The influence of facility design and human resource management on health care professionals.

BACKGROUND: Cost control of health care services is a strategic concern for organizations. To lower costs, some organizations reduce staffing levels. However, this may not be worth the trade-off, as the quality of services will likely be reduced, morale among health care providers tends to suffer, and patient satisfaction is likely to decline. PURPOSE: The potential synergy between human resource management and facility design and operation was investigated to achieve the goal of providing cost containment strategies without sacrificing the quality of services and the commitment of employees. METHODOLOGY: About 700 health care professionals from 10 acute-care hospitals participated in this cross-sectional study. The authors used structural equation modeling to test whether employees' evaluations of their physical work environment and human resource practices were significantly associated with lower job-related anxiety, higher job satisfaction, and higher organizational commitment. FINDINGS: The analysis found that employees' evaluations of their physical work environment and human resource practices influenced their job-related feelings and attitudes. Perceived organizational support mediated this relationship. The study also found a small but positive interaction effect between the physical work environment and human resource practices. The influence of physical work environment was small, mainly because of the high predictive value of human resource practices and strong confounding variables included in the analysis. This study specifically showed the role of facility design in reducing job-related anxiety among caregivers. PRACTICE IMPLICATIONS: Preliminary evidence is provided that facility design can be used as a managerial tool for improving job-related attitudes and feelings of employees and earning their commitment. Providing a healthy and safe work environment can be perceived by employees as an indication that the organization respects them and cares about their well-being, which might be reciprocated with higher levels of motivation and commitment toward the organization.

The saliency of geographical landmarks for community navigation: A photovoice study with persons living with dementia.

This study uses the photovoice method to explore how persons living with mild-to-moderate dementia perceive neighborhood landmarks and identify characteristics that render these landmarks salient for outdoor navigation. Previous research has highlighted the role of well-designed, stable geographical landmarks in improving the navigability of neighborhoods for persons living with dementia. However, the specific attributes that render landmarks salient have not yet been sufficiently explored, resulting in inadequate evidence-based environmental design guidelines for dementia-friendly communities. To address this gap, a photovoice study was conducted with five community-dwelling persons living with dementia and their care partners, as part of a dementia-friendly neighborhood walking program in the city of Seattle, USA. Photovoice facilitated the exploration of saliency of neighborhood landmarks from an emic perspective by (i) empowering persons living with dementia to identify and take photos of salient landmarks during the group walk and (ii) interpret and reflect on attributes that contributed to saliency using the photos as visual aids in a focus group discussion and survey questionnaire. Participants associated the saliency of landmarks with two groups of attributes: (i) visual distinctiveness, which encompassed physical aspects, such as size, shape, color, texture; and (ii) meaningfulness, which included subjective factors of personal and emotional significance that linked the landmarks to participants' pasts, passions, hobbies, and emotions related to having dementia. Findings suggest that outdoor landmarks should be designed for maximum legibility and noticeability, as well as familiarity, recognizability, and memorability. The evidence from this research also points to the likely positive effect of salient neighborhood landmarks on the community navigation of persons living with dementia.

Evaluation of a Mental and Behavioral Health Patient Room Mockup at a VA Facility.

OBJECTIVE: The primary goal of this research was to evaluate a physical full-scale, high-fidelity mockup of a mental and behavioral health (MBH) inpatient room and bathroom. BACKGROUND: There is minimal research on design for MBH and no published research using mockups to evaluate a MBH design proposal. To address this gap, an interdisciplinary team developed an ideal Patient-Centered MBH Patient Room, which was built as a mockup at a Veterans Administration (VA) facility and evaluated by patients and staff in situ. METHOD: The mock-up was evaluated using a structured mixed methods process that incorporates feedback using Feedback Forms and facilitated Listening Sessions. Our two primary hypotheses were that the design, as represented by the mock-up, would be positively evaluated and that there would be a difference between staff and patient perceptions, with patients rating the design higher than staff. RESULTS: Quantitative analysis confirmed our hypotheses, revealing an overall positive response, with a difference between patients and staff. Contrary to hypothesis, staff consistently rated the design higher than patients. Qualitative analysis found mixed reception of the design and three primary themes: safety, homeyness/deinstitutionalization, and positive distraction/nature. CONCLUSIONS: Physical mock-ups may be an effective tool for evaluation of a proposed design; however, staff perceptions of the environment may differ from those of patients. One drawback of using a physical high-fidelity mock-up is the expectation that the mock-up perfectly represents the proposed design. With this project, even small unfinished details were distracting to the participants and may have negatively affected the evaluation.

The stress-reducing effects of art in pediatric health care: art preferences of healthy children and hospitalized children.

Art is assumed to possess therapeutic benefits of healing for children, as part of patient-focused design in health care. Since the psychological and physiological well-being of children in health care settings is extremely important in contributing to the healing process, it is vitally important to identify what type of art supports stress reduction. Based on adult studies, nature art was anticipated to be the most preferred and to have stress-reducing effects on pediatric patients. Nature art refers to art images dominated by natural vegetation, flowers or water. The objective of this study was to investigate what type of art image children prefer, and what type of art image has potentially stress-reducing effects on children in hospitals. This study used a three-phase, multi-method approach with children aged 5-17 years: a focus group study (129 participants), a randomized study (48 participants), and a quasi-experimental study design (48 participants). Findings were evaluated from three phases.

The Importance of Specific Workplace Environment Characteristics for Maximum Health and Performance: Healthcare Workers' Perspective.

OBJECTIVE: To examine the importance of specific workplace environment characteristics for maximum health and performance, assigned by healthcare employees, and how they relate to the nature of their work. METHODS: A cross-sectional mixed-method study was conducted with content analysis and robust regression models to examine the relationship between workplace environment characteristics and perceived importance in promoting health and performance. RESULTS: Our findings suggest that perceptions of key environment characteristics that safeguard health and performance in healthcare workplaces may vary by employee sex, setting, and nature of healthcare work involved. Theme and model descriptions of the influence of these factors on participant perceptions are provided. CONCLUSIONS: Employee feedback on workplace characteristics that impact health and performance could be instrumental in determining the priorities of workplace design.

The Effects of Spatial Enclosure on Social Interaction Between Older Adults With Dementia and Young Children.

OBJECTIVE: To examine the impact of spatial enclosures on social interaction between older adults with early stage dementia and young children. BACKGROUND: Intergenerational interaction through meaningful activities can promote positive affects and behaviors of children and older adults. The development of social interaction is closely related to the physical environment in association with personal competence of older adults with dementia and young children. However, minimal attention has been given to the role of physical environment in influencing intergenerational interaction. METHODS: A quasi-experiment examined the functional relationship between the amount of spatial enclosure and the types of social behaviors of older adults with dementia and young children. Semi-structured interviews, aided by a photographic simulation, were developed to explore the participants' perceptions of and experiences with the different degrees of spatial enclosure. RESULTS: Findings showed that the semienclosed spatial plan impacted both prosocial and antisocial behaviors of older adults with dementia in their interactions with young children. This apparent discrepancy was associated with two conflicting perceptions: a sense of openness and the lack of control due to distraction created by the loose visual boundary. There was no correlation between the elder-child neutral behaviors and the degrees of spatial enclosure. CONCLUSION: This study suggests that spaces with moderate openness without visual and acoustic distraction are the most desirable to promote prosocial behaviors of older adults with dementia and young children. Additionally, elder-child prosocial behaviors were likely facilitated by specific design features such as adequate personal space, the perception of openness, and possible spaces that provide both prospect and refuge in relation to spatial enclosure.

Perceived neighborhood environments and leisure-time walking among korean adults: an application of the theory of planned behavior.

OBJECTIVE: To examine personal, social, and perceived environmental factors related to leisure-time walking behavior among Korean adults using the framework of the Theory of Planned Behavior (TPB). BACKGROUND: Sedentary lifestyle and physical inactivity contribute to rising obesity rates and chronic diseases among Korean adults. Understanding correlates of walking is necessary to develop effective interventions to promote regular walking. METHODS: A cross-sectional survey was conducted in 2008 among 424 Korean adults. Participants completed a questionnaire on perceived neighborhood environment, the TPB constructs, and leisure-time walking behavior. RESULTS: Those who participated in leisure-time walking had more positive perceptions of aesthetics and expressed greater perceived behavioral control (PBC) and intention of walking than nonwalkers. Also, walking correlated with intention and PBC, and perceived crime safety. Intentions were moderately to strongly associated with attitude, PBC, and subjective norm. Integrating TPB constructs and the perceived environment variable (crime safety) resulted in a moderate fit of the data [χ(2)= 2.372, df = 5; p = 0.796; NFI = 0.99; RMSEA = 0.00] with approximately 45.6% variance of intention and 19.4% of the response variance of walking explained. The model showed that perceived safety from crime was not directly related to leisure-time walking, but indirectly predicted walking through the TPB model. CONCLUSIONS: Perceived safety was identified as an important environmental variable among Korean adults, and the TPB offered a good prediction of walking behavior. Identifying individual, social, and neighborhood environmental correlates of walking can help develop policies to promote public health for a more active and healthier community.