Executive Summary of Key Concepts

Arsalan Gharaveis and Mahshad Kazem-Zadeh

Built environment design is a significant way to promote the patients and their families, staff, and society’s quality of life, which should be considered in the whole spectrum of cancer continuum. The continuous changes in dealing with cancer would lead to variety in trends for facility and space design.

Based on the literature, the main variables and key concepts of this systematic review were defined as follows:

Physical environment: Perceived and objective characteristics of physical surroundings in which humans as users spend their time.

Arsalan Gharaveis, D. Kirk Hamilton, Debajyoti Pati, and Mardelle Shepley

The findings of this study support the importance of visibility as an environmental factor that can enhance collaborative communication in emergency departments. Also, this exploratory research supported the significance of visibility in improvement of teamwork and reduction of security risks in emergency departments. Based on the literature, the main variables and key concepts of this study were defined as follows:

Physical environment: Perceived and objective characteristics of physical surroundings in which humans as users spend their time.

Debajyoti Pati, Jaehoon Lee, Sahar Mihandoust, Mahshad Kazem-Zadeh, and Youngha Oh

This article presents findings from a systematic study of the physical design of hospital rooms, focusing on identifying the top physical design factors contributing to patient falls. Falls represent one of the top 10 reported sentinel events in American hospitals. It has been a challenging issue affecting patients, family members, and providers for a long time. Most studies on falls, however, have been concentrated in the areas of intrinsic (within the patient) factors, with very limited studies available on the designed physical environment. This study conducted a series of experiments in a physical mock-up of a patient room and used the latest technologies to track fall initiation moments in study participants. The first phase of data analysis identified any and all factors contributing to falls. This article presents findings from Phase II analysis of the same data, where advanced statistical analysis of data was conducted to identify those factors with the highest odds of contributing to falls. Five elements/attributes of concern were found. These five factors represent areas that could be manipulated to reduce patient falls during unassisted ambulation.

Daejin Kim and Margaret Portillo

As a case-control study, the main purpose of this research was to identify significant relationships between environmental hazards and fall risks. This study (1) explored the consequences of falls in two residential units that were identified as having the highest and lowest fall rates within a senior living community; (2) examined the relationship between age, mobility, and environmental hazards; and (3) compared and contrasted the fall hazards between the highest and lowest fall rate buildings.

Fall history analysis indicated that falls that occurred in the bathroom were more likely to cause severe injury. In addition, fall accidents in the bedroom and bathroom were more likely to happen between 12 a.m. and 8 a.m. By taking a comprehensive measurement approach that included home assessment and a resident interview, research findings revealed that with increasing age and use of mobility assistive aids, there was a corresponding increase in the total number of environmental hazards from both assessment approaches. Also, this research provided empirical evidence that home hazards were significantly and independently associated with the incident rate of falls. In other words, the high fall rate building included more environmental hazards compared to the low fall rate building regardless of residents’ age and mobility.

Barbara B. Brewer, Kathleen M. Carley, Marge Benham-Hutchins, Judith A. Effken, and Jeffrey Reminga

We used a longitudinal design and social network analysis to investigate whether nursing staff communication patterns (patterns of network metrics such as communication density or centrality) interact with nursing unit shapes (e.g., compact square, compact circle, racetrack, or cross) to affect the rate of patient falls on 24 acute care nursing units in three acute care hospitals. Staff communication networks were derived from nursing staff surveys, and patient fall rates were provided by hospitals at 4 times over a 7-month period. Floor plans were used to determine nursing unit design. Medium- to large-sized racetrack-shaped nursing units had statistically fewer falls than medium- to large-sized cross-shaped nursing units, while controlling for unmeasured factors related to the hospital. In general, cross-shaped decentralized units had less effective communication structures (as evidenced by lower density, diffusion, clustering coefficient, and eigenvector centrality network metrics) than racetrack-shaped hybrid or compact square-shaped centralized units. The impact of nursing unit shape on communication and safety should be considered when designers work with nurses on hospital construction of nursing care units.

Amy Kurowski-Burt and John Christopher Haddox

Persons with disabilities often face addressable barriers to healthcare participation related to the physical healthcare facility. This qualitative study engaged four disability-related stakeholder groups in focus groups (patients, caregivers of patients, advocates, and providers) to identify and understand perceived facility-based barriers to healthcare participation in Appalachia.

Analysis of participant comments in focus group settings identified six categories of barriers (in order beginning with most mentions): accessibility, provider awareness and education, transportation, availability of services, financial, and support systems. While transportation or lack thereof is often the first topic to arise when discussing healthcare access with rural residents, it was not the primary concern in this study. Accessibility—both exterior and interior—was the primary concern to the four stakeholder groups, with each group prioritizing a different aspect of accessibility to be their greatest barrier. All participant groups indicated that healthcare providers are often insensitive to the disabilities of their patients—Provider Awareness and Education. Insensitivity is often revealed in communications between focus group members and healthcare facility staff during check-in, waiting period, and appointment scheduling. In addition to the associated physical challenges, there is a cognitive aspect associated with the accessibility scenario at a facility. Stakeholders expressed that the presence of physical barriers indicates a lack of compassion and understanding on the part of the providers.

A recognition and understanding of these barriers by designers, healthcare administrators, and providers, along with an understanding of how to address/remove them, could assist in the improved delivery of healthcare to populations with disabilities.

Gordon F. West and Traceee J. Rose

To maintain a competitive advantage and to meet the needs of the communities they serve, hospitals spend considerable time and money on renovations. These types of projects typically result in workflow changes, potentially putting patients at risk. To mitigate this, the use of simulation is employed to act as a dress rehearsal, allowing staff to assess the functionality of equipment and to get a sense for possible workflow modifications. Additionally, this process allows the organization time to identify any issues and address those problems prior to patient care delivery. This project provided nursing leadership with a critical assessment of the readiness of nursing staff to transition to this new area while ensuring the ability to provide safe patient care.

Masoumeh Nazarian, Andrew Price, Peter Demian, and Masoud Malekzadeh

Data on staff journeys within a workplace can be used to help determine the optimum proximity of different spaces and/or to select the most efficient layout from the available options. This article proposes a method for maximizing the reliability and comprehensibility of such data without overreliance on the observer’s technical expertise or sophistication of recording equipment.

The article provides an example of how the data gathered and analyzed from the case study ward can inform future design decisions by proposing design guidelines which include suggestions on the location of the nurse station, treatment room, staff room, ward entrance, and patient rooms and a proximity matrix of all spaces in a hospital ward.

Megan Catt and Renganathan Giridharan

Design for well-being is an approach that considers both the psychological and physiological impacts of architecture on its occupants, in order to create built spaces that promote well-being and enhance health. This study seeks to investigate the adoption of well-being-focused design in dementia wards, by comparing a theoretical background to real-world practice. Firstly, by investigating a “best practice” model, derived from existing theory, a benchmark is established against which functioning wards are appraised during a series of observational visits to wards in the United Kingdom. The firsthand observation of National Health Service dementia specialist, acute facilities, and discussion with medical staff provides valuable insight into the environments in which patients are being cared for, as well as the opportunity to gauge the perception of design for well-being among care providers. This approach means that the subject is discussed not only from an architectural perspective but from a care provision, management, and operational stance, taking into account the practicalities and obstacles that exist in this field—looking beyond the theoretical ideal, and toward the reality of current practice and standard for healthcare design.