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.

Educational Challenges in Healthcare Design: Training Multidisciplinary Professionals for Future Hospitals and Healthcare.

BACKGROUND: Healthcare environments are one of the most complex and demanding fields of work. Scientific, technological and research developments along with new discoveries within health promotion and prevention strategies are increasingly requiring a multidisciplinary and interdisciplinary approach. Therefore, it is likely that the current professions will need to be significantly adapted to accommodate new and more specialized roles. OBJECTIVES: To present an overview of the current educational and training courses of the emerging professions, such as hospital planner, physician-engineer, doctor-architect, nurse-architect or engineer, we review the present global training courses (BSc, MSc, specialization and PhD courses) related to healthcare design focusing on the fields of Medicine and Nursing, Architecture and Engineering sciences. RESULTS: The paper analyses the literature review and website analysis about active teaching programs and courses. Several academic institutions offer BSc, MSc and PhD degree programs in Healthcare Design, Environmental and Building Hygiene, and Public Health. In addition, there are several professional postgraduate courses, either in classroom, hybrid-based or online. CONCLUSIONS: A considerable number of international training experiences addresses the topic of training multidisciplinary professionals. Further in-depth investigations are needed to examine the content, teaching format and impact of the courses, student outcomes and professional careers, fields of interest and the degree of collaborations with other institutions.

A project to identify the best practices and health performance objectives for building construction and renovation.

The 2014-2018 National Prevention Plan (NPP), in order to promote a correct relationship between health and the environment, indicated, among the central objectives, the definition of guidelines to promote the building hygiene codes in an eco-compatible way, but also to develop specific skills on the subject of confined environments and residential construction in the operators of the Regional Health Services. The CCM2015 Project has therefore set itself the goal of taking stock of the best health practices available today in terms of sustainability and eco-compatibility in the buildings' construction and renovation actions. All this in order to define updated health performance targets to be made available to the competent Authorities, to adapt the current legislation at national, regional and local level, and finally to define the contents of a continuing education (training courses) capable to support operators in risk assessment related to the built environment and in the definition of effective preventive measures.

Indoor environmental quality, occupant satisfaction, and acute building-related health symptoms in Green Mark-certified compared with non-certified office buildings.

Indoor environmental quality (IEQ) has become an important component of green building certification schemes. While green buildings are expected to provide enhanced IEQ, higher occupant satisfaction, and less risks of occupant health when compared with non-green buildings, the literature suggests inconsistent evidence due to diverse research design, small sample size, and weak statistical analysis. This study compared several outcomes pertinent to IEQ performance in green and non-green office buildings in Singapore. Adopting a cross-sectional study design, objective measurements were taken in eight green and six non-green buildings, and satisfaction and acute health symptom risks of 367 occupants were obtained. Green buildings exhibited lower concentration of PM2.5, bacteria, and fungi and maintained temperature and humidity more consistently compared to non-green counterparts. The mean ratings for satisfaction with temperature, humidity, lighting level, air quality, and indoor environment were higher in green buildings (with statistical significance P < 0.05). There was statistically significant reduction in risk of occupants having headache, unusual fatigue, and irritated skin in green buildings. Although matching of buildings and occupant characteristics, survey participation bias, and sampling duration (a 1-week snapshot) of IEQ monitoring remain as limitations, this study offered positive association of green buildings with qualitatively and quantitatively measured performance of IEQ.

Assessing the impact of household participation on satisfaction and safe design in humanitarian shelter projects.

Participation has long been considered important for post-disaster recovery. Establishing what constitutes participation in post-disaster shelter projects, however, has remained elusive, and the links between different types of participation and shelter programme outcomes are not well understood. Furthermore, recent case studies suggest that misguided participation strategies may be to blame for failures. This study analysed 19 shelter projects implemented in the Philippines following Typhoon Haiyan in November 2013 to identify the forms of participation employed. Using fuzzy-set qualitative comparative analysis, it assessed how household participation in the planning, design, and construction phases of shelter reconstruction led to outcomes of household satisfaction and safe shelter design. Participation was operationalised via eight central project tasks, revealing that the involvement of households in the early planning stages of projects and in construction activities were important for satisfaction and design outcomes, whereas engagement during the design phase of projects had little impact on the selected outcomes.

Building Evidence for Health: Green Buildings, Current Science, and Future Challenges.

Civilizational challenges have questioned the status quo of energy and material consumption by humans. From the built environment perspective, a response to these challenges was the creation of green buildings. Although the revolutionary capacity of the green building movement has elevated the expectations of new commercial construction, its rate of implementation has secluded the majority of the population from its benefits. Beyond reductions in energy usage and increases in market value, the main strength of green buildings may be the procurement of healthier building environments. Further pursuing the right to healthy indoor environments could help the green building movement to attain its full potential as a transformational public health tool. On the basis of 40 years of research on indoor environmental quality, we present a summary of nine environment elements that are foundational to human health. We posit the role of green buildings as a critical research platform within a novel sustainability framework based on social-environmental capital assets.

Pre-Sabine room acoustic design guidelines based on human voice directivity.

With the work of Wallace C. Sabine on the lecture hall of the Fogg Art Museum and concert hall of Boston Symphony Hall, a foundation for the field of architectural acoustics as a science was laid between 1895 and 1900. Prior to that, architects employed various notions in acoustic design. Previous studies by the authors have reviewed 18th and 19th century design guidelines that were based on the quantification of the perception threshold between direct sound and first order reflections, with these guidelines being followed in the design of several rooms with acoustical demands. This study reviews an alternate metric guideline, based on the directivity and propagation distance of the human voice, which was utilized in several halls also during the 18th and 19th centuries. The related acoustic experiments tested how far sound was perceivable towards the front, sides, and rear of a speaking person. These ratios were used in the acoustical design of at least five lecture halls, four theater halls, one opera hall, and one concert hall, constructed in Germany, England, and the USA. These historic designs, and comparisons to modern measures and guidelines, are reviewed.

A measuring instrument for the auditory perception of rooms: The Room Acoustical Quality Inventory (RAQI).

With the Room Acoustical Quality Inventory (RAQI), a measuring instrument for the perceptual space of performance venues for music and speech has been developed. First, a focus group with room acoustical experts determined relevant aspects of room acoustical impression in the form of a comprehensive list of 50 uni- and bipolar items in different categories. Then, n = 190 subjects rated their acoustical impression of 35 binaurally simulated rooms from 2 listening positions, with symphonic orchestra, solo trumpet, and dramatic speech as audio content. Subsequent explorative and confirmative factor analyses of the questionnaire data resulted in three possible solutions with four, six, and nine factors of room acoustical impression. The factor solutions, as well as the related RAQI items, were tested in terms of reliability, validity, and several types of measurement invariance, and were cross-validated by a follow-up experiment with a subsample of 46% of the original participants, which provided re-test reliabilities and stability coefficients for all RAQI constructs. The resulting psychometrically evaluated measurement instrument can be used for room quality assessment, acoustical planning, and the further development of room acoustical parameters in order to predict primary acoustical qualities of venues for music and speech.

Interdisciplinary Development of an Improved Emergency Department Procedural Work Surface Through Iterative Design and Use Testing in Simulated and Clinical Environments.

STUDY OBJECTIVE: A stable and readily accessible work surface for bedside medical procedures represents a valuable tool for acute care providers. In emergency department (ED) settings, the design and implementation of traditional Mayo stands and related surface devices often limit their availability, portability, and usability, which can lead to suboptimal clinical practice conditions that may affect the safe and effective performance of medical procedures and delivery of patient care. We designed and built a novel, open-source, portable, bedside procedural surface through an iterative development process with use testing in simulated and live clinical environments. METHODS: The procedural surface development project was conducted between October 2014 and June 2016 at an academic referral hospital and its affiliated simulation facility. An interdisciplinary team of emergency physicians, mechanical engineers, medical students, and design students sought to construct a prototype bedside procedural surface out of off-the-shelf hardware during a collaborative university course on health care design. After determination of end-user needs and core design requirements, multiple prototypes were fabricated and iteratively modified, with early variants featuring undermattress stabilizing supports or ratcheting clamp mechanisms. Versions 1 through 4 underwent 2 hands-on usability-testing simulation sessions; version 5 was presented at a design critique held jointly by a panel of clinical and industrial design faculty for expert feedback. Responding to select feedback elements over several surface versions, investigators arrived at a near-final prototype design for fabrication and use testing in a live clinical setting. This experimental procedural surface (version 8) was constructed and then deployed for controlled usability testing against the standard Mayo stands in use at the study site ED. Clinical providers working in the ED who opted to participate in the study were provided with the prototype surface and just-in-time training on its use when performing bedside procedures. Subjects completed the validated 10-point System Usability Scale postshift for the surface that they had used. The study protocol was approved by the institutional review board. RESULTS: Multiple prototypes and recursive design revisions resulted in a fully functional, portable, and durable bedside procedural surface that featured a stainless steel tray and intuitive hook-and-lock mechanisms for attachment to ED stretcher bed rails. Forty-two control and 40 experimental group subjects participated and completed questionnaires. The median System Usability Scale score (out of 100; higher scores associated with better usability) was 72.5 (interquartile range [IQR] 51.3 to 86.3) for the Mayo stand; the experimental surface was scored at 93.8 (IQR 84.4 to 97.5 for a difference in medians of 17.5 (95% confidence interval 10 to 27.5). Subjects reported several usability challenges with the Mayo stand; the experimental surface was reviewed as easy to use, simple, and functional. In accordance with experimental live environment deployment, questionnaire responses, and end-user suggestions, the project team finalized the design specification for the experimental procedural surface for open dissemination. CONCLUSION: An iterative, interdisciplinary approach was used to generate, evaluate, revise, and finalize the design specification for a new procedural surface that met all core end-user requirements. The final surface design was evaluated favorably on a validated usability tool against Mayo stands when use tested in simulated and live clinical settings.

Rethinking ADA signage standards for low-vision accessibility.

Americans With Disabilities Act (ADA) and International Code Council (ICC) standards for accessible buildings and facilities affect design and construction of all new and renovated buildings throughout the United States, and form the basis for compliance with the ADA. While these standards may result in acceptable accessibility for people who are fully blind, they fall far short of what they could and should accomplish for those with low vision. In this article I critique the standards, detailing their lack of evidence base and other shortcomings. I suggest that simply making existing requirements stricter (e.g., by mandating larger letter size or higher contrasts) will not ensure visual accessibility and therefore cannot act as a valid basis for compliance with the law. I propose two remedies. First, requirements for visual characteristics of signs intended to improve access for those with low vision should be expressed not in terms of physical features, such as character height and contrast, but rather in terms of the distance at which a sign can be read by someone with nominally normal (20/20) visual acuity under expected lighting conditions for the installed environment. This would give sign designers greater choice in design parameters but place on them the burden of ensuring legibility. Second, mounting of directional signs, which are critical for effective and efficient wayfinding, should be required to be in consistent and approachable locations so that those with reduced acuity may view them at close distance.

Building Community: Stakeholder Perspectives on Walking in Malls and Other Venues.

Mall walking has been a popular physical activity for decades. However, little is known about why mall managers support these programs or why adults choose to walk. Our study aim was to describe mall walking programs from the perspectives of walkers, managers, and leaders. Twenty-eight walkers, 16 walking program managers, and six walking program leaders from five states participated in a telephone or in-person semi-structured interview (N = 50). Interview guides were developed using a social-ecological model. Interviews were recorded, transcribed verbatim, and analyzed thematically. All informants indicated satisfaction with their program and environmental features. Differences in expectations were noted in that walkers wanted a safe, clean, and social place whereas managers and leaders felt a need to provide programmatic features. Given the favorable walking environments in malls, there is an opportunity for public health professionals, health care organizations, and providers of aging services to partner with malls to promote walking.

Strategic Behavior in Certifying Green Buildings: An Inquiry of the Non-building Performance Value.

This study determines the magnitude of the market signaling effect arising from Leadership in Energy and Environmental Design certification for green buildings and explores the mechanisms behind the signaling effect. Previous studies have shown that signaling or marketability plays an important role in the pursuit for Leadership in Energy and Environmental Design and equivalent green-building certification. By analyzing all new construction projects receiving Leadership in Energy and Environmental Design certification from 2000 to 2012 in the US, this study estimates the relative importance of 'green' signaling. This broad perspective using project-level data enables an analysis of some drivers of signaling and the pursuit of marketing benefits. The roles of local competition and market conditions, as well as municipal regulations are examined, especially as they differ between types of building owners (e.g., for-profit firms, governments, nonprofits). The results indicate that the non-building performance value-value captured by Leadership in Energy and Environmental Design signals above and beyond the specific building attributes that Leadership in Energy and Environmental Design certifies-dominates the attainment of Leadership in Energy and Environmental Design scores around certification tier thresholds. Further, strong evidence of spatial clustering of this non-building performance value for some owner types indicates that for-profit owners may be more responsive to local competition than non-profit owners. Local legislative mandates predict greater signaling intensity by government-owned buildings, as expected, but for-profit-owned projects tend to signal less, even after controls for local conditions. The results highlight the importance of local conditions, including peer effects and regulations, in driving non-building performance values across a wide range of green buildings.

Effect of mass housing settlement type on the comfortable open areas in terms of noise.

The layout of the structures according to the noise source is an important parameter in terms of the level of noise reaching to both open usage areas and the structure surfaces. In this paper, it is aimed to reveal the effect of mass housing settlement type on the size of suitable open usage areas in terms of noise. Comfortable open usage areas in 25 mass housing alternatives are determined for the case of being affected by three different road noises. The reliability of the simulation results is validated by on-site noise level measurements. As a result, it is seen that better results are obtained in linear, L, C, and U type alternatives than point-type blocks. Especially in alternatives consisting of point-and linear-type blocks, if the noise level is above 75 Leq (dBA), the percentage of comfortable open usage areas is very low. It is determined that the percentage of comfortable open areas increases between 50 and 100% by means of appropriately designed noise barriers.

[Dementia-friendly hospital wards : Expert recommendations for planning and design]. / Demenzsensible Krankenhausstationen : Expertenempfehlungen zu Planung und Gestaltung.

BACKGROUND: Hospitals face great challenges in the necessity of providing care for the rising number of elderly patients with dementia. The adaptation of the spatial environment represents an important component to improve the care situation of patients with dementia. For more than 30 years research results from long-term care have provided evidence on the therapeutic effect of numerous architectural features on people with dementia. Due to specific medical and organizational requirements in hospitals, the transferability of these findings is, however, limited. MATERIAL AND METHODS: An interdisciplinary workshop with experts from the fields of medicine, nursing, gerontology, self-help and architecture was conducted in July 2015. Based on existing research findings and experiences from pilot projects, the spatial requirements for dementia-friendly hospital wards were collated, suggested solutions were discussed from different perspectives and finally design recommendations were derived. RESULTS: The article gives a first comprehensive overview of architectural measures that are required for the design of dementia-friendly hospital wards. The recommendations provided range from architectural criteria, such as the size and spatial structure of hospital wards, to interior design elements, including orientation and navigation aids and the use of light and colors. Furthermore, information about the planning process are given.

Building Performance in Earthquakes and the U.S. Resiliency Council's Rating System.

The greatest value of a building rating system is one that meshes with economic decisions.

[Hygienic principles of the design of the space and architectural environment of kindergartens].

In the article there are considered current requirements for the design of the architectural environment of preschool institutions. These requirements provide conditions ofpreservation and promotion of health ofpreschool children. Among them are: the association of rooms according to a functional purpose; division of children collectives according to the age; rational placement of main rooms for the prevention ofpenetration of noise and pollution; ensuring convenientfunctional connections between different premises and group rooms and the parcel ofpreschool institutions; optimal solution of the light mode; rational air and thermal mode. There are made proposals for the expansion of the list of hygienic principles of the design of buildings of kindergartens: provision of conditions for realization of physical activity of children, the safe use of electronic educational equipment, and the creation of the barrier-free environment. There was established the insufficiency of areas of group rooms for the realization of voluntary motor activity of children in modern kindergartens and the need of the revision of the standard of the area of the group room per one child.

Seasonal variation in airborne endotoxin levels in indoor environments with different micro-environmental factors in Seoul, South Korea.

This study evaluated the variation over a year in airborne endotoxin levels in the indoor environment of five university laboratories in Seoul, South Korea, and examined the micro-environmental factors that influenced endotoxin levels. These included temperature, relative humidity, CO2, CO, illumination, and wind velocity. A total of 174 air samples were collected and analyzed using the kinetic limulus amebocyte lysate assay. Endotoxin levels ranged from <0.001 to 8.90EU/m(3), with an overall geometric mean of 0.240EU/m(3). Endotoxin levels showed significantly negative correlation with temperature (r=-0.529, p<0.001), CO2 (r=-0.213, p<0.001) and illumination (r=-0.538, p<0.001). Endotoxin levels tended to be higher in winter. Endotoxin levels in laboratories with rabbits were significantly higher than those of laboratories with mice. Multivariate regression analysis showed that the environmental factors affecting endotoxin levels were temperature (coefficient=-0.388, p<0.001) and illumination (coefficient=-0.370, p<0.001). Strategies aimed at reducing airborne endotoxin levels in the indoor environments may be most effective if they focus on illumination.

Regulatory requirements for nuclear power plant site selection in Malaysia-a review.

Malaysia has initiated a range of pre-project activities in preparation for its planned nuclear power programme. Clearly one of the first steps is the selection of sites that are deemed suitable for the construction and operation of a nuclear power plant. Here we outline the Malaysian regulatory requirements for nuclear power plant site selection, emphasizing details of the selection procedures and site characteristics needed, with a clear focus on radiation safety and radiation protection in respect of the site surroundings. The Malaysia Atomic Energy Licensing Board (AELB) site selection guidelines are in accord with those provided in International Atomic Energy Agency (IAEA) and United Stated Nuclear Regulatory Commission (USNRC) documents. To enhance the suitability criteria during selection, as well as to assist in the final decision making process, possible assessments using the site selection characteristics and information are proposed.

[Acoustic conditions in open plan offices - Pilot test results]. / Warunki akustyczne w pomieszczeniach biurowych open space ­ wyniki badan pilotazowych.

BACKGROUND: The main source of noise in open plan office are conversations. Office work standards in such premises are attained by applying specific acoustic adaptation. This article presents the results of pilot tests and acoustic evaluation of open space rooms. MATERIAL AND METHODS: Acoustic properties of 6 open plan office rooms were the subject of the tests. Evaluation parameters, measurement methods and criterial values were adopted according to the following standards: PN-EN ISO 3382- 3:2012, PN-EN ISO 3382-2:2010, PN-B-02151-4:2015-06 and PN-B-02151-3:2015-10. RESULTS: The reverberation time was 0.33- 0.55 s (maximum permissible value in offices - 0.6 s; the criterion was met), sound absorption coefficient in relation to 1 m2 of the room's plan was 0.77-1.58 m2 (minimum permissible value - 1.1 m2; 2 out of 6 rooms met the criterion), distraction distance was 8.5-14 m (maximum permissible value - 5 m; none of the rooms met the criterion), A-weighted sound pressure level of speech at a distance of 4 m was 43.8-54.7 dB (maximum permissible value - 48 dB; 2 out of 6 rooms met the criterion), spatial decay rate of the speech was 1.8-6.3 dB (minimum permissible value - 7 dB; none of the rooms met the criterion). CONCLUSIONS: Standard acoustic treatment, containing sound absorbing suspended ceiling, sound absorbing materials on the walls, carpet flooring and sound absorbing workplace barriers, is not sufficient. These rooms require specific advanced acoustic solutions. Med Pr 2016;67(5):653-662.

The experience of educational quality in undergraduate nursing students: a phenomenological study.

AIM: The evaluation of academic education has become crucial in the European Union since the Bologna Process encouraged all European universities to reach high quality standards in education. Although several studies have been conducted on the quality of undergraduate nursing education, few studies have explored this topic from the students' perspective. The purpose of this study was to describe the experience of educational quality in undergraduate nursing students. METHOD: The phenomenological method was used to study 55 students (mean age 24 years; 73% female) pursuing a baccalaureate degree in nursing in three universities in central Italy. RESULTS: The following five themes emerged from the phenomenological analysis: 1) quality of faculties: teaching skills, preparation, sensitivity to students, self-discipline; 2) theory-practice integration and communication between teaching and clinical area; 3) general management and organization of the programme; 4) quality of infrastructures: libraries, classrooms, information technology, services, administration, and communication; and 5) clinical tutorship: humanity, relationships and ability of the clinical tutor to guide and support. CONCLUSION: This study's novel finding was a deeper understanding of the educational quality's meanings among undergraduate nursing students. Students thought educational quality consisted of the faculty members' sensitivity towards their problems and the clinical tutors' humanity, interpersonal skills, guidance and support.