Strategies for Design

There are several major design strategies for inpatient rooms that involve the patient, the caregiver, and the environment that impacts the health, stay, and safety of the occupants. It is important to consider the healthcare environment “as an interdependent system comprised of the physical environment, work processes, organizational culture, workforce demographics, and information technology.” These strategies are designed to improve as a whole, the patients stay, the operations of the facility, the staff workflow, and the effectiveness of the facility.

Design Strategies for Patient Safety – A range of aspects included in hospital design typically consist of air quality, lighting, and patient room design. Inefficient building layouts, inadequate lighting, and non ergonomic workspaces commonly contribute to high stress and inefficiency in healthcare environments.
o Improving Air Quality: The reduction of VOC’s (volatile organic compounds) reduces indoor air pollution. Studies indicate that by decreasing VOCs can lead to a decrease in asthmatic problems, better quality of indoor air, and ultimately, better clinical outcomes. In a study researching the effects of newly painted environments, researchers found that a “significantly increased prevalence of symptoms related to asthma in relation to workplaces” was because of newly painted surfaces. o Another strategy for improving air quality is removing PVC in carpet and floor coverings. This also removes asthma triggers associated with PVC and does not require harsh chemicals to clean. These floors add additional acoustical support, as well as slip resistance and softer flooring in general.

o Clean air filtering systems are very important in healthcare design. To eliminate airborne pathogens in the environment, we must specify HVAC systems that use 100% outside air, a two-duct system that is less expensive to install and maintain. o Studies suggest families need space and amenities to be participants in the care-giving process. The article "Partners in caring: a partnership for healing" describes the effort to maximize the family-friendly environment of the patient room. The Partners in Caring philosophy, a project describing the "commitment between a patient, care partner and healthcare team to a relationship of hands-on support based on compassion, communication and choice empowering people to heal in a nurturing manner." This new environment has resulted in an improved patient and staff satisfaction and a decrease in patient complaints.
Wieslander, G., D. Norback, et al. (1996). "Asthma and the indoor environment: the significance of emission of formaldehyde and volatile organic compounds from newly painted indoor surfaces." International Archives of Occupational and Environmental Health
Rice, N., A. Streifel, et al. (2001). "An evaluation of hospital special-ventilation-room pressures." Infection Control and Hospital Epidemiology 22(1): 19-23.
Durston, P. (2006). "Partners in caring: a partnership for healing." Nursing Administration Quarterly 30(2): 105-111.

Design Strategies for Worker Safety - According to the American Nursing Association, 76% of nurses reported that unsafe working conditions interfered with their ability to provide quality care. These conditions consist of airborne infections acquired from both the hospital in general as well as direct contact with patients, back injuries from lifting and bending activities to care the patients, loud noise, poor lighting design, and over-crowded work stations. These conditions involve tasks including direct and indirect patient care, filling medications, communicating information to patients and families, and documenting the patients’ ailments, among other housekeeping tasks.
o Where patients are more susceptible to airborne infections because of their weak immune systems, nurses and staff is constantly exposed to several different conditions daily when working with patients directly. A clean air system is most important in isolated patient rooms; however, providing them throughout will reduce the spread of infection.

o Proper materiality in all work environments will prevent slipping during circulation and travel. Having a controlled amount of staff per workstation prevents overcrowding and increases workflow and process.
Design Strategies for Staff Effectiveness
o Reducing unnecessary variation - By providing a standard layout and location of equipment within the patient room, staff will work more effectively. By locating these entities within the same area per room, less time is spent on “hunting and gathering” activities, and clinicians are therefore able to spend more direct time with their patients. o The Synergy Model describes the process of shaping the entire building and its spaces to work efficiently as a whole for the care and safety of patients. This model was used in the design of St. Joseph’s Community Hospital in 2002 and has been effective ever since. o Proper Lighting can reduce eye strain and can often improve mood. Lighting has been known to have significant effects on moods and outcomes for individuals. One study showed that certain lighting techniques led to improved mental health and physical health outcomes for both patients and staff. o Where staff circulation is typically researched outside of the patient room, the minimal amount of walking distance in the room needs to be condensed and effective. o These factors are detrimental to the efficiency of how a patient room functions, as well as the quality of care for the patient.

Fong, D. B. and J. Losnegard (2004). "Lighting prescriptions. Balancing clinical and aesthetic needs in hospital spaces." Health Facilities Management 17(7): 19.
Quality of CareIt is important to identify core system requirements and facility design factors that can lead to failures and ultimately address the problems and adapt to new models of efficient care. Two key factors that address the quality of care in healthcare environments are reducing staff turnover and an increase in retention. Several studies may indicate that the physical environment also impacts staff outcomes; it is clear that a well-designed environment is not likely to succeed without a supportive work culture. These elements need to work together to maximize efficiency. In Anjali Joseph’s research about the quality of care in healthcare environments, the director of research found that the physical environment along with social support, organizational culture, and technology plays an important role in improving health, safety, effectiveness and satisfaction of the healthcare team.
In her article, “The Role of the Physical and Social Environment in Promoting Health, Safety, and Effectiveness in the Healthcare Workplace,” Joseph summarizes her research. She states that it has “become increasingly clear that efforts to improve the physical environment alone are not likely to help an organization achieve its goals without a complementary shift in work culture and practices.” Some key factors that need to be considered in the healthcare design process to increase quality of care and efficiency are:
o Identify operational and system problems that impact staff effectiveness and productivity and develop design care models to address these problems.
o Identify steps to promote culture change parallel to design changes. o Provide opportunities for spontaneous interactions with the healthcare team.
o Provide spaces for family so that they can be included in the treatment. o Consider installing ceiling lifts to decrease nurse injuries. o Conduct ergonomic evaluation of staff work areas. o Consider sources of injury and infection to staff. o Institute measures to reduce noise and stress among nurses.
o Consider work flows in relation to local of key spaces.

The Role of the Physical and Social Environment in Promoting Health, Safety, and Effectiveness in the Healthcare Workplace Anjali Joseph, Ph.D., Director of Research, The Center for Health Design. November 2006. Issue #3.

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