EXECUTIVE SUMMARY OF KEY CONCEPTS
RESEARCH Comparative Analysis of Hospital Energy Use: Pacific Northwest and Scandinavia Hospitals are large energy consumers. This study presents a side-by-side energy comparison of hospitals in Scandinavia and the United States. Case studies highlight unique attributes of systems, strategies, and architectural configurations of the Scandinavian precedents that lead to high performance in energy and interior environmental quality. For this analysis, four Scandinavian hospitals were evaluated and compared to four Pacific Northwest hospitals. The hospitals were chosen for their energy performance, age, size, and indication of relevance in current hospital design. The eight hospitals are compared based on energy performance, as determined by the Environmental Protection Agency’s Portfolio Manager. The Scandinavian hospitals use less energy at a site level compared to their Pacific Northwest counterparts, and they generally rank much higher in Energy Star score, due to both total site energy consumption and source energy type. These Scandinavian hospitals provide evidence for professionals in design, construction, and operation of U.S. hospitals that it is possible to achieve significantly reduced energy footprints and increased indoor environmental quality in healthcare facilities.
© 2014 VENDOME GROUP LLC
Informing Hospital Change Processes Through Visualization and Simulation: A Case Study at a Children’s Emergency Clinic Hospitals are exposed to changes of smaller or bigger nature almost on a continuous basis. The people working in the organization are an important partner in this change process. They possess considerable knowledge about practical realities of the organization and are more likely to embrace change when involved in the planning. The possibility to use visualization and simulation technology in such processes has grown with technological advancements. These technological aids can facilitate the communication between stakeholders and extract the institutional knowledge of the participants by letting them experience a change proposal through a simulated environment before it is implemented, enabling them to evaluate it beyond contemporary demands and current work structures. Long-term involvement, in combination with tools that are easily accessible for the participants, is integral for creating a participatory setting where the practitioners’ knowledge guides the process.
HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 5
EXECUTIVE SUMMARY OF KEY CONCEPTS Space Planners’ Perception of an Assessment Instrument for Briefs in the Pre-Design Phase of New Healthcare Environments Design decisions should be conveyed through documents (design proposals, programs and/ or briefs). This study presents an ongoing development of a new instrument to assess the content and quality of documents developed in the pre-design phase of new healthcare environments. There is lack of valid instruments to assess the content and quality of the documents even if the requirements have been focused for a long time. It is important to assess the content and quality of these documents as part of an ongoing assessment of the process. Results may enable systematic comparisons of the information in the documents within an organization or documents between different organizations. Assessments may also be helpful in understanding and identifying areas of the pre-design phase (P-DP) that need improvement. In general, the documents such as briefs created in P-DP are an underused source of data. Documentation is a valuable source of quality assurance because it ensures the transparency of the process and the effective evaluation of the completed building. Developing an instrument is a complex process, requiring time and consideration of the linguistic and semantic aspects of the instrument but also the usability. To ensure a valid instrument getting feedback from the main user of the instrument is essential. This study suggests preliminary validity evidence for the Content and Quality in Briefs Instrument (CQB-I).
6 WWW.HERDJOURNAL.COM
Design Characteristics of Acute Care Units in China Healthcare industry construction in China is one of fastest growing construction sectors in China and, arguably, in the world. However, systematic study of the current design patterns in Chinese hospitals has been rarely done. For this article, a descriptive study has been done of unit configuration, size, patient visibility, distance to nursing station and supplies, and lighting conditions in 25 units in 19 public hospitals built after 2003. The study found there are three dominant types of unit layout: single-corridor (52%), triangular (36%), and double-corridor (12%). The percentage of private rooms is very low (11%). Centralized nursing stations were found to be the only type of nurses’ working area. China also has a larger unit size in terms of number of patient beds. The average number of patient beds in a unit is 40.6 in China (versus 32.9 in the U.S.). The acute care units in China have longer walking distance and lower visibility from nursing station to patient bedside. The access to natural light and direct sunlight in patient rooms is superior to that in U.S. Because of the differences in economies and building codes, there are dramatic differences between the spatial characteristics of care units in China and the U.S.
Confirming, Classifying, and Prioritizing Needed Over-the-Bed Table Improvements via Methodological Triangulation This article presents the results of a qualitative study that confirmed, classified, and prioritized user needs for the design of a more
© 2014 VENDOME GROUP LLC
EXECUTIVE SUMMARY OF KEY CONCEPTS useful, usable, and actively assistive over-thebed table. This study builds upon a previous study that generated a list of needs for use in developing an actively assistive over-the-bed table. In this study, 14 healthcare subject matter experts and eight research and design subject matter experts engaged in a participatory and iterative research and design process in order to establish the usefulness and importance of each respective need statement from the previous list. A table demonstrating which needs are of high importance to both groups of subject matter experts and a classification of the design challenges each represents was produced. The results of this study indicate that designing a more useful, usable, and actively assistive over-the-bed table is primarily about the ability to position it optimally with respect to the user for any task, as well as improving its ease of use and usability. It is also important to make explicit and discuss the differences in priorities and perspectives demonstrated between research and design teams and their clients early in the research and design process.
RESEARCH METHODS Development and Psychometric Testing of a Post-Occupancy Evaluation Understanding the needs of patients, staff, and visitors in a healthcare environment is an essential component of the decision-making process for healthcare design professionals. In order to achieve excellence in occupant experience, improve patient outcomes, and enhance operational efficiencies, it is important for design professionals to understand the current chal-
© 2014 VENDOME GROUP LLC
lenges their building users face and how design can best support or eliminate those challenges. Post-occupancy evaluations (POEs) have become highly regarded throughout the industry as an effective tool for achieving this knowledge and understanding. However, it is critical that the tools and processes used to conduct POEs have been rigorously tested in order to ensure credible results. This article outlines the process of developing a standardized facility assessment that can be used for both existing facility assessments (EFAs) and post-occupancy evaluations. The concepts explored include a four-phased baseline process of measuring the success of the built environment as well as specific instructions on conducting a content validity test, an essential component in developing a survey questionnaire.
LITERATURE REVIEW Impact of the Design of the Built Environment on People with Dementia: An Evidence-Based Review For more than two decades, a large number of studies have established a relationship between the design of the physical environment of longterm care settings and outcomes of people with dementia. Simultaneously, the number of people with dementia in need of long-term care has been increasing. In light of these developments, strategies to create appropriate living environments for people with dementia are required. However, the methods employed in the research studies available are heterogeneous and the results are often conflicting. Consequently, the process of inte-
HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 7
EXECUTIVE SUMMARY OF KEY CONCEPTS grating the best evidence available into architectural designs may be hindered. In this review, the impact of the design of the built environment on people with dementia in long-term care settings was systematically analyzed using an evidence-based approach. The outcomes were thematically summarized into four main categories: basic design decisions, environmental attributes, ambience, and environmental information. The effectiveness of the interventions on behavior, cognition, function, well being, social abilities, orientation, and care outcomes of people with dementia was illustrated using matrices. With this study, architects and designers will be provided with credible evidence on which they can confidently base their design decisions. Researchers will be able to determine which environmental aspects have been well investigated and where there are gaps in the current state of the research.
Design Research and the Globalization of Healthcare Environments Global healthcare practice has expanded in the past 20 years. At the same time, the incorporation of research into the design process has gained prominence as best practice among architects. However, although international practice is expanding, international research is not growing at the same pace. Most research is being conducted in the United States.
8 WWW.HERDJOURNAL.COM
The authors of this study investigated the status of design research in a variety of international settings. We intended to answer the question, “how pervasive is healthcare design research outside of the United States?” The authors conclude that in addition to the need for more design research throughout the world, research objectives need to be expanded to address healthcare design in developing countries where the need is great and the resources are few. Additionally, firms must strive to increase the cultural competence of their professional staffs.
THEORY Positive Distraction and the Rehabilitation Hospitals of João Filgueiras Lima Despite the lack of formal integration of evidence-based design in healthcare architecture in Latin America, many of the basic tenets generated from design research have been incorporated into Brazilian rehabilitation hospitals. The use of positive distraction in the rehabilitation facilities designed by João Filgueiras Lima (Lelé) for the Sarah Network of Rehabilitation Hospitals is a clear example of this phenomenon and has served to inspire many current healthcare projects. Lelé’s success is a demonstration of the critical role familiarity with medical treatment protocols and insights regarding human behavior play in creating an alignment between research and practitioner experience.
© 2014 VENDOME GROUP LLC
RESEARCH Comparative Analysis of Hospital Energy Use: Pacific Northwest and Scandinavia Hospitals are large energy consumers. This study presents a side-by-side energy comparison of hospitals in Scandinavia and the United States. Case studies highlight unique attributes of systems, strategies, and architectural configurations of the Scandinavian precedents that lead to high performance in energy and interior environmental quality. For this analysis, four Scandinavian hospitals were evaluated and compared to four Pacific Northwest hospitals. The hospitals were chosen for their energy performance, age, size, and indication of relevance in current hospital design. The eight hospitals are compared based on energy performance, as determined by the Environmental Protection Agency’s Portfolio Manager. The Scandinavian hospitals use less energy at a site level compared to their Pacific Northwest counterparts, and they generally rank much higher in Energy Star score, due to both total site energy consumption and source energy type. These Scandinavian hospitals provide evidence for professionals in design, construction, and operation of U.S. hospitals that it is possible to achieve significantly reduced energy footprints and increased indoor environmental quality in healthcare facilities.
© 2014 VENDOME GROUP LLC
Informing Hospital Change Processes Through Visualization and Simulation: A Case Study at a Children’s Emergency Clinic Hospitals are exposed to changes of smaller or bigger nature almost on a continuous basis. The people working in the organization are an important partner in this change process. They possess considerable knowledge about practical realities of the organization and are more likely to embrace change when involved in the planning. The possibility to use visualization and simulation technology in such processes has grown with technological advancements. These technological aids can facilitate the communication between stakeholders and extract the institutional knowledge of the participants by letting them experience a change proposal through a simulated environment before it is implemented, enabling them to evaluate it beyond contemporary demands and current work structures. Long-term involvement, in combination with tools that are easily accessible for the participants, is integral for creating a participatory setting where the practitioners’ knowledge guides the process.
HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 5
EXECUTIVE SUMMARY OF KEY CONCEPTS Space Planners’ Perception of an Assessment Instrument for Briefs in the Pre-Design Phase of New Healthcare Environments Design decisions should be conveyed through documents (design proposals, programs and/ or briefs). This study presents an ongoing development of a new instrument to assess the content and quality of documents developed in the pre-design phase of new healthcare environments. There is lack of valid instruments to assess the content and quality of the documents even if the requirements have been focused for a long time. It is important to assess the content and quality of these documents as part of an ongoing assessment of the process. Results may enable systematic comparisons of the information in the documents within an organization or documents between different organizations. Assessments may also be helpful in understanding and identifying areas of the pre-design phase (P-DP) that need improvement. In general, the documents such as briefs created in P-DP are an underused source of data. Documentation is a valuable source of quality assurance because it ensures the transparency of the process and the effective evaluation of the completed building. Developing an instrument is a complex process, requiring time and consideration of the linguistic and semantic aspects of the instrument but also the usability. To ensure a valid instrument getting feedback from the main user of the instrument is essential. This study suggests preliminary validity evidence for the Content and Quality in Briefs Instrument (CQB-I).
6 WWW.HERDJOURNAL.COM
Design Characteristics of Acute Care Units in China Healthcare industry construction in China is one of fastest growing construction sectors in China and, arguably, in the world. However, systematic study of the current design patterns in Chinese hospitals has been rarely done. For this article, a descriptive study has been done of unit configuration, size, patient visibility, distance to nursing station and supplies, and lighting conditions in 25 units in 19 public hospitals built after 2003. The study found there are three dominant types of unit layout: single-corridor (52%), triangular (36%), and double-corridor (12%). The percentage of private rooms is very low (11%). Centralized nursing stations were found to be the only type of nurses’ working area. China also has a larger unit size in terms of number of patient beds. The average number of patient beds in a unit is 40.6 in China (versus 32.9 in the U.S.). The acute care units in China have longer walking distance and lower visibility from nursing station to patient bedside. The access to natural light and direct sunlight in patient rooms is superior to that in U.S. Because of the differences in economies and building codes, there are dramatic differences between the spatial characteristics of care units in China and the U.S.
Confirming, Classifying, and Prioritizing Needed Over-the-Bed Table Improvements via Methodological Triangulation This article presents the results of a qualitative study that confirmed, classified, and prioritized user needs for the design of a more
© 2014 VENDOME GROUP LLC
EXECUTIVE SUMMARY OF KEY CONCEPTS useful, usable, and actively assistive over-thebed table. This study builds upon a previous study that generated a list of needs for use in developing an actively assistive over-the-bed table. In this study, 14 healthcare subject matter experts and eight research and design subject matter experts engaged in a participatory and iterative research and design process in order to establish the usefulness and importance of each respective need statement from the previous list. A table demonstrating which needs are of high importance to both groups of subject matter experts and a classification of the design challenges each represents was produced. The results of this study indicate that designing a more useful, usable, and actively assistive over-the-bed table is primarily about the ability to position it optimally with respect to the user for any task, as well as improving its ease of use and usability. It is also important to make explicit and discuss the differences in priorities and perspectives demonstrated between research and design teams and their clients early in the research and design process.
RESEARCH METHODS Development and Psychometric Testing of a Post-Occupancy Evaluation Understanding the needs of patients, staff, and visitors in a healthcare environment is an essential component of the decision-making process for healthcare design professionals. In order to achieve excellence in occupant experience, improve patient outcomes, and enhance operational efficiencies, it is important for design professionals to understand the current chal-
© 2014 VENDOME GROUP LLC
lenges their building users face and how design can best support or eliminate those challenges. Post-occupancy evaluations (POEs) have become highly regarded throughout the industry as an effective tool for achieving this knowledge and understanding. However, it is critical that the tools and processes used to conduct POEs have been rigorously tested in order to ensure credible results. This article outlines the process of developing a standardized facility assessment that can be used for both existing facility assessments (EFAs) and post-occupancy evaluations. The concepts explored include a four-phased baseline process of measuring the success of the built environment as well as specific instructions on conducting a content validity test, an essential component in developing a survey questionnaire.
LITERATURE REVIEW Impact of the Design of the Built Environment on People with Dementia: An Evidence-Based Review For more than two decades, a large number of studies have established a relationship between the design of the physical environment of longterm care settings and outcomes of people with dementia. Simultaneously, the number of people with dementia in need of long-term care has been increasing. In light of these developments, strategies to create appropriate living environments for people with dementia are required. However, the methods employed in the research studies available are heterogeneous and the results are often conflicting. Consequently, the process of inte-
HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 7
EXECUTIVE SUMMARY OF KEY CONCEPTS grating the best evidence available into architectural designs may be hindered. In this review, the impact of the design of the built environment on people with dementia in long-term care settings was systematically analyzed using an evidence-based approach. The outcomes were thematically summarized into four main categories: basic design decisions, environmental attributes, ambience, and environmental information. The effectiveness of the interventions on behavior, cognition, function, well being, social abilities, orientation, and care outcomes of people with dementia was illustrated using matrices. With this study, architects and designers will be provided with credible evidence on which they can confidently base their design decisions. Researchers will be able to determine which environmental aspects have been well investigated and where there are gaps in the current state of the research.
Design Research and the Globalization of Healthcare Environments Global healthcare practice has expanded in the past 20 years. At the same time, the incorporation of research into the design process has gained prominence as best practice among architects. However, although international practice is expanding, international research is not growing at the same pace. Most research is being conducted in the United States.
8 WWW.HERDJOURNAL.COM
The authors of this study investigated the status of design research in a variety of international settings. We intended to answer the question, “how pervasive is healthcare design research outside of the United States?” The authors conclude that in addition to the need for more design research throughout the world, research objectives need to be expanded to address healthcare design in developing countries where the need is great and the resources are few. Additionally, firms must strive to increase the cultural competence of their professional staffs.
THEORY Positive Distraction and the Rehabilitation Hospitals of João Filgueiras Lima Despite the lack of formal integration of evidence-based design in healthcare architecture in Latin America, many of the basic tenets generated from design research have been incorporated into Brazilian rehabilitation hospitals. The use of positive distraction in the rehabilitation facilities designed by João Filgueiras Lima (Lelé) for the Sarah Network of Rehabilitation Hospitals is a clear example of this phenomenon and has served to inspire many current healthcare projects. Lelé’s success is a demonstration of the critical role familiarity with medical treatment protocols and insights regarding human behavior play in creating an alignment between research and practitioner experience.
© 2014 VENDOME GROUP LLC
