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BIM Forum_2010_Beyond a Reasonable Doubt

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BIM Forum_2010_Beyond a Reasonable Doubt

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BIM Forum_2010_Beyond a Reasonable Doubt

  1. 1. Beyond a Reasonable Doubt Can (or Should) BIM be Evidence-Based? Dr. Debajyoti Pati HKS Architects 14 October 2010
  2. 2. Presenter Debajyoti Pati PhD, FIIA, LEED©AP Vice President, Director of Research, HKS Architects Executive Director, Center for Advanced Design Research & Evaluation (CADRE)
  3. 3. Learning Objectives 1. Understand factors that contributed to the emergence of the EBD model 2. Understand the fundamental essence of the EBD practice model in healthcare 3. Illustrate how physical design is being linked to organizational performance and bottom line 4. Explore the implications of mapping the EBD model to BIM
  4. 4. Agenda  What is EBD and how it emerged?  What changes is it effecting?  Healthcare examples  Implications for BIM  Discussions
  5. 5. What is Evidence-Based Design  Evidence-based design is the conscientious, explicit and judicious use of current best evidence from research and practice in making critical decisions, together with an informed client, about the design of each individual and unique project. (Center for Health Design)  Is a natural parallel and analog to evidence- based medicine.  Applicable to all buildings sectors.  Started in the healthcare sector.
  6. 6. Emergence of EBD  1999 • Institute of Medicine (IOM)published a report underscoring the need for a safer healthcare system o 44,000 to 98,000 preventable deaths o Deaths from preventable medical errors exceed deaths from motor vehicle accident, breast cancer and AIDS.
  7. 7. Emergence of EBD  2001, 2003 • Agency for Healthcare Research and Quality (AHRQ) highlighted the role of the physical environment (in addition to the people, processes and procedures) in improving care quality and safety.
  8. 8. EBD :: EBM  The conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient.  Integrating individual clinical expertise with the best available external clinical evidence from systematic research. (Sackett D, 1996)  EBM is the integration of clinical expertise, patient values, and the best evidence into the decision making process for patient care.
  9. 9. CHANGING THE DESIGNER – CLIENT DYNAMICS
  10. 10. Designer’s Role  Respond to programmatic needs
  11. 11. Designer’s Role  Understand: • core organizational needs • business processes SURGERYDECISIONPRE-PROCEDUREPROCEDUREPOST-PROCEDURE
  12. 12. Designer’s Role  Identify strategic organizational objectives/ goals to be targeted through physical design
  13. 13. Designer’s Role  Identify and articulate relationships between physical design decisions and organizational outcomes based on best available evidence
  14. 14. Designer’s Role  Conduct research to inform decision-making if evidence is not available
  15. 15. Designer’s Role  Implement evidence- based decision  Assess outcomes Predictable outcomes based on available data New knowledge through research Identify Intentions/ Issues Develop Hypotheses Informed DESIGN Collect DATA Evaluate Data Modify Hypotheses Disseminate Findings Survey Literature Return on Investment (Hard and Soft)
  16. 16. FROM ACTIVE RESPONSE TO PROGRAMMATIC NEEDS TO ‘PREDICTABLE’ INFLUENCE ON OUTCOMES OF ORGANIZATIONAL INTEREST
  17. 17. HEALTHCARE EXAMPLES
  18. 18. Organizational Outcomes of Interest  Reduce patient falls • Cost =10K un-litigated  Reduce patient transfer • Cost per transfer = $ 300  Reduce hospital acquired infection • Cost per infection = 10- 30K  Nurse retention • Cost per recruitment = 60K  Patient satisfaction  Market segment, referrals  …
  19. 19. Patient Falls: Clarian Methodist Study Objective: Test impact on new acuity adaptable unit design on patient outcomes Decentralization Room-side documentation alcove Location: CCCC, Methodist Clarian, Indianapolis Procedure: Before-after study, 12 outcome measures, 2 years baseline and 3-years post-move data Key finding: Patient falls declined by 75% Hendrich, 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, 13(1), 35-45.
  20. 20. Patient Transfer: Clarian Methodist Study Objective: Test impact on new acuity adaptable unit design on patient outcomes Patient rooms designed to accommodate varying acuity levels Location: CCCC, Methodist Clarian, Indianapolis Procedure: Before-after study, 12 outcome measures, 2 years baseline and 3-years post-move data Key finding: Patient transport decreased by 90% Hendrich, 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, 13(1), 35-45.
  21. 21. Patient Visibility: Stanford-Harvard Study Objective: Contrast safety concerns of frontline staff with national patient safety initiatives Funding: AHRQ + Fishman-Davidson Center for Service and Operations Management Location: 20 representative sample of hospitals across the U.S. Data Source: 1,732 staff-identified operational failures (2004 – 2006) Key finding: Top factors affecting safety: Equipment and Facility Tucker, A., Singer, S., Hayes, J., & Falwell, A. (2008). Front-line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems. Health Services Research, 43(5), 1807-1829.
  22. 22. Stanford-Harvard Study: Failure Sources  Equipment/ Supply (18%)  Facility (18%) • Layout • Maintenance + Housekeeping • Non-functioning infrastructure  Communication/ Documentation (16%)  Staffing/staff development (16%)  Medication (12%)  Process/policy (6%)  Response time (4%)  Security (4%)  Infection control (3%)  Task management (2%) Tucker, A., Singer, S., Hayes, J., & Falwell, A. (2008). Front-line Staff Perspectives on Opportunities for Improving the Safety and Efficiency of Hospital Work Systems. Health Services Research, 43(5), 1807-1829.
  23. 23. Patient Visibility: Columbia University Study Objective: Assess whether patient outcomes are affected by ICU design Location: Columbia University Medical Center, Medical ICU; random room assignment Data Source: 664 patients; hospital mortality, ICU mortality, ICU LOS, ventilator-free days Key finding: Severely ill patients had significantly higher mortality in low-visibility rooms; 18% higher Leaf, D., Homel, P., & Factor, P. (2010). Relationship between ICU Design and Mortality. Chest, Pre-published online January 15, 2010.
  24. 24. Infection: Canadian HAI Study Objective: Evaluate association between roommate exposure and risk of HAIs Location: A tertiary care teaching hospital in southeastern Ontario Procedure: Retrospective data on adult patients between 2001 – 2005; MRSA/VRE; C difficile; total roommates, unique roommates Key findings: each additional roommate • 11% increase in C difficile risk • 10% increase in MRSA risk • 11% increase in VRE risk Hamel M, Zoutman D, O'Callaghan C. (2010). Exposure to hospital roommates as a risk factor for health care-associated infection. American Journal of Infection Control, 38(3), 173-181.
  25. 25. The PEBBLE Project Data Repository  PEBBLE • Launched by the Center for Health Design in 2000 • ~ 60 member hospitals • Before-after and post- occupancy data in a central database
  26. 26. IMPLICATIONS FOR BIM
  27. 27. BIM Objectives  Enhance facility procurement performance  Predict built facility performance • Energy • Maintenance • Lighting • …
  28. 28. BIM Status  Sophisticated performance models  Assertions untested • Little empirical evidence from built facilities to support contentions  Similar to LEED status  Standardization of performance measurement protocol emerging… • ASHRAE, USGBC, CIBSE
  29. 29. Key Question SHOULD BIM BE EVIDENCE-BASED?
  30. 30. Next Steps Evidence Base Client Needs
  31. 31. Evidence Base  Post-occupancy performance  Pebble type commitment  Central data base
  32. 32. Organizational Needs  Framing BIM within organizational needs • Controlling airborne infection may be more crucial than saving on HVAC cost…  Situating BIM within the larger context of organizational performance • It is not necessarily about more economic first and life cycle cost • It is about optimizing facility performance to target organizational goals
  33. 33. A DIFFERENT NATURE OF RELATIONSHIP WITH CLIENT ORGANIZATIONS MUST START WITH EVIDENCE Where is the evidence?
  34. 34. THANK YOU

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