Kate OkrasinskiChristine Dedding, PhD - VU Supervisor

Tjard de Cock Bruning, PhD - Academic Supervisor Dorien Tange, MSc - Daily Supervisor Mattie Schinkel, MSc - Onsite Manager

Understanding Healthcare Design Needs of the

Inpatient Rehabilitation Environment

Final Internship Presentation 22 September 2014

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Agenda: Context and Background

Literature Review Internship Research

Welcome!

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Healthcare Design Research

Patient Centered Care Evidence Based Designautonomy - dignity - privacy

patient is the priority, not provider convenience

clinical need - administrative constraints

design decisions based on credible scientific information to achieve desired outcomes

Qualitative Quantitative

The academic setting.....

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Inpatient Rehabilitation

Inpatient Hospital Setting (5-7 days)

Nursing Home Setting (end of life)

The research niche...

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Inpatient Rehabilitation

Inpatient Hospital Setting (5-7 days)

Nursing Home Setting (end of life)

The research niche...

Nature of the Care Providedclinically stable

longer average stay intensive daily therapies

“recovering in a new sense of self and of purpose within and beyond the limits of disability" (Deegan, 1988 p. 54).

Goals and Aims of the Care Provideddischarge home

return to meaningful roles and activities

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Cerebral Vascular Attack

Paraplegia C1-C8, T1-T6

Amputation Foot/Knee

Other Neuro. Disorders

Neuromuscular Disorders

35 patients96 days

213 patients84 days

49 patients 102 days

30 patients26 days

30 patients99 days

35% Women 69% Men

ages: 18-83 (avg. 55)

478 patients in 2013

Number of Beds Per Cluster 2013 Patient Demographics

Spinal CordInjury A

mp

utat

ion

Neurological Patients

Additional

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38

58

6

Overtoom, 2013

Anticipated with Relocation in 2017 112 Inpatient beds

The research setting...

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Literature Review Understanding Health, Healing and Safety of Inpatient

Facilities to Improve Inpatient Rehabilitation

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Health Safety

Healing

physical or physiological processes of recovery

psychological, and spiritual process processes of recovery

protected from, or is unlikely to experience danger, risk or injury

What are the design strategies of the inpatient hospital ward enrich the patient experience and facilitate a healthy, safe and healing environment for adults and

youth in the inpatient rehabilitation care setting?

Literature Review Research Question:

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Theoretical FrameworkThe Center for Health Design Evaluation Framework

Design Strategy

Environmental Characteristics Outcomes

Patient

Staff

Organizational

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Theoretical FrameworkThe Center for Health Design Evaluation Framework

Design Strategy

Environmental Characteristics Outcomes

Patient

Staff

Organizational

air quality contamination comfortglare

patient room layoutbathroom layoutstaff work space

morbidity/mortality fallssatisfaction stressstaff injuries work flow

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Health

SafetyHealing

Preliminary Results

improved sleepdecreased stress

wellbeing communication

engagementcomfort anxiety

medical errors hospital acquired infections

falls

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Health

SafetyHealing

Preliminary Results

improved sleepdecreased stress

wellbeing communication

engagementcomfort anxiety

medical errors hospital acquired infections

fallsEmpowerment

dignitysecuritychoiceidentity

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Health SafetyHealing Empowerment

Pat

ien

t R

oo

m

Ho

spit

al W

ard

Ho

spit

al

Limiting Noise and Managing Smells

Natural Lighting

Protected Spaces

Control Adequate Lighting

Spacial Variety Visual Connection to Staff

Materials, Layout and Management

Noise Reduction

Activity Spaces Connections to Nature

Way Finding

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Conclusions from the Literature Review

for the existing body of research.....

for Rehabilitation.....

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privacy is paramountauditory - olfactory - visual

(caution regarding isolation)

the importance of variety and opportunity

Conclusions from the Literature Review

for the existing body of research.....

for Rehabilitation.....

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+ application of conceptual framework+ geographic distribution

Limitations

- patient perspectives - inclusion of disabled

- degree of detail

Strengths

privacy is paramountauditory - olfactory - visual

(caution regarding isolation)

the importance of variety and opportunity

Conclusions from the Literature Review

for the existing body of research.....

for Rehabilitation.....

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Exploratory Qualitative

Call for Further Research

Patient CenteredCare

Participatory Research

Evidence Based Design

Academically rooted in....

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Exploratory Qualitative

Call for Further Research

Patient CenteredCare

Participatory Research

Evidence Based Design

Academically rooted in....

Research Setting....

Reade- Rehabilitation, Amsterdam the Netherlands

Appropriate Timing anticipated relocation and renovation by 2017

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Internship Research

The inpatient rehabilitation care environment: Understanding patient and provider priorities in the ward, and evaluating design strategies to address patient needs.

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Research Question

What do patients, families, healthcare providers and healthcare

designers identify as key needs and values within the design of an

inpatient rehabilitation ward, and which design strategies emerge from

the prioritization of these needs and values?

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Research Development Data Collection

Responsive Discourse

2014

Preliminary Interviews

Shadowing

Practice Interviews

Guidance Meeting

“My Ward Design” Interviews

Prioritization Value Identification

Analysis

Written Report Presentation

Interactive Presentation of Findings

LiteratureReview

february march april may june july august september

Internship Study Design and Timeline

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Methodology

Experiences Examples

Stories

“My Ward Design”

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Environment and Stress Framework by Rashid and Zimring, 2008

Theoretical Framework

Design Strategy

Environmental Characteristics Outcomes

Patient

Staff

Organizational

The Center for Health Design Evaluation Framework

Design Strategies

Proxemic Theory

Patient Characteristics Length of Stay

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Healthcare Staff

Patients

Accessory Staff

Peer Counselor Client Services

Spiritual Leaders

Spinal Cord Injury Neuromuscular Disease

Surgical Recovery Stroke

Physician Nurses

Therapists

Research Population

6 9 4

Clinical Observations

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Informal Interviews

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Formal Interviews

National Rehabilitation Hospital, Dublin, Ireland

Beatrixoord, Haren, The Netherlands

Additional Site Visits

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Data Collection

drawings

concept maps

prioritized value lists

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Initial Impressions

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Initial Impressions

Intimate

Personal

Social

Participants Definition of Proxemic Spaces

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Initial Impressions

Intimate

Personal

Social

Participants Definition of Proxemic Spaces

Nurses

Physicians Therapists

Patients

Families

intimate sp

ace

personal sp

ace

social space

Focus of Values by Proxemic Space and Participant Group

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The Needs and Values within Inpatient Rehabilitation

Findings

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Values and Design Strategies within Intimate Space

Security Acuity Appropriate Design

Lighting

Control Safety

Separate Areas

intimate

priva

te social

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Dignity

PrivacyRest

Autonomy

Intimacy

Access

Protected from Loneliness and Isolation

Support

Security

Like Home

Opportunity for Visitors

Accessible Design Active Rest

Enough Space Storage

Clean

FlexiblePersonalized

Values and Design Strategies within Personal Space

Single Patient Room Design

Shared Room Design

General Values within Personal Space

intimate

priva

te social

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Accessible

Inviting Participation

opportunities for connecting

Welcoming Normal

Variety

Informal Cozy

Connected to the World

Stimulate Social Interaction... Free from Interruption

Intimate Enough Space

...without Obligation

Values and Design Strategies within Social Space

Terraces

Adaptable Spaces

Cafe FamilyPlay Space

Library

Smoking Areas

Restaurant Gardens

intimate

priva

te social

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Integrating Needs and Values into Design Strategies for Inpatient Rehabilitation

Findings

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Drawing Conclusions

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Private Bathrooms

Enough Space Accessible

Inviting Participation

opportunities for connecting

Welcoming

Normal Variety Informal Cozy

Connected to the World

Free from Interruption

Intimate

Stimulate Social Interaction... ...without Obligation

Support

Homey

Opportunity for Visitors

Accessible Design

Active Rest

Enough Space

Protected from Loneliness and Isolation

Security

Storage

Clean

FlexiblePersonalized

Privacy

Dignity

Rest

Autonomy

Intimacy

Security Acuity Appropriate Design

Lighting Control

Safety

Separate Areas

Drawing Conclusions

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Private Bathrooms

Enough Space Accessible

Inviting Participation

opportunities for connecting

Welcoming

Normal Variety Informal Cozy

Connected to the World

Free from Interruption

Intimate

Stimulate Social Interaction... ...without Obligation

Support

Homey

Opportunity for Visitors

Accessible Design

Active Rest

Enough Space

Protected from Loneliness and Isolation

Security

Storage

Clean

FlexiblePersonalized

Privacy

Dignity

Rest

Autonomy

Intimacy

Security Acuity Appropriate Design

Lighting Control

Safety

Separate Areas

length of stay patient characteristics

Drawing Conclusions

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Private Bathrooms

Enough Space Accessible

Inviting Participation

opportunities for connecting

Welcoming

Normal Variety Informal Cozy

Connected to the World

Free from Interruption

Intimate

Stimulate Social Interaction... ...without Obligation

Support

Homey

Opportunity for Visitors

Accessible Design

Active Rest

Enough Space

Protected from Loneliness and Isolation

Security

Storage

Clean

FlexiblePersonalized

Privacy

Dignity

Rest

Autonomy

Intimacy

Security Acuity Appropriate Design

Lighting Control

Safety

Separate Areas

length of stay patient characteristics

Visible Progression Through Rehabilitation

A Balance between Privacy and Social Opportunity

The Importance of Spatial Variety

Drawing Conclusions

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Protected Privacy

Intimacy

Autonomy

Inviting Participation

Opportunity without Obligation

Autonomy/ Choice Privacy

Rest Frequency

Variety

A Balance between Privacy and Social Opportunity intimate

priva

te social

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Phase 1 Phase 2 Phase 3

discharge admission

Rest and Recovery Social Engagement Preparation for Discharge

Visible Progression Through Rehabilitation intimate

priva

te social

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The Importance of Spatial Variety

Family Play Area

Library Smoking Areas

Restaurant Terraces Garden

Lounge

Dinning Area TV/Game Room

Gymnasium

inpatient only areas public access areas

Activity Room Cafe

intimate

priva

te social

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Conclusions

Significance of Proxemics distinctdefinitions

values

Diversity of Experience throughout one person’s experience among different diagnoses groups

Importance of Design

emotional, physical and social impact of healthcare design on the rehabilitation

patient population

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Reade’s Future......

Explore the wealth of knowledge on hand further

Prioritize the patient experience and value systems

Utilize environmental psychology and design throughout the process

diversity of opinion and process

Build on this foundation

Seize the Opportunity to Innovate

not only as a reflection, but as a process

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Questions and Remarks

Sincere thanks to the following...Dorien, Elmer, Christine and Mattie and all the participants inside and outside

Reade for the support, enthusiasm and cooperation.

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