hcd_2007_flexibility study
TRANSCRIPT
Defining the Design Characteristics of a
S f l Ad t blSuccessful AdaptableInpatient Unit
Debajyoti Pati, PhD, AIIATom E. Harvey Jr., AIA, MPH, FACHA
Acknowledgements/Credits
• AIA 2006 Research Grant• Herman Miller• Dr Carolyn Cason, UT Arlington School of Nursing• Parker Adventist Hospital Parker CO• Parker Adventist Hospital, Parker, CO• Clarian West Medical Center, Avon, IN• Laredo Medical Center, Laredo, TXLaredo Medical Center, Laredo, TX• McKay-Dee Hospital Center, Ogden, UT• Bon Secours St. Francis Hospital,Charleston, SC• St. Rose Dominican Hospital – Siena, Henderson,
NV
Learning objectives
• Understand the role of flexibility in promoting ffi i i ti tefficiency in patient care.
• Understand what ‘flexibility’ means from various stakeholders’ perspective on inpatient units.p p p
• Understand characteristics of the physical environment that impede or facilitate flexibility.
• Obt i d d t di f i ti t it• Obtain a deeper understanding of inpatient unitoperations, coordination between caregivers, and implications of such factors on the physical design.
Content
• Flexibility background• Information gap• Framework• Question• Question• Method• Flexibility meaningFlexibility meaning• Flexibility to Adapt• Flexibility to Convert• Flexibility to Expand• Conclusions
Flexibility background
• The architectural perspective:– Workplace and retail sectors: shearing layers
• Shell, services, scenery, set• Site, structure, skin, services, space plan, stuff
– Healthcare sector: systems• Open building paradigm
– Primary, secondary, tertiary • Spine concept
Information gap
• Hospital level flexibility concepts
• Very little information at inpatient unit level:Universal rooms– Universal rooms
– Distributed caregiver workstations
• Importance:– Changing demographics– Changing labor marker
Change unit operational model
g g– Changing technology– High volume investment on bed units
Question
• What does flexibility mean to different stakeholders?
• What physical design variables influence stakeholders’ flexibility?
• What designs elements promote or hinder flexibility?flexibility?
Framework
• Flexibility to adapt: accommodate change without change in environmentchange in environment
• Flexibility to convert: accommodate change after simple/inexpensive physical alteration
• Flexibility to expand: expand over time• Flexibility to expand: expand over time
Method
• SETTING– Six hospitals– Medical-surgical units
• SAMPLING– Purposive
M i i i bilit– Maximize variability
• DESIGNDESIGN– Exploratory– Qualitative
Method
• PARTICIPANTS– Nursing, RT, Materials
Management, EVS, Pharmacy, Dietary
• TOOLS– Semi-structuredSemi structured
interviews– Plan of inquiry– Content analysisContent analysis
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Parker Adventist Hospital
2004 100 36 Irregular Racetrack Primary 1:5 YesHospitalParker COClarian West Medical CenterAvon IN
2005 76 32 Square Racetrack Primary 1:4 Yes
Laredo Medical 1998 325 36 Pinwheel Racetrack Functional/ 1:8 NoCenterLaredo TX
Modular
McKay-Dee Hospital CenterOgden UT
2002 317 28 Triangle/ Rectangle
Racetrack Functional 1:5 No
Bon Secours St 1997 141 40 Square Radial Modified/ 1:5 NoBon Secours St.Francis HospitalCharleston SC
1997 141 40 Square Radial Modified/Modular
1:5 No
St Rose Dominican Hospital-SienaH d NV
1999 214 34 Other T-Shape Functional 1:6 Yes
Henderson NV
Parker AdventistFIGURE LEGENDM MedicationE EquipmentC Clean Supply/ UtilityS Soiled Supply/ UtilityS Soiled Supply/ UtilityN Nursing Station
Construction Completion 2004Total Bed 100SqFt per Bed 607Unit Size 36Unit Shape Irregular
Circulation Racetrack
Nursing Model Primary
Nurse:Patient Ratio 1:5U i l R YUniversal Room Yes
Clarian WestFIGURE LEGENDM MedicationE EquipmentC Clean Supply/ UtilityS Soiled Supply/ UtilityS Soiled Supply/ UtilityN Nursing Station
Construction Completion 2005Total Bed 76SqFt per Bed 700Unit Size 32Unit Shape Square
Circulation Racetrack
Nursing Model Primary
Nurse:Patient Ratio 1:4Universal Room Yes
Laredo Medical CenterFIGURE LEGENDM MedicationE EquipmentC Clean Supply/ UtilityS Soiled Supply/ UtilityS Soiled Supply/ UtilityN Nursing Station
Construction Completion 1998Total Bed 325SqFt per Bed 528Unit Size 36Unit Size 36Unit Shape Pinwheel
Circulation Racetrack
Nursing Model Functional/Modular
Nurse:Patient Ratio 1:8Universal Room No
McKay DeeFIGURE LEGENDM MedicationE EquipmentC Clean Supply/ UtilityS Soiled Supply/ UtilityS Soiled Supply/ UtilityN Nursing Station
Construction Completion 2002Total Bed 317SqFt per Bed 673Unit Size 28Unit Shape Triangle/
Rectangle
Circulation Racetrack
Nursing Model Functional
Nurse:Patient Ratio 1:5Universal Room No
St Francis HospitalFIGURE LEGENDM MedicationE EquipmentC Clean Supply/ UtilityS Soiled Supply/ UtilityS Soiled Supply/ UtilityN Nursing Station
Construction Completion 1997Total Bed 141SqFt per Bed 520Unit Size 40Unit Shape SquareUnit Shape Square
Circulation Radial
Nursing Model Modified/ Modular
Nurse:Patient Ratio 1:5Universal Room No
St Rose Dominican-SienaFIGURE LEGENDM MedicationE EquipmentC Clean Supply/ UtilityS Soiled Supply/ UtilityS Soiled Supply/ UtilityN Nursing Station
Construction Completion 1999Total Bed 214SqFt per Bed 541Unit Size 34Unit Shape OtherUnit Shape Other
Circulation T-Shape
Nursing Model Functional
Nurse:Patient Ratio 1:6Universal Room Yes
Flexibility meaning
• Management– Ability to manipulate higher-level resources (staffing,
teaming) to address unique circumstances and uncertainties
• Direct caregiver– Ability to multi-task and multi-skill to optimize patient care,
maximize efficiency and address unique situations
• Non-nursing personnelo u s g pe so e– Ability to manipulate resources to effectively address
nursing management and direct care giver needs
Peer lines-of-sight
• Operational issue • Implications– Helping hand,
mentoring, socialization, de-stressing
Aff t
– Simple shape units– Corner location of
caregiver workstation in t• Affects
– Nurse, respiratory therapist
support core– Back-stage corridors
linking caregiver workstations• Environmental
correlates– Caregiver work station,
workstations– Simple circulation
configurationg ,
corridor shape, corridor configuration
Patient visibility
• Operational issue • Implications– Higher acuity, JCAHO
regulations, non-contiguous patients
Aff t
– Multiple caregiver work centers with proximal patient roomsU b t t d i htli• Affects
– Nurse, nursing administration,
i t th i t
– Unobstructed sightlineto patient rooms
– Outboard toilet locationrespiratory therapist
• Environmentalcorrelates– Caregiver workstation,
medication room, utility room
Multiple division/zoning option
• Operational issue • Implications– Perceived barriers– Assignment problems
• Affects
– Stairwell and support spaces located at end of an array of patient rooms or inside theAffects
– Nurse, nursing administration,
• Environmental
rooms, or inside thesupport core
– Simple circulation configurationEnvironmental
correlates– Stairwell, support
spaces staff toilets
g
spaces, staff toilets
Proximity of support
• Operational issue • Implications– Walking distance– Stress, fatigue
• Affects
– Simple shape, symmetrical units
– Distributed nursing tAffects
– Nurse, nursing administration,environmental services,
support spaces proximate to distributed caregiver workstations
– Decentralized room-dietary services, materials management, respiratory therapy
E i t l
– Decentralized room-side supply cabinets
• Environmentalcorrelates– Patient room, support
spaces
Resilience to move services
• Operational issue • Implications– Long term census
fluctuation• Affects
– Standardized room– Standardized support
core– Nurse, nursing
administration• EnvironmentalEnvironmental
correlates– Standardization
Inter-unit movements
• Operational issue • Implications– Multi-unit caregiver
responsibility• Affects
– Communicating stair inside unit
– Proximal location of ti l i l ti– Nurse, environmental
services, dietary services, materials
t
vertical circulation core– Back corridor inter-unit
linkU b t t d h i t lmanagement,
pharmacy, respiratory therapy
• Environmental
– Unobstructed horizontalcirculation
• Environmentalcorrelates– Vertical circulation core,
unit proximity horizontalunit proximity, horizontalaccess
Service expansion options
• Operational issue • Implications– Census fluctuations– Unit-service misfit
• Affects
– Visual or geographic cues to help unit subdivisionsB k id li kAffects
– Nurse, nursing administration
• Environmental
– Back corridor linksbetween adjacent units
Environmentalcorrelates– Unit size, unit
configuration unitconfiguration, unitadjacency
Service expansion optionsC
SOFT SPACE FOR SUPPORT CORESUPPORT CORE
EXPANSION/ SHARING
NNSERVICE SPREAD
INTO ADJOINING UNIT
N
Adjustable support core
• Operational issue • Environmentall t– Supply and equipment
storage– Shape and size of
correlates– Cabinetry, support room
shape, support room si erooms
• Affects– Nurse, nursing
size• Implications
– Modular, movable administration,environmental services, dietary services, materials management
compartments or cart system for storage
– Minimize walls with MEP elementsmaterials management,
pharmacy, respiratory therapy
MEP elements
Expandable support core
• Operational issue • Environmentall t– Operational changes
over time• Affects
correlates– Adjacent functions
• Implications– Nurse, nursing
administration,environmental services, di t i
p– Soft program adjacent
spaces
dietary services,materials management,pharmacy, respiratory therapypy
Brief bibliography
Chefurka, T., Nesdoly, F. and Christie, J. , 2006, “Concepts in Flexibility in Healthcare Facility Planning, Design, and Construction”. The AcademyHealthcare Facility Planning, Design, and Construction . The AcademyJournal Online, http://www.aia.org/aah/journal, pp. 34-43.
Hamilton, K. 2000 - Design for Flexibility in Critical Care. Proceedings of ICU 2010, Center for Health Systems and Design, Texas A&M University, April.
Hendrich A Fay J Sorrels A K 2004 Effects of Acuity-Adaptable Rooms onHendrich, A., Fay, J., Sorrels, A.K., 2004. Effects of Acuity Adaptable Rooms onFlow of Patients and Delivery of Care. American Journal of Critical Care, Vol. 13 /1, pp.35-45.
Kendall, S. H., 2004, Open Building: A New Paradigm in Hospital Architecture. AIA Academy Journal, 7th Edition, pp.22-27.y , , pp
Ulrich, R., Zimring, C., Quan, X., and Joseph, A., 2004, “The Role of the Physical Environment in the Hospital of the 21st Century: A Once-in-a-Lifetime Opportunity”. The Center for Health Design, http://www.healthdesign.org/ research/reports/pdfs/role _physical_env.pdf
Varawalla, H. 2004, “Designing for Flexibility Building in order and direction for growth and change”. Express Healthcare Management , August 15-30, 2006, http://www.expresshealthcaremgmt.com/ 20040831/architecture01.shtml
Contact information
Debajyoti Pati, PhD, AIIADirector of Research, HKS Architects,
Tom E Harvey Jr, AIA, FACHA, MPHPrincipal, HKS Architects,
1919 McKinney Avenue, Dallas, TX, [email protected]
1919 McKinney Avenue, Dallas, TX,[email protected]