Evidence-Based Design for Healthcare Improvement

Chapter 1.1: Evidence-Based Design: Addressing the Challenges and Changes in Healthcare

Chapter 1.2: Chasing Value: Exploring How the Built Environment Can Contribute to Healthcare Value

• • 1.2.1 Introduction
• • 1.2.2 Defining VALUE
• • 1.2.3 Examples: Designing VALUE
• • 1.2.3.1 Industry-Value-Based Healthcare Buildings – Building the Connection to the Component
• • 1.2.3.2 Industry-Value-Based Buildings – Building the Connection to the Perspective
• • 1.2.4 Designed to Improve Value: Illustration of Practice
• • 1.2.5 Conclusions

Chapter 1.3: Evidence-Based Design: History, Issues, and Opportunities

• • 1.3.1 Introduction
• • 1.3.2 The Context of EBD and Its Rapid Adoption
• • 1.3.2.1 Rapid Adoption of EBD
• • 1.3.2.2 Examples of EBD Impact
• • 1.3.3 Disciplinary and Methodological Roots of EBD
• • 1.3.3.1 Architectural Research and Systems Engineering
• • 1.3.3.2 Environmental Psychology and Environment-and-Behavior Studies
• • 1.3.3.3 Space Syntax and Network Analysis
• • 1.3.3.4 Human-Centered Design and Co-Design
• • 1.3.4 Key EBD Findings
• • 1.3.4.1 Single-Patient Rooms: Multiple Mechanisms, Strong Evidence
• • 1.3.4.2 Environmental Quality: Stress Reduction Through Sensory Mechanisms
• • 1.3.4.3 Strategic Facility Features: High-Impact, Cost-Effective Interventions
• • 1.3.4.4 Population-Specific Applications
• • 1.3.5 Challenges in EBD Research and Implementation
• • 1.3.6 Implementation Barriers and the Need for Systematic Approaches
• • 1.3.6.1 Financial and Organizational Constraints
• • 1.3.6.2 Institutional Resistance and Cultural Inertia
• • 1.3.6.3 Limited Stakeholder Engagement
• • 1.3.6.4 Inadequate Change Management and Transition Support
• • 1.3.6.5 Challenges in Translating Evidence into Actionable Guidance
• • 1.3.6.6 Gaps in Post-Occupancy Evaluation and Continuous Learning
• • 1.3.7 A Framework for Embedding EBD in Practice
• • 1.3.7.1 Consolidated Framework for Implementation Research (CFIR)
• • 1.3.7.2 Five-Phase Framework for EBD Implementation: Linking Design, Innovation, and Evidence
• • 1.3.8 Future Challenges and Opportunities
• • 1.3.8.1 Building an Effective Evidence Base
• • 1.3.8.2 Strategies for Collaborative Evidence-Building
• • 1.3.8.3 Emerging Technologies
• • 1.3.9 Conclusion
• • 1.3.9.1 Broadening EBD Practice Through Diverse Evidence Methods
• • 1.3.9.2 Taking Action: Next Steps for Key Stakeholders

Chapter 2.1: Designing Safer and More Human-Centered Operating Rooms

• • 2.1.1 Introduction
• • 2.1.2 Key Trends, Opportunities, and Problems in OR Design
• • 2.1.3 The Evidence-Base for OR Design
• • 2.1.3.1 OR Size
• • 2.1.3.2 OR Configuration
• • 2.1.3.3 OR Door Design and Location
• • 2.1.3.4 Workspace Design and Ergonomics
• • 2.1.3.5 Sightlines and Visibility in the OR
• • 2.1.3.6 Ventilation and Air Quality
• • 2.1.3.7 Noise
• • 2.1.3.8 Lighting
• • 2.1.3.9 OR Surfaces and Materials
• • 2.1.4 Designing a Human-Centered OR
• • 2.1.4.1 Systems Engineering Approach
• • 2.1.4.2 Evidence-Based OR Design Prototype
• • 2.1.5 Actions for Designers, Researchers, and Health Systems
• • 2.1.6 Future Trends

Chapter 2.2: Harm Reduction by Design: Optimizing Patient Rooms to Reduce Infection

• • 2.2.1 Introduction
• • 2.2.2 Background
• • 2.2.2.1 Contact Pathogen Considerations
• • 2.2.2.2 Waterborne Pathogen Considerations
• • 2.2.2.3 Airborne Pathogen Considerations
• • 2.2.2.4 General Infection Prevention Considerations
• • 2.2.3 Design Attributes that Support Infection Prevention
• • 2.2.3.1 Reducing Contact Pathogen Exposure
• • 2.2.3.2 Reducing Waterborne Pathogen Exposure
• • 2.2.3.3 Reducing Airborne Pathogen Exposure
• • 2.2.3.4 Examples of Projects that Incorporate IPC-Minded Design
• • 2.2.4 Actions for Designers, Researchers, and Health Systems
• • 2.2.4.1 Designers
• • 2.2.4.2 Researchers
• • 2.2.4.3 Healthcare Systems
• • 2.2.5 Future Trends
• • 2.2.6 Conclusions

Chapter 2.3: Architecture Can Keep Healthcare Workers Safe: Doffing Area Design to Improve Safety and Workflow in Caring for Patients with Serious Communicable Diseases

• • 2.3.1 Introduction
• • 2.3.2 The Environmental Context of PPE Doffing Risks
• • 2.3.3 Types and Layouts of PPE Doffing Spaces
• • 2.3.4 Design Strategies for Safe PPE Doffing
• • 2.3.4.1 Location, Size, and Configuration of PPE Doffing Area
• • 2.3.4.2 Environmental Cues and Doffing Area Design
• • 2.3.4.3 Design of Patient Room Doors, Windows, and Adjacent Areas
• • 2.3.4.4 Location and Design of PPE Disposal and PPE Supply
• • 2.3.5 Actions for Designers, Researchers, and Health Systems
• • 2.3.6 Future Trends
• • 2.3.6.1 Human-Centered Design and Focusing on Patient’s Experience During Isolation
• • 2.3.6.2 Staff Health and Wellness During a Pandemic
• • 2.3.6.3 Integration of Technology to Support Patient Experience and Staff Safety
• • 2.3.6.4 Increased Focus on Sustainable Solutions for Use of PPE
• • 2.3.7 Conclusions

Chapter 2.4: Improving Primary Care Teamwork and Communication by Team-Based Clinic Design

• • 2.4.1 Introduction
• • 2.4.2 Physical Space and Teamwork
• • 2.4.3 Clinic Design Attributes that Improve Teamwork
• • 2.4.3.1 Colocation of Staff Members and Especially Staff Visual Connections Predict Higher Teamwork Perceptions
• • 2.4.3.2 Workstation Proximity Predicted More Frequent Observed Communication
• • 2.4.3.3 Visual Connections Between Spaces, Team Room and Exam Rooms, Enable Flexible Use of Spaces with Awareness of the Spaces
• • 2.4.4 Actions for Designers, Researchers, and Health Systems
• • 2.4.5 Future Trends

Chapter 3.1: Environmental Design to Enhance Well-Being and Experience for Healthcare Workers

• • 3.1.1 Introduction
• • 3.1.2 Supporting Staff Well-Being Through Environmental Design – A Review of the Literature
• • 3.1.2.1 Resilience
• • 3.1.2.2 Safety
• • 3.1.2.3 Teamwork
• • 3.1.2.4 Autonomy
• • 3.1.3 Actions for Designers, Researchers and Health Systems
• • 3.1.4 Future Trends
• • 3.1.5 Conclusion

Chapter 3.2: Experience Design for the Immersed Moving Visitor: Introducing “Diachronic Experiences” and Layout as Critical Research and Design Considerations

• • 3.2.1 Introduction
• • 3.2.2 Experience Design for the Immersed Moving Observer
• • 3.2.2.1 Types of Experiences
• • 3.2.3 Background Concepts and Theories Regarding Experience of the Moving Observer
• • 3.2.3.1 Theories of Experience
• • 3.2.3.2 Layout and its Analysis
• • 3.2.4 Evidence from Literature
• • 3.2.4.1 “Closeness” and Cognition
• • 3.2.5 Actions for Designers, Researchers, and Health Systems
• • 3.2.6 Future Trends

Chapter 3.3: Inpatient Room Design to Meet the Challenge of Patient Expectations

• • 3.3.1 Introduction – The Multiple Roles and Complexities of the Acute Inpatient Room
• • 3.3.2 Background – Influencers of Patient Satisfaction and Experience of Care
• • 3.3.3 Review of the Literature – Design Attributes that Improve Patient Satisfaction and Experience of Care
• • 3.3.3.1 Unit Configuration
• • 3.3.3.2 Room Handedness
• • 3.3.3.3 Bathroom Design
• • 3.3.3.4 Windows
• • 3.3.3.5 Family Zones
• • 3.3.4 Actions for Designers, Researchers, and Health Systems
• • 3.3.5 Future Trends
• • 3.3.6 Conclusion

Chapter 3.4: A Light Touch: How to Use Light to Improve Patient Experience

• • 3.4.1 Introduction
• • 3.4.2 History of Hospital Lighting Design
• • 3.4.3 Health Outcomes and Other Nonvisual Impacts of Light
• • 3.4.3.1 Sleep
• • 3.4.3.2 Alertness and Cognition
• • 3.4.3.3 Mood and Depression
• • 3.4.4 Actions for Designers, Researchers, and Health Systems
• • 3.4.4.1 Guidelines for the Design Phase
• • 3.4.4.2 Guidelines for Everyday Practice
• • 3.4.5 Best Practice Example: The University of Kentucky Children’s Hospital
• • 3.4.6 Future Trends
• • 3.4.6.1 Better Quality Light
• • 3.4.6.2 Better Controls
• • 3.4.6.3 Better Metrics
• • 3.4.7 Conclusion

Chapter 3.5: Shhhh. I am Trying to Heal: Designing Healthy Soundscapes to Support Patients and Staff

• • 3.5.1 Introduction
• • 3.5.2 Unique Challenges of Healthcare Soundscapes
• • 3.5.3 Impacts of Healthcare Soundscapes
• • 3.5.3.1 Potential Impacts on Patients
• • 3.5.3.2 Potential Impacts on Staff
• • 3.5.3.3 Overarching Impacts
• • 3.5.4 Actions for Designers, Researchers, and Health Systems
• • 3.5.5 Future Trends: Positive and Holistic Approaches to Soundscape Design Team Collaborations
• • 3.5.6 Conclusion

Chapter 4.1: Using Design to Empower People Facing Cognitive Decline in the Community and Healthcare Facilities

• • 4.1.1 Introduction
• • 4.1.2 Background
• • 4.1.2.1 Environmental Needs for Aging in Place and Social Activities
• • 4.1.2.2 Environmental Needs for Dementia Care
• • 4.1.3 CAIP: An Exploratory Agenda to Improve Home for Progressive Cognitive Decline
• • 4.1.3.1 CAIP: Research Focus and Framework
• • 4.1.3.2 CAIP: Methods and Key Findings
• • 4.1.4 A Living Laboratory for the CEP
• • 4.1.4.1 Cognitive Empowerment Program
• • 4.1.4.2 Purpose, Design Process, and Principles of the Cognitive Empowerment Center
• • 4.1.4.3 Design and Current Use of the CEC
• • 4.1.5 Experience Room – Case Example from Mayo Clinic
• • 4.1.6 Actions for Designers, Researchers, and Health Systems
• • 4.1.7 Future Trends
• • 4.1.8 Conclusion

Chapter 4.2: Evidence-Based Innovative Rural Hospital Design

• • 4.2.1 Introduction
• • 4.2.2 Background
• • 4.2.2.1 Rural-Urban Health Disparities
• • 4.2.2.2 Historical Development of CAHs
• • 4.2.2.3 Rural Hospital Closures
• • 4.2.2.4 Innovative Rural Healthcare Delivery Models and Facility Design
• • 4.2.2.5 Strengthen the Community Tie: Provide and Collaborate on the Community Focus that Provides Services Outside The Hospital Setting
• • 4.2.2.6 Alternative Emergency and Ambulatory Care-Based Rural Health Delivery Systems
• • 4.2.2.7 Focus on Addressing the Root Cause of Community Health Issues in Rural Communities and Providing a Continuum of Care
• • 4.2.3 CAH Postoccupancy Research Case Study
• • 4.2.3.1 Research Methods
• • 4.2.3.2 Standardized Patient Room POE
• • 4.2.3.3 Medical Workflow and Departmental Adjacencies
• • 4.2.3.4 Financial and Patient Performance
• • 4.2.3.5 Rural Hospital Design Prototype: Reviving Main Street
• • 4.2.4 Actions for Designers, Researchers, and Health Systems
• • 4.2.5 Future Trends
• • 4.2.5.1 Community-Based Integrated Care
• • 4.2.5.2 Expand Telemedicine and Electronic Medical Records in Rural Communities
• • 4.2.5.3 Shift Focus to Outpatient Care and Alternative Models of Care
• • 4.2.5.4 Address Root Conditions for Improving Community Health
• • 4.2.6 Conclusions

Chapter 4.3: All In: Clinic Design for Connected Care and Communication

• • 4.3.1 Introduction
• • 4.3.2 Background
• • 4.3.3 Design Considerations for Hybrid Care
• • 4.3.3.1 Spaces for Telehealth
• • 4.3.3.2 Flexibility of Spaces for Different Modes of Care
• • 4.3.3.3 Awareness for Both On- and Off-Site Staff Members
• • 4.3.3.4 On-Stage Physical and Virtual Spaces
• • 4.3.3.5 Patient Support Areas
• • 4.3.4 Actions for Designers, Researchers, and Health Systems
• • 4.3.5 Future Trends