' initial ratings of a new workspace are likely to change over time as they adjust their work practices to the physical environment.
Operationalizing Lean Health Assets
Authors: Price Ilfryn , Pinder James , Wyton Paul G.
Published: February 2015

Objective:

To demonstrate the potential of employing unconventional facility/facilities management (FM) performance indicators in healthcare settings to enable more strategic conversations between FM and business users concerning asset performance.

Background:

The theoretical background for a Lean asset approach and a high-level analysis of data from hospital trusts in England have been published elsewhere. This paper reports on the first uses of that approach in operational settings.

Method:

Observations are drawn primarily from three case studies.

Results:

The individual studies support the premise that the conventional emphasis on cost per square meter (m2) as a preeminent measure of FM disguises a portfolio of too much underutilized space. They provide a means of putting a healthcare estates strategy in terms that will engage business users.

Conclusions:

Despite a growing interest in Lean approaches in healthcare, the philosophy has not yet been extended to the estate. This study demonstrates that alternative benchmarks are possible.
Measuring the Structure of Visual Fields in Nursing Units
Authors: Lu Yi
Published: February 2015

Objective:

The purpose of this study was to develop quantitative measures of the structure of visual fields in nursing units.

Background:

The structure of visual fields in nursing units—especially visibility toward patient beds—is believed to have a direct influence on the routine use of space by medical staff and patient outcomes within units. Although previous studies are suggestive, none has developed rigorous measures of the visibility within nursing units.

Methods:

To compare the degree of visibility toward patient beds among different nursing units, the targeted visibility index (TVI) was introduced. The TVI measures the degree to which an observer can see all targets in a nursing unit. It provided a comparative spatial quality evaluation of various nursing unit configurations with differing numbers of patient beds. It was developed and programmed on the ArcGIS version 9.2 platform (ESRI Inc., Redlands, CA) with component object model-based ArcObjects and Visual Basic for Application language (Microsoft).

Results:

The assessment of three nursing unit designs by TVI aligned exactly with empirical evaluations conducted in previous studies.

Conclusions:

This study provided an opportunity and supplied relevant measures for healthcare facility designers to specify the visual structures of important behavioral effects. It is anticipated that the TVI will contribute to the understanding of healthcare design and the resulting outcomes.
Developing a Usability Evaluation Tool to Assess the Patient Room Bathroom
Authors: Fink Nicole , Pak Richard , Battisto Dina
Published: February 2015

Objective:

The goal of this project was to create an easy-to-administer and inexpensive tool that can help identify usability issues in a patient room bathroom during the design process so improvements can be made before the final product is constructed and put into operation.

Background:

The bathroom is an essential part of any hospital patient room, yet it is associated with nurse dissatisfaction and patient falls. Minimal literature has examined whether the physical structure of various elements within the bathroom are efficient, safe, and satisfactory for the majority of users. Furthermore, there is a paucity of human factor guidelines for architects and designers to follow to ensure the usability of bathroom space for a wide variety of users.

Methods:

The authors adapted a common technique used in software usability: the heuristic evaluation. A heuristic evaluation is a “discount” evaluation method used to quickly and efficiently evaluate the usability flaws of user interfaces. Three methods were used to provide input for the heuristic evaluation: (1) Review of existing heuristic evaluations, reported hospital bathroom problems, and safety checklists; (2) Interviews with nurses and nursing assistants; and (3) Focus groups with nurses. Analysis of the interview and focus group transcripts enabled the categorization of the types of problems nurses encounter in the patient room bathroom. These categories served as the basis for the heuristics in the heuristic evaluation tool.

Results:

Eleven major heuristics (or categories of problems in the bathroom) were identified initially. The authors then went through several iterations of designing and refining the heuristic evaluation to form parsimonious categories and subcategories. Each of the eventual six major heuristic categories contains a general description as well as specific exemplar questions. These detailed subcategories enable an evaluator to easily gauge whether a bathroom adheres to the guideline, to write any comments about a particular issue, and to rate the severity of any problems.

Conclusions:

The bathroom heuristic evaluation was designed to be a discount usability evaluation tool. It can be used to assess a hospital bathroom during the design process for major usability issues, enabling necessary alterations before a final product is developed.
The Effects of Nature Images on Pain in a Simulated Hospital Patient Room
Authors: Vincent Ellen , Battisto Dina , Grimes Larry , McCubbin James
Published: February 2015

Background:

Views of nature have been reported to relieve stress and pain, making nature an ideal medium for use in healthcare settings. In hospitals whose design does not allow for a view of nature, virtual and surrogate views of nature may be viable therapeutic options.

Objective:

This study tests the effects of specific nature images, as defined by Appleton's prospect refuge theory of landscape preference, on participants experiencing pain. The hypotheses were: (1) Nature views are variable in their impact on specific psychological and physiological health status indicators; and (2) Prospect and refuge nature scenes are more therapeutic than hazard nature scenes. The research question was (1) Which nature image categories are most therapeutic as evidenced by reduced pain and positive mood?

Methods:

An experiment using mixed methods assessed the effects of four different nature scenes on physiological (blood pressure, heart rate) and psychological (mood) responses when a person was subjected to a pain stressor. Four groups were subjected to a specific nature image category of prospect, refuge, hazard, or mixed prospect and refuge; the fifth group viewed no image. The Short-Form McGill Pain Questionnaire and the Profile of Mood States survey instruments were used to assess pain and mood, respectively. Continuous physiological readings of heart rate and blood pressure were collected. Pain was induced through a cold pressor task, which required participants to immerse their nondominant hand in ice water for up to 120 seconds.

Results:

The mixed prospect and refuge image treatment showed significantly lower sensory pain responses, and the no-image treatment indicated significantly higher affective pain perception responses. The hazard image treatment had significantly lower diastolic blood pressure readings during the pain treatment, but it also had significantly high total mood disturbance.

Conclusions:

Although there was no clear “most” therapeutic image, the mixed prospect and refuge image showed significant potential to reduce sensory pain. The hazard image was the most effective at distracting participants from pain, but it should not be considered a positive distraction because it also received the highest mood disturbance scores of all groups.
The Effects of Presence and Influence in Nature Images in a Simulated Hospital Patient Room
Authors: Vincent Ellen , Battisto Dina , Grimes Larry
Published: February 2015

Background:

Nature images are frequently used for therapeutic purposes in hospital settings. Nature images may distract people from pain and promote psychological and physiological well-being, yet limited research is available to guide the selection process of nature images.

Objective:

The hypothesis is that higher degrees of presence and/or influence in the still photograph make it more effective at holding the viewer's attention, which therefore may distract the viewer from pain, and therefore be considered therapeutic. Research questions include: (1) Is there a significant difference in the level of perceived presence among the selected images? (2) Is there a significant difference in the level of perceived influence among the selected images? (3) Is there a correlation between levels of presence and levels of influence?

Methods:

109 college students were randomly assigned to one of four different image categories defined by Appleton's prospect refuge theory of landscape preference. Categories included prospect, refuge, hazard, and mixed prospect and refuge. A control group was also included. Each investigation was divided into five periods: prereporting, rest, a pain stressor (hand in ice water for up to 120 seconds), recovery, and postreporting. Physiological readings (vital signs) were measured repeatedly using a Dinamap automatic vital sign tracking machine. Psychological responses (mood) to the image were collected using a reliable instrument, the Profile of Mood States.

Results:

No significant statistical difference in levels of presence was found among the four image categories. However, levels of influence differed and the hazard nature image category had significantly higher influence ratings and lower diastolic blood pressure readings during the pain treatment. A correlation ( r = .62) between presence and influence was identified; as one rose, so did the other. Mood state was significantly low for the hazard nature image after the pain stressor experience.

Conclusions:

Though the hazard image caused distraction from pain, it is nontherapeutic because of the low mood ratings it received. These preliminary findings contribute methodology to the research field and stimulate interest for additional research into the visual effects of nature images on pain.
Developing the Birth Unit Design Spatial Evaluation Tool (BUDSET) in Australia: A Qualitative Study
Authors: Foureur Maralyn J. , Epi Grad Dip Clin , Leap Nicky , Davis Deborah L. , Forbes Ian F. , Homer Caroline S. E.
Published: February 2015

Objective:

To develop a tool known as the Birth Unit Design Spatial Evaluation Tool (BUDSET), to assess the optimality of birth unit design.

Background:

The space provided for childbirth influences the physiology of women in labor. Optimal birth spaces are likely to enable women to have physiologically normal labor and birth. The measurement of an optimal birth space is currently impossible, because limited tools are available. Research into optimal birth unit design is also limited.

Methods:

The BUDSET was developed using a qualitative study. Data collection included an extensive literature review, interviews with key informants (architects, midwife clinicians, and researchers) and an expert panel. A Pattern Language format was used to synthesize the literature and data obtained from the key informants.

Results:

The BUDSET is based on 18 design principles and is divided into four domains (Fear Cascade; Facility; Aesthetics; Support) with three to eight assessable items in each.

Conclusion:

Birth units must be designed so that they facilitate and support the physiology of normal childbirth. The BUDSET may provide a way to assess the optimality of birth units and determine which domain areas may need to be improved.
Technology and Building Design: Initiatives to Reduce Inpatient Falls among the Elderly
Authors: Hignett Sue
Published: February 2015

This paper offers a narrative exploration of interventions for inpatient falls among the elderly with respect to the design of technology (equipment and furniture) and buildings. Most of the contributory risk factors for inpatient falls among the elderly were identified in the 1950s, but incident and injury rates remain relatively unchanged in the 2000s. Interventions have predominantly focused on staff and organizational changes, for example monitoring (observation) and communication, possibly in response to increased patient privacy (isolation) in single rooms. The clinical response has been to modify the patient by means of medication review, continence management, and impact protectors. This paper considers whether technology and building design have helped or hindered the newly admitted frail and/or confused elderly patient at risk of falling, assuming the provision of good nursing and medical practice (e.g., observation, treatment, and care).