Transitioning to a New Facility: The Crucial Role of Employee Engagement.

EXECUTIVE SUMMARY: Transitioning to a new facility can be challenging for employees and detrimental to operations. A key aspect of the transition is employee understanding of, and involvement in, the design of the new facility. The literature lacks a comprehensive study of the impact of change engagement throughout the design, construction, and activation of a project as well as how that can affect perceptions, expectations, and, eventually, satisfaction of employees. The purpose of this research was to examine employee perceptions and satisfaction throughout a hospital design, construction, and activation process. Three pulse-point surveys were administered throughout the transition of a children's hospital emergency department and neonatal intensive care unit to a new facility. We also administered a postoccupancy survey 3 months after the move into the new facility. We received 544 responses and analyzed them to assess the relationship between involvement in design or change engagement initiatives and overall perceptions. The results revealed a strong relationship between employee engagement and their level of preparedness to move, readiness to adapt, and satisfaction. Early involvement in the design of a facility or new processes can significantly affect staff preparedness and readiness to adapt as well as employees' overall satisfaction with the building after occupancy. In addition, our findings suggest that keeping a finger on the pulse of employee perceptions and expectations throughout the design, construction, and activation phase is critical to employee preparedness and satisfaction in transitioning to a new facility.

A Value Analysis of Lean Processes in Target Value Design and Integrated Project Delivery.

OBJECTIVE: To investigate what key stakeholders consider to be the advantages and the opportunities for improvement in using lean thinking and tools in the integrated project delivery (IPD) process. METHOD: A detailed literature review was followed by case study of a Lean-IPD project. Interviews with members of the project leadership team, focus groups with the integrated team as well as the design team, and an online survey of all stakeholders were conducted. ANALYSIS: Statistical analysis and thematic content analysis were used to analyze the data, followed by a plus-delta analysis. RESULTS: (1) Learning is a large, implicit benefit of Lean-IPD that is not currently captured by any success metric; (2) the cardboard mock-up was the most successful lean strategy; (3) although a collaborative project, the level of influence of different stakeholder groups was perceived to be different by different stakeholders; (4) overall, Lean-IPD was rated as better than traditional design-bid-build methods; and (5) opportunities for improvement reported were increase in accurate cost estimating, more efficient use of time, perception of imbalance of control/influence, and need for facilitation (which represents different points of view). CONCLUSION: While lean tools and an IPD method are preferred to traditional design-bid-build methods, the perception of different stakeholders varies and more work needs to be done to allow a truly shared decision-making model. Learning was identified as one of the biggest advantages.

A Review of Design and Policy Interventions to Promote Nurses' Restorative Breaks in Health Care Workplaces.

The nursing profession in the United States is on the precipice of a crisis. Nurses are essential to the health care industry, and maintaining quality nursing care is a primary concern of today's health care managers. Health care facilities report high rates of staff burnout and turnover, and interest in the nursing profession among younger students is declining. Health care leaders must improve nurses' job satisfaction, performance, and retention. However, they often overlook the need for nurses' respite and underestimate the value of well-designed staff break areas. An exhaustive and systematic literature search was conducted in the summer of 2014, and all studies found on the topic were reviewed for their relevance and quality of evidence. The existing literature about the main causes of nurses' fatigue, barriers that prevent nurses from taking restorative breaks, and consequences of nurses' fatigue for staff, patient, and facility outcomes demonstrates the pressing need for interventions that improve nurses' working conditions. Additional literature on the restorative effects of breaks and the value of well-designed break areas indicates that efforts to improve breakroom design can play an important role in improving nurses' job satisfaction and performance.

The implications of high-quality staff break areas for nurses' health, performance, job satisfaction and retention.

AIM: The main study objective was to explore policy and design factors contributing to nurses' perception of how well-designed staff break areas can play an important beneficial role in relation to their overall job satisfaction, retention, performance and job-related health concerns. BACKGROUND: Nurses are extremely valuable to the healthcare industry; however, today's nursing profession is challenged by nurses' fatigue and its negative consequences on nurses' health and the quality of patient care they provide. METHODS: Preliminary interviews were conducted with 10 nurses who worked as consultants in the healthcare design and construction industry. Based on findings, an online survey was developed and distributed to over 10 000 members of the Academy of Medical-Surgical Nurses in the United States. RESULTS: The majority of nurses viewed high-quality break spaces as 'fairly' or 'very' important in terms of their potential to positively influence staff, patient and facility outcomes. Stress, rest breaks and the quality of break areas were some of the significant factors contributing to their perception. CONCLUSION/IMPLICATIONS FOR NURSING MANAGEMENT: The results of this empirical study support the conclusion that improvements in healthcare facility policies regarding staff breaks, as well as the creation of better-designed break areas, can be of significant benefit for nurses and the patients that they serve.

The Seniors' Outdoor Survey: An Observational Tool for Assessing Outdoor Environments at Long-Term Care Settings.

PURPOSE OF THE STUDY: To describe the development and psychometric testing of the Seniors' Outdoor Survey (SOS), an instrument for evaluating how well the outdoor space in a long-term care setting supports the preferences and outdoor usage of residents. DESIGN AND METHODS: Content validity of the main SOS items initially was based on relevant literature and preliminary studies in diverse long-term care settings. After conducting a multiregional pilot study with 152 outdoor spaces at 68 assisted living facilities, the instrument was substantially revised and tested for interrater and test-retest reliability with 22 outdoor spaces at 12 long-term care settings, using 2 raters. Validity was examined using content analysis of resident survey responses (N = 1,128) from the multiregional study and specific item validation by subject matter experts (N = 53). RESULTS: The final instrument contains 60 ratable items organized in 5 domains: access to nature (14 items), outdoor comfort and safety (15 items), walking and outdoor activities (14 items), indoor-outdoor connection (11 items), and connection to the world (6 items). Intraclass correlation coefficient (ICC) estimates of interrater reliability were .91 for the overall instrument, ranging from .83 to .98 for the 5 domains. Interrater reliability (ICC) was above .70 for more than 79% of individual items. Test-retest reliability (ICC) was .92, ranging from .81 to .98 for domains. IMPLICATIONS: The SOS tool fills a gap in the available environmental assessment instruments, providing a reliable way for researchers, providers, and designers to evaluate and compare the supportive potential of outdoor spaces for long-term care residents.

Restorative Design Features for Hospital Staff Break Areas: A Multi-Method Study.

OBJECTIVES: The study investigated the main restorative components of staff break areas in healthcare facilities, by assessing usage patterns, verbal/visual preferences, and perceived restorative qualities of specific design features found in break areas for hospital staff. BACKGROUND: Nurses are extremely important to the healthcare industry, and maintaining the quality of nursing care is a central concern for healthcare administrators. While healthcare leaders are concerned about improving nurses' satisfaction, performance, and job retention, they may overlook the importance of respite for nurses and underestimate the value of designing staff break areas to maximize their restorative potential. METHODS: A multi-method approach combined qualitative explorations (focused interviews and narrative survey questions) with quantitative measurements (discrete survey questions and a visual ranking of break-room spaces), and the results were compared and triangulated. RESULTS: It was found that staff break areas are more likely to be used if they are in close proximity to nurses' work areas, if they have complete privacy from patients and families, and if they provide opportunities for individual privacy as well as socialization with coworkers. Having physical access to private outdoor spaces (e.g., balconies or porches) was shown to have significantly greater perceived restorative potential, in comparison with window views, artwork, or indoor plants. CONCLUSIONS: The results of this empirical study support the conclusion that improvements in the restorative quality of break areas may significantly improve nurses' satisfaction and stress reduction, potentially leading to improved care for the patients they serve.

Field Research and Parametric Analysis in a Medical-Surgical Unit.

OBJECTIVE: To study the workplace in a medical-surgical (med-surg) unit and to identify suboptimal environmental conditions that can be improved in the current unit and avoided in future design, through rapidly deployed field research and timely simulation. BACKGROUND: Literature emphasizes the importance of the healthcare workplace and the effect on patient outcomes. What is lacking are studies conducted on-site and used for immediate application in design to assess and improve workplace conditions. METHODS: A rapidly deployed field research and simulation study was conducted in a 40-bed med-surg unit of a large healthcare system as part of the process of designing a new medical tower. Online surveys, systematic behavioral observations, semi-structured interviews, sound studies, and advanced spatial analysis through parametric modeling were conducted. RESULTS: The following created challenges for patient monitoring, care coordination, and management: (1) waste and variability in walking, (2) limited point-of-use access to supplies, (3) large distances traveled for minor tasks, and (4) low visibility and connectivity. The corridor is used as a workspace/communication hub. There is a distinct difference in beginning of day and night shift patterns and between walking "distance" and walking "sequence." There is a tendency for nurses to multitask, but a simulation exercise shows that for key tasks like medication delivery, multitasking may not always reduce walking distances. CONCLUSION: Co-location of medications, supplies, and nourishment; accommodation for work on wheels; and spatial and technological connectivity between care team and patients should be considered while designing a med-surg unit. Understanding the key activity sequences helps determine the proximity of spaces in relationship to patient rooms and each other.