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.
Fundamento. El lugar donde paren las madres condiciona su proceso de parto y nivel de satisfacción. El objetivo de este estudio es identificar las experiencias y percepciones acerca de los elementos de diseño del entorno del parto hasta el alta hospitalaria, que influyen en la experiencia de las madres a largo plazo. Metodología. Investigación fenomenológica de tipo método biográfico, a través del análisis temático inductivo de veinticinco testimonios de parto en el hospital, escritos por madres arquitectas, ingenieras, paisajistas o diseñadoras de interiores. Resultados. Los resultados se organizaron en cuatro temas y siete subtemas. El primer tema es la Impresión a primera vista y largo plazo que se subdivide en los subtemas Itinerario despersonalizado en accesos y pasillos y Búsqueda instintiva de conexión con la naturaleza. El segundo tema trata sobre el Acompañamiento y arropamiento durante el proceso de parto y se subdivide en Como en un hotel: espacio para el movimiento y adaptación personalizada y Desamparo, frío e incertidumbre: espacios donde estar contra su voluntad. El tercer tema son los Daños (en espacios) colaterales, que engloba La integración de los aseos en el proceso de parto, los Quirófanos inmutables ante el parto por cesárea y las Salas de neonatos que no integran a las familias. El cuarto tema incluye Propuestas de mejora para nuevos diseños. Conclusiones. Esta investigación permite profundizar en aspectos de diseño identificados en literatura reciente y mostrar que son necesarios más estudios que incorporen la experiencia de la mujer en el proceso del parto para promocionar políticas de diseño basadas en evidencias. (AU)
Background. The birthplace has a crucial role in shaping the childbirth experience and mothers satisfaction levels. This study aimed to identify the experiences and perceptions that may have an impact in the long-term on mothers birthing experience, considering hospital design features in the birthing environment until discharge. Methods. Inductive thematic analysis of twenty-five hospital labor testimonies employing a phenomenological research approach and utilizing a biographical method. Participants were women with a professional background in architecture, landscape architecture, engineering, or interior design. Results. The results are organized into four themes and seven subthemes. The first theme is First sight and long term impression which is subdivided into the subthemes Depersonalized itinerary in entrances and corridors and Instinctive search for connection with nature. The second theme deals with Accompaniment and tucking in during the birthing process, subdivided into Hotel-like: space for movement and personalized adaptation and Helplessness, cold and uncertainty: spaces to be against ones will. The third theme is Damage in collateral rooms, which includes The integration of toilets in the birthing process, Operating rooms unchangeable in the face of cesarean delivery and Neonatal units that do not integrate families. Finally, the fourth theme includes Improvement proposals for new designs. Conclusions. This study contributes to the existing literature by deepening the understanding of the design features identified in hospitals in recent studies. Further research incorporating the experiences of women in the birthing process is needed to facilitate evidence-based design policies. (AU)
Humans , Female , Architecture , Environment Design , Hospital Design and Construction , Humanizing Delivery , Birth Setting , Qualitative Research
BACKGROUND: The birthplace has a crucial role in shaping the childbirth experience and mothers' satisfaction levels. This study aimed to identify the experiences and perceptions that may have an impact in the long-term on mothers' birthing experience, considering hospital design features in the birthing environment until discharge. METHODS: Inductive thematic analysis of twenty-five hospital labor testimonies employing a phenomenological research approach and utilizing a biographical method. Participants were women with a professional background in architecture, landscape architecture, engineering, or interior design. RESULTS: The results are organized into four themes and seven subthemes. The first theme is "First sight and long term impression" which is subdivided into the subthemes "Depersonalized itinerary in entrances and corridors" and "Instinctive search for connection with nature". The second theme deals with "Accompaniment and tucking in during the birthing process", subdivided into "Hotel-like: space for movement and personalized adaptation" and "Helplessness, cold and uncertainty: spaces to be against one's will". The third theme is "Damage in collateral rooms", which includes "The integration of toilets in the birthing process", "Operating rooms unchangeable in the face of cesarean delivery" and "Neonatal units that do not integrate families". Finally, the fourth theme includes "Improvement proposals for new designs". CONCLUSIONS: This study contributes to the existing literature by deepening the understanding of the design features identified in hospitals in recent studies. Further research incorporating the experiences of women in the birthing process is needed to facilitate evidence-based design policies.
Delivery, Obstetric , Mothers , Pregnancy , Infant, Newborn , Female , Humans , Male , Hospitals , Patient Discharge , Qualitative Research
AIM: The architecture of neonatal units plays a key role in developmental strategies and preterm outcomes. The aim was to evaluate the design of Spanish neonatal units and its impact on the participation of parents in neonatal care. METHODS: A web-based survey was sent to all level III Spanish neonatal units, including questions about hospital data, architectural design, facilities and family participation. RESULTS: The study included 63 units. Most units (87%) had part or all the intensive care patients located in open bay units, while 54% had at least one individual patient cubicle. Single family rooms, defined as those including enough space and furniture for family members to stay with the infant without restrictions, were available in 8 units (13%). Eighteen units (29%) had a structured programme of family education. Units with single family rooms were more likely to have parental participation in rounds (p < 0.01), safety protocols (p = 0.02), oxygen management (p < 0.01) and nasogastric tube feeding (p = 0.02), as well as to allow siblings to participate in kangaroo care (p < 0.01). CONCLUSION: Widely variable architectural designs and policies were found in Spanish neonatal units. The presence of single family rooms may have impacted the participation of parents in neonatal care.
Infant, Premature , Intensive Care Units, Neonatal , Infant, Newborn , Infant , Humans , Spain , Parents , Surveys and Questionnaires
AIM: The research sheds light on the challenges and limitations of Spanish and Italian hospital design by looking at the gaps between education and practice. BACKGROUND: Hospital design plays an important role in providing high-quality and cost-effective facilities for any healthcare system. Spain and Italy face contemporary challenges (i.e., elderly population, staff retention, and obsolete healthcare facilities) and have similar issues of life expectancy, health expenditure, hospital beds provision, and decentralized tax-financed healthcare systems. METHOD: A cross-sectional, mixed-method study was used. This involved two different data collection strategies and analysis for each area of investigation: (i) education and (ii) practice. For the former, educational programs were reviewed via a web search; for the latter, an online survey of 53 architectural/engineering offices involved in hospital design was conducted. RESULTS: Hospital design education is limited to 0/58 in Spanish and 2/60 courses in Italian universities, although each country offers three postgraduate courses. The practitioners' survey shows that even though their offices have a long history of healthcare design, only 48% in Spain and 60% in Italy have received specific university training. Office staff lack employees with medical backgrounds, which hinders any partnership between health and design fields either for design practice or the education fields. Laws, national regulations, technical guidelines, and previous experience are the most useful information sources, while international scientific publications appear underused by practitioners. CONCLUSIONS: Italian and Spanish healthcare architecture could be improved by promoting multidisciplinary teams (in practice and education) and improving the education offer by tailoring it to national needs.
Delivery of Health Care , Hospitals , Aged , Cross-Sectional Studies , Humans , Italy , Spain
EDAC stands for Evidence-based Design Accreditation and Certification and identifies individuals able to apply the evidence-based design process for healthcare buildings. This process consists of basing design decisions on credible research to achieve the best possible outcomes. What differentiates this design process from others is its emphasis on using research both to inform a priori and to evaluate a posteriori design decision. The evidence-based design term appeared printed for the first time in 2000 but its origins date back to three key factors that happened years before: i) the evidence-based medicine movement, ii) the patientcentred care movement and, iii) a published paper that related a design strategy (the windows of the hospitalisation patient bedroom) with the recovery process of the patients. This scientific link between design and clinical outcomes not only evidenced the potential of architectural design on influencing patients' recovery but also the financial impact for the healthcare institutions. While in other countries evaluation mechanisms are already in place to improve the efficiency and performance of healthcare buildings, in Spain only one person has obtained the EDAC program. To what extent can this knowledge be incorporated into the Spanish design process for healthcare buildings and will this influence architects to confront their social responsibility with the healthcare system?
El acrónimo EDAC corresponde a las siglas inglesas Evidence-based Design Accreditation and Certification e identifica a las personas capaces de aplicar el proceso de diseño basado en evidencias en la arquitectura sanitaria. Este proceso consiste en fundamentar las decisiones de diseño en investigaciones creíbles con el fin de conseguir los mejores resultados posibles. Su principal característica reside en el énfasis del uso de la investigación, tanto para informar a priori como para evaluar a posteriori las decisiones de diseño. El término Evidence-Based Design apareció impreso por primera vez en 2000, aunque sus orígenes se remontan a tres factores clave que sucedieron años atrás: i) el movimiento de la medicina basada en evidencias; ii) el movimiento de los cuidados centrados en los/las pacientes; iii) la publicación de un estudio científico que relacionaba una estrategia de diseño (las ventanas de la habitación de hospitalización) con el proceso de recuperación de los pacientes. Este vínculo empírico entre el diseño y los resultados médicos puso en evidencia no solo el potencial que tiene el diseño arquitectónico en la recuperación de pacientes, sino la repercusión económica que supone para las instituciones sanitarias. Mientras que en otros países ya se utilizan mecanismos de evaluación de la arquitectura sanitaria para mejorar la efectividad de sus infraestructuras, en España tan solo una persona cuenta con la certificación EDAC. ¿Hasta dónde se podría llegar si se incorporara este conocimiento al proceso de diseño y los/las arquitectos/as afrontaran su responsabilidad social para con el sistema sanitario?
Accreditation/standards , Certification/standards , Evidence-Based Facility Design , Health Services Research , Humans , Public Health Administration , Social Responsibility , Spain
El acrónimo EDAC corresponde a las siglas inglesas Evidence-based Design Accreditation and Certificatione identifica a las personas capaces de aplicar el proceso de diseño basado en evidencias en la arquitectura sanitaria. Este proceso consiste en fundamentar las decisiones de diseño en investigaciones creíbles con el fin de conseguir los mejores resultados posibles. Su principal característica reside en el énfasis del uso de la investigación, tanto para informar a priori como para evaluar a posteriori las decisiones de diseño. El término Evidence-Based Design apareció impreso por primera vez en 2000, aunque sus orígenes se remontan a tres factores clave que sucedieron años atrás: I) el movimiento de la medicina basada en evidencias; II) el movimiento de los cuidados centrados en los/las pacientes; III) la publicación de un estudio científico que relacionaba una estrategia de diseño (las ventanas de la habitación de hospitalización) con el proceso de recuperación de los pacientes. Este vínculo empírico entre el diseño y los resultados médicos puso en evidencia no solo el potencial que tiene el diseño arquitectónico en la recuperación de pacientes, sino la repercusión económica que supone para las instituciones sanitarias. Mientras que en otros países ya se utilizan mecanismos de evaluación de la arquitectura sanitaria para mejorar la efectividad de sus infraestructuras, en España tan solo una persona cuenta con la certificación EDAC. ¿Hasta dónde se podría llegar si se incorporara este conocimiento al proceso de diseño y los/las arquitectos/as afrontaran su responsabilidad social para con el sistema sanitario?
EDAC stands for Evidence-based Design Accreditation and Certification and identifies individuals able to apply the evidence-based design process for healthcare buildings. This process consists of basing design decisions on credible research to achieve the best possible outcomes. What differentiates this design process from others is its emphasis on using research both to inform a priori and to evaluate a posteriori design decision. The evidence-based design term appeared printed for the first time in 2000 but its origins date back to three key factors that happened years before: I) the evidence-based medicine movement, II) the patient-centred care movement and, III) a published paper that related a design strategy (the windows of the hospitalisation patient bedroom) with the recovery process of the patients. This scientific link between design and clinical outcomes not only evidenced the potential of architectural design on influencing patients' recovery but also the financial impact for the healthcare institutions.While in other countries evaluation mechanisms are already in place to improve the efficiency and performance of healthcare buildings, in Spain only one person has obtained the EDAC program. To what extent can this knowledge be incorporated into the Spanish design process for healthcare buildings and will this influence architects to confront their social responsibility with the healthcare system?
Humans , Accreditation/standards , Certification/standards , Evidence-Based Facility Design , Health Services Research , Public Health Administration , Social Responsibility , Spain
