Factors Impeding Flexible Inpatient Unit Design

December 5, 2012


Objective: To identify and examine factors extraneous to the design decision-making process that could impede the optimization of flexibility on inpatient units.

Background: A 2006 empirical study to identify domains of design decisions that affect flexibility on inpatient units found some indication in the context of the acuity-adaptable operational model that factors extraneous to the design process could have negatively influenced the successful implementation of the model. This raised questions regarding extraneous factors that might influence the successful optimization of flexibility.

Method: An exploratory, qualitative method was adopted to examine the question. Stakeholders from five recently built acute care inpatient units participated in the study, which involved three types of data collection: (1) verbal protocol data from a gaming session; (2) in-depth semi-structured interviews; and (3) shadowing frontline personnel. Data collection was conducted between June 2009 and November 2010.

Results: The study revealed at least nine factors extraneous to the design process that have the potential to hinder the optimization of flexibility in four domains: (1) systemic; (2) cultural; (3) human; and (4) financial.

Conclusions: Flexibility is critical to hospital operations in the new healthcare climate, where cost reduction constitutes a vital target. From this perspective, flexibility and efficiency strategies can be influenced by (1) return on investment, (2) communication, (3) culture change, and (4) problem definition. Extraneous factors identified in this study could also affect flexibility in other care settings; therefore, these findings may be viewed from the overall context of hospital design.

Key Words: Healthcare design, flexibility, evidence-based design

Preferred Citation: Pati, D., Evans, J., Harvey, Jr., T. E., & Bazuin, D. (2012). Extraneous factors impeding flexible inpatient unit design. Health Environments Research & Design Journal, 6(1), 83-104.

Flexibility, traditionally considered an important attribute of healthcare design, will become even more crucial to the financial viability of healthcare organizations in the future because the central focus of future healthcare in the United States will be cost curtailment (The Advisory Board Company, 2011). Because the dialogue on cost reduction is occurring within the broader framework of the continuum of care, the emphasis on reducing the cost of providing care in acute care settings will accelerate.

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