Comparing User Perceptions of Surgical Environments: Simulations in a High-Fidelity Physical Mock-Up Versus a Postoccupancy Evaluation.

OBJECTIVE: The purpose of this study was to compare perceptions and behaviors of end users participating in simulations in a high-fidelity physical mock-up of an operating room (OR) prototype with the perceptions and behaviors of end users in the built out ORs postoccupancy. BACKGROUND: Simulation-based evaluations of high-fidelity physical mock-ups of proposed layouts are increasingly being conducted during the facility design process to understand impacts on workflow and potential adverse patient safety outcomes. Nevertheless, it is unclear to what extent user experiences in these simulated healthcare spaces are similar to those in built and occupied healthcare environments. METHODS: Using interviews, surveys, and observations, this study compared user evaluations in a high-fidelity physical mock-up of an OR with user evaluations of the built and occupied OR postoccupancy. Workflow disruptions were also analyzed using video recordings for a simulated pediatric surgery and five pediatric surgeries in the actual OR. RESULTS: This study found that user perceptions and behavior in the two types of environments were mostly similar with regard to perceived support for the location of surgeon workstation, perceived space and task performance, perceived access to storage locations, boom setup, and OR cleanability. Participant's ratings differed for supportiveness of the mobile Circulating Nurse (CN) workstation, maneuvering booms, and environmental disruptions. CONCLUSION: Simulation-based evaluations are extremely beneficial during the design process and can provide valuable input to design teams as well as clinical teams about workflow and safety issues that allow design issues to be addressed before construction.

Perceived Usability of Seating in an Outpatient Waiting Area: A Combined Approach Utilizing Virtual Reality and Actual Seating Prototypes.

OBJECTIVE: This study proposed a combined methodology to evaluate the perceived usability of healthcare seats that were first selected in a virtual waiting room which provided the context of use for the seats. BACKGROUND: There has been an increased interest in using virtual reality (VR) for evaluation of seating in interior environments. Although VR offers a less expensive approach compared to evaluating seats in situ, using VR has limitations as users cannot experience the actual seat prototypes. METHOD: Participants (N = 92) experienced a virtual waiting room with various seat groupings and were prompted with four task-based scenarios through which they selected a seat. After the VR phase, they experienced their selected seats in a lab and used an online questionnaire to evaluate the seating. Semi-structured interviews were conducted to garner similarities and differences in participants' experience of virtual and real seats. RESULTS: Three categories including comfort, support, and flexibility were extracted from the questionnaire. While support and comfort categories were highly ranked by participants, the category rankings varied depending on participants' age, gender, tasks, and seat types. Interviews revealed that there were differences in experience of the seating materials in VR versus reality, and therefore experiencing the real seats was useful in seating evaluation. CONCLUSIONS: The findings suggest that the combined methodology using VR and real seating in a lab is a reliable tool for designers and furniture manufacturers to obtain users' perceived usability evaluation of seating during the design process while the actual context is absent.

Evaluating Care Partner Preferences for Seating in an Outpatient Surgery Waiting Area Using Virtual Reality.

OBJECTIVE: The purpose of this study was to examine the factors impacting seating choices of care partners while conducting common tasks in an outpatient surgical center waiting room. BACKGROUND: Waiting rooms in healthcare environments have been previously studied to understand how factors such as aesthetics, privacy, comfort, and positive distractions impact user perception of quality of care. Although care partners of patients often spend long hours in the surgical waiting rooms, no studies have addressed users' seat type and location preferences in waiting areas. METHODS: In this study, 92 participants made seat selections while performing scenario-based tasks in a virtual waiting area. A mixed-methods approach including a survey and semi-structured interviews was utilized to capture participants' feedback on how certain factors (e.g., visibility, accessibility, privacy, comfort, and aesthetic quality) impacted their choices. RESULTS: The optimal seat location and type in the waiting area varied depending on the type of task care partners were engaged in. While being able to sit with their loved one was the most important factor influencing seat selection during patient check-in, seat location was the most important factor in all other scenarios. The importance of factors such as seat comfort, seat type, visual and auditory privacy, and visibility to registration area varied across scenarios. However, the visual appearance of the seating remained equally important across all scenarios. CONCLUSIONS: The use of different scenarios allowed users to identify their preferences regarding seating within the context of their specific needs at different points in the waiting process.

The Fit Between Spatial Configuration and Idealized Flows: Mapping Flows in Surgical Facilities as Part of Case Study Visits.

PURPOSE: This study proposes a flow mapping approach for surgical facilities that can be implemented by design teams as a component of case study tours. BACKGROUND: The provision of healthcare services involves simultaneous and closely coupled flows of people, objects, and information, and the efficiency of these flows is influenced by the spatial configuration of the buildings where these services are housed. Many architecture firms conduct case study tours to inform their design process. However, these tours often lack a structured way of documenting different flows and interpreting observations. A structured approach is needed during the design process to understand the impact of spatial configuration on healthcare flows. METHOD: Site tours were conducted at four surgery centers to develop and test an evidence-based flow mapping approach. Idealized flows within surgical facilities were first identified from the literature, followed by the development of a data collection tool aimed at documenting these flows in each case study through a pre-assessment questionnaire, a physical assessment, and interviews with staff. RESULTS: The flow mapping tool kit was effective in allowing the design team to systematically understand the physical configuration of surgical flows across case studies. The tool also allowed the team to identify spatial configuration characteristics acting as barriers and facilitators to idealized flows. CONCLUSIONS: The flow mapping approach was able to provide structure for conducting these short tours more effectively via observations and staff inquiry, enabling design teams to draw more meaningful conclusions from case study tours and conduct comparisons between healthcare facilities visited.

Perioperative anxiety in pediatric surgery: Induction room vs. operating room.

BACKGROUND: Perioperative anxiety can have a profound and lasting effect on children and their parents, with up to 70 percent of children undergoing outpatient surgery experiencing significant physiologic and/or psychological manifestations of anxiety throughout the ambulatory surgical process. The physical healthcare environment itself can contribute to these feelings, substantially impacting the level of anxiety experienced by both the child and their parent. OBJECTIVE: This study sought to examine whether a difference exists between utilization of an induction room vs. the operating room on child and parent perioperative anxiety for parent present induction. METHODS: A single institution multi-site prospective observational study was conducted with a cohort of 51 healthy children aged 6-12 years, receiving an outpatient tonsillectomy and/or adenoidectomy and their parent. The methodological approach utilized for this study was Ecological Momentary Assessment. Two psychological measures of anxiety, (i) momentary and (ii) environmental, and one physiologic measure of anxiety (i) electrodermal activity were used. Data were captured separately for child and parent. RESULTS: For children who underwent anesthetic induction in the induction room, all three anxiety responses were significantly lower and exhibited a large positive effect [momentary (P = .0002, d = 1.984, induction room = 3.76, operating room = 7.07), environmental (P = .018, d = 1.160, induction room = 1.72, operating room = 0.85), and electrodermal activity (P = .039, d = 1.007, induction room = 0.76, operating room = 1.51)], as compared to children who were induced in the operating room. Electrodermal activity was also statistically significantly lower, with a large positive effect, in the postoperative environment (P = .004, d = 1.454, induction room = 0.21, operating room = 0.60) for Children who were induced in the induction room, as compared to the operating room cohort. No significant differences were found between parents for momentary and environmental anxiety, and electrodermal anxiety. CONCLUSIONS: The nonpharmacological strategy of using an induction room for anesthetic induction of children may be clinically effective in reducing anxiety as compared to an operating room.

Practice-Based Research Methods and Tools: Introducing the Design Diagnostic.

OBJECTIVE: To introduce a composite tool called Design Diagnostic that allows a rapid but triangulated insight into key areas of a facility combining the methods of shadowing, behavior mapping, surveys, interviews, photo-essays, and parametric analysis to determine key challenges and opportunities for improvement, identify future design drivers, and recommend simple "do-now" changes. BACKGROUND: Research-based practice relies on agile and nimble methods to investigate, evaluate, and apply research in project work. This requires the ability to scale methodologies, so they can provide actionable insights in often constrained time lines. Surveys, observations, space analytics, and lit reviews often need to be done in extremely short periods of time. In this article, we share how these processes can be condensed to meet time constraints of project time lines, with the critical reminder not to generalize contextually derived insights. CONCLUSION: Combining field research (shadowing and behavior mapping) with user engagement (interviews), user feedback (surveys), and analytics of the plan itself allows designers and owners to understand the relationship between design intent and operational outcome and be resource effective in capital planning projects. Scaling these methods to fit the time and resource availability, and ensuring that results are always reviewed and applied in context, is critical.

Using Virtual Reality to Compare Design Alternatives Using Subjective and Objective Evaluation Methods.

OBJECTIVE: This study sought to develop a method that supports a more evidence-based approach to evaluating multiple design options in virtual reality (VR), combining subjective insights gathered using traditional approaches and objective feedback gathered using the VR platform. Additionally, this study sought to understand how objective data garnered from the VR platform could be used to compliment traditional evaluation strategies. BACKGROUND: VR can be a viable research platform for supporting evidence-based design practices. Prior studies have predominately utilized experiential user feedback. While able to provide valuable subjective insights, these approaches are less effective in making objective comparisons between multiple designs alternatives. METHOD: A repeated measures study was conducted with nursing faculty. User feedback was captured through surveys, interviews, and the VR platform. RESULTS: The survey, interview, and the objective VR data converged in terms of identifying the highest performing design option. Survey data showed that Room 2 performed best in terms of perceived physical access to supplies, unobstructed movement, and availability of space to accommodate additional equipment. VR data showed that participants in Room 2 had significantly higher visibility to both patient and care partners throughout their simulated interaction. CONCLUSION: Simulation-based evaluations in VR that use a combination of users' subjective insights and objective data obtained from VR can be an effective tool for helping designers evaluate multiple design options. The use of scenario-based simulations provided a structured and clinically relevant approach to comparing three preoperative rooms, supporting a more robust assessment of users' physical response to a simulated healthcare environment.

Understanding the impact of the physical health care environment on nurse fatigue.

AIM(S): The purpose of this study was to investigate factors in the physical health care environment (PHE) contributing to nurse fatigue. BACKGROUND: Nurses experience high levels of physical, mental and overall fatigue related to the physically demanding and mentally complex nature of bedside care. METHOD(S): This study used secondary data analysis of a 2017 focus group session, which explored: (a) challenges nursing professionals face while delivering care, (b) the effect of nurse fatigue on care delivery and (c) system factors that can either reduce or contribute to nurse fatigue. Eleven volunteers from a health care design focused nursing organisation participated in the focus group. RESULTS: Twenty-seven design elements across four environmental categories were identified in this study as impacting fatigue. The effects of fatigue were found to have implications at the individual level (nurse and patient), the organisational level and the profession at large. Fatigue effects were found to be cumulative. CONCLUSION(S): Findings suggest that the PHE can have a substantial impact on nurse fatigue and contribute to profound effects with patient and staff safety implications. IMPLICATIONS FOR NURSING MANAGEMENT: This study provides nursing managers, hospital administrators, nurses and designers with evidence for utilizing the PHE to mitigate and prevent nurse fatigue.

Comparing the Effectiveness of Four Different Design Media in Communicating Desired Performance Outcomes With Clinical End Users.

OBJECTIVE: The purpose of this study was to compare the effectiveness of four different design communication media in helping clinical end users understand spatial and functional information and in supporting their ability to provide design feedback. BACKGROUND: It is critical to involve clinical end users early in the design process to test design solutions and ensure the design of a new healthcare facility supports their ability to deliver high-quality care. Traditional architectural design communication media such as floor plans and perspectives can be challenging for clinical design team members to understand. Physical and virtual mock-ups are becoming more popular as design communication media. However, nominal evidence exists comparing the effectiveness of different design media in supporting clinical end-user engagement and contribution during the design process. METHOD: An exploratory, qualitative study was conducted with clinical end users to evaluate the effectiveness of four different media commonly used in design communication. RESULTS: Traditional architectural representations convey limited useful information to clinical end users, impacting the amount and type of feedback they can provide. More immersive media, such as physical and virtual mock-ups, support an increasingly holistic understanding of proposed design solutions, inciting more design solutions that range from the inclusion and exclusion of design features to location, position, and functionality of those features. CONCLUSIONS: When used in combination, each media can contribute to eliciting clinical end-user feedback at varying scales. The overall preference and higher effectiveness in eliciting design feedback from clinical end users highlights the importance of physical mock-up in communicating healthcare design solutions.

Demonstrating the Effect of the Built Environment on Staff Health-Related Quality of Life in Ambulatory Care Environments.

OBJECTIVE: To determine the impact of the built environment on staff health-related quality of life (HRQoL) in a federally qualified health center (FQHC). BACKGROUND: Staff within FQHCs face many challenges that can significantly impact their HRQoL. Design features directed toward reducing stress have been shown to improve staff health outcomes in acute care environments. However, minimal literature exists linking design features to health outcomes within FQHCs. METHOD: A cross-sectional, observational study was conducted involving three FQHCs that contain varying levels of enhancements to their interior features. A total of 75 staff across the sites participated in the indoor environmental quality (IEQ) survey, measuring satisfaction and perceived productivity. Measurements for staff HRQoL were captured using the quality of well-being (QWB) scale, which was administered to 10 staff at each site. Standard regression diagnostics were used to examine fit and find influential observations. RESULTS: QWB scores were normally distributed, and a dose-response relationship was found between QWB scores and level of enhancements. As the categories of satisfaction and perceived productivity increased, the average QWB score increased. Regression models showed overall statistical significance and predicted between a quarter to a half of the change in QWB scores. CONCLUSIONS: This pilot study suggests that the more enhancements included in the interior features of a FQHC, the greater the returns to staff HRQoL. Findings also suggest that staff with a lower QWB appreciate enhancements more. Design strategies associated with improved staff well-being should be evaluated in terms of the amount of HRQoL they contribute.