Benchmarking Relevance for Hospital Design and Planning: An International Web-Based Survey.

OBJECTIVE: The study aims to investigate what design practitioners and healthcare facility managers deem as important benchmarking metrics worldwide, investigating country differences in benchmarking usage and which metrics are prioritized. BACKGROUND: Benchmarking is a regular practice in the healthcare sector, both for clinical and managerial aspects to compare, measure, and improve standardized processes. However, limited knowledge is available about benchmarking procedures in hospital planning, design, and construction. METHODS: A web-based survey was designed, revised, and pilot-tested in five countries; it was adjusted according to local experts' suggestions and submitted globally via SoSci multilingual platform to persons involved in hospital design, research, construction, and facility management. It was composed of closed questions on 5-point Likert-type scale ranking frequency or importance and open-ended questions divided into six sections. Two hundred and eighty full responses have been collected. Statistical analysis was performed via PowerBI and R-Studio, while qualitative analysis was performed via MAXQDA. RESULTS: The findings reported allow for both specific insights per each country or category as well as enabling general considerations of a practice that is becoming always more international with 30%-50% of respondents working in the international context. The evaluation of the survey highlights the most important benchmarks, among others. For example, for respondents from the top five countries (Sweden, Spain, Germany, Italy, and the United States), the most important metric for benchmark comparability is whether the project was new construction, new construction attached to an existing hospital, or interior renovation. Construction date, client type (public vs. private), and country of location were also generally rated as the most important metrics by respondents. Other metrics that were consistently rated as important globally included inpatient unit layout, walking distances, number of floors, and whether all patient rooms are private. Space-related metrics are considered very important elements in the design and planning of healthcare facilities worldwide. Regarding cost-related metrics, all countries consider the ratio construction cost per building gross area as the most important. CONCLUSIONS: Benchmarking emerges as a relevant tool for hospital design and planning as it can support efficiency, standardization, and confidence; currently, benchmarking is still underutilized due to the challenge of international comparison, access to data outside each specific company, and variation design metrics nationally. Benchmarking strategies should be further investigated to support knowledge exchange and to ensure reliable and comparable information globally.

A Comparison of Hospital Area Measurement in Germany, Canada, Australia, and the United States: Part 1.

OBJECTIVES: This article compares national standards for area measurements of healthcare facilities in four countries and examines the risks and differences that can arise when comparing building areas of healthcare facilities internationally. BACKGROUND: In the planning and management of healthcare facilities, the utilization and comparison of building floor areas plays a major role. Differences in terminology, classification, and methodology help to reduce planning and cost risks when applied on a local and national level. The proper allocation of building floor space is vital in the design of room programs, determination of floor space, construction costs, and operating costs. METHODS: Each of the four hospital area measurement standards is compared to discern similarities and differences. RESULTS: Most countries use a three-tier system of hospital area measurement: building gross area, department gross area, and department net area. Few differences were found between country standards for department area, though the German standards do not fully address this tier. Variation is found in whether a country includes certain functions in the hospital area-such as research space, shell space, or central energy plants-which can have a significant impact on the overall hospital area. CONCLUSIONS: This article informs further development of individual country standards and highlights principles to consider for international hospital area comparison.

Associations of Patient and Staff Outcomes With Inpatient Unit Designs Incorporating Decentralized Caregiver Workstations: A Systematic Review of Empirical Evidence.

OBJECTIVES:: This systematic literature review synthesizes and assesses quality of research addressing associations of patient and staff outcomes with inpatient unit designs incorporating decentralized caregiver workstations. BACKGROUND:: A current hospital design trend is to include decentralized caregiver workstations on inpatient units. A review of literature addressing decentralized unit design is needed. METHODS:: The systematic review methodology was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Database searches were conducted for studies published in peer-reviewed journals through October 2017. Included were empirical studies associating patient and/or staff outcomes and unit design with decentralized caregiver workstations. Individual studies were evaluated for quality using established methods, and Grading of Recommendations Assessment, Development and Evaluation (GRADE) and GRADE-Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERQual) guided rigorous inspection of evidence quality and strength for quantitative outcomes and qualitative findings, respectively. RESULTS:: The search yielded 1,096 records with 36 full-text articles examined and 12 articles included in the final review. This work was dominated by studies with limited analyses. Staff outcomes have been most widely studied, especially collaboration/communication and walking. Overall, studies exploring decentralized nursing as a design intervention have produced limited results for both staff and patient outcomes. Strength of evidence of the current literature with quantitative methods as a whole was rated very low quality. CONCLUSIONS:: Although varying degrees of caregiver workstation decentralization in inpatient units are now common, the literature addressing the impacts of such designs is of very low quality and shows inconsistency in associated outcomes. Rigorous, well-designed studies with consistently defined design and outcome measures are needed for greater confidence in determining any effects of decentralized unit design.

Toward a Safer and Cleaner Way: Dealing With Human Waste in Healthcare.

Organizations must evaluate their infection control plans in a holistic and inclusive manner to continue reducing healthcare-associated infection (HAI) rates, including giving consideration to the manner of collecting and disposing of patient waste. Manual washing of bedpans and other containers poses a risk of spreading infection via caregivers, the environment, and the still-contaminated bedpan. Several alternative disposal methods are available and have been tested in some countries for decades, including options such as bedpan washer-disinfector machines, macerator machines, and disposable bedpans. This article reviews methods and issues related to human waste disposal in healthcare settings. Healthcare organizations must evaluate the options thoroughly and then consistently implement the option most in line with its goals and culture.

A comparative evaluation of Swedish intensive care patient rooms.

OBJECTIVE: This study investigates how design strategies in three recent intensive care units in Sweden impact patients, families, and staff. The area of focus is the patient room "module," usually consisting of a pair of patient rooms and a joint location for monitoring and documentation. BACKGROUND: Many countries are expanding their number of intensive care beds and are also in the process of incorporating evidence-based design strategies such as single-bed patient rooms and access to daylight and nature. This situation provides a significant opportunity to review and learn from facilities leading the way in these areas. METHODS: Three intensive care units completed since 2010 were evaluated in relation to a combination of criteria. Methods included plan drawing analysis, staff questionnaires (n = 72), staff interviews (n = 9), and systematic observation (6 hours). RESULTS: In some patient rooms, access to daylight and/or outdoor views was excellent, while in other rooms such access was hindered by frosted glass or adjacent bushes or buildings. Single-bed rooms gave family members improved privacy and greater ability to stay in the patient room. Some patient room modules provided efficient patient observation and staff collaboration, but more noise and reduced patient privacy. Other modules provided a calm patient room environment, but caused some staff to feel isolated and have difficulty in getting assistance. CONCLUSIONS: The evaluation of the three projects reveals variation in whether design strategies successfully achieve their desired outcomes. Varying designs of the patient room module affect users in unique ways and must balance privacy, visibility, quietness, and staff access to assistance. KEYWORDS: Critical care/intensive care, organizational transformation, outcomes, post occupancy, work environment.

Podem as pedagogias críticas sustar as políticas de direita? / Can critical pedagogies interrupt rightist policies?

Grande parte da literatura sobre 'pedagogias críticas' tem sido política e teoricamente importante e nos ajudou a avançar em várias frentes. Com muita freqüência, no entanto, ela não tem sido relacionada o bastante com os modos pelos quais o atual movimento em direção ao que poder ser mais bem chamado de 'modernização conservadora' alterou o senso comum e transformou as condições materiais e ideológicas que cercam o ensino. Desse modo, ele às vezes torna-se uma forma do que pode ser mais bem chamado de retórica do 'romantismo das possibilidades', na qual a linguagem da possibilidade substitui uma análise habilidosa e consistente do que realmente é o equilíbrio de forças e o que é necessário para mudar as políticas neoliberais e conservadoras na alfabetização e em toda a esfera da educação. Examino os modos pelos quais o terreno social e cultural da política e do discurso educacionais tem sido alterado 'in loco', por assim dizer. Afirmo que precisamos estabelecer conexoes mais próximas entre nossos discursos teóricos e críticos, de um lado, e as transformações reais que estão atualmente deslocando políticas e práticas educacionais para direções fundamentalmente de direita, de outro. Desse modo, parte da minha discussão é conceitual e política; mas parte dela precisará ser de natureza empírica para que eu possa ordenar o que se conhece sobre os efeitos reais e materiais do deslocamento para a direita na educação(AU)

Ensino e trabalho feminino: uma analise comparativa da historia e ideologia

Ha uma historia correlacao entre o acesso de grande numero de mulheres a uma ocupacao, como e o caso do magisterio, e a transformacao desta, que se torna alvo de tentativas insistentes de maior racionalizacao e controle pelo Estado e pelo capital - no caso, sobre curriculos e a pratica docente. Originalmente com predominancia masculina nos Estados Unidos e na Inglaterra, o magisterio passou a ser ocupacao feminina na virada do seculo. O exame dessa passagem mostra a imbricada interacao entre as relacoes patriarcais e as pressoes economicas, sob a dominancia da ideologia da domesticidade feminina, operando sobre o magisterio: alem dos requisitos para a qualificacao de mestres e mestras serem diferentes, destinos eram diferentes para as recem-formadas, segundo se originassem das classes trabalhadoras ou das classes medias, embora ambas partilhassem o mesmo baixo status. A resistencia das professoras primarias a desqualificacao que se operava assume tanto formas 'silenciosas' quanto as abertas, de organizacao sindical, inclusive levando mestras e ex-mestras a militancia feminista. Ainda que as vezes com resultados contraditorios, esses movimentos sao parte de um muito mais amplo - e ainda hoje tao necessario - no sentido de desafiar as relacoes patriarcais tanto em casa quanto no trabalho.