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Designing the Physical Layout for an Effective Hospital
Dillan Brewer
HADM 4000-002
Developing Health Care Organizations
April 29, 2015
I certify that I have read all the guidelines for research papers for this course, both in the course
syllabus and in the Web page handout “Guidelines for Research Papers”, and that this paper
fully complies with them, except for any waivers made by explicit prior agreement with the
instructor
Designing the PhysicalLayout for an Effective Hospital
Executive Summary
It is important for health care facilities to perform all of the necessary tasks and
requirements needed to be able to provide the best quality and care available to their patients.
One of these tasks is to design a physical layout that will make the hospital efficient and
effective. The physical layout of a hospital can have a tremendous impact on how effective the
care is that is given to patients. The layout impacts everything that happens on a daily basis in a
health care facility. Administrators must work with other health care professionals and the design
team in order to create a satisfactory layout that will best serve the health care needs of the
patients.
Traditional hospitals were viewed negatively by its patients. The last place anyone ever
wanted to be a person was sick was the hospital because going to the hospital normally made
things worse. The designs of these hospitals were inefficient and not capable of meeting the
needs of patients. The buildings were poorly structured and not capable providing optimum care.
New designs and processes were needed to make hospitals into a positive image.
Designing new hospitals is no small task. Organizations should conduct site visits,
perform extensive research, and determine what the overall goals and strategies are of the
hospital. There are several designing methods that can be performed to provide an effective
physical layout. Simulations can be done to decide how different layouts will affect patient
satisfaction and quality of care. Methods such as Lean management and evidence-based design
also allow for health care organizations to determine what is the best possible physical layout for
their facilities. Some organizations can even use these methods to remodel older hospitals in
order to make the layouts successful for their facilities.
The attributes, products, and equipment that contribute to the layout are vital in providing
a facility that will be able to meet the health care needs of patients. There are many variables that
hospitals can add to a layout to make the design more friendly and satisfying to patients. The
visual and audible environments can have an impact on the layout and the health of patients in
the hospital. Planning the location of materials such as workstations, supplies, and equipment is
important in having an effective healthcare facility.
The overall goal for designing an effective physical layout for a hospital is to have the
best atmosphere and efficient area to provide the best quality care to patients in the facility. A
successful hospital design will satisfy the needs of its patients in the more productive and safe
way. An effective hospital layout will allow health care professionals to perform quality health
care services that will improve the lives of patients.
I. The Overview of Hospital Design
A. Traditional Hospitals
1. Layout of Hospitals
2. Design of Architecture
3. Patient Views of Traditional Hospitals
B. New Designs for Hospitals
1. Evidence-based Design as a Guiding Principle
2. Creating New Processes from Identifying Hospital Needs
II. The Designing Process for New Facilities
A. Site Visits and Research
B. Design Selection
C. Changing the Paradigm
1. Value Stream and LEAN Management
2. Workplace Organization Design
3. Workflow Analysis
D. Making Older Hospitals Efficient in Today’s Society
III. The Importance of Layout for a Patient-centered Environment
A. Layout Attributes, Products, and Equipment
B. The Visual Environment
C. An Audible Atmosphere and Need for Communication
IV. Hospitals with Effectively Implemented Layouts
V. Conclusion: The Need for Successful Layouts
Table of Contents
Introduction………………………….…………………………………………………...1
The Overview of Hospital Design…………………………………………………….....2
Traditional Hospitals…………………………………………………………….2
New Designs for Hospitals……………………………………………………….3
The Designing Process for New Facilities………………………………………………4
Site Visits and Research…………………………………………………………4
DesignSelection………………………………………………………………….5
Changing the Paradigm…………………………………………………………7
Making Older Hospital’s Efficient in Today’s Society……………………….11
The Importance of Layout for a Patient-centered Environment…….……………...12
Layout Attributes, Products, and Equipment……………….…….……...…..12
The Visual Environment……………………………………………………….13
An Audible Atmosphere and Need for Communication…………….……….15
Hospitals with Effectively Implemented Layouts…………………………………….16
Conclusion: The Needfor Successful Layouts……………………….……………….19
Works Cited…………………………………………………………………...………..21
Introduction
The physical layout of a health care facility has serious and important effects on the
processes that take place within a health care organization. The layout of a health care facility
plays a crucial role in the daily occurring operations of the business. Each facility must be
planned extraordinarily well so that there are limited expenses for future renovations and
modifications. Effective facility-planning techniques have been found to reduce operational
inefficiencies and may lower such costs by up to thirty percent (Huang).
There are many health care facilities that lack an effective layout for their hospitals and
medical practices, but many do not do so intentionally. It comes from not understanding the
effect that the physical layout has on the performance of the health care organization. The
physical layout is often overlooked compared to other important business needs such as time,
money, equipment, and staffing. Space planning is important in the success of a health care
organization, but this designing of an optimal health care facility is often ignored and set aside to
deal with at another time.
The designing of the physical layout for a hospital needs to be dealt with at the beginning
of the building process of a hospital. This will help make sure that the performance and quality
of care for that organization is not halted or impeded. In order to plan for future designs, there
must first be an understanding of how hospital layouts used to be designed and why there
became a need for change in health care facilities in regard to the physical layout and design of a
hospital.
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The Overview of Hospital Design
Traditional Hospitals
The terms used to describe how traditional hospitals were viewed as can be
visualized in words such as “dreadful,” “awful,” and “discomforting.” These are all deemed
reasonable terms in regard to how hospitals were in the past.
Hospitals were places that many people tried to avoid. Traditional hospitals were
regarded as places where people only went if it was absolutely necessary. This was because if
someone was sick, it was likely that the person would not make it out of the hospital alive.
Hospitals were viewed poorly not only by the events that took place on the inside, but by how
the design and architecture of these health care facilities were as well. The architecture of the
hospitals evoked feelings and emotions that negatively impacted the visualization of the
facilities. There was no sense of comfort and homeliness in the hospitals. The environmental
factors did not contribute to a feeling of protectiveness and safety from the medical events
occurring in the lives of each patient. Many traditional hospitals were dull in atmospheric
appearances and the lack of vibrancy did not appeal to the patients waiting to be examined.
Everything was very congested in terms of patient and employee workflow, which
stressed out health care providers and made the patients anxious. The layout of the examining
rooms for the patients tended to not give much privacy and this made patients feel uncomfortable
when dealing with their medical issues. The walls were very thin and sound from one room to
the next could be easily heard by nearby physicians and patients. In fact, the only physical
structures that were allowing privacy and a blockade from catching another patient’s diseases in
the examining rooms were curtains being help up on steel rails. This lack of privacy was not very
patient-oriented for those wanting to be seen by a health care provider. The lack of privacy for
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patients and the threat of diseases being spread easily in the hospital environment were key
factors in determining that a new layout system for health care organizations was needed.
Fortunately, with the advancement in technology, the image of hospital’s has changed
from being a place of lingering death to a place where effective treatment can be given
(Miller: 30). Hospitals began to address patient needs and began to create an environment that
was more accommodating for people entering a health care facility. Other aspects of health care
in the hospital setting began to change, such as more flexible visiting hours, improved meals for
patients, and better documentation of a patient’s health. Efforts in design change were also
visible such as improved lighting, noise reduction, and a more homely environment with colorful
walls and more comfortable bedding (Miller: 30).
The growth of medical technology shifted the mindset of healthcare from curative to
preventive models. In order to increase the quality of care and the overall health of patients, new
designs in hospital layouts were needed. This would help lead to an increase in overall efficiency
of health care professionals and better safety for the people involved with these health care
organizations.
New Designs for Hospitals
Healthcare has become very focused on being patient-centered. Health care organizations
are now more than ever under pressure to not only provide quality care that is cost effective, but
also keep quality as a key focus such as in reducing medical errors.
In order to keep this mentality, healthcare organizations have adapted the idea of
evidence-based design. The study of this method has become significant. With architects
constructing and remodeling healthcare facilities, evidence-based design is an approach that will
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increase the overall quality and performance of care in hospitals. This method has been proven to
help with not only patient healing, but also health care professionals well-being and safety of the
entire facility. The physical environment at a hospital has been proven to affect several health
care issues such as pain, stress, errors, and the overall health of a patient. Evidence-based design
is used by managers and architects in order to plan and design health care facilities. It also should
feature the input of all different specialties of healthcare professionals such as nurses, physicians,
and technicians. Using an evidence-based design helps to ensure that hospitals are safer, health
care professionals are less stressful, and patients are receiving the highest quality of care with
little safety hazards (Spikes).
The Designing Process for Facilities
Site Visits and Research
The speed at which healthcare rapidly changes makes it difficult at times to ensure a
hospital is up to date on the latest healthcare technology and medical practices. If a health care
organization falls behind with the changing of medical technology, a facility can become
ineffective and inefficient. Health care managers and architects must also be able to manage the
change that health care goes through. Designing a new health care facility can be a difficult task
when facing such a rapid and always evolving culture. Architects can use site visits and research
strategies to make sure the designs of a layout are kept in proper standards and all requirements
are fulfilled. Site visits allow for designers to view different layouts to see which alternative is
most beneficial for their own health care organization they are designing. Site visits also help
identify potential problems that different layouts can and may encounter throughout the years of
a health care organization.
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When conducting a site visit, it is important that a design team is created before
performing any further tasks. Having a whole team of designers can help create a variety
of new ideas and perspectives in regard to creating their own layout for a hospital. It is important
to make sure everyone understands the overall goals of what they plan to accomplish as a design
team. The design team can break apart into different groups to focus on specific, general, and
departmental designs for their health care organization. In terms of specific items, the designers
can focus on matters such as patient room walls or nursing stations. General designing can show
how to structure a facility to become patient-centered and to improve the quality of the facility
(Marberry: 5). A departmental design would focus on learning the operations of specific
departments such as an intensive care unit or an emergency department.
Conducting research lets an organization see what the state-of-the-art facilities look like
and how these facilities are managed and operated. It is important to conduct research on
different types of healthcare layouts so it can be easily seen what type of layout will work best
for the desired goals and needs of the facility needing to be designed. Once different facilities are
researched and visited, architects can decide which facility they want to design. Analyzing
research also opens up the opportunity to see and determine if maybe there are variables that
could be added in order to improve a particular layout of a hospital. It is important to make sure
that these processes occur because if the proper design is not selected, it could lower the
effectiveness of that particular hospital. (Marberry: 8).
DesignSelection
The best facility designs involve multi-step processes in deciding what layout a health
care organization is going to use and how the health care organization is going to implement the
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design. This process begins by observing and analyzing the current situation. A health care
organization needs to identify what its needs and goals are. The health care facility also needs to
identify where possible problems and issues may occur during the implementation of the design
of the hospital. There needs to be an observation of space regarding what type and how much
space is being used currently and what the future needs will be when implementing the design.
Flow charts should be utilized in determining where and how the layout of all materials, rooms,
equipment, and providers will move throughout the health care facility (Evans). There should
also be multiple possible layouts designed in case something happens in which the first layout
implementation goes wrong and the next best possible solution is needed.
One very popular tool that is being used to determine which process to use in designing a
layout is by using simulations. Simulations for designs help to determine layout criteria such as
costs, flexibility, safety for patients and providers, utilization, and maintenance (Liu). The
simulations help to show how possible each layout design is and how it would be able to operate.
It takes in considerations that make the designing process difficult such as high costs, long
construction times, and compatibility of systems. The costs that are considered in the simulations
are the costs for initial implementation and for maintaining the layout. The safety measures taken
by a hospital affect not only patients, but also employees in the health care facility. Simulations
show how durable the hospital layout can be over long periods of time and how easily it is for
health care providers to optimize the utility of the layout in order to increase the quality of care
for the patients of the health care facility. There needs to be as little workflow movement as
possible for health care providers in the hospital to ensure the quality of care is not decreased
because of the fatigue of its providers.
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The speed of movement and workflow within the health care facility is one of the most
important criteria in deciding what layout to implement. Saving time moving around in the
hospital saves the hospital money and efficiency so the layout must be able to produce the most
efficient movement of workflow in the health care facility. Maintaining the sustainability of the
physical layout is also a very important factor for choosing the proper layout as well as providing
environmentally friendly aspects to the health care facility. These two factors are important
because providing eco-friendly appliances and having proper maintenance techniques for a
particular layout can help the hospital save lots of time, money, and resources in the longevity of
the health care organization (Liu).
Changing the Paradigm
New health care facilities are undergoing a vital change in how care and quality are
evaluated. Facilities are being asked to operate with fewer resources while still improving the
results for the patients keeping quality and safety as top priorities. Providers must work with
these changes in order to receive as much reimbursement from insurance companies as possible.
The most popular method currently in producing these types of results is by using Lean
management. This methodology is designed to reduce waste while performing at a high quality
and productivity of services. This process was standardized and perfected by the Toyota
Production System in the assembling of cars (Joseph).
Designing a layout for a hospital uses many key Lean principles. The objectives of Lean
are to have a focus on patients in order to discharge them in a timely fashion after receiving good
care, reduce costs of the hospital, and to improve the quality of the care. Other Lean objectives
are to reduce the time spent on a particular task or area and to simplify the work process so that
8
patient satisfaction is high and the care given to each patient is a direct result of each individual’s
health care needs. The optimal facility layout involves obtaining smooth flow, minimizing
handling distances, reducing costs and wastes, and improving the work environment (Joseph).
In order to develop the most optimal layout, there needs to be an assessment of how
current operations are running and how the new Lean design will benefit the future of the
hospital. A workflow analysis is crucial in designing an effective layout. A workflow analysis is
used with being able to value stream a particular facility and its physical layout (Novicoff). A
value stream shows all the activities required to bring a service from a health care provider to the
patient in fulfillment of their services needed. Using value stream can evaluate deficiencies in
quality of the services rendered and wastes of a hospital. This layout system focuses on reducing
wait time, reduce waste, high quality assurance, and using no unordinary resources to provide the
best care available. A hospital that uses the Lean system will also use visual controls in aiding
its patients and health care providers. These visual controls are simple signals that provide an
immediate understanding of a situation or condition. Visual controls in a layout will help reduce
time wasted and increase the efficiency of the health care facility.
A workflow analysis shows how materials, patient information, and people in the health
care organization move through a hospital. It is used in order to improve efficiency, safety, and
the quality of care given within the facility. The figure below shows the workflow of patients
through a typical hospital layout. Patient flow can become rather complex with lots of moving
parts and therefore it is important to try to eliminate as much movement as possible. When
transportation is decreased, there can be a prevention of medical errors and this will help keep
high quality measures for the hospital.
9
1
A Lean layout will not only provide an area of space for the daily operations of the
present, but will also be prepared to adapt to the always changing health care environment and
1 “LSCC Adult Health and Wellness at Lake Aire Visit Workflow.” [Online Image]. (2010).
Web. 18 Mar. 2015. Retrieved from http://www.slideshare.net/ataveechai/clinic-
workflow-diagram.
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the space needed to grow within the facility. This type of layout design will always be trying to
have continuous improvement for the layout. The layout is always prepared and open to new
ideas for better processing of health care for the organization.
The transportation aspect of Lean is also very important when designing the physical
layout of a hospital. A health care facility does not want excessive movement of patients,
medicines, or supplies. Therefore, the design of the hospitals needs to be where each item a
patient needs or will use is as close to the patient as possible from the time the patient arrives to
the hospital until the time the patient is discharged. The less movement there is within the
hospital, the better of a design the layout is. Having a Lean facility includes being able to have
alternative layouts ready for evaluation if something changes within the health care organization.
It is very beneficial to be a Lean facility because if done correctly, the layout will optimize
workflow, increase staff productivity, reduce wastes, be more efficient, have a safer environment,
and will attain the highest level of quality possible (Joseph).
Even though there may be some resistance to the process changing of Lean, the usage of
Lean in the designing process of a layout will result in better satisfaction and experiences for all
people involved in the health care facility. There will be a reduction in wait time when using
Lean and this will lead to higher patient satisfaction. The quality of care for each patient will be
higher because there will be less medical error and fatigue by health care providers. The patient
satisfaction will also increase because patients will be able to spend more time with their
providers because workflows will be able to reduce unneeded transportation and movement
throughout the hospital. Many processing techniques will become standardized and this will help
reduce waste and errors in the health care facility. Employees will also be satisfied because they
will be able to conduct their procedures in a safe environment. Health care provider needs will be
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attainted at a faster rate using this methodology. This process will allow for helping the patient
receive quality care to be the focus in the hospital (Joseph).
Making Older Hospitals Efficient in Today’s Society
A big issue facing health care in the United States is the aging of the buildings of
hospitals. Older hospitals were designed to mainly house and treat patients and these facilities
can sometimes have lots of difficulty adapting to the present needs of hospitals. Many architects
have a hard time making older hospitals work for the goals of health care facilities today. Aging
facilities make it a challenge to retrofit the buildings with new technology and state-of-the-art
equipment, even as educated patients demand the highest level of innovation available when
seeking out their hospital of choice (Wardlaw). The problem with older hospitals is that many
were not built for expansion either vertically or horizontally. It is important to make sure that the
design of older facilities will be able to meet the goals and desires of the hospital.
Another key issue in dealing with older health care facilities is the safety hazards an older
hospital may have. The hospital needs to have enough space so that patient flow and
organizational flow is not hazardous. The overall structure of the hospital must be sound,
meaning that the roofing, walls, and flooring are all in good keep. (Miller: 64).
Many hospitals that become bought out by larger health care organization undergo
restoration projects in order to keep up with the demanding quality and safety concerns I health
care. Renovating hospitals can help lower costs and are a cheaper alternative than building a
layout from the ground up. The problem with this strategy is that the parameters of the design are
limited in regard to how much can actually be changed on an established building. Older
hospitals have many concerns and issues when dealing with their overall effectiveness and
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efficiency for modern health care, but those facilities that are able to undergo renovation can
become vital acquisitions to many prominent health care organizations throughout the country.
The Importance of Layout for Patient-centered Environment
Layout Attributes, Products, and Equipment
There are several important factors to consider when implementing and designing the
layout for a hospital in order for the facility to be optimal and effective. There must be a
determination of the resources given and how those resources will improve the quality and safety
of care given in the organization. Designing private in-patient rooms is able to decrease infection
rates and increase the privacy of patients in a hospital. It is also a good idea to have decentralized
nursing stations in the layout of the facility. The decentralization of work stations for health care
professionals helps to improve the visibility of patient rooms and decreases the distance that the
nurses and other staff are from each patient’s room (Hamilton). Unit configuration and location
for different medical devices and products helps to promote the efficiency in the process of
delivering high quality of care.
It is also important to consider the little variables that make healthcare run smoothly on a
daily basis. The idea of washing a physician’s hands before and after each surgery to eliminate
the spread of germs and diseases was a major milestone in delivering health care to those who
were sick and unhealthy. Promoting hand washing as often as possible can be done by providing
hand-washing stations often throughout a facility. It is also important to remember that you are
not only providing a service to the patient, but to the family and caretakers of the patient as well.
This causes a need for an efficient family area within the patients room. This helps to promote
communication with the family and the health care providers, it gives way to trust being
13
established between the family and the health care providers, and its helps to promote the desired
positive patient satisfaction within the facility (Spikes).
The health care staff can also suggest ideas on how to help benefit the facility to ensure
the layout is capable of supporting all the needs of the hospital. If the staff feels like the
workspace currently is too small, the new layout can provide a larger workspace for the health
care professionals to use. It is also important to make sure that there are lots of storage areas
within the hospital layout. There needs to be enough storage to be able to put away supplies,
carts, medical devices, and other equipment items.
With the increase in health information technology and electronic health records, there
needs to be computer workstations in all patients’ rooms that can be mounted to the room so that
there is always a computer in each room. There should also be concerns for energy conservation
and the overall “green” concept in the new layout. Having efficient equipment and materials
throughout the facility such as for lighting and power services can help increase the quality of
services, promote patient safety more effectively, and can decrease the costs of the health care
facility in the long run. Providing an effective layout can help the staff learn cost and safety
outcomes, which can in turn lead to better patient and employee satisfaction. (Marmion).
The Visual Environment
The atmosphere created visually can have a large impact on the overall patient experience
and satisfaction when they go to a hospital. The physical layout of a facility where care services
take place is viewed as an important factor relating to how patients undergo the healing process.
Being hospitalized can become a very stressful and anxiety filled time in a patient’s life. It can be
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both physically and mentally exhausting for patients and they desire to have the best health care
facilities and services available to them when these patients enter a hospital.
The physical layout of a hospital can have a huge affect on the overall patient satisfaction
of their health care. The visual environment can consist of windows, lighting, views of nature,
art, wall coloring, and plant life. The visual environment can have an impact on cost and quality
of care for each patient that walks into the hospital. Studies suggest that covered furnishing,
colors of items and walls, and art are environmental factors that can positively affect the
recovery and rehabilitation of a patient in a hospital setting (Laursen).
The visual environment has a considerable effect on pain control and therapeutic
activities that go on during the stay at a health care facility. The impact that a hospital’s
atmosphere can have on a patient’s anxiety and pain can be very beneficial to the health care
organization. If the environment is able to be a positive experience and patient satisfaction is
good, then healthcare costs of the hospital could be reduced for that particular patient. Making
sure that there is ample sunlight available to each patient’s room is also beneficial for the
hospital and the patient it is providing care for at that certain time. Adding plants and vegetation
to the patient’s room or simply having a view of it outside the window can create for a more
homelike atmosphere. This can help lower anxiety levels and calm patients during their stay at a
healthcare facility. Designing rooms with vibrant and positive colors also can help relieve
patients of stress, pain, and anxiety. When these feelings and emotions are suppressed, the
patient will begin to want to move on with their lives and leave the hospital. This helps to
decrease the length of stay and now the hospital can see more patients at a faster rate. This also
benefits the hospital by gain more reimbursement values for profit for themselves and spend less
on each patient a physician will encounter (Laursen).
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An Audible Atmosphere and the Needfor Communication
The quality of care can be greatly impacted by a variety of different components. One of
the biggest and most influential of these is the process of communication in delivering care of
good quality and safety. The physical design of a health care facility can significantly impact the
effectiveness of communication within a health care organization among health care providers.
Lack of effective communication is one of the main causes of medical error in health
care. The effect of spatial layout in the physical design of a hospital plays a valuable role in
determining the efficiency of communication amongst health care providers. Spatial elements of
a hospital unit that reduce physical accessibility and generate limited visibility were found to
reduce the frequency of communication among health care providers, which negatively impacted
the quality of care received by patients (Hua). One design that has proven to help decrease
incorrect communication is the decentralization of provider units in a health care organization.
Traditionally, most hospitals are centralized meaning there is one provider station serving as the
main unit for provider interaction and affiliation. An effective facility should be decentralized.
In a decentralized layout, there are multiple provider stations throughout the health care facility.
There are many positive takeaways in regard to a decentralized layout system for a
hospital. There are some primary goals of this type of layout such as helping to limit provider
fatigue. The fatigue is a result from walking lots of paces very often throughout a long shift at
the hospital. Decreasing fatigue will not only make the providers more satisfied, but providers
will also have improved quality of care which will lead to higher patient satisfaction and reduced
costs for the health care organization. This also will increase patient safety because if a provider
is fatigued, the provider is more likely to create a medical error while interacting with the patient.
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Decentralized units also help control the workspace that is always crowded and noisy if it was a
centralized unit. Being more spread out helps the providers give faster feedback to patients
increasing the overall experience at the hospital. In decentralized units, providers have forty
percent more visits to patient rooms and that patients experienced significantly quicker responses
to calls made (Hua).
Positive audible noises have been shown to help with patient satisfaction and anxiety
while being tended to by physicians and nurses. Soft and light music has been proven to help
relieve the stress and reduce the nerves that in-patients have while waiting in their rooms for a
particular surgery or operation (Steinke). While patients are waiting to be called back by their
physicians, many hospitals will play relaxing and soothing rhythms and tunes to help ease the
anxiety that patients may be feeling at the hospital. A hospital design that had speakers in the
waiting rooms and in the examination rooms would lead to positive patient satisfaction because
the music would help distract from any discomfort that the patient might be feeling during the
process of receiving care from a health care provider.
Hospitals with Effectively Implemented Layouts
Health care facility design is like other organizational designs in that each specific
hospital has its own unique layout that has its own set of benefits specifically for that hospital.
Each hospital will have its own specific needs and goals that the facility will try to achieve. No
matter if it is a small or large hospital, each hospital will all have their own particular layout that
best suits that health care facility. There are many types and examples of hospitals that
effectively implemented a physical layout that became successful for its practice. It is important
17
to understand that hospitals may appear differently, but each hospital must strive to provide the
best quality of care to its patients and an effective layout can make this goal more attainable.
There have been many successful hospital layouts implemented over the years ranging in
a variety of different types of hospitals. When looking at a patient care unit, a great example is
San Francisco’s Pacific Presbyterian Medical Center. It inspires a more residential atmosphere
where patients can even prepare their own food in kitchenettes. There is a full-spectrum lighting
and mostly wood finishes rather than metal on the chairs and seating within the hospital. There is
also lots of artwork throughout the health care facility and rooms are often decorated with lots of
the patient’s own belongings to make them feel like are more at home. The nursing stations are
very large areas and these stations are open to patients and their families in order to help be a
patient-centered environment. The rooms are incredibly large so that there is plenty of seating for
visitors, room for the providers’ work area, and media accessories such as televisions and video
players (Miller: 178).
Pinelake Medical Center also has a really effective layout design for a hospital.
Architects wanted to have a comfortable environment that incorporated a convenient
way-finding for all patients which would minimize conflict between inpatient and outpatient
traffic. Pinelake Medical Center uses decentralization of traditional departments to help provide
better services for the patients in the hospital. All the patient rooms are oversized to
accommodate family and visitors and are furnished in a residential style, giving each room a
home feeling. There are large storage areas for patient items and medical items as well. The
rooms are all painted with vibrant colors and the lighting in each room can be altered depending
on whether or not the provider needs more of an exam lighting style rather than a residential
lighting style. Provider stations are located no more than fifty feet from each room, which is
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needed when trying to have a facility that is providing patient-focused care. Supplies and
medical equipment are always located close to the patient rooms so that time is reduced when a
patient needs anything during an inpatient visit (Miller: 192).
Pediatric Surgery Centers also have their own specific layout needs that help to ensure
that the children being treated are given the highest quality of care. A great example of a
pediatric hospital design is the Vanderbilt University Medical Center. This hospital has large
operating rooms so that all the equipment needed for procedures can easily fit and be moved
around if needed. The waiting room features large family areas with lots of natural light and
pleasant views of the outdoors. It is also located across from the major hospital which provides
patients with an emotional security if the services provided in the pediatric facility become to
extraneous for those health care providers. The workflow is designed in a way that patients enter,
go to surgery, recovery, and back to their assigned rooms all without ever crossing other patients
at various levels of their procedures. The design has a pod arrangement which is more efficient
for the nursing staff because it greatly reduces the time travel to and from the workstations. The
rooms are also decorated and painted to help relieve the stress and anxiety that many children
have when visiting the hospital. Bright colors and decorations of the most popular children items
help to ease the pain that surgery might have for young children in a health care facility
(Miller: 227).
Women’s Centers have also emerged over the past few decades as organizations being
designed specifically for the needs of females and the services women require. The layout of
women’s centers should be able to include a complete list of OB/GYN services, diagnostic
screening services, fertility clinic services, fitness and exercise programs, education programs,
psychological/sociological counseling services, plastic surgery services, and cardiology services
19
for all types of women (Miller: 245). One particular facility that successfully designed a layout
suitable for of these requirements is the Greater Baltimore Medical Center. This is a rather larger
four-story facility that gives off the ambiance of a very prestigious hotel in Baltimore. Attention
is given to create a homelike atmosphere by using finishes, artwork, and other materials. The
facility is covered with plant life with an abundance of natural light. Each room is highly
furnished with lots of intimacy items such as comfortable chairs and lamps. There is lots of
storage so that delivery equipment can be put away until needed and the recreational outreach
and gymnasium can help provide a relief of stress for the in-patient women of the medical center.
(Miller: 246).
Each one of these health care facilities was able to create the best possible layouts for
their respective hospitals. There are different needs and desires that a women’s center would
need with its physical layout versus the needs and desires of a children’s hospital. In order to
design the most successful physical layout, the architects and managers must determine the
overall heath care goals of the facility and what strategies should be applied to make sure the
highest quality of care is given to the patients in the hospital. Successful hospitals are also able to
help reduce wastes and lower management costs of the health care organization. The physical
layout will have a significant impact on health care patients satisfaction as well as the health care
providers satisfaction. A correctly implemented layout for a hospital, like the previous examples
shown, will be a beneficial environment in providing patient care.
Conclusion: The Need for a Successful Layout
The physical layout for a hospital is very crucial for the overall success of the health care
facility. There should be lots of factors considered in the layout to confirm that it will be efficient
20
and have high quality measures. Planning the location of materials such as workstations,
equipment, supplies, and other miscellaneous items is important in being able to have an
effective health care facility. A hospital must be able to consider the further expansion of its
health care organization for the future when contemplating the physical layout. It should be a
goal of the hospital to have a layout that increases the economical use of the space so that it
optimizes the full capability of resources and the health care providers. The hospital should also
try to increase the effectiveness of how each place in the layout is being used so there is
maximum efficiency.
The layout of the health care facility must manage each of the individual processes that
occur on a daily basis effectively and must make sure the flow of patient, materials, information,
and providers is helping the health care organization achieve its overall goals. This workflow
should also be in accordance to health care policies so that there are no hazardous concerns that
could be detrimental to the hospital. The layout should be able to be designed exactly how the
architects and managers want the layout to be, but it must also be a flexible layout in case
something comes up in the health care organization that needs to be addressed and implemented
to ensure the best quality of care is given to the patients in the hospital setting.
Although the layout’s overall goal should be to provide the best care to the patients of the
facility, a successful hospital design should also be able to satisfy the needs and desires of the
health care professionals that work within the health care organization (Huang). Health care
professionals in the hospital should feel comfortable, safe, and satisfied in going to work for the
health care facility. If a hospital is able to keep these standards of efficiency and quality, then the
design of the layout was successful and the hospital will be able to serve as a beneficial provider
of care to many people.
21
Works Cited
Evans, Jennie. “Evolving Leadership in Healthcare Design.” Health Environments
Research & Design Journal 7.4 (2014): 9-12. Academic Search Premier. Web. 3 Mar.
2015. (AU Library)
Hamilton, Kirk. “Reflecting on Three Decades of Practice: Where’s the Rigor?” Health
Environment Research & Design Journal 4.1 (2010): 89-94. Academic Search
Premier. Web. 5 Mar. 2015. (AU Library)
Hua, Ying. “ Effects of Nursing Unit Spatial Layout on Quality of Care and Patient
Safety.” Health Environment Research & Design Journal 6.1 (2012): 8-38.
Academic Search Premier. Web. 27 Feb. 2015. (AU Library)
Huang, Yu-Li. “Selecting a pharmacy layout design using a weighted scoring system.”
American Journal of Health-System Pharmacy 69.9 (2012): 796-804. Academic
Search Premier. Web. 2 Mar. 2015. (AU Library)
Joseph, Thomas. “Design a Lean Laboratory Layout.” MLO: Medical Laboratory Observer
38.2 (2006): 24-31. Academic Search Premier. Web. 22 Feb. 2015. (AU Library)
Laursen, Jannine. “Effects of Environmental Design on Patient Outcome: A Systematic
Review.” Health Environments Research & Design Journal 7.4 (2014): 108-119.
Academic Search Premier. Web. 10 Mar. 2015. (AU Library)
Liu, Wei. “The Effects of Physical Environments in Medical Wards on Medication
Communication Processes Affecting Patient Safety.” Health & Place 26.1 (2014):
188-198. Academic Search Premier. Web. 6 Mar. 2015. (AU Library)
“LSCC Adult Health and Wellness at Lake Aire Visit Workflow.” [Online Image]. (2010).
Web. 18 Mar. 2015. Retrieved from http://www.slideshare.net/ataveechai/clinic-
workflow-diagram.
Marberry, Sara. Healthcare Design. RA 967.H45. New York: John Wiley & Sons, Inc.,
2007. Print.
Marberry, Sara. Innovations in Healthcare Design. RA 967.S96. New York: Van
Nostrand Reinhold, 2005. Print.
Marmion, Paul. “Rethinking Hospital Design.” ASHRAE Journal 54.6 (2012): 84-92.
Academic Search Premier. Web. 3 Mar. 2015. (AU Library)
Miller, Richard. Hospital and Healthcare Facility Design. RA 967.M49. New York: McGraw-
Hill Inc., 2005. Print.
22
Novicoff, Wendy M. “Data-Driven Performance Improvement in Designing Healthcare Spaces.”
Health Environments Research & Design Journal 7.1 (2013): 79-84. Academic Search
Premier. Web. 27 Feb. 2015. (AU Library)
Spikes, Telisa. “Utilizing Evidence-Based Design in a Community Hospital ICU.”
Nursing Economic$ 28.4 (2010): 279-282. Academic Search Premier. Web. 6
Mar. 2015. (AU Library)
Steinke, Claudia. “ Assessing the Physical Service Setting: A Look at Emergency Departments.”
Health Environments Research & Design Journal 8.2 (2015): 31-42. Academic Search
Premier. Web 6 Mar. 2015. (AU Library)
Wardlaw, Whitney. “8 Paths to Better Hospital Design.” Industrial Engineer 47.2 (2015):
29-37. Academic Search Premier. Web. 8 Mar. 2015. (AU Library)

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Developing Care Organizations

  • 1. Designing the Physical Layout for an Effective Hospital Dillan Brewer HADM 4000-002 Developing Health Care Organizations April 29, 2015 I certify that I have read all the guidelines for research papers for this course, both in the course syllabus and in the Web page handout “Guidelines for Research Papers”, and that this paper fully complies with them, except for any waivers made by explicit prior agreement with the instructor
  • 2. Designing the PhysicalLayout for an Effective Hospital Executive Summary It is important for health care facilities to perform all of the necessary tasks and requirements needed to be able to provide the best quality and care available to their patients. One of these tasks is to design a physical layout that will make the hospital efficient and effective. The physical layout of a hospital can have a tremendous impact on how effective the care is that is given to patients. The layout impacts everything that happens on a daily basis in a health care facility. Administrators must work with other health care professionals and the design team in order to create a satisfactory layout that will best serve the health care needs of the patients. Traditional hospitals were viewed negatively by its patients. The last place anyone ever wanted to be a person was sick was the hospital because going to the hospital normally made things worse. The designs of these hospitals were inefficient and not capable of meeting the needs of patients. The buildings were poorly structured and not capable providing optimum care. New designs and processes were needed to make hospitals into a positive image. Designing new hospitals is no small task. Organizations should conduct site visits, perform extensive research, and determine what the overall goals and strategies are of the hospital. There are several designing methods that can be performed to provide an effective physical layout. Simulations can be done to decide how different layouts will affect patient satisfaction and quality of care. Methods such as Lean management and evidence-based design also allow for health care organizations to determine what is the best possible physical layout for their facilities. Some organizations can even use these methods to remodel older hospitals in order to make the layouts successful for their facilities. The attributes, products, and equipment that contribute to the layout are vital in providing a facility that will be able to meet the health care needs of patients. There are many variables that hospitals can add to a layout to make the design more friendly and satisfying to patients. The visual and audible environments can have an impact on the layout and the health of patients in the hospital. Planning the location of materials such as workstations, supplies, and equipment is important in having an effective healthcare facility. The overall goal for designing an effective physical layout for a hospital is to have the best atmosphere and efficient area to provide the best quality care to patients in the facility. A successful hospital design will satisfy the needs of its patients in the more productive and safe way. An effective hospital layout will allow health care professionals to perform quality health care services that will improve the lives of patients.
  • 3. I. The Overview of Hospital Design A. Traditional Hospitals 1. Layout of Hospitals 2. Design of Architecture 3. Patient Views of Traditional Hospitals B. New Designs for Hospitals 1. Evidence-based Design as a Guiding Principle 2. Creating New Processes from Identifying Hospital Needs II. The Designing Process for New Facilities A. Site Visits and Research B. Design Selection C. Changing the Paradigm 1. Value Stream and LEAN Management 2. Workplace Organization Design 3. Workflow Analysis D. Making Older Hospitals Efficient in Today’s Society III. The Importance of Layout for a Patient-centered Environment A. Layout Attributes, Products, and Equipment B. The Visual Environment C. An Audible Atmosphere and Need for Communication IV. Hospitals with Effectively Implemented Layouts V. Conclusion: The Need for Successful Layouts
  • 4. Table of Contents Introduction………………………….…………………………………………………...1 The Overview of Hospital Design…………………………………………………….....2 Traditional Hospitals…………………………………………………………….2 New Designs for Hospitals……………………………………………………….3 The Designing Process for New Facilities………………………………………………4 Site Visits and Research…………………………………………………………4 DesignSelection………………………………………………………………….5 Changing the Paradigm…………………………………………………………7 Making Older Hospital’s Efficient in Today’s Society……………………….11 The Importance of Layout for a Patient-centered Environment…….……………...12 Layout Attributes, Products, and Equipment……………….…….……...…..12 The Visual Environment……………………………………………………….13 An Audible Atmosphere and Need for Communication…………….……….15 Hospitals with Effectively Implemented Layouts…………………………………….16 Conclusion: The Needfor Successful Layouts……………………….……………….19 Works Cited…………………………………………………………………...………..21
  • 5. Introduction The physical layout of a health care facility has serious and important effects on the processes that take place within a health care organization. The layout of a health care facility plays a crucial role in the daily occurring operations of the business. Each facility must be planned extraordinarily well so that there are limited expenses for future renovations and modifications. Effective facility-planning techniques have been found to reduce operational inefficiencies and may lower such costs by up to thirty percent (Huang). There are many health care facilities that lack an effective layout for their hospitals and medical practices, but many do not do so intentionally. It comes from not understanding the effect that the physical layout has on the performance of the health care organization. The physical layout is often overlooked compared to other important business needs such as time, money, equipment, and staffing. Space planning is important in the success of a health care organization, but this designing of an optimal health care facility is often ignored and set aside to deal with at another time. The designing of the physical layout for a hospital needs to be dealt with at the beginning of the building process of a hospital. This will help make sure that the performance and quality of care for that organization is not halted or impeded. In order to plan for future designs, there must first be an understanding of how hospital layouts used to be designed and why there became a need for change in health care facilities in regard to the physical layout and design of a hospital.
  • 6. 2 The Overview of Hospital Design Traditional Hospitals The terms used to describe how traditional hospitals were viewed as can be visualized in words such as “dreadful,” “awful,” and “discomforting.” These are all deemed reasonable terms in regard to how hospitals were in the past. Hospitals were places that many people tried to avoid. Traditional hospitals were regarded as places where people only went if it was absolutely necessary. This was because if someone was sick, it was likely that the person would not make it out of the hospital alive. Hospitals were viewed poorly not only by the events that took place on the inside, but by how the design and architecture of these health care facilities were as well. The architecture of the hospitals evoked feelings and emotions that negatively impacted the visualization of the facilities. There was no sense of comfort and homeliness in the hospitals. The environmental factors did not contribute to a feeling of protectiveness and safety from the medical events occurring in the lives of each patient. Many traditional hospitals were dull in atmospheric appearances and the lack of vibrancy did not appeal to the patients waiting to be examined. Everything was very congested in terms of patient and employee workflow, which stressed out health care providers and made the patients anxious. The layout of the examining rooms for the patients tended to not give much privacy and this made patients feel uncomfortable when dealing with their medical issues. The walls were very thin and sound from one room to the next could be easily heard by nearby physicians and patients. In fact, the only physical structures that were allowing privacy and a blockade from catching another patient’s diseases in the examining rooms were curtains being help up on steel rails. This lack of privacy was not very patient-oriented for those wanting to be seen by a health care provider. The lack of privacy for
  • 7. 3 patients and the threat of diseases being spread easily in the hospital environment were key factors in determining that a new layout system for health care organizations was needed. Fortunately, with the advancement in technology, the image of hospital’s has changed from being a place of lingering death to a place where effective treatment can be given (Miller: 30). Hospitals began to address patient needs and began to create an environment that was more accommodating for people entering a health care facility. Other aspects of health care in the hospital setting began to change, such as more flexible visiting hours, improved meals for patients, and better documentation of a patient’s health. Efforts in design change were also visible such as improved lighting, noise reduction, and a more homely environment with colorful walls and more comfortable bedding (Miller: 30). The growth of medical technology shifted the mindset of healthcare from curative to preventive models. In order to increase the quality of care and the overall health of patients, new designs in hospital layouts were needed. This would help lead to an increase in overall efficiency of health care professionals and better safety for the people involved with these health care organizations. New Designs for Hospitals Healthcare has become very focused on being patient-centered. Health care organizations are now more than ever under pressure to not only provide quality care that is cost effective, but also keep quality as a key focus such as in reducing medical errors. In order to keep this mentality, healthcare organizations have adapted the idea of evidence-based design. The study of this method has become significant. With architects constructing and remodeling healthcare facilities, evidence-based design is an approach that will
  • 8. 4 increase the overall quality and performance of care in hospitals. This method has been proven to help with not only patient healing, but also health care professionals well-being and safety of the entire facility. The physical environment at a hospital has been proven to affect several health care issues such as pain, stress, errors, and the overall health of a patient. Evidence-based design is used by managers and architects in order to plan and design health care facilities. It also should feature the input of all different specialties of healthcare professionals such as nurses, physicians, and technicians. Using an evidence-based design helps to ensure that hospitals are safer, health care professionals are less stressful, and patients are receiving the highest quality of care with little safety hazards (Spikes). The Designing Process for Facilities Site Visits and Research The speed at which healthcare rapidly changes makes it difficult at times to ensure a hospital is up to date on the latest healthcare technology and medical practices. If a health care organization falls behind with the changing of medical technology, a facility can become ineffective and inefficient. Health care managers and architects must also be able to manage the change that health care goes through. Designing a new health care facility can be a difficult task when facing such a rapid and always evolving culture. Architects can use site visits and research strategies to make sure the designs of a layout are kept in proper standards and all requirements are fulfilled. Site visits allow for designers to view different layouts to see which alternative is most beneficial for their own health care organization they are designing. Site visits also help identify potential problems that different layouts can and may encounter throughout the years of a health care organization.
  • 9. 5 When conducting a site visit, it is important that a design team is created before performing any further tasks. Having a whole team of designers can help create a variety of new ideas and perspectives in regard to creating their own layout for a hospital. It is important to make sure everyone understands the overall goals of what they plan to accomplish as a design team. The design team can break apart into different groups to focus on specific, general, and departmental designs for their health care organization. In terms of specific items, the designers can focus on matters such as patient room walls or nursing stations. General designing can show how to structure a facility to become patient-centered and to improve the quality of the facility (Marberry: 5). A departmental design would focus on learning the operations of specific departments such as an intensive care unit or an emergency department. Conducting research lets an organization see what the state-of-the-art facilities look like and how these facilities are managed and operated. It is important to conduct research on different types of healthcare layouts so it can be easily seen what type of layout will work best for the desired goals and needs of the facility needing to be designed. Once different facilities are researched and visited, architects can decide which facility they want to design. Analyzing research also opens up the opportunity to see and determine if maybe there are variables that could be added in order to improve a particular layout of a hospital. It is important to make sure that these processes occur because if the proper design is not selected, it could lower the effectiveness of that particular hospital. (Marberry: 8). DesignSelection The best facility designs involve multi-step processes in deciding what layout a health care organization is going to use and how the health care organization is going to implement the
  • 10. 6 design. This process begins by observing and analyzing the current situation. A health care organization needs to identify what its needs and goals are. The health care facility also needs to identify where possible problems and issues may occur during the implementation of the design of the hospital. There needs to be an observation of space regarding what type and how much space is being used currently and what the future needs will be when implementing the design. Flow charts should be utilized in determining where and how the layout of all materials, rooms, equipment, and providers will move throughout the health care facility (Evans). There should also be multiple possible layouts designed in case something happens in which the first layout implementation goes wrong and the next best possible solution is needed. One very popular tool that is being used to determine which process to use in designing a layout is by using simulations. Simulations for designs help to determine layout criteria such as costs, flexibility, safety for patients and providers, utilization, and maintenance (Liu). The simulations help to show how possible each layout design is and how it would be able to operate. It takes in considerations that make the designing process difficult such as high costs, long construction times, and compatibility of systems. The costs that are considered in the simulations are the costs for initial implementation and for maintaining the layout. The safety measures taken by a hospital affect not only patients, but also employees in the health care facility. Simulations show how durable the hospital layout can be over long periods of time and how easily it is for health care providers to optimize the utility of the layout in order to increase the quality of care for the patients of the health care facility. There needs to be as little workflow movement as possible for health care providers in the hospital to ensure the quality of care is not decreased because of the fatigue of its providers.
  • 11. 7 The speed of movement and workflow within the health care facility is one of the most important criteria in deciding what layout to implement. Saving time moving around in the hospital saves the hospital money and efficiency so the layout must be able to produce the most efficient movement of workflow in the health care facility. Maintaining the sustainability of the physical layout is also a very important factor for choosing the proper layout as well as providing environmentally friendly aspects to the health care facility. These two factors are important because providing eco-friendly appliances and having proper maintenance techniques for a particular layout can help the hospital save lots of time, money, and resources in the longevity of the health care organization (Liu). Changing the Paradigm New health care facilities are undergoing a vital change in how care and quality are evaluated. Facilities are being asked to operate with fewer resources while still improving the results for the patients keeping quality and safety as top priorities. Providers must work with these changes in order to receive as much reimbursement from insurance companies as possible. The most popular method currently in producing these types of results is by using Lean management. This methodology is designed to reduce waste while performing at a high quality and productivity of services. This process was standardized and perfected by the Toyota Production System in the assembling of cars (Joseph). Designing a layout for a hospital uses many key Lean principles. The objectives of Lean are to have a focus on patients in order to discharge them in a timely fashion after receiving good care, reduce costs of the hospital, and to improve the quality of the care. Other Lean objectives are to reduce the time spent on a particular task or area and to simplify the work process so that
  • 12. 8 patient satisfaction is high and the care given to each patient is a direct result of each individual’s health care needs. The optimal facility layout involves obtaining smooth flow, minimizing handling distances, reducing costs and wastes, and improving the work environment (Joseph). In order to develop the most optimal layout, there needs to be an assessment of how current operations are running and how the new Lean design will benefit the future of the hospital. A workflow analysis is crucial in designing an effective layout. A workflow analysis is used with being able to value stream a particular facility and its physical layout (Novicoff). A value stream shows all the activities required to bring a service from a health care provider to the patient in fulfillment of their services needed. Using value stream can evaluate deficiencies in quality of the services rendered and wastes of a hospital. This layout system focuses on reducing wait time, reduce waste, high quality assurance, and using no unordinary resources to provide the best care available. A hospital that uses the Lean system will also use visual controls in aiding its patients and health care providers. These visual controls are simple signals that provide an immediate understanding of a situation or condition. Visual controls in a layout will help reduce time wasted and increase the efficiency of the health care facility. A workflow analysis shows how materials, patient information, and people in the health care organization move through a hospital. It is used in order to improve efficiency, safety, and the quality of care given within the facility. The figure below shows the workflow of patients through a typical hospital layout. Patient flow can become rather complex with lots of moving parts and therefore it is important to try to eliminate as much movement as possible. When transportation is decreased, there can be a prevention of medical errors and this will help keep high quality measures for the hospital.
  • 13. 9 1 A Lean layout will not only provide an area of space for the daily operations of the present, but will also be prepared to adapt to the always changing health care environment and 1 “LSCC Adult Health and Wellness at Lake Aire Visit Workflow.” [Online Image]. (2010). Web. 18 Mar. 2015. Retrieved from http://www.slideshare.net/ataveechai/clinic- workflow-diagram.
  • 14. 10 the space needed to grow within the facility. This type of layout design will always be trying to have continuous improvement for the layout. The layout is always prepared and open to new ideas for better processing of health care for the organization. The transportation aspect of Lean is also very important when designing the physical layout of a hospital. A health care facility does not want excessive movement of patients, medicines, or supplies. Therefore, the design of the hospitals needs to be where each item a patient needs or will use is as close to the patient as possible from the time the patient arrives to the hospital until the time the patient is discharged. The less movement there is within the hospital, the better of a design the layout is. Having a Lean facility includes being able to have alternative layouts ready for evaluation if something changes within the health care organization. It is very beneficial to be a Lean facility because if done correctly, the layout will optimize workflow, increase staff productivity, reduce wastes, be more efficient, have a safer environment, and will attain the highest level of quality possible (Joseph). Even though there may be some resistance to the process changing of Lean, the usage of Lean in the designing process of a layout will result in better satisfaction and experiences for all people involved in the health care facility. There will be a reduction in wait time when using Lean and this will lead to higher patient satisfaction. The quality of care for each patient will be higher because there will be less medical error and fatigue by health care providers. The patient satisfaction will also increase because patients will be able to spend more time with their providers because workflows will be able to reduce unneeded transportation and movement throughout the hospital. Many processing techniques will become standardized and this will help reduce waste and errors in the health care facility. Employees will also be satisfied because they will be able to conduct their procedures in a safe environment. Health care provider needs will be
  • 15. 11 attainted at a faster rate using this methodology. This process will allow for helping the patient receive quality care to be the focus in the hospital (Joseph). Making Older Hospitals Efficient in Today’s Society A big issue facing health care in the United States is the aging of the buildings of hospitals. Older hospitals were designed to mainly house and treat patients and these facilities can sometimes have lots of difficulty adapting to the present needs of hospitals. Many architects have a hard time making older hospitals work for the goals of health care facilities today. Aging facilities make it a challenge to retrofit the buildings with new technology and state-of-the-art equipment, even as educated patients demand the highest level of innovation available when seeking out their hospital of choice (Wardlaw). The problem with older hospitals is that many were not built for expansion either vertically or horizontally. It is important to make sure that the design of older facilities will be able to meet the goals and desires of the hospital. Another key issue in dealing with older health care facilities is the safety hazards an older hospital may have. The hospital needs to have enough space so that patient flow and organizational flow is not hazardous. The overall structure of the hospital must be sound, meaning that the roofing, walls, and flooring are all in good keep. (Miller: 64). Many hospitals that become bought out by larger health care organization undergo restoration projects in order to keep up with the demanding quality and safety concerns I health care. Renovating hospitals can help lower costs and are a cheaper alternative than building a layout from the ground up. The problem with this strategy is that the parameters of the design are limited in regard to how much can actually be changed on an established building. Older hospitals have many concerns and issues when dealing with their overall effectiveness and
  • 16. 12 efficiency for modern health care, but those facilities that are able to undergo renovation can become vital acquisitions to many prominent health care organizations throughout the country. The Importance of Layout for Patient-centered Environment Layout Attributes, Products, and Equipment There are several important factors to consider when implementing and designing the layout for a hospital in order for the facility to be optimal and effective. There must be a determination of the resources given and how those resources will improve the quality and safety of care given in the organization. Designing private in-patient rooms is able to decrease infection rates and increase the privacy of patients in a hospital. It is also a good idea to have decentralized nursing stations in the layout of the facility. The decentralization of work stations for health care professionals helps to improve the visibility of patient rooms and decreases the distance that the nurses and other staff are from each patient’s room (Hamilton). Unit configuration and location for different medical devices and products helps to promote the efficiency in the process of delivering high quality of care. It is also important to consider the little variables that make healthcare run smoothly on a daily basis. The idea of washing a physician’s hands before and after each surgery to eliminate the spread of germs and diseases was a major milestone in delivering health care to those who were sick and unhealthy. Promoting hand washing as often as possible can be done by providing hand-washing stations often throughout a facility. It is also important to remember that you are not only providing a service to the patient, but to the family and caretakers of the patient as well. This causes a need for an efficient family area within the patients room. This helps to promote communication with the family and the health care providers, it gives way to trust being
  • 17. 13 established between the family and the health care providers, and its helps to promote the desired positive patient satisfaction within the facility (Spikes). The health care staff can also suggest ideas on how to help benefit the facility to ensure the layout is capable of supporting all the needs of the hospital. If the staff feels like the workspace currently is too small, the new layout can provide a larger workspace for the health care professionals to use. It is also important to make sure that there are lots of storage areas within the hospital layout. There needs to be enough storage to be able to put away supplies, carts, medical devices, and other equipment items. With the increase in health information technology and electronic health records, there needs to be computer workstations in all patients’ rooms that can be mounted to the room so that there is always a computer in each room. There should also be concerns for energy conservation and the overall “green” concept in the new layout. Having efficient equipment and materials throughout the facility such as for lighting and power services can help increase the quality of services, promote patient safety more effectively, and can decrease the costs of the health care facility in the long run. Providing an effective layout can help the staff learn cost and safety outcomes, which can in turn lead to better patient and employee satisfaction. (Marmion). The Visual Environment The atmosphere created visually can have a large impact on the overall patient experience and satisfaction when they go to a hospital. The physical layout of a facility where care services take place is viewed as an important factor relating to how patients undergo the healing process. Being hospitalized can become a very stressful and anxiety filled time in a patient’s life. It can be
  • 18. 14 both physically and mentally exhausting for patients and they desire to have the best health care facilities and services available to them when these patients enter a hospital. The physical layout of a hospital can have a huge affect on the overall patient satisfaction of their health care. The visual environment can consist of windows, lighting, views of nature, art, wall coloring, and plant life. The visual environment can have an impact on cost and quality of care for each patient that walks into the hospital. Studies suggest that covered furnishing, colors of items and walls, and art are environmental factors that can positively affect the recovery and rehabilitation of a patient in a hospital setting (Laursen). The visual environment has a considerable effect on pain control and therapeutic activities that go on during the stay at a health care facility. The impact that a hospital’s atmosphere can have on a patient’s anxiety and pain can be very beneficial to the health care organization. If the environment is able to be a positive experience and patient satisfaction is good, then healthcare costs of the hospital could be reduced for that particular patient. Making sure that there is ample sunlight available to each patient’s room is also beneficial for the hospital and the patient it is providing care for at that certain time. Adding plants and vegetation to the patient’s room or simply having a view of it outside the window can create for a more homelike atmosphere. This can help lower anxiety levels and calm patients during their stay at a healthcare facility. Designing rooms with vibrant and positive colors also can help relieve patients of stress, pain, and anxiety. When these feelings and emotions are suppressed, the patient will begin to want to move on with their lives and leave the hospital. This helps to decrease the length of stay and now the hospital can see more patients at a faster rate. This also benefits the hospital by gain more reimbursement values for profit for themselves and spend less on each patient a physician will encounter (Laursen).
  • 19. 15 An Audible Atmosphere and the Needfor Communication The quality of care can be greatly impacted by a variety of different components. One of the biggest and most influential of these is the process of communication in delivering care of good quality and safety. The physical design of a health care facility can significantly impact the effectiveness of communication within a health care organization among health care providers. Lack of effective communication is one of the main causes of medical error in health care. The effect of spatial layout in the physical design of a hospital plays a valuable role in determining the efficiency of communication amongst health care providers. Spatial elements of a hospital unit that reduce physical accessibility and generate limited visibility were found to reduce the frequency of communication among health care providers, which negatively impacted the quality of care received by patients (Hua). One design that has proven to help decrease incorrect communication is the decentralization of provider units in a health care organization. Traditionally, most hospitals are centralized meaning there is one provider station serving as the main unit for provider interaction and affiliation. An effective facility should be decentralized. In a decentralized layout, there are multiple provider stations throughout the health care facility. There are many positive takeaways in regard to a decentralized layout system for a hospital. There are some primary goals of this type of layout such as helping to limit provider fatigue. The fatigue is a result from walking lots of paces very often throughout a long shift at the hospital. Decreasing fatigue will not only make the providers more satisfied, but providers will also have improved quality of care which will lead to higher patient satisfaction and reduced costs for the health care organization. This also will increase patient safety because if a provider is fatigued, the provider is more likely to create a medical error while interacting with the patient.
  • 20. 16 Decentralized units also help control the workspace that is always crowded and noisy if it was a centralized unit. Being more spread out helps the providers give faster feedback to patients increasing the overall experience at the hospital. In decentralized units, providers have forty percent more visits to patient rooms and that patients experienced significantly quicker responses to calls made (Hua). Positive audible noises have been shown to help with patient satisfaction and anxiety while being tended to by physicians and nurses. Soft and light music has been proven to help relieve the stress and reduce the nerves that in-patients have while waiting in their rooms for a particular surgery or operation (Steinke). While patients are waiting to be called back by their physicians, many hospitals will play relaxing and soothing rhythms and tunes to help ease the anxiety that patients may be feeling at the hospital. A hospital design that had speakers in the waiting rooms and in the examination rooms would lead to positive patient satisfaction because the music would help distract from any discomfort that the patient might be feeling during the process of receiving care from a health care provider. Hospitals with Effectively Implemented Layouts Health care facility design is like other organizational designs in that each specific hospital has its own unique layout that has its own set of benefits specifically for that hospital. Each hospital will have its own specific needs and goals that the facility will try to achieve. No matter if it is a small or large hospital, each hospital will all have their own particular layout that best suits that health care facility. There are many types and examples of hospitals that effectively implemented a physical layout that became successful for its practice. It is important
  • 21. 17 to understand that hospitals may appear differently, but each hospital must strive to provide the best quality of care to its patients and an effective layout can make this goal more attainable. There have been many successful hospital layouts implemented over the years ranging in a variety of different types of hospitals. When looking at a patient care unit, a great example is San Francisco’s Pacific Presbyterian Medical Center. It inspires a more residential atmosphere where patients can even prepare their own food in kitchenettes. There is a full-spectrum lighting and mostly wood finishes rather than metal on the chairs and seating within the hospital. There is also lots of artwork throughout the health care facility and rooms are often decorated with lots of the patient’s own belongings to make them feel like are more at home. The nursing stations are very large areas and these stations are open to patients and their families in order to help be a patient-centered environment. The rooms are incredibly large so that there is plenty of seating for visitors, room for the providers’ work area, and media accessories such as televisions and video players (Miller: 178). Pinelake Medical Center also has a really effective layout design for a hospital. Architects wanted to have a comfortable environment that incorporated a convenient way-finding for all patients which would minimize conflict between inpatient and outpatient traffic. Pinelake Medical Center uses decentralization of traditional departments to help provide better services for the patients in the hospital. All the patient rooms are oversized to accommodate family and visitors and are furnished in a residential style, giving each room a home feeling. There are large storage areas for patient items and medical items as well. The rooms are all painted with vibrant colors and the lighting in each room can be altered depending on whether or not the provider needs more of an exam lighting style rather than a residential lighting style. Provider stations are located no more than fifty feet from each room, which is
  • 22. 18 needed when trying to have a facility that is providing patient-focused care. Supplies and medical equipment are always located close to the patient rooms so that time is reduced when a patient needs anything during an inpatient visit (Miller: 192). Pediatric Surgery Centers also have their own specific layout needs that help to ensure that the children being treated are given the highest quality of care. A great example of a pediatric hospital design is the Vanderbilt University Medical Center. This hospital has large operating rooms so that all the equipment needed for procedures can easily fit and be moved around if needed. The waiting room features large family areas with lots of natural light and pleasant views of the outdoors. It is also located across from the major hospital which provides patients with an emotional security if the services provided in the pediatric facility become to extraneous for those health care providers. The workflow is designed in a way that patients enter, go to surgery, recovery, and back to their assigned rooms all without ever crossing other patients at various levels of their procedures. The design has a pod arrangement which is more efficient for the nursing staff because it greatly reduces the time travel to and from the workstations. The rooms are also decorated and painted to help relieve the stress and anxiety that many children have when visiting the hospital. Bright colors and decorations of the most popular children items help to ease the pain that surgery might have for young children in a health care facility (Miller: 227). Women’s Centers have also emerged over the past few decades as organizations being designed specifically for the needs of females and the services women require. The layout of women’s centers should be able to include a complete list of OB/GYN services, diagnostic screening services, fertility clinic services, fitness and exercise programs, education programs, psychological/sociological counseling services, plastic surgery services, and cardiology services
  • 23. 19 for all types of women (Miller: 245). One particular facility that successfully designed a layout suitable for of these requirements is the Greater Baltimore Medical Center. This is a rather larger four-story facility that gives off the ambiance of a very prestigious hotel in Baltimore. Attention is given to create a homelike atmosphere by using finishes, artwork, and other materials. The facility is covered with plant life with an abundance of natural light. Each room is highly furnished with lots of intimacy items such as comfortable chairs and lamps. There is lots of storage so that delivery equipment can be put away until needed and the recreational outreach and gymnasium can help provide a relief of stress for the in-patient women of the medical center. (Miller: 246). Each one of these health care facilities was able to create the best possible layouts for their respective hospitals. There are different needs and desires that a women’s center would need with its physical layout versus the needs and desires of a children’s hospital. In order to design the most successful physical layout, the architects and managers must determine the overall heath care goals of the facility and what strategies should be applied to make sure the highest quality of care is given to the patients in the hospital. Successful hospitals are also able to help reduce wastes and lower management costs of the health care organization. The physical layout will have a significant impact on health care patients satisfaction as well as the health care providers satisfaction. A correctly implemented layout for a hospital, like the previous examples shown, will be a beneficial environment in providing patient care. Conclusion: The Need for a Successful Layout The physical layout for a hospital is very crucial for the overall success of the health care facility. There should be lots of factors considered in the layout to confirm that it will be efficient
  • 24. 20 and have high quality measures. Planning the location of materials such as workstations, equipment, supplies, and other miscellaneous items is important in being able to have an effective health care facility. A hospital must be able to consider the further expansion of its health care organization for the future when contemplating the physical layout. It should be a goal of the hospital to have a layout that increases the economical use of the space so that it optimizes the full capability of resources and the health care providers. The hospital should also try to increase the effectiveness of how each place in the layout is being used so there is maximum efficiency. The layout of the health care facility must manage each of the individual processes that occur on a daily basis effectively and must make sure the flow of patient, materials, information, and providers is helping the health care organization achieve its overall goals. This workflow should also be in accordance to health care policies so that there are no hazardous concerns that could be detrimental to the hospital. The layout should be able to be designed exactly how the architects and managers want the layout to be, but it must also be a flexible layout in case something comes up in the health care organization that needs to be addressed and implemented to ensure the best quality of care is given to the patients in the hospital setting. Although the layout’s overall goal should be to provide the best care to the patients of the facility, a successful hospital design should also be able to satisfy the needs and desires of the health care professionals that work within the health care organization (Huang). Health care professionals in the hospital should feel comfortable, safe, and satisfied in going to work for the health care facility. If a hospital is able to keep these standards of efficiency and quality, then the design of the layout was successful and the hospital will be able to serve as a beneficial provider of care to many people.
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