Patient Rooms

Design Considerations for Aging Populations

March 4, 2013     Jaynelle F. Stichler, DNSc, RN, EDAC, NEA-BC, FACHE, FAAN
Sustainable Design

Corporate Sustainability: The Environmental Design and Human Resource Management Interface in Healthcare Settings

March 4, 2013     Hessam Sadatsafavi, MA and John Walewski, PhD

Abstract

Purpose of the Paper: The purpose of this study is to provide healthcare organizations with a new perspective for developing strategies to enrich their human resource capabilities and improve their performance outcomes. The focus of this study is on leveraging the synergy between organizational management strategies and environmental design interventions.

Background: This paper proposes a framework for linking the built environment with the human resource management system of healthcare organizations. The framework focuses on the impact of the built environment regarding job attitudes and behaviors of healthcare workers. Research from the disciplines of strategic human resource management, resource-based view of firms, evidence-based design, and green building are utilized to develop the framework.

Theoretical Framework: The positive influence of human resource practices on job attitudes and behaviors of employees is one mechanism to improve organizational performance outcomes. Organizational psychologists suggest that human resource practices are effective because they convey that the organization values employee contributions and cares about their well-being. Attention to employee socio-emotional needs can be reciprocated with higher levels of motivation and commitment toward the organization. In line with these findings, healthcare environmental studies imply that physical settings and features can have a positive influence on job attitudes and the behavior of caregivers by providing for their physical and socio-emotional needs.

Conclusions: Adding the physical environment as a complementary resource to the array of human resource practices creates synergy in improving caregivers' job attitudes and behaviors and enhances the human capital of healthcare firms.

Keywords: Staff, evidence-based design, interdisciplinary, modeling, perceived organizational support

Preferred Citation: Sadatsafavi, H., & Walewski, J. (2013). Corporate sustainability: The environmental design and human resource management interface in healthcare settings. Health Environments Research & Design Journal 6(2), pp 98-118.

Safety

Facility Design to Reduce Hospital-Acquired Infection

March 4, 2013     D. Kirk Hamilton, FAIA, FACHA, EDAC
Evidence-Based Design

Can Better Outdoor Environments Lead to Cost Benefits in Assisted Living Facilities Through Increased Word-of-Mouth Referrals?

March 4, 2013     Susan Rodiek, PhD; May M. Boggess, PhD; Chanam Lee, PhD; Geoffrey J. Booth, MPub Admin; and Alisan Morris, MSLD

Abstract

Objective: This study explores how better outdoor environments may produce cost benefits for assisted living providers by raising occupancy levels through increased resident satisfaction and word-of-mouth referrals.

Background: Older adults who spend even minimal time outdoors may reap substantial health benefits. However, many existing outdoor areas in assisted living facilities are reportedly underutilized, in part because of design issues. Providers may be more willing to improve outdoor areas if they produce cost benefits for provider organizations.

Methods: This study used data from a recent assisted living survey to assess the relationship between satisfaction with outdoor spaces, time spent outdoors, and resulting improvements in mood. A financial analysis was developed to estimate potential benefits from improved outdoor areas attributable to increased occupancy and decreased marketing costs associated with increased word-of-mouth referrals.

Results: Increasing resident satisfaction with outdoor areas (from approximately 29% to 96%) results in residents spending more time outdoors (increase of 1½ hours per week per resident) and improved psychological well-being (12% increase in feeling better). This greater overall satisfaction leads to 8% more residents willing to refer potential residents to their community. Because word-of-mouth referrals by current residents are a major factor in resident recruitment, improving outdoors areas leads to an estimated 4% increase in new residents, resulting in over $170,000 of increased revenue per year for a community of 100 residents.

Conclusions: Improved outdoor space can provide substantial cost benefits for assisted living providers. Increasing resident well-being and satisfaction, and thereby generating additional word-of-mouth referrals, can result in higher occupancy levels.

Keywords: Outdoor environments, assisted living, cost benefits, resident satisfaction, occupancy levels, seniors, rental income, word-of-mouth referral

Preferred Citation: Rodiek, S., Boggess, M. M., Lee, C., Booth, G. J., & Morris, A. (2013). Can better outdoor environments lead to cost benefits in assisted living facilities through increased word-of-mouth referrals? Health Environments Research & Design Journal 6(2), pp. 12-26.

Evidence-Based Design

How to Rate the Quality of a Research Paper: Introducing a Helpful Algorithm for Architects and Designers

March 4, 2013     Gesine Marquardt, PhD and Tom Motzek, MSc

Keywords: Decision-making, evidence-based design, methodology

Team Work Areas

Moderating Role of Interior Amenities on Hospital Medical Directors' Patient-Related Work Stresses

March 4, 2013     Blossom Yen-Ju Lin, PhD; Yung-Kai Lin, MD, EMBA; Chi Wen Juan, MD; Suhsing Lee, PhD; and Cheng-Chieh Lin, MD, PhD

Abstract

Objective: Considering hospital medical directors' work stress, this study aims to examine how interior amenities might moderate the effect of work stress on their health.

Background: Previous studies have revealed that hospital medical directors-senior physicians in the management positions with high-demand jobs in clinical practices and management-had a lower self-rated health.

Methods: This was a cross-sectional survey study and 737 hospital medical directors in Taiwan were included. A developed and structured questionnaire covered the dimensions of patient-related work stress (i.e., physician-patient relationship stress and patient condition stress), hospital interior amenities (i.e., indoor plants, aquarium, music, art and exhibitions, and private or personalized spaces that are common or surround the workplace of healthcare professionals), and self-rated health status and health complaints. Hierarchical regressions were performed.

Results: Hospital medical directors' physician-patient relationship stresses were found to have more negative effects on their self-reported health status and complaints than do their patient condition stresses; however, only indoor plants were found to have moderating effects on their short-term health complaints (p < 0.05). On the other hand, the hospital medical directors' patient condition stresses were negatively related to their short-term health complaints; however, music, art and exhibitions, and private or personalized spaces in the workplaces had moderating effects (p < 0.05).

Conclusions: Considering the unavoidable patient-related work stresses imposed on hospital medical directors, some proposed interior amenities can produce buffering effects on work stress to some extent. Future studies could focus on finding alternatives to relieve hospital medical directors' physician-patient relationship work stresses.

Keywords: Evidence-based design, physicians, privacy and security, satisfaction, work environment

Preferred Citation: Lin, B. Y.-J., Lin, Y.-K., Juan, C.W., Lee, S., Lin, C.-C. (2013). Moderating role of interior amenities on hospital medical directors' patient-related work stresses. Health Environments Research & Design Journal 6(2), pp 77-92.

Evidence-Based Design

An Investigation of Noncompliant Toilet Room Designs for Assisted Toileting

March 4, 2013     Jon Sanford, MArch and Sheila J. Bosch, PhD

Abstract

Objective: By comparing an Americans with Disabilities Act Accessibility Guidelines (ADAAG) compliant design with alternative designs, this pilot study resulted in recommendations for designing patient bathrooms to facilitate assisted toileting.

Background: The ADA Accessibility Guidelines were developed primarily to address the needs of disabled populations, such as returning Vietnam veterans, with sufficient upper body strength to transfer independently directly from a wheelchair to the toilet. However, the majority of older persons with disabilities (90%) stand to transfer to the toilet, rather than laterally moving from the wheelchair to the toilet.

Methods: The research used a repeated measures research design to evaluate caregiver responses during assisted toileting for various toilet configurations. The study included 20 patients who were transferred onto and off of a toilet for each of four different configurations by one or two caregivers. Toileting trials were videotaped and analyzed by an occupational therapist. Additionally, caregivers completed five-question, self-report surveys after each toileting trial.

Results: Survey data indicate that staff members prefer the largest of the tested configurations, where the centerline of the toilet is 30 inches from the sidewall, rather than the 18 inches required by the ADAAG, and where there are two fold-down grab bars provided. Caregivers perceived the grab bar locations as better for helping them safely transfer subjects in a modified (non-ADAAG) configuration, and also that the grab bar style in a modified configuration (non-ADAAG) improved safety when transferring subjects.

Conclusions: Although caregivers were observed to safely transfer residents to and from the toilet for all configurations tested, regulations regarding accessibility of patient bathrooms should acknowledge the perceived benefits of increasing the distance from the sidewall to the centerline of the toilet to as much as 30 inches and allowing two fold-down grab bars instead of the required sidewall and back-wall grab bars.

Keywords: ADA, toilet room design, healthcare design, evidence-based design, human factors, safety, staff

Preferred Citation: Sanford, J., & Bosch, S. (2013). An investigation of noncompliant toilet room designs for assisted toileting. Health Environments Research & Design Journal 6(2), pp 43-57.

Evidence-Based Design

Process Simulation During the Design Process Makes the Difference: Process Simulations Applied to a Traditional Design

March 4, 2013     Roberto Traversari, BSc, MBA; Rien Goedhart, MSc; and Jan Maarten Schraagen, PhD

Abstract

Objective: The objective is evaluation of a traditionally designed operating room using simulation of various surgical workflows.

Background: A literature search showed that there is no evidence for an optimal operating room layout regarding the position and size of an ultraclean ventilation (UCV) canopy with a separate preparation room for laying out instruments and in which patients are induced in the operating room itself. Neither was literature found reporting on process simulation being used for this application. Many technical guidelines and designs have mainly evolved over time, and there is no evidence on whether the proposed measures are also effective for the optimization of the layout for workflows.

Methods: The study was conducted by applying observational techniques to simulated typical surgical procedures. Process simulations which included complete surgical teams and equipment required for the intervention were carried out for four typical interventions. Four observers used a form to record conflicts with the clean area boundaries and the height of the supply bridge. Preferences for particular layouts were discussed with the surgical team after each simulated procedure.

Results: We established that a clean area measuring 3 x 3 m and a supply bridge height of 2.05 m was satisfactory for most situations, provided a movable operation table is used. The only cases in which conflicts with the supply bridge were observed were during the use of a surgical robot (Da Vinci) and a surgical microscope. During multiple trauma interventions, bottlenecks regarding the dimensions of the clean area will probably arise.

Conclusions: The process simulation of four typical interventions has led to significantly different operating room layouts than were arrived at through the traditional design process.

Keywords: Evidence-based design, human factors, work environment, operating room, traditional design, process simulation, surgical workflows

Preferred Citation: Traversari, R., Goedhart, R., & Schraagen, J. M. (2013). Process simulation during the design process makes the difference: Process simulations applied to a traditional design. Health Environments Research & Design Journal 6(2), pp 58-76.

Evaluations

The Effect of Garden Designs on Mood and Heart Output in Older Adults Residing in an Assisted Living Facility

March 4, 2013     Seiko Goto, PhD; Bum-Jin Park, PhD; Yuko Tsunetsugu, PhD; Karl Herrup, PhD; and Yoshifumi Miyazaki, PhD

Abstract

Objective: The objective of this study is to trace short-term changes in mood and heart function in elderly individuals in response to exposure to different landscaped spaces.

Background: Nineteen elderly but cognitively intact residents of an assisted living facility participated in the study. They were exposed to three landscaped spaces: a Japanese style garden, an herb garden, and a simple landscaped area planted with a single tree.

Methods: To assess the effect of different landscaped spaces on older adults, individuals were monitored for mood and cardiac function in response to short exposures to spaces. Mood state was assessed using Profile of Mood States (POMS) before and after viewing the spaces. Cardiac output was assessed using a portable electrocardiograph monitor before and during the viewing.

Results: We found that the structured gardens evoked greater responses in all outcome measures. Scores on the POMS improved after observation of the two organized gardens compared to responses to the simple landscaped space with a single tree. During the observation period, heart rate was significantly lower in the Japanese garden than in the other environments, and sympathetic function was significantly lower as well.

Conclusions: We conclude that exposure to organized gardens can affect both the mood and cardiac physiology of elderly individuals. Our data further suggest that these effects can differ depending on the types of landscape to which an individual is exposed.

Keywords: Elderly, Japanese garden, herb garden, heart rate, mood, healing environment

Preferred Citation: Goto, S., Park, B-J., Tsunetsugu, Y., Herrup, K., & Miyazaki, Y. (2013). The effect of garden designs on mood and heart output in older adults residing in an assisted living facility. Health Environments Research & Design Journal 6(2), pp 27-42.

Evidence-Based Design

Lean-Led Hospital Design: Creating the Efficient Hospital of the Future

March 4, 2013     Ron Smith, AIA, ACHA, EDAC
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