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HCD_2007_Flexibility Study
This document discusses research on defining the design characteristics of a successful adaptable inpatient unit. The research studied six hospitals to understand what flexibility means to different stakeholders and how physical design influences flexibility. Key findings include that flexibility was found to mean adaptability, convertability, and expandability. Design characteristics like proximity of support spaces, lines of sight, and adjustable core spaces promoted flexibility by accommodating operational changes.
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HCD_2007_Flexibility Study
- 1. EVIDENCE BASED DESIGNEVIDENCEBASED DESIGN RESEARCH STUDIES
- 2. Defining the Design Characteristicsof a S f l Ad t blSuccessful Adaptable Inpatient Unit Debajyoti Pati, PhD, AIIA Tom E. Harvey Jr., AIA, MPH, FACHA
- 3. Acknowledgements/Credits • AIA 2006Research Grant • Herman Miller • Dr Carolyn Cason, UT Arlington School of Nursing • Parker Adventist Hospital Parker CO• Parker Adventist Hospital, Parker, CO • Clarian West Medical Center, Avon, IN • Laredo Medical Center, Laredo, TXLaredo Medical Center, Laredo, TX • McKay-Dee Hospital Center, Ogden, UT • Bon Secours St. Francis Hospital,Charleston, SC • St. Rose Dominican Hospital – Siena, Henderson, NV
- 4. Learning objectives • Understandthe role of flexibility in promoting ffi i i ti tefficiency in patient care. • Understand what ‘flexibility’ means from various stakeholders’ perspective on inpatient units.p p p • Understand characteristics of the physical environment that impede or facilitate flexibility. • Obt i d d t di f i ti t it• Obtain a deeper understanding of inpatient unit operations, coordination between caregivers, and implications of such factors on the physical design.
- 5. Content • Flexibility background •Information gap • Framework • Question• Question • Method • Flexibility meaningFlexibility meaning • Flexibility to Adapt • Flexibility to Convert • Flexibility to Expand • Conclusions
- 6. Flexibility background • Thearchitectural perspective: – Workplace and retail sectors: shearing layers • Shell, services, scenery, set • Site, structure, skin, services, space plan, stuff – Healthcare sector: systems • Open building paradigm – Primary, secondary, tertiary • Spine concept
- 7. Information gap • Hospitallevel flexibility concepts • Very little information at inpatient unit level: Universal rooms– Universal rooms – Distributed caregiver workstations • Importance: – Changing demographics – Changing labor marker Change unit operational model g g – Changing technology – High volume investment on bed units
- 8. Question • What doesflexibility mean to different stakeholders? • What physical design variables influence stakeholders’ flexibility? • What designs elements promote or hinder flexibility?flexibility?
- 9. Framework • Flexibility toadapt: accommodate change without change in environmentchange in environment • Flexibility to convert: accommodate change after simple/inexpensive physical alteration • Flexibility to expand: expand over time• Flexibility to expand: expand over time
- 10. Method • SETTING – Sixhospitals – Medical-surgical units • SAMPLING – Purposive M i i i bilit– Maximize variability • DESIGNDESIGN – Exploratory – Qualitative
- 11. Method • PARTICIPANTS – Nursing,RT, Materials Management, EVS, Pharmacy, Dietary • TOOLS – Semi-structuredSemi structured interviews – Plan of inquiry – Content analysisContent analysis
- 12. Sample uction etion ed ze ape tion gModel Patient sal Name Constru Comple TotalBe UnitSiz UnitSha Circulat Nursing Nurse:P Ratio Univers Room Parker Adventist Hospital 2004 10036 Irregular Racetrack Primary 1:5 Yes Hospital Parker CO Clarian West Medical Center Avon IN 2005 76 32 Square Racetrack Primary 1:4 Yes Laredo Medical 1998 325 36 Pinwheel Racetrack Functional/ 1:8 No Center Laredo TX Modular McKay-Dee Hospital Center Ogden UT 2002 317 28 Triangle/ Rectangle Racetrack Functional 1:5 No Bon Secours St 1997 141 40 Square Radial Modified/ 1:5 NoBon Secours St. Francis Hospital Charleston SC 1997 141 40 Square Radial Modified/ Modular 1:5 No St Rose Dominican Hospital-Siena H d NV 1999 214 34 Other T-Shape Functional 1:6 Yes Henderson NV
- 13. Parker Adventist FIGURE LEGEND MMedication E Equipment C Clean Supply/ Utility S Soiled Supply/ UtilityS Soiled Supply/ Utility N Nursing Station Construction Completion 2004 Total Bed 100 SqFt per Bed 607 Unit Size 36 Unit Shape Irregular Circulation Racetrack Nursing Model Primary Nurse:Patient Ratio 1:5 U i l R YUniversal Room Yes
- 14. Clarian West FIGURE LEGEND MMedication E Equipment C Clean Supply/ Utility S Soiled Supply/ UtilityS Soiled Supply/ Utility N Nursing Station Construction Completion 2005 Total Bed 76 SqFt per Bed 700 Unit Size 32 Unit Shape Square Circulation Racetrack Nursing Model Primary Nurse:Patient Ratio 1:4 Universal Room Yes
- 15. Laredo Medical Center FIGURELEGEND M Medication E Equipment C Clean Supply/ Utility S Soiled Supply/ UtilityS Soiled Supply/ Utility N Nursing Station Construction Completion 1998 Total Bed 325 SqFt per Bed 528 Unit Size 36Unit Size 36 Unit Shape Pinwheel Circulation Racetrack Nursing Model Functional/ Modular Nurse:Patient Ratio 1:8 Universal Room No
- 16. McKay Dee FIGURE LEGEND MMedication E Equipment C Clean Supply/ Utility S Soiled Supply/ UtilityS Soiled Supply/ Utility N Nursing Station Construction Completion 2002 Total Bed 317 SqFt per Bed 673 Unit Size 28 Unit Shape Triangle/ Rectangle Circulation Racetrack Nursing Model Functional Nurse:Patient Ratio 1:5 Universal Room No
- 17. St Francis Hospital FIGURELEGEND M Medication E Equipment C Clean Supply/ Utility S Soiled Supply/ UtilityS Soiled Supply/ Utility N Nursing Station Construction Completion 1997 Total Bed 141 SqFt per Bed 520 Unit Size 40 Unit Shape SquareUnit Shape Square Circulation Radial Nursing Model Modified/ Modular Nurse:Patient Ratio 1:5 Universal Room No
- 18. St Rose Dominican-Siena FIGURELEGEND M Medication E Equipment C Clean Supply/ Utility S Soiled Supply/ UtilityS Soiled Supply/ Utility N Nursing Station Construction Completion 1999 Total Bed 214 SqFt per Bed 541 Unit Size 34 Unit Shape OtherUnit Shape Other Circulation T-Shape Nursing Model Functional Nurse:Patient Ratio 1:6 Universal Room Yes
- 19.
- 20. Flexibility meaning • Management –Ability to manipulate higher-level resources (staffing, teaming) to address unique circumstances and uncertainties • Direct caregiver – Ability to multi-task and multi-skill to optimize patient care, maximize efficiency and address unique situations • Non-nursing personnelo u s g pe so e – Ability to manipulate resources to effectively address nursing management and direct care giver needs
- 21.
- 22. Peer lines-of-sight • Operationalissue • Implications – Helping hand, mentoring, socialization, de-stressing Aff t – Simple shape units – Corner location of caregiver workstation in t• Affects – Nurse, respiratory therapist support core – Back-stage corridors linking caregiver workstations • Environmental correlates – Caregiver work station, workstations – Simple circulation configuration g , corridor shape, corridor configuration
- 23.
- 24. Patient visibility • Operationalissue • Implications – Higher acuity, JCAHO regulations, non- contiguous patients Aff t – Multiple caregiver work centers with proximal patient rooms U b t t d i htli• Affects – Nurse, nursing administration, i t th i t – Unobstructed sightline to patient rooms – Outboard toilet location respiratory therapist • Environmental correlates – Caregiver workstation, medication room, utility room
- 25.
- 26. Multiple division/zoning option •Operational issue • Implications – Perceived barriers – Assignment problems • Affects – Stairwell and support spaces located at end of an array of patient rooms or inside theAffects – Nurse, nursing administration, • Environmental rooms, or inside the support core – Simple circulation configurationEnvironmental correlates – Stairwell, support spaces staff toilets g spaces, staff toilets
- 27. Multiple division/zoning option MODIFIEDCORNERS = PERCEIVE D BARRIER
- 28. Proximity of support •Operational issue • Implications – Walking distance – Stress, fatigue • Affects – Simple shape, symmetrical units – Distributed nursing t Affects – Nurse, nursing administration, environmental services, support spaces proximate to distributed caregiver workstations – Decentralized room- dietary services, materials management, respiratory therapy E i t l – Decentralized room- side supply cabinets • Environmental correlates – Patient room, support spaces
- 29.
- 30. Resilience to moveservices • Operational issue • Implications – Long term census fluctuation • Affects – Standardized room – Standardized support core – Nurse, nursing administration • EnvironmentalEnvironmental correlates – Standardization
- 31. Resilience to moveservices
- 32. Inter-unit movements • Operationalissue • Implications – Multi-unit caregiver responsibility • Affects – Communicating stair inside unit – Proximal location of ti l i l ti – Nurse, environmental services, dietary services, materials t vertical circulation core – Back corridor inter-unit link U b t t d h i t lmanagement, pharmacy, respiratory therapy • Environmental – Unobstructed horizontal circulation • Environmental correlates – Vertical circulation core, unit proximity horizontalunit proximity, horizontal access
- 33.
- 34. Service expansion options •Operational issue • Implications – Census fluctuations – Unit-service misfit • Affects – Visual or geographic cues to help unit subdivisions B k id li k Affects – Nurse, nursing administration • Environmental – Back corridor links between adjacent units Environmental correlates – Unit size, unit configuration unitconfiguration, unit adjacency
- 35. Service expansion options C SOFTSPACE FOR SUPPORT CORESUPPORT CORE EXPANSION/ SHARING N NSERVICE SPREAD INTO ADJOINING UNIT N
- 36.
- 37. Adjustable support core •Operational issue • Environmental l t– Supply and equipment storage – Shape and size of correlates – Cabinetry, support room shape, support room si erooms • Affects – Nurse, nursing size • Implications – Modular, movable administration, environmental services, dietary services, materials management compartments or cart system for storage – Minimize walls with MEP elementsmaterials management, pharmacy, respiratory therapy MEP elements
- 38.
- 39.
- 40. Expandable support core •Operational issue • Environmental l t– Operational changes over time • Affects correlates – Adjacent functions • Implications – Nurse, nursing administration, environmental services, di t i p – Soft program adjacent spaces dietary services, materials management, pharmacy, respiratory therapypy
- 41. Expandable support core C SOFTSPACE FOR SUPPORT CORESUPPORT CORE EXPANSION/ SHARING N N N
- 42. We thank youfor your attention!
- 43. Brief bibliography Chefurka, T.,Nesdoly, F. and Christie, J. , 2006, “Concepts in Flexibility in Healthcare Facility Planning, Design, and Construction”. The AcademyHealthcare Facility Planning, Design, and Construction . The Academy Journal Online, http://www.aia.org/aah/journal, pp. 34-43. Hamilton, K. 2000 - Design for Flexibility in Critical Care. Proceedings of ICU 2010, Center for Health Systems and Design, Texas A&M University, April. Hendrich A Fay J Sorrels A K 2004 Effects of Acuity-Adaptable Rooms onHendrich, A., Fay, J., Sorrels, A.K., 2004. Effects of Acuity Adaptable Rooms on Flow of Patients and Delivery of Care. American Journal of Critical Care, Vol. 13 /1, pp.35-45. Kendall, S. H., 2004, Open Building: A New Paradigm in Hospital Architecture. AIA Academy Journal, 7th Edition, pp.22-27.y , , pp Ulrich, R., Zimring, C., Quan, X., and Joseph, A., 2004, “The Role of the Physical Environment in the Hospital of the 21st Century: A Once-in-a- Lifetime Opportunity”. The Center for Health Design, http://www.healthdesign.org/ research/reports/pdfs/role _physical_env.pdf Varawalla, H. 2004, “Designing for Flexibility Building in order and direction for growth and change”. Express Healthcare Management , August 15-30, 2006, http://www.expresshealthcaremgmt.com/ 20040831/architecture01.shtml
- 44. Contact information Debajyoti Pati,PhD, AIIA Director of Research, HKS Architects, Tom E Harvey Jr, AIA, FACHA, MPH Principal, HKS Architects, 1919 McKinney Avenue, Dallas, TX, 75201 214.969.5599 dpati@hksinc.com 1919 McKinney Avenue, Dallas, TX,75201 214.969.5599 tharvey@hksinc.com