Urban Legends Of Healthcare Design

2009 PDC Conference & Exhibition

urban legends of Healthcare Design

Speaker: Matthew W. Kennedy, ACHA, National Healthcare Executive, SSOE, Inc.

Moderator: Linda Delano, Western Division Business Leader, SSOE, Inc.

urban legendsof

Healthcare Design



Today’s Discussion

I. The Pressure for Better Outcomes

II. Looking at the Evidence

III. The Continuing Evolution of EBD

IV. Improving Your EBD Approach



..let’s start with a quick story



“Children who eat candyhave better test scores”



Is it true?



“Children who eat candyhave better test scores”



“...I think that this market isnow challenging anythingthat doesn’t really havescience behind it.”Robert Levine, Turner Construction,

quoted from HFM Magazine





Is your design utilizing the evidenceor another “Urban Legend”?



Comments from your Peers....



Strong Incentives to Succeed:

More results with less costs

More results in less time

• Better process efficiencies

• “High-Performance” care environments

• Increased competition

• Growing knowledge needs



Need for “Fact-Based” Approach:

?ConfirmedCost Impact

?ConfirmedEfficiencies

?ConfirmedOutcomes

EBDBest Practices



5. PROJECT SPECIFIC QUALIFICATIONS:

The Owner is interested in designing the project inaccordance with the principals of “Evidence BasedDesign” but not necessarily with developing theproject as a pebble facility. Please comment on yourfirm’s experience with these principals

5. PROJECT SPECIFIC QUALIFICATIONS:

The Owner is interested in designing the project inaccordance with the principals of “Evidence BasedDesign” but not necessarily with developing theproject as a pebble facility. Please comment on yourfirm’s experience with these principals

Using the A/E Selection Process

1.A: Provide Hard data to support “evidence-based design” experience;i. Documented evidence of elevated patient satisfaction scoresii. Documented evidence of improved nursing productivityiii. Documented evidence of reduced costs of operationiv. Provide patient census growth/admissions as a result of design

1.A: Provide Hard data to support “evidence-based design” experience;i. Documented evidence of elevated patient satisfaction scoresii. Documented evidence of improved nursing productivityiii. Documented evidence of reduced costs of operationiv. Provide patient census growth/admissions as a result of design

TAB 6: DESIGN BUILD APPROACH AND SERVICES

The following approach and services should be addressed:

6.2: Design process to maximize evidence base designimplementation (from patient, visitor, staff, andefficiency standpoint)

iv. Provide patient census growth/admissions as a result of designiv. Provide patient census growth/admissions as a result of design

Documented evidence of elevated patient satisfaction scoresii. Documented evidence of improved nursing productivityiii. Documented evidence of reduced costs of operationiv. Provide patient census growth/admissions as a result of design

TAB 6: DESIGN BUILD APPROACH AND SERVICESTAB 6: DESIGN BUILD APPROACH AND SERVICESTAB 6: DESIGN BUILD APPROACH AND SERVICESii. Documented evidence of improved nursing productivityii. Documented evidence of improved nursing productivity

The following approach and services should be addressed:The following approach and services should be addressed:The following approach and services should be addressed:iv. Provide patient census growth/admissions as a result of designiv. Provide patient census growth/admissions as a result of design

6.2: Design process to maximize evidence base design6.2: Design process to maximize evidence base designimplementation (from patient, visitor, staff, andefficiency standpoint)

TAB 6: DESIGN BUILD APPROACH AND SERVICES

The following approach and services should be addressed:

6.2: Design process to maximize evidence base designimplementation (from patient, visitor, staff, andefficiency standpoint)



Leading to Increased EBD Presence

$40.7B

$25.23B

$15.3B

Total HC Construction

Total Utilizing EBD

TOTAL VALUE AT RISK

62%53%

20082006






All EBD Initiatives Start withLooking at the Research!



• Journals:

Peer reviewedCHER, HERD, InformeDesign

• Studies should be:

Empirically based

Utilize scientific rigor, quality ofresearch design, large samplesizes, high degree of control

Identify reliable patterns to findings

So Where’s the Beef?



Are You Willing to Invest in these Design Strategies?

Universal RoomsShortened TravelDistances

Patient Centered Care



“Designs which reduce nurse traveldistances increase staff efficiencies”



• Nursing represent the largest segment ofhealthcare staff within the hospital.

• Average distance walked/shift = 3.0miles/daytime shift.

• Decreased travel distances = more timespent on direct patient care activities?

How Do Nurses Spend Their Time?



• Joint study conducted by AscensionHealth, Kaiser Permanente and PurdueUniversity.

• Study included participation of 767 nursesfrom 36 M/S units around the country.

• Study objectives include determiningvariations in distance traveled, time spentby category, and workload between threetypes of unit design:

Travel Distance Case Study #1:

Radial

Corridor

Race Track



• No statistically significant relationshipwas found linking differences inarchitectural types to differences in timespent with patients.

• More variation found in miles traveledand patient time between nurses on thesame unit then between units.

Case Study Findings:

Radial

Corridor

Race Track



Travel Distance Case Study #2:

• Previous study conducted at theRochester Methodist Hospital by theNational Center for Health ServicesResearch and Development.

• Study investigated the specific impactthe unit design had on activities andsubjective feelings of nursing personnel.

• Study evaluated three types of unitdesigns all built at the new hospitalbuilding (specifically constructed forhospital research).

Radial

Corridor

Race Track



• Staff on radial units found to travel lessand spend more time with patients.

• However, staff working on radial unitsalso found to have more time in allcategories identified.


Radial

Corridor

Race Track



“Designs which reduce nurse traveldistances increase staff efficiencies”



• Staff efficiencies depend uponmultiple factors.

• Nurses ability to organize work andstaffing assignments has greater impacton efficiency than lessened traveldistances.

• Nurses adaptability allows them tocompensate for limitations imposed bythe physical design.

What Can Be Learned?



“Designs utilizing universal patient roomsaccommodate change more readily”



Acuity Adaptable Care Model

Multiple acuities cared for on asingle nursing unit/room

Universal Room Design

Adaptable for use in varyingpatient acuity levels



Acuity Adaptable Care Model

Not a universally acceptedmodel of care.

Universal Room Design

How well does a standardizedroom adapt to customized carelevels?



• Study conducted at six adult M/S Unitsacross U.S.

• Three of six hospitals utilized universalroom designs.

Universal Room Case Study:

• Study identified three end-user definitionsof flexibility;

Adaptable

Convertible

Expandable



• At room level - benefits of adaptability ofUniversal Room Design could not bedetermined.

• At unit level – Universal Room designconcepts could impede operational flexibilityin 3 of the 7 areas studied:

Peer lines of sightPatient VisibilityZoning Options




“Designs utilizing universal patient roomsaccommodate change more readily”



• Completed studies of overall flexibility inhealthcare settings are few; moreresearch found for retail and workplacesetting.

• Studies on flexibility at the nursing unitlevel even fewer.

• Universal Room Design giving way toAcuity Adaptable Room model.




“Designs which are patient centeredlead to better clinical outcomes.”



Patient Centered Care: considers patients’cultural traditions, their personal preferencesand values, their family situations, and theirlifestyles (Institute for HealthcareImprovement)

Patient Centered Design: designs that put thepatients needs and preferences first



Many levels in which to approach subject,today we focus only on three:

Day Lighting SoundNature



• Study by JM Walch and Associates.

• Tested effects of patient exposure tosunlight on pain medication levels afterspine surgery.

• Patients assigned to a “dim” room or“bright” room for recovery.

Day Lighting Case Study:



• Study indicated a 22% decrease inanalgesic medication by recoveringpatients assigned to a “bright” room.




• Study conducted with patientsrecovering from heart surgery.

• Patients randomly assigned roomsproviding exposure to images of nature,abstract art, a blank panel or nothing atall.

Nature Case Study:



• Patients in rooms where exposed toimages of nature switched from strongeranalgesics to weaker ones during recoverycompared to other patients in study.




• Study conducted with 165 patientsundergoing elective colonoscopy.

• Patients assigned to one of threegroups:

Visual distractionsVisual + audio distractionsNo distractions

Sound Levels Case Study:



• Study revealed patients withvisual + audio distractions hadsignificantly reduced pain scoresand PCS use.




“Designs which are patient centeredlead to better clinical outcomes.”



• Each study had good control groupdefinition.

• Each study had limited variables.

• Large volume of studies in this subject;greater correlation between studies.

• Significantly reduced patient stressorscan result in shortened recovery andless pain medication required.







Amount of EBD studies continuesto grow:

1968 - 1998 842004 6002008 +1,000Tomorrow ??,???

EBD Continues to Evolve:




• Same-Handed Rooms

• Design Flexibility

• Family Outcomes

• Support Services

• Staff Stressors

• Patient Safety

• Medication Errors

• LOS

Future Areas ofResearch

Past Areas of Research

“...this emphasis on the elements that are a part of the theory ofsupportive design can allow other domains of knowledge to beoverlooked”Kirk Hamilton

HERD Journal


HERD Journal


HERD Journal



Creating better environments for studythrough collaborations:

• The Pebble Project/Partnerships• Ascension/Kaiser/Purdue• SRHS/Clemson/Others

HealthcareProviders

UniversityPrograms

A/EFirms




Final Comments from your Peers....



• Improving your “critical eye”

• Utilize methodologies to maintain rigor

• Identify your EBD Champion!

How to Better Your Approach to EBD:



E-Copies of this presentation ( with supporting evidence) can be downloaded from SSOE.COM

urban legendsof

Healthcare Design

Documents

Urban Legends Of Healthcare Design