Urban Legends Of Healthcare Design

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How is research evidence being used and how is it being abused in healthcare design? I invite you to review this presentation made at the 2009 ASHE International Conference on Healthcare Planning, Design and Construction to find out those answers!

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Urban Legends Of Healthcare Design

  1. 1. urban legends of Healthcare Design urban legends of Healthcare Design Moderator: Linda Delano, Western Division Business Leader, SSOE, Inc. Speaker: Matthew W. Kennedy, ACHA, National Healthcare Executive, SSOE, Inc. 2009 PDC Conference & Exhibition
  2. 2. urban legends of Healthcare Design Today’s Discussion I. The Pressure for Better Outcomes II. Looking at the Evidence III. The Continuing Evolution of EBD IV. Improving Your EBD Approach 2009 PDC Conference & Exhibition
  3. 3. urban legends of Healthcare Design ..let’s start with a quick story 2009 PDC Conference & Exhibition
  4. 4. urban legends of Healthcare Design “Children who eat candy have better test scores” 2009 PDC Conference & Exhibition
  5. 5. urban legends of Healthcare Design Is it true? 2009 PDC Conference & Exhibition
  6. 6. urban legends of Healthcare Design “Children who eat candy have better test scores” 2009 PDC Conference & Exhibition
  7. 7. urban legends of Healthcare Design Is your design utilizing the evidence or another “Urban Legend”? “...I think that this market is “...I think that this market is now challenging anything now challenging anything that doesn’t really have that doesn’t really have science behind it.” science behind it.” Robert Levine, Turner Construction, Robert Levine, Turner Construction, quoted from HFM Magazine quoted from HFM Magazine 2009 PDC Conference & Exhibition
  8. 8. urban legends of Healthcare Design Comments from your Peers.... 2009 PDC Conference & Exhibition
  9. 9. urban legends of Healthcare Design Strong Incentives to Succeed: • Better process efficiencies • “High-Performance” care environments • Increased competition • Growing knowledge needs More results with less costs More results in less time 2009 PDC Conference & Exhibition
  10. 10. urban legends of Healthcare Design Need for “Fact-Based” Approach: Best Practices EBD Confirmed Outcomes ? Confirmed Efficiencies ? Confirmed Cost Impact ? 2009 PDC Conference & Exhibition
  11. 11. urban legends of Healthcare Design Using the A/E Selection Process 5. PROJECT SPECIFIC QUALIFICATIONS: 5. PROJECT SPECIFIC QUALIFICATIONS: The Owner is interested in designing the project in The Owner is interested in designing the project in accordance with the principals of “Evidence Based 1.A: Provide Hard data towith the principals of “Evidence Based accordance 1.A: ProvideDesign” buttosupport “evidence-based design” experience; Hard data support “evidence-based design” experience; i.i. Design” butnot necessarily with developing the not necessarily with developing the Documented evidence of elevated patient satisfaction scores Documented evidenceDESIGN BUILD APPROACH AND SERVICES project as aapebble6:facility.Please comment on yourscoresSERVICES of elevated patient satisfaction TAB 6:facility. Please comment on yourAND ii. project as pebble DESIGN BUILD APPROACH TAB Documented evidence of improved nursing productivity ii. Documented evidence ofthese principals productivity firm’s experience with improved nursing firm’s experience with these principals iii. Documented evidence of reduced costs of operation iii. Documented evidence of reduced costsandoperationshould be addressed: The following approach of services iv. Provide patientThe following approach andasaaresultshould be addressed: services iv. Provide patientcensus growth/admissions as resultof design census growth/admissions of design 6.2: Design process to maximize evidence base design 6.2: Design process to maximize evidence base design implementation (from patient, visitor, staff, and implementation (from patient, visitor, staff, and efficiency standpoint) efficiency standpoint) 2009 PDC Conference & Exhibition
  12. 12. urban legends of Healthcare Design Leading to Increased EBD Presence 2006 2008 53% 62% Total HC Construction $40.7B Total Utilizing EBD $25.23B TOTAL VALUE AT RISK $15.3B 2009 PDC Conference & Exhibition
  13. 13. urban legends of Healthcare Design Comments from your Peers.... 2009 PDC Conference & Exhibition
  14. 14. urban legends of Healthcare Design All EBD Initiatives Start with Looking at the Research! 2009 PDC Conference & Exhibition
  15. 15. urban legends of Healthcare Design So Where’s the Beef? • Journals: Peer reviewed CHER, HERD, InformeDesign • Studies should be: Empirically based Utilize scientific rigor, quality of research design, large sample sizes, high degree of control Identify reliable patterns to findings 2009 PDC Conference & Exhibition
  16. 16. urban legends of Healthcare Design Are You Willing to Invest in these Design Strategies? Shortened Travel Universal Rooms Patient Centered Care Distances 2009 PDC Conference & Exhibition
  17. 17. urban legends of Healthcare Design “Designs which reduce nurse travel distances increase staff efficiencies” 2009 PDC Conference & Exhibition
  18. 18. urban legends of Healthcare Design How Do Nurses Spend Their Time? • Nursing represent the largest segment of healthcare staff within the hospital. • Average distance walked/shift = 3.0 miles/daytime shift. • Decreased travel distances = more time spent on direct patient care activities? 2009 PDC Conference & Exhibition
  19. 19. urban legends of Healthcare Design Travel Distance Case Study #1: • Joint study conducted by Ascension Health, Kaiser Permanente and Purdue University. Radial • Study included participation of 767 nurses from 36 M/S units around the country. Race Track • Study objectives include determining variations in distance traveled, time spent by category, and workload between three types of unit design: Corridor 2009 PDC Conference & Exhibition
  20. 20. urban legends of Healthcare Design Case Study Findings: • No statistically significant relationship was found linking differences in architectural types to differences in time Radial spent with patients. • More variation found in miles traveled Race Track and patient time between nurses on the same unit then between units. Corridor 2009 PDC Conference & Exhibition
  21. 21. urban legends of Healthcare Design Travel Distance Case Study #2: • Previous study conducted at the Rochester Methodist Hospital by the National Center for Health Services Radial Research and Development. • Study investigated the specific impact the unit design had on activities and Race Track subjective feelings of nursing personnel. • Study evaluated three types of unit designs all built at the new hospital Corridor building (specifically constructed for hospital research). 2009 PDC Conference & Exhibition
  22. 22. urban legends of Healthcare Design Case Study Findings: • Staff on radial units found to travel less and spend more time with patients. Radial • However, staff working on radial units also found to have more time in all categories identified. Race Track Corridor 2009 PDC Conference & Exhibition
  23. 23. urban legends of Healthcare Design “Designs which reduce nurse travel distances increase staff efficiencies” 2009 PDC Conference & Exhibition
  24. 24. urban legends of Healthcare Design What Can Be Learned? • Staff efficiencies depend upon multiple factors. • Nurses ability to organize work and staffing assignments has greater impact on efficiency than lessened travel distances. • Nurses adaptability allows them to compensate for limitations imposed by the physical design. 2009 PDC Conference & Exhibition
  25. 25. urban legends of Healthcare Design “Designs utilizing universal patient rooms accommodate change more readily” 2009 PDC Conference & Exhibition
  26. 26. urban legends of Healthcare Design Acuity Adaptable Care Model Universal Room Design Multiple acuities cared for on a Adaptable for use in varying single nursing unit/room patient acuity levels 2009 PDC Conference & Exhibition
  27. 27. urban legends of Healthcare Design Acuity Adaptable Care Model Universal Room Design Not a universally accepted How well does a standardized model of care. room adapt to customized care levels? 2009 PDC Conference & Exhibition
  28. 28. urban legends of Healthcare Design Universal Room Case Study: • Study conducted at six adult M/S Units across U.S. • Three of six hospitals utilized universal room designs. • Study identified three end-user definitions of flexibility; Adaptable Convertible Expandable 2009 PDC Conference & Exhibition
  29. 29. urban legends of Healthcare Design Case Study Findings: • At room level - benefits of adaptability of Universal Room Design could not be determined. • At unit level – Universal Room design concepts could impede operational flexibility in 3 of the 7 areas studied: Peer lines of sight Patient Visibility Zoning Options 2009 PDC Conference & Exhibition
  30. 30. urban legends of Healthcare Design “Designs utilizing universal patient rooms accommodate change more readily” 2009 PDC Conference & Exhibition
  31. 31. urban legends of Healthcare Design What Can Be Learned? • Completed studies of overall flexibility in healthcare settings are few; more research found for retail and workplace setting. • Studies on flexibility at the nursing unit level even fewer. • Universal Room Design giving way to Acuity Adaptable Room model. 2009 PDC Conference & Exhibition
  32. 32. urban legends of Healthcare Design “Designs which are patient centered lead to better clinical outcomes.” 2009 PDC Conference & Exhibition
  33. 33. urban legends of Healthcare Design Patient Centered Care: considers patients’ cultural traditions, their personal preferences and values, their family situations, and their lifestyles (Institute for Healthcare Improvement) Patient Centered Design: designs that put the patients needs and preferences first 2009 PDC Conference & Exhibition
  34. 34. urban legends of Healthcare Design Many levels in which to approach subject, today we focus only on three: Day Lighting Nature Sound 2009 PDC Conference & Exhibition
  35. 35. urban legends of Healthcare Design Day Lighting Case Study: • Study by JM Walch and Associates. • Tested effects of patient exposure to sunlight on pain medication levels after spine surgery. • Patients assigned to a “dim” room or “bright” room for recovery. 2009 PDC Conference & Exhibition
  36. 36. urban legends of Healthcare Design Case Study Findings: • Study indicated a 22% decrease in analgesic medication by recovering patients assigned to a “bright” room. 2009 PDC Conference & Exhibition
  37. 37. urban legends of Healthcare Design Nature Case Study: • Study conducted with patients recovering from heart surgery. • Patients randomly assigned rooms providing exposure to images of nature, abstract art, a blank panel or nothing at all. 2009 PDC Conference & Exhibition
  38. 38. urban legends of Healthcare Design Case Study Findings: • Patients in rooms where exposed to images of nature switched from stronger analgesics to weaker ones during recovery compared to other patients in study. 2009 PDC Conference & Exhibition
  39. 39. urban legends of Healthcare Design Sound Levels Case Study: • Study conducted with 165 patients undergoing elective colonoscopy. • Patients assigned to one of three groups: Visual distractions Visual + audio distractions No distractions 2009 PDC Conference & Exhibition
  40. 40. urban legends of Healthcare Design Case Study Findings: • Study revealed patients with visual + audio distractions had significantly reduced pain scores and PCS use. 2009 PDC Conference & Exhibition
  41. 41. urban legends of Healthcare Design “Designs which are patient centered lead to better clinical outcomes.” 2009 PDC Conference & Exhibition
  42. 42. urban legends of Healthcare Design What Can Be Learned? • Each study had good control group definition. • Each study had limited variables. • Large volume of studies in this subject; greater correlation between studies. • Significantly reduced patient stressors can result in shortened recovery and less pain medication required. 2009 PDC Conference & Exhibition
  43. 43. urban legends of Healthcare Design Comments from your Peers.... 2009 PDC Conference & Exhibition
  44. 44. urban legends of Healthcare Design EBD Continues to Evolve: Amount of EBD studies continues to grow: 1968 - 1998 84 2004 600 2008 +1,000 Tomorrow ??,??? 2009 PDC Conference & Exhibition
  45. 45. urban legends of Healthcare Design EBD Continues to Evolve: Past Areas of Research Future Areas of Research • Staff Stressors • Same-Handed Rooms • Patient Safety • Design Flexibility • Medication Errors • Family Outcomes • LOS • Support Services “...this emphasis on the elements that are aapart of the theory of “...this emphasis on the elements that are part of the theory of supportive design can allow other domains of knowledge to be supportive design can allow other domains of knowledge to be overlooked” overlooked” Kirk Hamilton Kirk Hamilton HERD Journal HERD Journal 2009 PDC Conference & Exhibition
  46. 46. urban legends of Healthcare Design EBD Continues to Evolve: Healthcare Providers Creating better environments for study through collaborations: • The Pebble Project/Partnerships A/E University • Ascension/Kaiser/Purdue Firms Programs • SRHS/Clemson/Others 2009 PDC Conference & Exhibition
  47. 47. urban legends of Healthcare Design Final Comments from your Peers.... 2009 PDC Conference & Exhibition
  48. 48. urban legends of Healthcare Design How to Better Your Approach to EBD: • Improving your “critical eye” • Utilize methodologies to maintain rigor • Identify your EBD Champion! 2009 PDC Conference & Exhibition
  49. 49. urban legends of Healthcare Design urban legends of Healthcare Design E-Copies of this presentation ( with supporting evidence) can be downloaded from SSOE.COM 2009 PDC Conference & Exhibition

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