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EVIDENCE BASED DESIGNEVIDENCE BASED DESIGN
RESEARCH STUDIES
Defining the Design
Characteristics of a
S f l Ad t blSuccessful Adaptable
Inpatient Unit
Debajyoti Pati, PhD, AIIA
Tom E....
Acknowledgements/Credits
• AIA 2006 Research Grant
• Herman Miller
• Dr Carolyn Cason, UT Arlington School of Nursing
• Pa...
Learning objectives
• Understand the role of flexibility in promoting
ffi i i ti tefficiency in patient care.
• Understand...
Content
• Flexibility background
• Information gap
• Framework
• Question• Question
• Method
• Flexibility meaningFlexibil...
Flexibility background
• The architectural perspective:
– Workplace and retail sectors: shearing layers
• Shell, services,...
Information gap
• Hospital level flexibility concepts
• Very little information at inpatient unit level:
Universal rooms– ...
Question
• What does flexibility mean to different
stakeholders?
• What physical design variables influence
stakeholders’ ...
Framework
• Flexibility to adapt: accommodate change without
change in environmentchange in environment
• Flexibility to c...
Method
• SETTING
– Six hospitals
– Medical-surgical units
• SAMPLING
– Purposive
M i i i bilit– Maximize variability
• DES...
Method
• PARTICIPANTS
– Nursing, RT, Materials
Management, EVS,
Pharmacy, Dietary
• TOOLS
– Semi-structuredSemi structured...
Sample
uction
etion
ed
ze
ape
tion
gModel
Patient
sal
Name
Constru
Comple
TotalBe
UnitSiz
UnitSha
Circulat
Nursing
Nurse:P...
Parker Adventist
FIGURE LEGEND
M Medication
E Equipment
C Clean Supply/ Utility
S Soiled Supply/ UtilityS Soiled Supply/ U...
Clarian West
FIGURE LEGEND
M Medication
E Equipment
C Clean Supply/ Utility
S Soiled Supply/ UtilityS Soiled Supply/ Utili...
Laredo Medical Center
FIGURE LEGEND
M Medication
E Equipment
C Clean Supply/ Utility
S Soiled Supply/ UtilityS Soiled Supp...
McKay Dee
FIGURE LEGEND
M Medication
E Equipment
C Clean Supply/ Utility
S Soiled Supply/ UtilityS Soiled Supply/ Utility
...
St Francis Hospital
FIGURE LEGEND
M Medication
E Equipment
C Clean Supply/ Utility
S Soiled Supply/ UtilityS Soiled Supply...
St Rose Dominican-Siena
FIGURE LEGEND
M Medication
E Equipment
C Clean Supply/ Utility
S Soiled Supply/ UtilityS Soiled Su...
FINDINGS
Flexibility meaning
• Management
– Ability to manipulate higher-level resources (staffing,
teaming) to address unique circ...
FLEXIBILITY TO ADAPT
Peer lines-of-sight
• Operational issue • Implications
– Helping hand,
mentoring, socialization,
de-stressing
Aff t
– Simp...
Peer lines-of-sight
Patient visibility
• Operational issue • Implications
– Higher acuity, JCAHO
regulations, non-
contiguous patients
Aff t
–...
Patient visibility
Multiple division/zoning option
• Operational issue • Implications
– Perceived barriers
– Assignment problems
• Affects
– ...
Multiple division/zoning option
MODIFIED CORNERS
= PERCEIVE D
BARRIER
Proximity of support
• Operational issue • Implications
– Walking distance
– Stress, fatigue
• Affects
– Simple shape,
sym...
Proximity of support
Resilience to move services
• Operational issue • Implications
– Long term census
fluctuation
• Affects
– Standardized roo...
Resilience to move services
Inter-unit movements
• Operational issue • Implications
– Multi-unit caregiver
responsibility
• Affects
– Communicating st...
Inter-unit movements
Service expansion options
• Operational issue • Implications
– Census fluctuations
– Unit-service misfit
• Affects
– Visua...
Service expansion options
C
SOFT SPACE FOR
SUPPORT CORESUPPORT CORE
EXPANSION/ SHARING
N
NSERVICE SPREAD
INTO ADJOINING
UN...
FLEXIBILITY TO CONVERT
Adjustable support core
• Operational issue • Environmental
l t– Supply and equipment
storage
– Shape and size of
correlat...
Adjustable support core
FLEXIBILITY TO EXPAND
Expandable support core
• Operational issue • Environmental
l t– Operational changes
over time
• Affects
correlates
– Adja...
Expandable support core
C
SOFT SPACE FOR
SUPPORT CORESUPPORT CORE
EXPANSION/ SHARING
N
N
N
We thank you for your attention!
Brief bibliography
Chefurka, T., Nesdoly, F. and Christie, J. , 2006, “Concepts in Flexibility in
Healthcare Facility Plan...
Contact information
Debajyoti Pati, PhD, AIIA
Director of Research, HKS Architects,
Tom E Harvey Jr, AIA, FACHA, MPH
Princ...
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HCD_2007_Flexibility Study

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HCD_2007_Flexibility Study

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HCD_2007_Flexibility Study

  1. 1. EVIDENCE BASED DESIGNEVIDENCE BASED DESIGN RESEARCH STUDIES
  2. 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. 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. 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. 5. Content • Flexibility background • Information gap • Framework • Question• Question • Method • Flexibility meaningFlexibility meaning • Flexibility to Adapt • Flexibility to Convert • Flexibility to Expand • Conclusions
  6. 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. 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. 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. 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. 10. Method • SETTING – Six hospitals – Medical-surgical units • SAMPLING – Purposive M i i i bilit– Maximize variability • DESIGNDESIGN – Exploratory – Qualitative
  11. 11. Method • PARTICIPANTS – Nursing, RT, Materials Management, EVS, Pharmacy, Dietary • TOOLS – Semi-structuredSemi structured interviews – Plan of inquiry – Content analysisContent analysis
  12. 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. 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. 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. 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. 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. 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. 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
  19. 19. FINDINGS
  20. 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
  21. 21. FLEXIBILITY TO ADAPT
  22. 22. Peer lines-of-sight • Operational issue • Implications – Helping hand, mentoring, socialization, de-stressing Aff t – Simple shape units – Corner location of caregiver workstation in t• Affects – Nurse, respiratory therapist support core – Back-stage corridors linking caregiver workstations • Environmental correlates – Caregiver work station, workstations – Simple circulation configuration g , corridor shape, corridor configuration
  23. 23. Peer lines-of-sight
  24. 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
  25. 25. Patient visibility
  26. 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
  27. 27. Multiple division/zoning option MODIFIED CORNERS = PERCEIVE D BARRIER
  28. 28. Proximity of support • Operational issue • Implications – Walking distance – Stress, fatigue • Affects – Simple shape, symmetrical units – Distributed nursing t Affects – Nurse, nursing administration, environmental services, support spaces proximate to distributed caregiver workstations – Decentralized room- dietary services, materials management, respiratory therapy E i t l – Decentralized room- side supply cabinets • Environmental correlates – Patient room, support spaces
  29. 29. Proximity of support
  30. 30. Resilience to move services • Operational issue • Implications – Long term census fluctuation • Affects – Standardized room – Standardized support core – Nurse, nursing administration • EnvironmentalEnvironmental correlates – Standardization
  31. 31. Resilience to move services
  32. 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
  33. 33. Inter-unit movements
  34. 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
  35. 35. Service expansion options C SOFT SPACE FOR SUPPORT CORESUPPORT CORE EXPANSION/ SHARING N NSERVICE SPREAD INTO ADJOINING UNIT N
  36. 36. FLEXIBILITY TO CONVERT
  37. 37. Adjustable support core • Operational issue • Environmental l t– Supply and equipment storage – Shape and size of correlates – Cabinetry, support room shape, support room si erooms • Affects – Nurse, nursing size • Implications – Modular, movable administration, environmental services, dietary services, materials management compartments or cart system for storage – Minimize walls with MEP elementsmaterials management, pharmacy, respiratory therapy MEP elements
  38. 38. Adjustable support core
  39. 39. FLEXIBILITY TO EXPAND
  40. 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
  41. 41. Expandable support core C SOFT SPACE FOR SUPPORT CORESUPPORT CORE EXPANSION/ SHARING N N N
  42. 42. We thank you for your attention!
  43. 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. 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

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