2. Defining the Design
Characteristics of a
S f l Ad t blSuccessful Adaptable
Inpatient Unit
Debajyoti Pati, PhD, AIIA
Tom E. Harvey Jr., AIA, MPH, FACHA
3. Acknowledgements/Credits
• AIA 2006 Research Grant
• Herman Miller
• Dr Carolyn Cason, UT Arlington School of Nursing
• Parker Adventist Hospital Parker CO• Parker Adventist Hospital, Parker, CO
• Clarian West Medical Center, Avon, IN
• Laredo Medical Center, Laredo, TXLaredo Medical Center, Laredo, TX
• McKay-Dee Hospital Center, Ogden, UT
• Bon Secours St. Francis Hospital,Charleston, SC
• St. Rose Dominican Hospital – Siena, Henderson,
NV
4. Learning objectives
• Understand the role of flexibility in promoting
ffi i i ti tefficiency in patient care.
• Understand what ‘flexibility’ means from various
stakeholders’ perspective on inpatient units.p p p
• Understand characteristics of the physical
environment that impede or facilitate flexibility.
• Obt i d d t di f i ti t it• Obtain a deeper understanding of inpatient unit
operations, coordination between caregivers, and
implications of such factors on the physical design.
5. Content
• Flexibility background
• Information gap
• Framework
• Question• Question
• Method
• Flexibility meaningFlexibility meaning
• Flexibility to Adapt
• Flexibility to Convert
• Flexibility to Expand
• Conclusions
6. Flexibility background
• The architectural perspective:
– Workplace and retail sectors: shearing layers
• Shell, services, scenery, set
• Site, structure, skin, services, space plan, stuff
– Healthcare sector: systems
• Open building paradigm
– Primary, secondary, tertiary
• Spine concept
7. Information gap
• Hospital level flexibility concepts
• Very little information at inpatient unit level:
Universal rooms– Universal rooms
– Distributed caregiver workstations
• Importance:
– Changing demographics
– Changing labor marker
Change unit operational
model
g g
– Changing technology
– High volume investment on bed units
8. Question
• What does flexibility mean to different
stakeholders?
• What physical design variables influence
stakeholders’ flexibility?
• What designs elements promote or hinder
flexibility?flexibility?
9. Framework
• Flexibility to adapt: accommodate change without
change in environmentchange in environment
• Flexibility to convert: accommodate change after
simple/inexpensive physical alteration
• Flexibility to expand: expand over time• Flexibility to expand: expand over time
10. Method
• SETTING
– Six hospitals
– Medical-surgical units
• SAMPLING
– Purposive
M i i i bilit– Maximize variability
• DESIGNDESIGN
– Exploratory
– Qualitative
12. Sample
uction
etion
ed
ze
ape
tion
gModel
Patient
sal
Name
Constru
Comple
TotalBe
UnitSiz
UnitSha
Circulat
Nursing
Nurse:P
Ratio
Univers
Room
Parker Adventist
Hospital
2004 100 36 Irregular Racetrack Primary 1:5 Yes
Hospital
Parker CO
Clarian West
Medical Center
Avon IN
2005 76 32 Square Racetrack Primary 1:4 Yes
Laredo Medical 1998 325 36 Pinwheel Racetrack Functional/ 1:8 No
Center
Laredo TX
Modular
McKay-Dee
Hospital Center
Ogden UT
2002 317 28 Triangle/
Rectangle
Racetrack Functional 1:5 No
Bon Secours St 1997 141 40 Square Radial Modified/ 1:5 NoBon Secours St.
Francis Hospital
Charleston SC
1997 141 40 Square Radial Modified/
Modular
1:5 No
St Rose
Dominican
Hospital-Siena
H d NV
1999 214 34 Other T-Shape Functional 1:6 Yes
Henderson NV
13. Parker Adventist
FIGURE LEGEND
M Medication
E Equipment
C Clean Supply/ Utility
S Soiled Supply/ UtilityS Soiled Supply/ Utility
N Nursing Station
Construction Completion 2004
Total Bed 100
SqFt per Bed 607
Unit Size 36
Unit Shape Irregular
Circulation Racetrack
Nursing Model Primary
Nurse:Patient Ratio 1:5
U i l R YUniversal Room Yes
14. Clarian West
FIGURE LEGEND
M Medication
E Equipment
C Clean Supply/ Utility
S Soiled Supply/ UtilityS Soiled Supply/ Utility
N Nursing Station
Construction Completion 2005
Total Bed 76
SqFt per Bed 700
Unit Size 32
Unit Shape Square
Circulation Racetrack
Nursing Model Primary
Nurse:Patient Ratio 1:4
Universal Room Yes
15. Laredo Medical Center
FIGURE LEGEND
M Medication
E Equipment
C Clean Supply/ Utility
S Soiled Supply/ UtilityS Soiled Supply/ Utility
N Nursing Station
Construction Completion 1998
Total Bed 325
SqFt per Bed 528
Unit Size 36Unit Size 36
Unit Shape Pinwheel
Circulation Racetrack
Nursing Model Functional/
Modular
Nurse:Patient Ratio 1:8
Universal Room No
16. McKay Dee
FIGURE LEGEND
M Medication
E Equipment
C Clean Supply/ Utility
S Soiled Supply/ UtilityS Soiled Supply/ Utility
N Nursing Station
Construction Completion 2002
Total Bed 317
SqFt per Bed 673
Unit Size 28
Unit Shape Triangle/
Rectangle
Circulation Racetrack
Nursing Model Functional
Nurse:Patient Ratio 1:5
Universal Room No
17. St Francis Hospital
FIGURE LEGEND
M Medication
E Equipment
C Clean Supply/ Utility
S Soiled Supply/ UtilityS Soiled Supply/ Utility
N Nursing Station
Construction Completion 1997
Total Bed 141
SqFt per Bed 520
Unit Size 40
Unit Shape SquareUnit Shape Square
Circulation Radial
Nursing Model Modified/
Modular
Nurse:Patient Ratio 1:5
Universal Room No
18. St Rose Dominican-Siena
FIGURE LEGEND
M Medication
E Equipment
C Clean Supply/ Utility
S Soiled Supply/ UtilityS Soiled Supply/ Utility
N Nursing Station
Construction Completion 1999
Total Bed 214
SqFt per Bed 541
Unit Size 34
Unit Shape OtherUnit Shape Other
Circulation T-Shape
Nursing Model Functional
Nurse:Patient Ratio 1:6
Universal Room Yes
20. Flexibility meaning
• Management
– Ability to manipulate higher-level resources (staffing,
teaming) to address unique circumstances and
uncertainties
• Direct caregiver
– Ability to multi-task and multi-skill to optimize patient care,
maximize efficiency and address unique situations
• Non-nursing personnelo u s g pe so e
– Ability to manipulate resources to effectively address
nursing management and direct care giver needs
24. Patient visibility
• Operational issue • Implications
– Higher acuity, JCAHO
regulations, non-
contiguous patients
Aff t
– Multiple caregiver work
centers with proximal
patient rooms
U b t t d i htli• Affects
– Nurse, nursing
administration,
i t th i t
– Unobstructed sightline
to patient rooms
– Outboard toilet location
respiratory therapist
• Environmental
correlates
– Caregiver workstation,
medication room, utility
room
26. Multiple division/zoning option
• Operational issue • Implications
– Perceived barriers
– Assignment problems
• Affects
– Stairwell and support
spaces located at end of
an array of patient
rooms or inside theAffects
– Nurse, nursing
administration,
• Environmental
rooms, or inside the
support core
– Simple circulation
configurationEnvironmental
correlates
– Stairwell, support
spaces staff toilets
g
spaces, staff toilets
32. Inter-unit movements
• Operational issue • Implications
– Multi-unit caregiver
responsibility
• Affects
– Communicating stair
inside unit
– Proximal location of
ti l i l ti
– Nurse, environmental
services, dietary
services, materials
t
vertical circulation core
– Back corridor inter-unit
link
U b t t d h i t lmanagement,
pharmacy, respiratory
therapy
• Environmental
– Unobstructed horizontal
circulation
• Environmental
correlates
– Vertical circulation core,
unit proximity horizontalunit proximity, horizontal
access
34. Service expansion options
• Operational issue • Implications
– Census fluctuations
– Unit-service misfit
• Affects
– Visual or geographic
cues to help unit
subdivisions
B k id li k
Affects
– Nurse, nursing
administration
• Environmental
– Back corridor links
between adjacent units
Environmental
correlates
– Unit size, unit
configuration unitconfiguration, unit
adjacency
40. Expandable support core
• Operational issue • Environmental
l t– Operational changes
over time
• Affects
correlates
– Adjacent functions
• Implications
– Nurse, nursing
administration,
environmental services,
di t i
p
– Soft program adjacent
spaces
dietary services,
materials management,
pharmacy, respiratory
therapypy
43. Brief bibliography
Chefurka, T., Nesdoly, F. and Christie, J. , 2006, “Concepts in Flexibility in
Healthcare Facility Planning, Design, and Construction”. The AcademyHealthcare Facility Planning, Design, and Construction . The Academy
Journal Online, http://www.aia.org/aah/journal, pp. 34-43.
Hamilton, K. 2000 - Design for Flexibility in Critical Care. Proceedings of ICU
2010, Center for Health Systems and Design, Texas A&M University, April.
Hendrich A Fay J Sorrels A K 2004 Effects of Acuity-Adaptable Rooms onHendrich, A., Fay, J., Sorrels, A.K., 2004. Effects of Acuity Adaptable Rooms on
Flow of Patients and Delivery of Care. American Journal of Critical Care, Vol.
13 /1, pp.35-45.
Kendall, S. H., 2004, Open Building: A New Paradigm in Hospital Architecture.
AIA Academy Journal, 7th Edition, pp.22-27.y , , pp
Ulrich, R., Zimring, C., Quan, X., and Joseph, A., 2004, “The Role of the
Physical Environment in the Hospital of the 21st Century: A Once-in-a-
Lifetime Opportunity”. The Center for Health Design,
http://www.healthdesign.org/ research/reports/pdfs/role _physical_env.pdf
Varawalla, H. 2004, “Designing for Flexibility Building in order and direction for
growth and change”. Express Healthcare Management , August 15-30,
2006, http://www.expresshealthcaremgmt.com/
20040831/architecture01.shtml
44. Contact information
Debajyoti Pati, PhD, AIIA
Director of Research, HKS Architects,
Tom E Harvey Jr, AIA, FACHA, MPH
Principal, HKS Architects,
1919 McKinney Avenue, Dallas, TX, 75201
214.969.5599
dpati@hksinc.com
1919 McKinney Avenue, Dallas, TX,75201
214.969.5599
tharvey@hksinc.com
