Urban Legends Of Healthcare Design

urban legends of Healthcare Design

urban legends
of
Healthcare Design

Moderator: Linda Delano, Western Division Business Leader, SSOE, Inc.
Speaker: Matthew W. Kennedy, ACHA, National Healthcare Executive, SSOE, Inc.

2009 PDC Conference & Exhibition


Today’s Discussion

I. The Pressure for Better Outcomes
II. Looking at the Evidence
III. The Continuing Evolution of EBD
IV. Improving Your EBD Approach



..let’s start with a quick story



“Children who eat candy
have better test scores”



Is it true?



Is your design utilizing the evidence
or another “Urban Legend”?

“...I think that this market is
“...I think that this market is
now challenging anything
now challenging anything
that doesn’t really have
that doesn’t really have
science behind it.”
science behind it.”
Robert Levine, Turner Construction,
Robert Levine, Turner Construction,
quoted from HFM Magazine
quoted from HFM Magazine



Comments from your Peers....



Strong Incentives to Succeed:
• Better process efficiencies
• “High-Performance” care environments
• Increased competition
• Growing knowledge needs

More results with less costs

More results in less time



Need for “Fact-Based” Approach:

Best Practices EBD
Confirmed
Outcomes ?
Confirmed
Efficiencies ?
Confirmed
Cost Impact ?



Using the A/E Selection Process
5. PROJECT SPECIFIC QUALIFICATIONS:
5. PROJECT SPECIFIC QUALIFICATIONS:

The Owner is interested in designing the project in
The Owner is interested in designing the project in
accordance with the principals of “Evidence Based
1.A: Provide Hard data towith the principals of “Evidence Based
accordance
1.A: ProvideDesign” buttosupport “evidence-based design” experience;
Hard data support “evidence-based design” experience;
i.i. Design” butnot necessarily with developing the
not necessarily with developing the
Documented evidence of elevated patient satisfaction scores
Documented evidenceDESIGN BUILD APPROACH AND SERVICES
project as aapebble6:facility.Please comment on yourscoresSERVICES
of elevated patient satisfaction
TAB 6:facility. Please comment on yourAND
ii. project as pebble DESIGN BUILD APPROACH
TAB
Documented evidence of improved nursing productivity
ii. Documented evidence ofthese principals productivity
firm’s experience with improved nursing
firm’s experience with these principals
iii. Documented evidence of reduced costs of operation
iii. Documented evidence of reduced costsandoperationshould be addressed:
The following approach of services
iv. Provide patientThe following approach andasaaresultshould be addressed:
services
iv. Provide patientcensus growth/admissions as resultof design
census growth/admissions of design
6.2: Design process to maximize evidence base design
6.2: Design process to maximize evidence base design
implementation (from patient, visitor, staff, and
implementation (from patient, visitor, staff, and
efficiency standpoint)
efficiency standpoint)



Leading to Increased EBD Presence

2006 2008

53% 62%

Total HC Construction $40.7B
Total Utilizing EBD $25.23B

TOTAL VALUE AT RISK $15.3B



All EBD Initiatives Start with
Looking at the Research!



So Where’s the Beef?
• Journals:
Peer reviewed
CHER, HERD, InformeDesign
• Studies should be:
Empirically based
Utilize scientific rigor, quality of
research design, large sample
sizes, high degree of control
Identify reliable patterns to findings



Are You Willing to Invest in these Design Strategies?

Shortened Travel Universal Rooms Patient Centered Care
Distances


“Designs which reduce nurse travel
distances increase staff efficiencies”



How Do Nurses Spend Their Time?
• Nursing represent the largest segment of
healthcare staff within the hospital.
• Average distance walked/shift = 3.0
miles/daytime shift.
• Decreased travel distances = more time
spent on direct patient care activities?



Travel Distance Case Study #1:
• Joint study conducted by Ascension
Health, Kaiser Permanente and Purdue
University.
Radial
• Study included participation of 767 nurses
from 36 M/S units around the country.
Race Track • Study objectives include determining
variations in distance traveled, time spent
by category, and workload between three
types of unit design:
Corridor



Case Study Findings:
• No statistically significant relationship
was found linking differences in
architectural types to differences in time
Radial spent with patients.

• More variation found in miles traveled
Race Track and patient time between nurses on the
same unit then between units.

Corridor



Travel Distance Case Study #2:
• Previous study conducted at the
Rochester Methodist Hospital by the
National Center for Health Services
Radial Research and Development.
• Study investigated the specific impact
the unit design had on activities and
Race Track
subjective feelings of nursing personnel.
• Study evaluated three types of unit
designs all built at the new hospital
Corridor building (specifically constructed for
hospital research).



• Staff on radial units found to travel less
and spend more time with patients.

Radial • However, staff working on radial units
also found to have more time in all
categories identified.
Race Track

Corridor



What Can Be Learned?
• Staff efficiencies depend upon
multiple factors.
• Nurses ability to organize work and
staffing assignments has greater impact
on efficiency than lessened travel
distances.
• Nurses adaptability allows them to
compensate for limitations imposed by
the physical design.



“Designs utilizing universal patient rooms
accommodate change more readily”



Acuity Adaptable Care Model Universal Room Design
Multiple acuities cared for on a Adaptable for use in varying
single nursing unit/room patient acuity levels



Acuity Adaptable Care Model Universal Room Design
Not a universally accepted How well does a standardized
model of care. room adapt to customized care
levels?



Universal Room Case Study:
• Study conducted at six adult M/S Units
across U.S.
• Three of six hospitals utilized universal
room designs.
• Study identified three end-user definitions
of flexibility;
Adaptable
Convertible
Expandable



• At room level - benefits of adaptability of
Universal Room Design could not be
determined.
• At unit level – Universal Room design
concepts could impede operational flexibility
in 3 of the 7 areas studied:
Peer lines of sight
Patient Visibility
Zoning Options



• Completed studies of overall flexibility in
healthcare settings are few; more
research found for retail and workplace
setting.
• Studies on flexibility at the nursing unit
level even fewer.
• Universal Room Design giving way to
Acuity Adaptable Room model.



“Designs which are patient centered
lead to better clinical outcomes.”



Patient Centered Care: considers patients’
cultural traditions, their personal preferences
and values, their family situations, and their
lifestyles (Institute for Healthcare
Improvement)

Patient Centered Design: designs that put the
patients needs and preferences first



Many levels in which to approach subject,
today we focus only on three:

Day Lighting Nature Sound



Day Lighting Case Study:

• Study by JM Walch and Associates.
• Tested effects of patient exposure to
sunlight on pain medication levels after
spine surgery.
• Patients assigned to a “dim” room or
“bright” room for recovery.




• Study indicated a 22% decrease in
analgesic medication by recovering
patients assigned to a “bright” room.



Nature Case Study:

• Study conducted with patients
recovering from heart surgery.
• Patients randomly assigned rooms
providing exposure to images of nature,
abstract art, a blank panel or nothing at
all.




• Patients in rooms where exposed to
images of nature switched from stronger
analgesics to weaker ones during recovery
compared to other patients in study.



Sound Levels Case Study:
• Study conducted with 165 patients
undergoing elective colonoscopy.
• Patients assigned to one of three
groups:
Visual distractions
Visual + audio distractions
No distractions



• Study revealed patients with
visual + audio distractions had
significantly reduced pain scores
and PCS use.




• Each study had good control group
definition.
• Each study had limited variables.
• Large volume of studies in this subject;
greater correlation between studies.

• Significantly reduced patient stressors
can result in shortened recovery and
less pain medication required.



EBD Continues to Evolve:

Amount of EBD studies continues
to grow:

1968 - 1998 84
2004 600
2008 +1,000
Tomorrow ??,???




Past Areas of Research Future Areas of
Research
• Staff Stressors • Same-Handed Rooms
• Patient Safety • Design Flexibility
• Medication Errors • Family Outcomes
• LOS • Support Services

“...this emphasis on the elements that are aapart of the theory of
“...this emphasis on the elements that are part of the theory of
supportive design can allow other domains of knowledge to be
supportive design can allow other domains of knowledge to be
overlooked”
overlooked”
Kirk Hamilton
Kirk Hamilton
HERD Journal
HERD Journal



Healthcare
Providers Creating better environments for study
through collaborations:

• The Pebble Project/Partnerships
A/E University • Ascension/Kaiser/Purdue
Firms Programs • SRHS/Clemson/Others



Final Comments from your Peers....



How to Better Your Approach to EBD:
• Improving your “critical eye”
• Utilize methodologies to maintain rigor
• Identify your EBD Champion!



urban legends
of
Healthcare Design

E-Copies of this presentation ( with supporting evidence) can be downloaded from SSOE.COM


Urban Legends Of Healthcare Design

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