How to Design Hospital Settings for Visually Impaired Patients.

It is essential for healthcare institutions to accommodate the needs of the growing population of visually impaired patients. Hospital leaders must implement strategies to guarantee these patients' autonomy. We reviewed the literature and identified measures hospitals have implemented to accommodate visually impaired patients. To bridge gaps in the literature, we interviewed healthcare managers from five different hospitals in the United States. These interviews reveal that, while different levels of accommodations are already offered by those institutions, accommodations are generally extremely basic, and leave enormous room for improvement to ensure that the visually impaired receive proper care and dignified treatment.

Emergency management in fever clinic during the outbreak of COVID-19: an experience from Zhuhai.

Coronavirus disease 2019 (COVID-19) is a global health threat. A hospital in Zhuhai adopted several measures in Fever Clinic Management (FCM) to respond to the outbreak of COVID-19. FCM has been proved to be effective in preventing nosocomial cross infection. Faced with the emergency, the hospital undertook creative operational steps in relation to the control and spread of COVID-19, with special focuses on physical and administrative layout of buildings, staff training and preventative procedures. The first operational step was to set up triaging stations at all entrances and then complete a standard and qualified fever clinic, which was isolated from the other buildings within our hospital complex. Secondly, the hospital established its human resource reservation for emergency response and the allocation of human resources to ensure strict and standardised training methods through the hospital for all medical staff and ancillary employees. Thirdly, the hospital divided the fever clinic into partitioned areas and adapted a three-level triaging system. The experiences shared in this paper would be of practical help for the facilities that are encountering or will encounter the challenges of COVID-19, i.e. to prevent nosocomial cross infection among patients and physicians.

Advancing evidence-based healthcare facility design: a systematic literature review.

Healthcare facility design is a complex process that brings together diverse stakeholders and ideally aligns operational, environmental, experiential, clinical, and organizational objectives. The challenges inherent in facility design arise from the dynamic and complex nature of healthcare itself, and the growing accountability to the quadruple aims of enhancing patient experience, improving population health, reducing costs, and improving staff work life. Many healthcare systems and design practitioners are adopting an evidence-based approach to facility design, defined broadly as basing decisions about the built environment on credible and rigorous research and linking facility design to quality outcomes. Studies focused on architectural options and concepts in the evidence-based design literature have largely employed observation, surveys, post-occupancy study, space syntax analysis, or have been retrospective in nature. Fewer studies have explored layout optimization frameworks, healthcare layout modeling, applications of artificial intelligence, and layout robustness. These operations research/operations management approaches are highly valuable methods to inform healthcare facility design process in its earliest stages and measure performance in quantitative terms, yet they are currently underutilized. A primary objective of this paper is to begin to bridge this gap. This systematic review summarizes 65 evidence-based research studies related to facility layout and planning concepts published from 2008 through 2018, and categorizes them by methodology, area of focus, typology, and metrics of interest. The review identifies gaps in the existing literature and proposes solutions to advance evidence-based healthcare facility design. This work is the first of its kind to review the facility design literature across the disciplines of evidence-based healthcare design research, healthcare systems engineering, and operations research/operations management. The review suggests areas for future study that will enhance evidence-based healthcare facility designs through the integration of operations research and management science methods.

A hermeneutic-phenomenological study of paediatric intensive care unit nurses' professional identity following hospital redesign: Lessons learned for managers.

AIM: To provide insights for health care managers by exploring paediatric intensive care unit nurses' lived experience of professional identity in the context of organisational change. BACKGROUND: While professional identity improves retention of nurses and provision of quality care, outcomes of importance for managers, organisational change perturbs this identity. METHOD: The study used a hermeneutic-phenomenological design. Data were collected via individual interviews, photographs, participant observation and document review. A purposive sampling strategy was used to recruit paediatric intensive care unit nurses (n = 15) in a large Canadian paediatric hospital. RESULTS: Nurses' critical care identity eroded in this organisation due to the interplay between hospital redesign and new eligibility criteria for patient admissions. CONCLUSION: Interactions between multiple projects and the unit context, as well as nursing professional identity, need to be considered early on during project planning. This study fills an important gap in research concerning the management challenges brought about by the intersection of multiple changes. IMPLICATIONS FOR NURSING MANAGEMENT: The results from this study bring to light three important lessons for nurse managers: 1) the specific unit context should be evaluated before a project is initiated; 2) the physical environment needs to be considered when determining staffing requirements; and 3) identity transitions need to be managed.

Making Spaces for Staff Breaks: A Design Anthropology Approach.

PURPOSE: This article proposes and demonstrates a design anthropological approach to hospital design and architecture and engages this approach to advance recent discussions of the question of designing for staff breaks. BACKGROUND: We respond to calls for attention to sensory and experiential dimensions of hospital architecture and design through social science approaches and to research into the sensory environments for staff breaks. METHOD: Design anthropology enables us to surface the experiential and unspoken knowledge and practice of hospital staff, which is inaccessible through conventional consultations, quantitative post-occupancy evaluation surveys, or traditional interviews. We draw on ethnographic research into the everyday experience, improvisatory activity, and imagined futures of staff working in the psychiatric department of a large new architecturally designed hospital in Australia. RESULTS: We argue that while the sensory aspects of hospital design conventionally cited-such as light and green areas-are relevant, attention to staff priorities that emerge in practice reveals that well-being is contingent on other qualities and resources. CONCLUSIONS: This suggests a refocus, away from the idea that environments impact on staff to create well-being, to understanding how staff improvise to create environments of well-being. We outline the implications of this research for an agenda for design for well-being in which architects and designers are often constrained by generic design briefs to argue for a shift in policy that attends more deeply to staff as future users of hospital designs.

Efficacy of Medical Operations and Layout Planning Onboard Nontraditional US Navy Vessels at High Seas.

INTRODUCTION: Attempting to expedite delivery of care to wounded war fighters, this study aimed to quantify the ability of medical and surgical teams to perform lifesaving damage control and resuscitation procedures aboard nontraditional US Navy Vessels on high seas. Specifically, it looked at the ability of the teams to perform procedures in shipboard operating and emergency rooms by analyzing motion of personnel during the procedures. METHODS: One hundred and twelve damage control and resuscitation procedures were performed during a voyage of the US Naval Ship Brunswick in transit from Norfolk, Virginia, to San Diego, California. The ability of personnel to perform these procedures was quantified by the use of motion link analysis designed to track the movement of each participant as they completed their assigned tasks. RESULTS: The link analysis showed no significant change in the number of movements of participants from the beginning to the end of the study. However, there was a learning effect observed during the study, with teams completing tasks faster at the end of the study than at the beginning. CONCLUSION: This shows that the working conditions aboard the US Naval Ship Brunswick were satisfactory for the assigned tasks, indicating that these medical operations may be feasible aboard nontraditional US Navy vessels.

Dementia Friendly Hospital Design: Key Issues for Patients and Accompanying Persons in an Irish Acute Care Public Hospital.

OBJECTIVES: Research was conducted to investigate the impact of the hospital environment on older people including patients with dementia and their accompanying persons (APs). The article presents key research findings in the case study hospital. BACKGROUND: For many patients, the hospital is challenging due to the busy, unfamiliar, and stressful nature of the environment. For a person with dementia, the hospital experience can be exacerbated by cognitive impairment and behavioral or psychological symptoms and can therefore prove to be a frightening, distressing, and disorientating place. METHOD: The findings are based on a stakeholder engagement process where the research team spent approximately 150 hr observing within the hospital, administered 95 questionnaires to patients and/or APs, and conducted 12 structured interviews with patients and APs. A thematic analysis was employed to analyze and generate key themes emerging from the process. RESULTS: Themes were grouped into overarching issues and design issues across spatial scales. CONCLUSION: This research confirms the negative impact of the acute hospital setting on older people with cognitive impairments including dementia and delirium. The multiple perspectives captured in this study, including most importantly people with dementia, ensure that stakeholder needs can be used to inform the design of the hospital environment. The research points to the value of understanding the lived experience of the person with dementia and APs. The voices of patients, particularly persons with dementia and their APs, are a crucial element in helping hospitals to fulfill their role as caregiving and healing facilities.

Renovation in hospitals: Training construction crews to work in health care facilities.

BACKGROUND: Health care facilities require frequent renovations to maintain or enhance their service, and to meet the dynamic demands of their patients. Construction activities in active health care facilities are a significant contributor to various challenges that range from infection to death. It is therefore essential to minimize the adverse impacts of construction activities on health care units as well as their adjacent sites. METHODS: A questionnaire was developed to study current training modules to prepare construction crews to work in health care environments. The survey was disseminated among professionals of the top 15 health care contractors. A total of 129 individuals participated, and their responses were analyzed using descriptive and categorical statistics. RESULTS: This study investigates current training practices regarding (1) the level of training, (2) the frequency of training, and (3) the impact that the sensitivity of the project has on the training. To effectively prepare construction crews, special training must be provided to them. CONCLUSIONS: There are uncertainties about the sufficiency and impact of the existing training. Existing trainings are tailored for upper management positions, and the amount/frequency of training for construction crews are substantially low. Findings of this study contribute to characterizing the activities and conditions pertaining to training of construction crews.

Chemical Pollution in Healing Spaces: The Decalogue of the Best Practices for Adequate Indoor Air Quality in Inpatient Rooms.

Indoor air quality (IAQ) is one of the main topics in which governments are focusing. In healthcare facilities, several studies have reported data analysis and case studies to improve users' health. Nowadays, although many studies have been conducted related to the biological and physical risks, the chemical risks have been less investigated and only in some specific functional areas of the hospitals. Starting from some systematic reviews and research works, this paper aims to list the best healthy practices for an adequate IAQ in inpatient wards. In particular, the decalogue lists the strategies related to chemical pollution, starting from design and management, with a focus on (a) localization of hospitals and inpatient rooms, (b) hospital room, (c) microclimatic parameters, (d) ventilation systems, (e) materials and finishing, (f) furniture and equipment, (g) cleaning products and activities, (h) maintenance and (i) management activities, and (l) users and workers. The multidisciplinary approach emphasizes the need for interdisciplinary knowledge and skills aimed to find solutions able to protect users' health status. The design and management decision-making, ranging from the adequate choices of construction site and hospital exposure, finishing materials, cleaning and maintenance activities, etc., which can affect the IAQ must be carried out based on scientific research and data analysis.

Chief Nursing Officers' Perspectives on Hospital-Based Building or Remodeling Projects.

OBJECTIVE: This descriptive survey explores the experiences of chief nursing officers (CNOs) who have participated in hospital-based building or remodeling projects. BACKGROUND: As a pivotal member of the leadership team for facility projects, CNOs are often charged with contributing to decisions regarding placement of technology connections, selection of design elements to prevent healthcare-associated infections, choice of location for supplies, and management of construction change orders. METHODS: A descriptive survey approach guided telephone interviews with 12 CNOs from across the United States. Credibility was achieved through peer debriefing and member checking. Transferability was demonstrated through detailed description; dependability and confirmability were demonstrated through an audit trail of the data collection and analysis processes. RESULTS: Three main themes were identified, and a list of practice implications was developed. CONCLUSIONS: CNOs can use the recommendations from this study as a starting point for future building or remodeling projects.

Designing Penfield: Inside the Montreal Neurological Institute.

Neurosurgeon Wilder Penfield (1891-1976) envisioned hospital architecture as a powerful medical tool. Focusing on two key interiors in the 1934 Montreal Neurological Institute (MNI)-the operating room and the foyer-this article engages newly accessible textual and material evidence to show Penfield's intense involvement in the design of the building. A unique, tri-level surgical room, with a sophisticated setup for photography, made the MNI's surgery interactive. The OR is discussed with regard to the relationship of doctors and architects and Penfield's penchant for architectural travel. Subsequently, we visit the foyer as a spatial counterpoint to the operating room. Its design enabled a particular, Penfield-inspired view of the brain and recounted neurological history in the language of Art Deco design. An emphasis on axial movement pushed visitors to "consume" a work of sculpture, meticulously copied from another in Paris. The architecture of the MNI thus monumentalized Penfield's accomplishments, by his own design.

Women's Prenatal and Labor Experiences in a Hospital With an Early-Labor Lounge.

OBJECTIVE: To evaluate the information that women with low-risk pregnancies received during the prenatal period about latent labor and the early-labor lounge (ELL) and their subsequent use of the ELL. DESIGN: Cross-sectional design with survey. SETTING/LOCAL PROBLEM: Community hospital in the northeastern United States with a low-risk cesarean birth rate of 33%, which exceeds the national target rate of 23.9%. PARTICIPANTS: Low-risk, nulliparous, pregnant women with a term singleton vertex fetus at hospital admission (N = 67). INTERVENTION/MEASUREMENTS: An electronic survey was administered before hospital discharge following birth. The survey assessed prenatal education, use of the ELL, admission characteristics, and birth satisfaction. Descriptive analysis was used. RESULTS: Nearly half (43.9%) of the women surveyed used the ELL. ELL users received prenatal care (72.3%), knew signs of active labor (93.1%), and had a cesarean birth rate of 7.1%. Significantly greater proportions of women prenatally cared for by midwives reported knowledge of the signs of early labor (100% vs. 80%; χ2 = 4.4, p = .04) and of the availability of the ELL (18.2% vs. 70.6%; χ2 = 15.2, p < .001). A range of activities were offered in the ELL, and at least 75% of women indicated that all activities were helpful during latent labor. Birth satisfaction scores, measured on a scale of 0 to 40, with 40 indicating greatest satisfaction, ranged from 22 to 35 among ELL participants. CONCLUSION: An ELL is a care innovation that hospitals can consider for providing support to women with low-risk pregnancies during the latent phase of labor. Women who used the ELL reported feeling that it provided guidance and support. An ELL is a woman-centered option for delayed admission.

Mock-Ups: Using Experiential Simulation Models in the Healthcare Design Process.

PURPOSE: The purpose of this article was to explore how different types of mock-ups are being used in the healthcare design process and present a methodology framework for the process. BACKGROUND: Historically, physical mock-ups have been used in healthcare design primarily to test construction techniques. Although this historic use of mock-ups assisted the design team in decision-making, newer forms of mock-ups have evolved that expand the input provided into decision-making. These newer techniques, rapid prototyping, early build-out, virtual reality, and enhancements to the traditional physical mock-up focus more on challenging the functionality of the space, testing new operational concepts, and increasing user input. METHOD: This methodology article utilized five case studies in which different types and combinations of mock-ups were used in the design process and then, the methodology compares the realism, immersion, and testability of each mock-up technique. RESULTS: For each mock-up type, the case studies described the purpose of the technique, the advantages and disadvantages, the most appropriate phase for its use in the design process, the estimated cost, and the process logistics. These components are compared to assist in developing a methodology for a variety of design situations. CONCLUSIONS: The findings related to different mock-up techniques are a valuable tool for healthcare design teams to use in selecting the most appropriate mock-up technique and the proposed methodology will assist in executing the mock-up process.

Cost-Effectiveness of Multifaceted Built Environment Interventions for Reducing Transmission of Pathogenic Bacteria in Healthcare Facilities.

OBJECTIVES: The objective of this study is to determine the optimal allocation of budgets for pairs of alterations that reduce pathogenic bacterial transmission. Three alterations of the built environment are examined: handwashing stations (HW), relative humidity control (RH), and negatively pressured treatment rooms (NP). These interventions were evaluated to minimize total cost of healthcare-associated infections (HAIs), including medical and litigation costs. BACKGROUND: HAIs are largely preventable but are difficult to control because of their multiple mechanisms of transmission. Moreover, the costs of HAIs and resulting mortality are increasing with the latest estimates at US$9.8 billion annually. METHOD: Using 6 years of longitudinal multidrug-resistant infection data, we simulated the transmission of pathogenic bacteria and the infection control efforts of the three alterations using Chamchod and Ruan's model. We determined the optimal budget allocations among the alterations by representing them under Karush-Kuhn-Tucker conditions for this nonlinear optimization problem. RESULTS: We examined 24 scenarios using three virulence levels across three facility sizes with varying budget levels. We found that in general, most of the budget is allocated to the NP or RH alterations in each intervention. At lower budgets, however, it was necessary to use the lower cost alterations, HW or RH. CONCLUSIONS: Mathematical optimization offers healthcare enterprise executives and engineers a tool to assist with the design of safer healthcare facilities within a fiscally constrained environment. Herein, models were developed for the optimal allocation of funds between HW, RH, and negatively pressured treatment rooms (NP) to best reduce HAIs. Specific strategies vary by facility size and virulence.

Anticipated advantages and disadvantages of a move to 100% single-room hospital in Australia: A case study.

OBJECTIVES: There is an international policy trend for building government hospitals with greater proportions of single-occupancy rooms. The study aim was to identify advantages and disadvantages for patients and nursing staff of a pending move to 100% single-room hospital, in anticipation of the challenges for nurse managers of a different ward environment. This paper presents these findings, summarizing potential advantages and disadvantages as well as comparison with findings from similar studies in England. METHODS: Mixed method case study design was undertaken in four wards of a large hospital with multi-bed rooms. Three components of a larger study are reported here: nurse surveys and interviews, patient interviews of their experiences of the current multi-bedroom environment and expectations of new single-room environment. Integration was achieved via data transformation where results of the nursing staff survey and interviews and patient interviews were coded as narrative allowing for quantitative and qualitative data to be merged. RESULTS: Four constructs were derived: physical environment; patient safety and comfort; staff safety; and importance of interaction. CONCLUSION: There are important factors that inform nurse managers when considering a move to an all single-room design. These factors are important for nurses' and patients' well-being. IMPLICATIONS FOR NURSING MANAGEMENT: This study identified for nurse managers key factors that should be considerd when contributing to the design of a 100% single-room hospital. Nurses' voices are critically important to inform the design for a safe and efficient ward environment.

Facility Design: Reimagining Approaches to Childbirth in Hospital and Birth Center Settings.

Few maternity care clinicians are aware of the current regulations that guide design standards for childbirth facilities in the United States or the regulatory history. There is considerable variance among state regulations as well as oversight of facility standards for healthcare settings. Understanding evidence-based recommendations on how facility design affects health outcomes is critical to reversing the rise in maternal mortality and morbidity. A variety of measures can be implemented that promise to improve user satisfaction, quality of care, and efficiency for all who engage in the childbirth environment. Recommendations for change include broader assessment to better understand how clinicians and consumers simultaneously maneuver within a complex system. Key metrics include evaluation of workflow within available space, patient acuity and census patterns, integration of evidence-based recommendations, and options that promote physiologic birth. For the changes to succeed, human centered design must be implemented and diverse clinicians and consumers engaged in all phases of planning and implementation. Exploring characteristics and outcomes of low-risk women who receive care in a freestanding birth center or the European alongside maternity unit provides opportunity to reimagine and address improvements for inpatient, hospital birth.

Evaluating the Psychosocial Impact of Indoor Public Spaces in Complex Healthcare Settings.

OBJECTIVE: This article describes an approach to a metrics-based evaluation of public space in hospitals using cross-disciplinary qualitative and quantitative analyses. The method, Indoor Public Space Measurement (IPSM), is well suited to researchers and designers who intend to evaluate user-centered spatial solutions in hospitals and similar facilities. BACKGROUND: Healthcare is transiting toward a value-based policy at all levels. Choosing the right set of qualitative and quantitative analyses to support value-based design solutions is not always an easy journey for healthcare design consultants. This article seeks to pull together the key analyses to evaluate the impact of the hospital indoor public space on the psychosocial well-being of the hospital users. METHOD: A step-by step guide to performing key analyses to evaluate the impact of hospital indoor public space environment on the users' psychosocial well-being is provided. A case study from the authors' research is utilized to illustrate the application of the method. RESULTS: Interpolating the results of all the analyses, the reader can identify where in the layout most of interactions among users occur, identify their typology and evaluate the contribution to the general psychosocial well-being, and know which group of users is more exposed to a specific typology of interaction. CONCLUSIONS: The IPSM method can help design consultants to measure the impact of the built environment of hospital public space on its occupants' psychosocial well-being: factual knowledge about the users' behavioral response with respect to wayfinding and social interaction. The application of the method is not limited to healthcare settings only.

Assessing the Feasibility of Measuring Variation in Facility Design Among American Childbirth Facilities.

OBJECTIVE: To assess the feasibility of quantifying variation in childbirth facility design and explore the implications for childbirth service delivery across the United States. BACKGROUND: Design has been shown to impact quality of care in childbirth. However, most prior studies use qualitative data to examine associations between the design of patient rooms and patient experience. There has been limited exploration of measures of unit design and its impact on care provision. METHOD: We recruited 12 childbirth facilities that were diverse with regard to facility type, location, delivery volume, cesarean delivery rate, and practice model. Each facility provided annotated floor plans and participated in a site visit or telephone interview to provide information on their design and clinical practices. These data were analyzed with self-reported primary cesarean delivery rates to assess associations between design and care delivery. RESULTS: We observed wide variation in childbirth unit design. Deliveries per labor room per year ranged from 75 to 479. The ratio of operating rooms to labor rooms ranged from 1:1 to 1:9. The average distance between labor rooms and workstations ranged from 23 to 114 ft, and the maximum distance between labor rooms ranged from 9 to 242 ft. More deliveries per room, fewer labor rooms per operating room, and longer distances between spaces were all associated with higher primary cesarean delivery rates. CONCLUSIONS: Clinically relevant differences in design can be feasibly measured across diverse childbirth facilities. The design of these facilities may not be optimally matched to service delivery needs.