patient centered health care design

8/3/2019 Patient Centered Health Care Design

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B41Patient-CenteredHealth Care Design

www.HumanCenteredDesign.org

November 17, 2011Socially Sustainable Design

Build Boston


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The Boston Society of Architects/AIA is a Registered Provider with The

American Institute of Architects Continuing Education Systems. Credit

earned on completion of this program will be reported to CES Records for

AIA members. Certificates of Completion for non-AIA members are

available on request.

This program is registered with the AIA/CES for continuing professional

education. As such, it does not include content that may be deemed or

construed to be an approval or endorsement by the AIA of any material of

construction or any method or manner of handling, using, distributing, ordealing in any material or product. Questions related to specific

materials, methods, and services will be addressed at the conclusion of

this presentation.

Welcome


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This presentation is protected by US and International Copyright laws.

Reproduction, distribution, display and use of the presentation without

written permission of the speaker is prohibited.

Institute for Human Centered Design, 2011

Copyrighted Materials


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Institute for Human Centered Designan international, educational, non-profit organization

dedicated to enhancing the experiences of people of all ages and abilitiesthrough excellence in design.

www.humancentereddesign.org


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Design powerfully and profoundly

influences us and our sense ofconfidence, comfort, and control.

Variation in ability is ordinary, notspecial, and affects most of us for at

least part of our lives.

Design powerfully and profoundly

influences us and our sense of

confidence, comfort, and control.

Variation in ability is ordinary,

not special,

and it affects most of us

for at least part of our lives.

2 core ideas...


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2001 International Classification of

Functioning, Disability and Health

Mainstreamed the experience

of disability and recognized it as

a universal human experience

Equalized mental and physical reasons

for disability

Redefined disability as acontextual phenomenon,

dictated by the intersection of a person

and his/her environment


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DESIGNING FOR HUMAN DIVERSITYJosh Safdie, Director of IHCDstudioInstitute for Human Centered DesignBoston, MA

Urban Design PrinciplesRhode Island School of Design

Department of Architecture10 November 2011

7,000,000,000 DESIGN CRITICS

CANT BE WRONG


8/71http://www.un.org/apps/news/story.asp?NewsID=40257


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7,000,000,000 DESIGN CRITICS

CANT BE WRONG


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Presenters

Dak Kopec PhD, MS, MCHESAssociate Professor, New School of Architecture and Design, San Diego, CA

Steve Demos RA

Senior Architect, Institute for Human Centered Design, Boston, MA

Bob KayeSenior VP, Planning and Development, MassDevelopment, Boston, MA

Karen Braitmayer FAIAMember, US Access Board

Principal, Studio Pacifica, Ltd., Seattle, WA


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DAK Kopec, Ph.D., MS.Arch., MCHESAssociate Professor

Newschool of Architecture and Design

HEA

LTH,HE

ALTHCA

RE,AND

THEBUILTENVIRO

NMENT


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A FUNCTIONAL SOCIETY IS DEDICATED TO MEETING THE CORE NEED WITH

LITTLE THOUGHT TO COVARIABLES OR COFACTORS.


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Discovery of new ways to produce the

same consequence or obtain the same goal

Early hospital design is representative of

societys early developmental phase

In human development, Piaget calls this the

Sensory Motor Period

d d l d h k d


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Unintended consequences resulted in what Barker termed a

Behavior Setting


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Behavior Settings lead to a prescribed role that Talcott

Parsons called the Sick Role


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To break the chain of events we

must the change the setting.


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AssociationLocation Similarity Sensory Experiences

Perceptual Understanding Sense of Control


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Similarity: Hotels & Resorts

Control: Television,

Window Shade,

Temperature


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Control is the mastery

over ones body and

environment andability to satisfy basic

needs without or with

little compromise.

Belonging is

determined by

environmental

elements that satisfy

individual needs.


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BUT

WE NEED MORE


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Who are the Designers?

Architects Product and Industrial Designer

Management, Operations, Hospital Staff

Who are the Clients?

Patients

Visitors Staff


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Design Choices by Architect

Layout


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The Circuit: Designed for Hemiplegia


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Conflict: Corners


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Failure to Design for Hemiplegia


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Desk Location


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Space for Furniture


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Comfort: Window Sill Height


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Window Sills as Latent Storage, Display


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Privacy and Control ---Turf: Toilet Location


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Privacy and Control --- Turf: Curtain Location


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Design Choices by Product Designer

Role of Products in Recovery Designed to reflect the world out there, i.e., as a tool

for the occupational therapists?

Designed to accommodate change in ability?


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Requiring Aid from Others Telephone

Chairs

Privacy Curtain

Designed for the Patient Call Devices Table Bed adjustments


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Design Choices by Staff, Management

Role of Products in Recovery Designed to accommodate the patients change in ability ?

A modified design to allow patient to do something on theirown, i.e., the patient as patient?

No specialized design, but item is the everyday item usedby those not in the hospital?


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Gap in Service Counter


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Unreadable Messages


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Empty Desk


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Everything out of sight


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Telephone Location


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Privacy and Control: TV Location


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Guaranteeing Patient- and User-Centered Environments:Planning, Design, Construction & Management

Robert M. Kaye

Session B41November 17, 2011


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Issue

Health care, commercial, and residentialbuildings as delivered and managed mightnot provide accessibility at the standards

to which they were originally designed.


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Common Obstacles to Access


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Cause(s) and Responses

Design and spec for ramp, incl. soilcompaction

V/E of design and spec

Means and methods substitution bycontractor

Field inspection fails to catch improper

material from supplier Red paint stripe on walkway; then,

replacement of three concrete panels

St i B ildi D li


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Steps in Building Delivery:New Construction or Major Additions

1. Planning; Determination of Need

2. Design

3. Construction4. Code Inspection

5. Commissioning

6. Hand-off to the Owner7. Property Management (incl. maintenance

and upkeep)

Responsibilities


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Responsibilities

1. PlanningOwner, Staff (maybe), Planning/

Programming Consultants, A/E Team2. Design - Owner, Staff (maybe), A/E

3. ConstructionConstruction Manager (CM),

A/E, Owners Rep4. Code InspectionPublic Officials, CM, A/E

5. CommissioningConsultants, A/E, PropertyManagement Staff

6. Hand-overCM, A/E, Property Manager

7. Property Management (incl. maintenance andupkeep)Owner, Property Manager, Vendors


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Other Responsible Parties

Sub-consultants

Subcontractors

Suppliers

Vendors

Contract Employees

Contract Facilities Service Providers Many Others, incl. Renovation Architects

C l i C f


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Conclusions: Causes ofCompromised Accessibility

Many responsible parties

Many changes in leadership andresponsibility over the lives of projects and

buildings

Many needs for modifications and manyopportunities for error

No clear set of standards to guidedecisions at each stage of buildingplanning, design, construction and

management

C l i C f


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Conclusions: Causes ofCompromised Accessibility (cont.)

No clear team leader to provide continuityfor achievement of universal access

No clear definition of roles and

responsibilities Renovations might receive less scrutinythan new construction

Effects of repairs and equipment

replacement on universal access oftendepends on individual sensitivity andcommitment

No perceived imperative


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Examples

Rehab Hospital in Tucson, AZ - renovation

TUC, DFW, BOS new construction andrenovation

Luxury apartment complex in metro

Boston area new construction


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Rehab Hospital in Tucson, AZ

Renovation project in 2007 had staff input

Improvements: Bright, clean, cheery, safeenvironment

Access problems (examples):

- access to/from exterior public spaces

- detailing of in-room restroom- use of older hospital beds, other

equipment, etc.


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Cross Slope


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Grading & Trench Drain at Entry


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Tripping Hazard


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TUC, DFW & BOS Airports

Airport-provided, extra-wide wheelchairsdo not fit in HC bathroom stalls in such away as to permit easy transfers.


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Apartment Complex - Metro Boston

Constructed 2006

Owner/Operator/Property Manager is alarge national company


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Site/Civil Design Coordination

Site Design & Construction


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Site Design & ConstructionCoordination


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Existing Grade; Entry Design

Front Entry Design Construction &


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Front Entry Design, Construction, &Maintenance

Front Entry Design Construction &


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Front Entry Design, Construction, &Maintenance


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Existing Grades


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Recommendations

Model the provision of universal access inhealth care facilities, other institutionalbuildings, commercial buildings, and multi-

family residences after existing in-placesystems and procedures for the provision,certification, maintenance and periodic

testing of life safety systems.


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Recommendations (cont.)

Designate the project architect as theresponsible party through commissioning& building hand-over.

Designate state or municipal codeinspection official as the responsible partypost issuance of certificate of occupancy.

Establish regular schedule of inspections/certifications similar to elevatorinspections.


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patient centered health care design

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