Research Summaries

Research Summaries

With your support, The Academy on Architecture for Health Foundation funded three research grants for the current research cycle. These studies will provide useful and pragmatic information related to ambulatory care work environments, to the integrated project delivery process, as well as international healthcare. We continue to look for opportunities to partner and fund research that will contribute to the healthcare design practice.

Research funded in 2019

• DEVELOPMENT AND VALIDATION OF AN INSTRUMENT TO MEASURE NURSE EXPERIENCE OF THE INPATIENT CARE ENVIRONMENT

• OverviewImage Credit: https://www.serenityhospicecares.org/inpatient-unit/
• The Academy of Architecture for Health Foundation has awarded a $30,000 research grant to support the development and validation a research tool to measure nurses’ experience of inpatient care environments. The healthcare design community has long needed open-source, standardized measures that can be applied across firms, institutions and years. This study helps to fill that gap.This research will be led by an interdisciplinary team of researchers, clinicians and designers. Renae Rich, M.S., a research analyst at HDR, led the awarded proposal, and the core study team will include Francesqca Jimenez, M.S., a researcher at HDR, as well as a team of nurses from Methodist Hospital and Methodist Women’s Hospital in Omaha, Nebraska, led by Cheryl Bohacek, MSN, RN, OCN, oncology service leader at Methodist Hospital.“Current limitations in design research include a lack of valid measures that can provide direct feedback about the role of the built environment in producing desirable outcomes, and this work is addressing that gap in inpatient units,” Rich said.
• “Nurses hold valuable information on the design of the environment to promote healing as well as a positive work environment,” Bohacek added.
• “We believe that this research endeavor will not only inform our own processes in nursing practice and the delivery of healthcare services, but also contribute substantively to the field of healthcare design research,” said Teri Tipton Bruening, MSN, RN-BC, CNE, vice president and chief nursing officer at Methodist Hospital and Methodist Women’s Hospital. The study will initially draw upon data HDR has collected in several healthcare facilities over the past year and will include several subsequent phases of quantitative and qualitative data collection, analysis and refinement. Jeri Brittin, Ph.D., HDR’s director of research, noted that, “Renae has done an exceptional job of planning this work, and the resulting instrument will be published and made available for all in the industry to use. Consistent and valid measurement is critical to move the field of design research forward.” This grant would not be possible without the sponsorship of countless architects, healthcare designers, supporting firms, and industry partners. A special thanks goes to the Atreo Group and President, Harry Pliskin for their amazing support that allows these grants to be large enough to truly contribute to the advancement of the field.
• More press on AAHFoundation Grant Awardees for Development and Validation of an Instrument to Measure Nurse Experience of the Inpatient Care Environment
• Atreo Group helps healthcare facilities run more efficiently by providing solutions that contribute to better patient outcomes, higher employee satisfaction and lower long-term infrastructure and facilities costs. By enabling staff to be more efficient, we give time and resources back to healthcare facilities so they can improve the patient experience. All of our solutions are fully supported by our service organization. Discover Atreo Group through our companies.

Research funded in 2018

• VISUAL ENGAGEMENT WITH NATURE AND SPATIAL COGNITION: A STUDY OF HOSPITAL CIRCULATION SPACES THROUGH IMMERSIVE VIRTUAL ENVIRONMENT TECHNOLOGY

• AuthorsPrinciple Investigator:
  Shan Jiang, Ph.D. (West Virginia University)
  Consultants:
  Davis Allison, FAIA, FACHA, Professor and Director (Clemson University
  Andrew Duchowski, Ph.D., Professor (Clemson University)
• OverviewLarge hospitals are often complex and highly sophisticated environments due to their functional complexity and the way in which they evolve and grow over time. As a result, they typically present excessively institutional environments that can have negative effects on hospital occupants, such as wayfinding difficulties and spatial disorientation. As a core component of any healthcare facility, hospital circulation spaces remain neglected compared to the healthcare design and research in other domains conducted and reported to date. Visual engagement with nature, which has been proven therapeutic, has been hypothesized as playing the roles of wayfinding cues and facilitating spatial cognition in healthcare complexes. However, there is a paucity of empirical studies conducted on this topic, which has resulted in a significant knowledge gap.
  1. Hypothesis: Having visual access to nature from within hospital circulation spaces serve as identifiable and memorable landmarks and facilitate people’s spatial cognition and wayfinding performances in a diagnostic and treatment health care environment. The design of hospital circulation spaces with transparent connections and views to nature will be examined in relation to people’s spatial orientation and wayfinding performances compared to hospital corridors with no window views. People’s environmental experience of visual engagement with nature and the distribution of visual attention in hospital circulation spaces will be explored.

  This study will also examine Immersive Virtual Environment (IVE) technologies as complementary methods and tools in healthcare design research.In this exploratory, survey-embedded experimental study, 90 volunteers will complete various wayfinding tasks in fully immersive virtual hospital environments. Participants’ eye movements will be tracked and analyzed, and a series of variables will be measured to compare the time consumed to complete the tasks and the route selection. Participants’ navigation strategies will be interviewed through cognitive mapping. Participants will also take surveys to report their sense of direction.

  This study is meaningful and desirable from the greater emphasis on involving user participation in the caregiving and healing process. Study results will be translated to immediate design recommendations intended to help guide the layout of medical compartments, corridors, and courtyards in a complex hospital design, and provide alternative solutions to hospital wayfinding issues.

• POSITIVE HEALTH OUTCOMES BY ENVIRONMENTAL DESIGN: THE ROLE OF SPATIAL CONFIGURATION IN DESIGNING PHYSICAL ENVIRONMENT FOR PEOPLE EXPERIENCING DEMENTIA

• AuthorsPrinciple Investigator:
  Farhana Ferdous, PhD (Howard University)
  
• OverviewThe relationship between the physical environment and prevalence of social interaction have been a core topic of inquiry in environmental gerontology. By 2050, it has been estimated that the world will number 2 billion older adults, aged ≥60 years. Among them around 25 million people worldwide have dementia, and the number of people with dementia is predicted to exceed 80 million by 2040. A growing body of literature in the areas of environment-behavior studies shows that the physical environment affects positive behavioral changes, in turn, affecting individual, group and organizational outcomes, but little research has focused on older adults especially those with cognitive impairment by examining the physical environment of care facilities.Based on previous research this study would like to explore in what level and how does the spatial configuration of the built environment in long-term care facilities (LTCF) could influence the physical activity and social interaction among the residents.  By using non-pharmacological interventions, the purpose of this study is to measure the physical environment by analyzing the spatial configuration and layout in long-term care facilities that are believed to initiate physical activities and positive social interaction among dementia residents, staff and use the findings to give evidence-based design guidelines for future research and design of memory care facilities to promote therapeutic experience for people experiencing early to moderate stage dementia. The results of this study will give evidence-based design guidelines that are generalizable regardless of geographic location of the LTCF and will provide designers about the effectiveness or the weaknesses of their design decisions. As an expected outcome, this study will be able to establish that by combining physical activity with social interaction, the environmental design could have a protective effect against dementia.
  1. This study will objectively measure the spatial configuration of LTCF to evaluate the provision of physical activities (among residents) and social interactions (among residents and staff) to promote a healthy living for people experiencing early to moderate stage.
  1. Use findings of the study to inform more robust, multi-level research analysis and evidence- based design guidelines by suggesting alternative spatial layout of the physical environment in LTCF and thereby aimed at improving the therapeutic experience for people experiencing early to moderate stage.

Funding Cycle : 2015 – 2017

• Designing Emergency Departments to Provide Efficient, Patient-Centered Care: An Analysis of Split Flow and Sub-Waiting Area Models

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• Date2015 — 2017
• AuthorsJennifer Wiler MD, MBA, FACEP James Lennon, AIA, ACHA Dave Vincent, AIA, ACHA, LEED AP Negin Houshiarian MS (Architecture), PhD (Interior Architecture) Benjamin Easter MD (Healthcare Administration MBA Candidate) Debajyoti Pati MASA (Architecture), PhD (Architecture)
• OverviewAs emergency department (ED) crowding has worsened and its effects catalogued, ED leaders have sought process improvements to improve efficiency while architects have proposed design strategies to achieve the same. Unfortunately, these efforts have largely failed to cross professional boundaries. The present study explored the essential interaction between ED design and flow with a goal to optimize split-flow patient care systems.
  Methods: The study is a 2 factor analysis, examining the interaction of 3 flow models (split by Emergency Severity Index score, split by a physician, and no split) with 3 sub-waiting area types (no sub-waiting, 1 sub-waiting, and 2 sub-waiting). Thus, 9 total models were examined. Outcomes of interest were operational metrics (length of stay (LOS), bed utilization rate) and patient-centered metrics (door to provider time (D2P), left without being seen (LWBS) rate, and number of movements per patient). We used patient and encounter-level data from 30 randomly selected days at a 100,000 annual visit academic ED to create and specify ARENA discrete event simulation models. We validated 3 models against actual ED data, and then used these to extrapolate performance in the remaining 6 flow-design sub-types. Flow split by ESI with 1 waiting area (the most common model used by EDs) was used as the control. We also sought to determine the best design specification given a fixed flow as well as the best flow specification given a fixed design. Models were compared and analyzed for statistical significance and effect size using one-way analysis of variance (ANOVA) to find the most efficient model, two-way ANOVA to measure the impact of each group of independent variables (flow types and/or design types), and linear and non-linear regression.
  Results: One way ANOVA testing demonstrated the superiority of the ED flow split by a physician with 2 sub-waiting areas. This model resulted in the smallest LOS of 189.8 minutes (54 min shorter vs. control), and the highest bed utilization of 5.02 patients/bed/day (41.8% increase vs. control). In addition, physician-directed flow with 2 sub-waiting areas also showed superior performance in several patient-centered metrics, having the best D2P time of 9.6 minutes (vs. 26.3 min, control) and only a 1.17% LWBS rate. Not surprisingly, having 2 sub-waiting areas did result in an increase in the number of different treatment spaces a patient visited, 4.2 vs. 4. For any given flow type, adding 1 additional sub-waiting area resulted in a decreased LOS (range 20.9 – 37.3 min), increases in bed utilization (0.42 – 0.70 patients/bed/day), decreases in D2P (2.6 – 8.3 min), and decreases in LWBS (0.8% – 1.24%). For a given number of sub-waiting areas, flow split by a physician resulted in superior performance, followed by flow split by ESI, followed by no split flow.
  Conclusion: Modifications to both ED flow and physical design have significant potential to improve both operational and patient-centered metrics. In general, addition of sub-waiting areas and use of a physician to split flow, as opposed to ESI score sorting, significantly improved operational and patient centered metrics. EDs should consider implementation of a physician-based intake model with multiple sub-waiting areas to improve performance.

Funding Cycle : 2014 – 2016

• Mental and Behavioral Health Environments: Critical Considerations for Facility Design

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• Date2014 — 2016
• AuthorsMardelle M Shepley: (Cornell University) Angela Watson (Shepley Bulfinch Architects) Francis Pitts (Architecture Plus) Anne Garrity (Shepley Bulfinch Architects) Elizabeth Spelman (Shepley Bulfinch Architects) Janhawi Kelkar (College of Human Ecology, Cornell University) Andrea Fronsman (College of Human Ecology, Cornell University)
• Overview

  The purpose of the study was to identify features in the physical environment that are believed to positively impact staff and patients in psychiatric environments and use these features as the foundation for future research regarding the design of mental and behavioral health facilities. Methods Pursuant to a broad literature review that produced an interview script, researchers conducted 19 interviews of psychiatric staff, facility administrators and architects. Interview data were analyzed using the highly structured qualitative data analysis process authored by Lincoln and Guba (1985). Seventeen topics were addressed ranging from the importance of a deinstitutionalized environment to social interaction and autonomy. Results The interviewees reinforced the controversy that exists around the implications of a deinstitutionalized environment, when the resulting setting diminishes patient and staff safety. Respondents tended to support open nurse stations vs. enclosed stations. Support for access to nature and the provision of an aesthetic environment was strong. Most interviewees asserted that private rooms were highly desirable because lower room density reduces the institutional character of a unit. However, a few interviewees adamantly opposed private rooms because they considered the increased supervision of one patient by another to be a deterrent to self-harm. The need to address smoking rooms in future research received the least support of all topics. Conclusion Responses of interviews illustrate current opinion regarding best practice in the design of psychiatric facilities. The findings emphasize the need for more substantive research on appropriate physical environments in mental and behavioral health settings.

Funding Cycle : 2013 – 2014

• Designing Team Rooms for Collaboration In The Patient Centered Homes

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• Date2013 — 2014
• AuthorsJennifer DuBose: (SimTigrate Design Lab, Georgia Institute of Technology) Lisa Lim (SimTigrate Design Lab, Georgia Institute of Technology) Ross Westlake (Herman Miller)
• Overview

  Moving from a physician-centered practice to a care-team practice is a huge challenge, yet it’s critical in implementing patient-centered medical home models. This presentation will share how one group used mock-ups and simulation to help the care team from a federally qualified health clinic create a shared vision and culture change. Presenters will share the strategy for creating and engaging in the simulation and how those results were used to create the configuration for a newly renovated team hub that expressed the shared vision of the team. The simulation process allowed the care-team members to see each other in action and gave them a deeper, more insightful understanding of their behavior and spontaneous interactions with their colleagues, as well as the overall process. • Learn the critical cultural aspects of patient-centered medical home teams. • Identify cultural barriers to team-based care. • Explore mock-up and simulation techniques. • Obtain the keys to successfully shifting team-based cultures

• The Value Analysis of Lean Processes in Target Value Design and Integrated Project Delivery

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• Date2013 — 2014
• AuthorsCenter for Advanced Design Research & Evaluation (CADRE):

  Upali Nanda, PhD, Assoc. AIA, EDAC (Principal Investigator) Sipra Pati, MA

  Texas A&M University: Zofia Rybkowski, PhD (Co-Pi) Di Ai, MA Nivedita Kalyanaraman Adeleh Nejati, PhD

• Overview

  The objective of this research was to 1) assess the value of applying lean process improvement tools in design and project delivery by conducting a plus/delta analysis, and 2) create an inventory of metrics to develop a foundational framework to aid future Return-on-Investment (ROI) studies. By undertaking the case study of a health care facility project that implemented Lean-IPD and TVD, our intent was to make components of benefit and cost that are currently implicit, more explicit. It was found that the project saved $33,083,907 dollars from the estimate after validation. This was while accounting for an additional scope that was added to the project. While these figures are impressive, a common criticism of TVD and Integrated Project Delivery is the high level of commitment required from all team members, which translates to a large investment which is typically unaccounted for.

• Malawi Material Waiting Homes: Measuring the Impact of Holistic Design Approach on Maternal & Infant Health

• AuthorsCo-Investigators: Michael Murphy and Alan Ricks (MASS Design Group)
• OverviewThe Safe Motherhood Initiative is seeking to redesign a Maternity Waiting Home, where near-term pregnant mothers can stay in close proximity to a health facility. This study seeks to demonstrate how design can encourage facility-based deliveries and support improvements in maternal and neonatal health outcomes. By measuring the impacts of the redesigned MWH, Malawi hopes to generate evidence that can support the Malawian government as they scale this care model across the country.
• Preliminary Findings Can design influence user satisfaction and use?Adding to the literature of evidence-based design is a recent study funded by AAHF comparing user satisfaction of two maternity waiting homes in Malawi, each with a different architectural design. One home was built following a standard “barracks-like” design developed by the Ministry of Health, and the other a “village” design, developed by MASS Design Group, which responds to user needs by breaking up the sleeping quarters into more intimate spaces, adding toilets and showers, and integrating additional indoor and outdoor common spaces. Use of maternity waiting homes (residential facilities that temporarily house near-term pregnant mothers close to healthcare facilities that provide obstetrical care) are being promoted in developing countries, including Malawi, to provide access to safer facility-based deliveries but, in many cases, are being underutilized. This study sought to empirically show how designing maternity waiting homes to better meet mothers’ needs can influence user satisfaction and encourage their use — thereby increasing medical facility deliveries, and ultimately in reductions in maternal and infant morbidity and mortality.In the study, women at both sites were surveyed about their experiences staying at the maternity waiting homes. The “village” design had higher satisfaction ratings for the majority of design factors examined (sleep areas, private storage space, toilet and shower amenities, kitchen facilities, outdoor spaces, air and water quality, building maintenance, thermal comfort, and overall satisfaction) and final models showed that toilets and showers, guardian spaces, safety, building maintenance, sleep areas, and private storage spaces were the most important factors related to overall satisfaction. These findings not only demonstrate that design matters, but also identify where to focus limited resources to improve maternity waiting home design. Due to the study’s pending publication further reporting on results will be shared at a later date.

Funding Cycle : 2012 — 2013

• Hospital Rooms and Patients’ Well-being: Exploring Modeling Variables

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• Date2012 — 2013
• AuthorsAnn Sloan Devlin (Connecticut College) Cláudia Andrade (ISCTE – Instituto Universitário de Lisboa)
• Overview Multiple papers have been published from this in-depth study.Little research has explored how patients evaluate the physical environment of their hospital rooms. Most responses are captured by the Hospital Consumer Assessment of Healthcare Providers and Systems survey, which includes only two questions about the physical environment. Two hundred thirty-six orthopedic patients (78 in the United States and 158 in Portugal) listed three features of their hospital room that influenced their level of satisfaction with their hospital stay, indicating whether the feature was positive or negative.The comments were more positive (71.4%) than negative (28.6%). Using the framework of supportive design from Ulrich, over half the comments (64.31%) could be categorized in one of the three dimensions: 33.2% (positive distraction), 22.4% (perceived control), and 6.0% (social support). This total includes Internet (2.7%), which could be categorized as either social support or positive distraction. Comments called “other aspects” focused on overall environmental appraisals, cleanliness, and functionality and maintenance. The majority of comments could be accommodated by Ulrich’s theory, but it is noteworthy that other aspects emerge from patients’ comments and affect their experience. Cross-cultural differences pointed to the greater role of light and sun for Portuguese patients and health status whiteboard for U.S.Research supported by a grant from the AAHF and testing Ulrich’s Theory of Supportive Design as a field study has been accepted for publication and is “in press” at the Journal of Environmental Psychology.The article, authored by Cláudia Campos Andrade, Ann Sloan Devlin, Cícero Roberto Pereira, and Maria Luísa Lima showed that the larger the number of favorable elements in the patient’s hospital room, the lower the patient’s stress. Of Ulrich’s three elements in the Theory of Supportive Design, positive perceptions about the room qualities related to distraction and social support explain this effect. The author information, title, and abstract are below, and you can access the article in full as an “in press” publication on the website of the journal.Andrade, C. C., , Devlin, A. S., Pereira, C. R., & Lima, M. L. (2017, in press). “Do the hospital rooms make a difference for patients’ stress? A multilevel analysis of the role of perceived control, positive distraction, and social support.” Journal of Environmental Psychology. doi:10.106/j.jenvp.2017.06.008The physical environment of healthcare settings can contribute to preventing or reducing patients’ stress. Using Ulrich’s theory of supportive design (1991), this study tested whether this relationship occurs because the physical environment promotes perceptions of control, positive distractions, and social support. The research disentangles the contribution of the objective qualities of physical environment to stress, over and above patients’ perceptions about the environment. In a multi-site field study (five hospital units from two countries), 57 hospital rooms were assessed in terms of the number of favorable design features, and 187 patients responded to a questionnaire after surgery. Multilevel regression analysis showed that the greater the number of favorable design features, the less the patients’ stress, that positive perceptions about the room qualities in terms of how much social support and distraction they provide explain this effect, and that the relative importance of these dimensions may differ between cultures.

Funding Cycle : 2011 — 2012

• Comparative Analysis of Hospital Energy Use: Pacific Northwest and Scandinavia

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• Date2011 — 2012
• AuthorsHeather Burpee (University of Washington) Erin McDade (University of Washington)
• OverviewThis study is an outgrowth of previous research evaluating high quality, low energy hos­pitals that serve as examples for new high performance hospital design, construction, and operation. Through extensive interviews, numerous site visits, development of case studies, and data collection this team has established thorough qualitative and quanti­tative analyses of several contemporary Scandinavian and Pacific Northwest hospitals. These hospitals serve as significant examples for design teams that seek operational precedents for achieving aggressive energy and interior environmental quality (IEQ) goals. It is clear that a direct side-by-side quantitative energy comparisons of interna­tional and national examples are necessary for design teams and decision makers to draw informed conclusions about the viability of implementing energy saving solutions. This report seeks to provide such a comparison and to illustrate examples of qualitative attributes that lead to high indoor environmental quality.

Funding Cycle : 2010 — 2011

• Optimizing Toilet Location for Assisted Toileting

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• Date2010 — 2011
• RecipientAcademy of Architecture for Health — Tampa Bay
• AuthorsDr. Jon Sanford (Georgia Institute of Technology) Dr. Sheila Bosch (Gresham, Smith and Partners)
• OverviewSince its approval in 1991, the Americans with Disabilities Act Accessibility Guidelines (ADAAG) have included design requirements for restrooms, but these may be insufficient for persons who need assistance transferring on to and off of the toilet. This study used a repeated measures research design to evaluate caregiver responses during assisted toileting for 4 different toilet room configurations. Although there were no statistically significant differences observed in terms of unsafe staff movement (e.g., bending, twisting), caregivers overwhelmingly preferred the largest toilet room configuration with 2 fold-down grab bars, where they were able to move closer to the resident while assisting.

Funding Cycle : 2009 — 2010

• Environmental Correlates of Efficiency and Safety in Emergency Departments: An Exploratory Examination

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• Date2009 — 2010
• AuthorsDebajyoti Pati, (PH.D., FIIA, LEED© AP) Thomas E. Harvey Jr., (AIA, MPH, FACHA, LEED© AP; CADRE) Mary Ann Derr, RN, MBA (Synurgy Healthcare Solutions) John M. Deledda, MD (The University Hospital, University of Cincinnati) Sandra Lok, RN (Stantec)
• OverviewThis proposal (phase-I of a 3-phase study) will examine in-depth the physical design attributes of emergency departments, with the objective to developing a list of environmental correlates of safety and efficiency in ED operations. Increased quantity, timeliness, and intensity of care have created many challenges for the operation of EDs today. Interventions have been typically operational, although there is an implicit and growing recognition of the role of the physical environment. However, scientific literatures on ED physical design are not available. This proposal will adopt an exploratory, multi-measure approach to examine the interactions between ED operations and physical design at three sites, and identify domains of physical design decision-making that potentially influence efficiency and safety. Considering the crucial role of EDs in healthcare delivery, this study will provide important information to healthcare stakeholders, and constitute a foundation for future phases of this research.

• Area Calculation and Net-Gross Ratios in Hospital Design – year 2

• Date2009 — 2010
• AuthorsD. Kirk Hamilton, FAIA, FACHA, EDAC, Associate Professor (Texas A & M University)
• OverviewThis proposal is a continuation of the study supported last year by the Academy of Architecture for Health Foundation. The purpose of the proposed study is to establish a publicly accessible database of healthcare and hospital area calculations that can be updated and maintained over time. Therefore, this study aims to calculate the ratio between departmental net and gross square footage in all departments within hospitals. Following are the research methods to be used in the proposed study: (1) a one-day consensus conference; (2) an invitation to participate in the project; (3) collection of project plans and drawings from design firms; (4) conducting surveys of the participating firms and their designers to discover the program intentions; and (5) analysis of the data by conducting net-to-gross area calculations. This proposal is limited to asking for funding that will allow the researchers to hire a full-time graduate student worker for the summer semester.

Funding Cycle : 2008 — 2009

• A Study of Hospital Inpatient Unit Design Factors Impacting Direct Patient Care Time, Documentation Time, and Patient Safety

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• Date2008 — 2009
• AuthorsTom Clark, AIA and Scott Combs, AIA (Clark/Kjos Architects)
• OverviewThe study correlates locations of certain hospital inpatient unit support resources (medications, supplies, linens, equipment, documentation stations) with nurses’ perceptions of their impact on patient care objectives. in addition, it sought nurses’ judgment of various classes of collaboration spaces that they use. 14 nursing units, 150 nurse survey responses, and architects’ floor plans provided data. Analysis showed that reducing distance between patient bedside and medications, supplies, and linen is beneficial, but not for equipment. equipment distance is less important than reliability of location. Medication room size is critical for patient safety, 80 square feet minimum. Regarding documentation station position, decentralized and open to hallway views locations are preferred for patient safety. collaboration occurs at documentation stations, especially ones closest to patients.

• Area Calculations and Net : Gross Ratios in Hospital Design

• Date2008 — 2009
• AuthorsKirk Hamilton, FAIA, FACHA Dr. Sarel Lavy (Texas A & M University)
• OverviewThe proposed study is based on the “Analysis of departmental area in contemporary hospitals: calculation methodologies and design factors in major patient care departments,” as published on January 24, 2008, by D. Allison and D.K. Hamilton. The original pilot study was generously funded by the Academy of Architecture for Health Foundation (AAHF), Frank Zilm, and Don McKahan. The prior Allison and Hamilton study is used here as a prototype on which future measurements will be developed, and from which trends over time can be derived. The purpose of the proposed study is to establish a publicly accessible database of healthcare and hospital area calculations that can be updated and maintained over time. The searchable database will contain collected data on industry trends for the ratio between departmental net and departmental gross square-footage in significant patient care, diagnostic, and treatment departments within hospitals, including Emergency, Radiology, Surgery, Acute Care Inpatient Units, and Intensive Care Units which were in the pilot study and all other departments. The goal is to make planning data available to the industry in a way that allows for better predictions of square footage requirements and improved performance of healthcare buildings.

Funding Cycle : 2007 — 2008

• An Empirical Examination of Patient Room Handedness in Acute Medical-Surgical Settings

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• Date2007 — 2008
• RecipientCenter for Advanced Design Research & Evaluation (CADRE)
• AuthorsDr. Debajiyoti Pati, Thomas Harvey, Jennie Evans (HKS) Carolyn Cason (University of Texas, Arlington)
• Overview

  The purpose of this research was to evaluate whether standardized same-handed rooms were more efficient in comparison to standardized mirror-image rooms given that the former configuration was being adopted by many hospitals for their inpatient new units. This study examined the comparative effectiveness of both types of configurations and found that in acute medical-surgical settings standardized same-handed configurations may not contribute to process and workflow standardization any more than standardized mirror-image configurations.

  Study data show that standardization of processes and workflow to the extent of force functioning staff location on the right side of the patient, in acute medical-surgical settings, may not be achievable owing to numerous factors. Thus, designing same-handed environments may not contribute to process and workflow standardization. However, data show that physical design standardization (as a construct distinct from environmental handedness), leading to familiarity with the physical work environment, constitute an advantage in acute medical-surgical settings.

• Does the Size and Design of Family Areas within Patient Rooms Increase Family Involvement in Patient Care?

• Date2007 — 2008
• AuthorsDr. Sheila J. Bosch, (Gresham, Smith & Partners) Young-Seon Choi (Georgia Institute of Technology) Dr. Craig Zimring (Georgia Institute of Technology)
• Overview

  Gresham, Smith & Partners, in collaboration with Georgia Tech, investigated how the size and design typology of the in-room ICU family area is associated with family presence and family-member interactions with patients and caregivers. As hospitals become more patient-centered, they strive to create environments that are pleasing and comfortable for not only patients, but also family members. Although there has been a fair amount of research investigating family presence and health-related outcomes, there is very little data concerning the effects of the physical design on family member involvement. This study compared two intensive care units at Tampa General Hospital with different sizes and family zone design typologies within patient rooms. Study environments include the following; 1) a trauma intensive care unit (2D) with an open and small sized family area (type A) which is less than 30 square feet accommodating a non-reclining and, 2) a neurological intensive care unit (5K) with an open and moderately sized family area (type B) which is approximately 55 square feet and can accommodate a sleeper sofa, reclining chair and a non-reclining chair. It also includes a privacy curtain. Additionally, family presence in the public waiting areas was also evaluated. Two research methods were used in this study: 1) behavior mapping in the unit to evaluate the frequency and duration of family visits to patient rooms, interactions among those observed, and family member/visitor presence in the unit; and, 2) staff member focus group(s).

  Final analysis has not yet been completed, but preliminary analysis suggests that the more spacious family accommodations are associated with increased family presence.

• Evidence-based design meets evidence-based medicine: Validating new acoustic guidelines for healthcare facilities using a collaborative and trans-disciplinary approach for improving patient outcomes.

• Date2007 — 2008
• AuthorsJo M. Solet, Ph.D. (Principal Investigator) David M. Sykes, M.A. Andrew Carballeira, B.M. (Co-Investigators)
• OverviewClinical and legal concerns have begun driving new priorities in acoustic design of healthcare facilities. Clinically, adverse noise levels degrade sleep quality, interrupt communication of patients and providers, and impose unnecessary stress on both patients and healthcare professionals. Recent federal legislation (HIPAA) mandates protection of patient speech privacy. Of importance to hospitals, inadequate privacy registers as one of the leading categories of patient complaints, contributing to lowered quality-of-care ratings at healthcare facilities. Through combined state-of-the-art technologies in acoustics and sleep physiology, with the cooperation of two Harvard Medical School teaching hospitals, our unique interdisciplinary team will develop and use a prototype for replicable adjustable sound simulation and subject exposure, providing evidence-based guideline validation for acoustics in healthcare facilities.

• Impact of Single Family NICU Rooms on Family Behavior

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• Date2007 — 2008
• RecipientTexas A&M University
• AuthorsMardelle Shepley, PhD, FAIA (Texas A&M University) Debra Harris, PhD, AAID (IDR Studio) Robert White, MD (Memorial Hospital of South Bend)
• Overview

  The purpose of this research was to evaluate family interactions with staff, infants and other families in open bay and single family room (sFR) neonatal intensive care units. The study demonstrated that fewer interactions occurred in the single family rooms, but they were of longer duration. Almost all new construction in the us is considering building sFRs, and this study makes a valuable contribution towards understanding the implications of this health design trend.

  Family interactions with family members or families of other infants. Hypothesis 1, that there would be significantly more family interactions in the Open Bay setting than the SFR unit was not supported. The data in this study indicated that the mean time spent in conversation between the subject (parent) and parents of other infants was greater in the SFR unit than the Open Bay unit (p<0.05).

  Family interactions with staff. Regarding hypothesis 2, no significant difference between the impact of unit types (SFR or Open Bay) on family interactions with staff was demonstrated.Family interactions with their infants. Hypothesis 3, that families in SFRs would have more interactions with their infants than families in the Open Bay setting was supported for two of the variables. In the SFR, parents spent more time sitting and/or standing by their infant then in the Open Bay unit (p<0.05); also, parents in the SFR spent more time holding their infants than those in the Open Bay unit (p<0.05).

  Total interactions. We collapsed the data to combine the total number of incidents of family interactions and total time spent in family interactions, both of which proved to show significant differences. Fifty-eight percent of all recorded incidences were in the Open Bay unit, compared to 42% in the SFR (p<0.05). However, the story differs when comparing the means of the duration of time spent on these activities. The mean for the SFR unit was 24.98 minutes with a standard deviation of 36.38 minutes. The mean for the Open Bay unit was 12.97 minutes with a standard deviation of 17.67 (p<0.05). The average amount of time spent on recorded incidences was nearly double in the SFR compared to the Open Bay unit.

Funding Cycle : 2005 — 2006

• Analysis of Departmental Area in Contemporary Hospitals

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• Date2005 — 2006
• AuthorsDavid Allison, AIA, ACHA Clemson University Kirk Hamilton (FAIA, FACHA Texas A&M University) Frank Zilm (FAIA, FACHA) Scott Weinhoff (Clemson University) Megan Gerend (Clemson University) John Grant (Texas A&M University)
• Overview

  This study documents and compares the relationship between departmental net and departmental gross square footages in five primary patient care, diagnostic and treatment departments within contemporary hospitals: Emergency, Radiology, Surgery, Acute Care Inpatient Units and Intensive Care Units. The study examined 98 departmental areas representing a cross section of work from 11 architecture firms, and hospitals located in 14 States. It sought to identify both a range and mean of departmental net to gross ratios in contemporary hospital design in the United States. No formal industry wide study has been conducted on departmental net to gross ratios since the then AIA Committee on Architecture and Health last prepared a report on this topic more than 25 years ago. Given the substantive changes in healthcare practices and technologies underway since then, the researchers were interested in finding out if common planning assumptions accurately reflect planning and design practices today.

  The original proposal expected to examine 20 departmental plans for each of the five departments; however some difficulty in acquiring plans from both firms and health systems limited the ultimate number [n] of plans studied for each department to 18 or 19. Significant ranges in departmental net to gross ratios – from 0.33 to 0.62 – were found in the study group while the mean net to gross ratio for each departmental category fell within a range of 1.52 to 1.60. The size of the study group, and the range in total square footage for the departmental areas available to the team, serve as significant qualifications to the results of the study. The research team feels that while this study was a valuable start for helping the industry understand the net and gross area impact of contemporary planning practices, a larger set of departments need to be examined before more definitive conclusions can be reached.

  A secondary finding of the study discovered numerous potential variations in calculating departmental net and gross areas in contemporary facility design. An increasing range of “open” areas and other departmental design features require a significant number of judgment calls. This study indicates the need for better defined and shared industry standards in calculating departmental net and gross areas. It is hoped that the methodologies for calculating departmental net and gross areas used in this study can form the basis for industry standards.

• Integrated Knowledge Database

• Date2005 — 2006
• AuthorsEve A. Edelstein, Ph.D. (Neuro), M.Arch, Assoc. AIA
• Overview Information systems that extract detailed data about the influence of architectural elements on human responses will assist manufacturers and designers in the production and use of materials and systems that better serve user needs and outcomes. Text recognition systems could search and relate information in terms of relevance to an architectural project, so that programming and design reflect this information early in the process. For example, rather than a long list of article titles, a textual search on lighting systems might yield a table with the levels, frequency and timing of electrical lighting associated with a specific outcome or user group, linked to peer reviewed and validated research papers that support the findings. Reduction in the time taken to share and analyze information will serve productivity, and enable knowledge distribution more rapidly throughout each practice and the building community at large.

• Development of Webinars for the AIA Academy of Architecture for Health

• Date2005 — 2006
• AuthorsRay Pentecost, Dr. PH, AIA, ACHA
• Overview

  Funding from the AAH Foundation made it possible for the AIA Academy of Architecture for Health to plan two 1 1/2 hour webinars for the fall season, 2006. The first, “Decoding the New Guidelines for Healthcare Facilities,” was scheduled for November 16, 2006 and the second, “Innovations for Surgical Practice,” is scheduled for December 7, 2006. The first was to be presented by Kurt Rockstroh, AIA, ACHA and the second by George Tingwald, MD, AIA, ACHA. The first has been tentatively rescheduled to the first of 2007. One of the events already scheduled for Spring, 2007 is a presentation on innovations in imaging, to be led by Mo Stein, FAIA, FACHA.

  Based on lessons learned from previous and indeed the current webinar planning efforts the AIA AAH is moving toward several innovations for 2007, including an annual webinar calendar published at the start of the year, webinar activity planned throughout the year, not just in the Fall, and the introduction of innovative promotional devices, such as video clips of the speakers explaining the content of their presentations. In addition, the AIA AAH is contemplating archiving the webinars on their website for downstream use by individuals and firms unable to participate in the webinar event. Creative marketing at the AIA AAH spring conference (PDC with ASHE), the summer leadership conference, and the AIA AAH fall conference (with the Center for Health Design) will continue in an effort to build interest in AIA AAH webinar events.