HERD: Health Environments Research & Design Journal

The purpose of this article was to explore how different types of mock-ups are being used in the healthcare design process and present a methodology framework for the process.

Historically, physical mock-ups have been used in healthcare design primarily to test construction techniques. Although this historic use of mock-ups assisted the design team in decision-making, newer forms of mock-ups have evolved that expand the input provided into decision-making. These newer techniques, rapid prototyping, early build-out, virtual reality, and enhancements to the traditional physical mock-up focus more on challenging the functionality of the space, testing new operational concepts, and increasing user input.

This methodology article utilized five case studies in which different types and combinations of mock-ups were used in the design process and then, the methodology compares the realism, immersion, and testability of each mock-up technique.

For each mock-up type, the case studies described the purpose of the technique, the advantages and disadvantages, the most appropriate phase for its use in the design process, the estimated cost, and the process logistics. These components are compared to assist in developing a methodology for a variety of design situations.

The findings related to different mock-up techniques are a valuable tool for healthcare design teams to use in selecting the most appropriate mock-up technique and the proposed methodology will assist in executing the mock-up process.

To investigate whether a patient’s proximity to the nurse’s station or ward entrance at time of admission was associated with increased risk of adverse outcomes.

We conducted a retrospective cohort study of consecutive adult inpatients to 13 medical–surgical wards at an academic hospital from 2009 to 2013. Proximity of admission room to the nurse’s station and to the ward entrance was measured using Euclidean distances. Outcomes of interest include development of critical illness (defined as cardiac arrests or transfer to an intensive care unit), inhospital mortality, and increase in length of stay (LOS).

Of the 83,635 admissions, 4,129 developed critical illness and 1,316 died. The median LOS was 3 days. After adjusting for admission severity of illness, ward, shift, and year, we found no relationship between proximity at admission to nurse’s station our outcomes. However, patients admitted to end of the ward had higher risk of developing critical illness (odds ratio [OR] = 1.15, 95% confidence interval [CI] = [1.08, 1.23]), mortality (OR = 1.16, 95% CI [1.03, 1.33]), and a higher LOS (13-hr increase, 95% CI [10, 15] hours) compared to patients admitted closer to the ward entrance. Similar results were observed in sensitivity analyses adjusting for isolation room patients and considering patients without room transfers in the first 48 hr.

Our study suggests that being away from the nurse’s station did not increase the risk of these adverse events in ward patients, but being farther from the ward entrance was associated with increase in risk of adverse outcomes. Patient safety can be improved by recognizing this additional risk factor.

To assess the feasibility of quantifying variation in childbirth facility design and explore the implications for childbirth service delivery across the United States.

Design has been shown to impact quality of care in childbirth. However, most prior studies use qualitative data to examine associations between the design of patient rooms and patient experience. There has been limited exploration of measures of unit design and its impact on care provision.

We recruited 12 childbirth facilities that were diverse with regard to facility type, location, delivery volume, cesarean delivery rate, and practice model. Each facility provided annotated floor plans and participated in a site visit or telephone interview to provide information on their design and clinical practices. These data were analyzed with self-reported primary cesarean delivery rates to assess associations between design and care delivery.

We observed wide variation in childbirth unit design. Deliveries per labor room per year ranged from 75 to 479. The ratio of operating rooms to labor rooms ranged from 1:1 to 1:9. The average distance between labor rooms and workstations ranged from 23 to 114 ft, and the maximum distance between labor rooms ranged from 9 to 242 ft. More deliveries per room, fewer labor rooms per operating room, and longer distances between spaces were all associated with higher primary cesarean delivery rates.

Clinically relevant differences in design can be feasibly measured across diverse childbirth facilities. The design of these facilities may not be optimally matched to service delivery needs.

The present study aims to examine the influence of environmental color hue in a lactation room at a health center on users’ affective response and preference.

Hospital design plays an important role in the emotional experience of patients. In this regard, many studies have attempted to find relationships between design variables and healthcare facilities users’ response. Color has been frequently examined because it is always present in the environment and can be easily changed. However, most of the studies dealing with color–emotion relationships acquire users’ affective response by questionnaires developed by experts which could lead to inaccurate results since nonexperts may misunderstand concepts set by experts and use nonimmersive images to simulate the environments to assess.

To overcome these limitations, a Kansei Engineering–based approach was proposed. In the first phase, users’ specific affective factors for lactation rooms were determined using Semantic Differential. In the second phase, the influence of nine different color hues on users’ affective factors was obtained. An immersive display system was used to visualize the room altering hues in an isolated and controlled way.

(1) Six user’s affective factors connected to the lactation rooms were discovered: safety, elegance, coziness, spaciousness, simplicity, and luminosity, of which coziness has the most impact on the assessment of the room. (2) Warm colors like orange and yellow tend to score highly for coziness which puts them in leading positions when users’ assess lactation rooms.

Results provide recommendations for designers and show the advantages of using semantic differential and immersive displays to analyze user’s affective response to environments.

The objective of this study is to investigate a development project initiated and led by midwives.

The aim was to design an environment that could accommodate the wish to support professionalism while creating better and more cohesive patient treatment, improved patient safety, greater efficiency, higher quality, and stronger focus on the patient.

The theoretical and analytical account is conducted within the framework of design thinking (DT), replacing the traditional evidence-based design approach with an evidence-based design thinking (EBDT) process underpinning participatory DT and co-creation.

Based on a longitudinal case study on a participatory design process, interviews are conducted. DT principles are used in the analysis of the interviews.

Genuineness arises when all users experience that the physical setting optimally underpins the birthing situation. It is essential to make visible the importance of the physical setting to human behavior in any situation.

This study shows that midwives intuitively do EBDT. EBDT commands awareness of both research, design, midwifery care, and perspectives on space from women giving birth and their relatives. Collectively, that can provide the genuine scope of a healing birth environment.

The purpose of this study was to compare the effectiveness of four different design communication media in helping clinical end users understand spatial and functional information and in supporting their ability to provide design feedback.

It is critical to involve clinical end users early in the design process to test design solutions and ensure the design of a new healthcare facility supports their ability to deliver high-quality care. Traditional architectural design communication media such as floor plans and perspectives can be challenging for clinical design team members to understand. Physical and virtual mock-ups are becoming more popular as design communication media. However, nominal evidence exists comparing the effectiveness of different design media in supporting clinical end-user engagement and contribution during the design process.

An exploratory, qualitative study was conducted with clinical end users to evaluate the effectiveness of four different media commonly used in design communication.

Traditional architectural representations convey limited useful information to clinical end users, impacting the amount and type of feedback they can provide. More immersive media, such as physical and virtual mock-ups, support an increasingly holistic understanding of proposed design solutions, inciting more design solutions that range from the inclusion and exclusion of design features to location, position, and functionality of those features.

When used in combination, each media can contribute to eliciting clinical end-user feedback at varying scales. The overall preference and higher effectiveness in eliciting design feedback from clinical end users highlights the importance of physical mock-up in communicating healthcare design solutions.

To identify spatial design factors that influence informal interprofessional team-based communication within hospital emergency departments (EDs).

Effective team communication in EDs is critical for interprofessional collaborative care and prevention of serious errors due to miscommunication. Limited evidence exists about how informal communication in EDs is shaped by the physical workspace and how workplace design principles can improve the quality of ED team communication.

Two health services with four hospital sites in Victoria, Australia, participated. A multistage mixed-methods approach used (1) an anonymous online communication network survey (N = 103) to collect data on patterns and locations of informal interprofessional team communication among ED staff, (2) focus groups (N = 37) and interviews (N = 3) using photoelicitation to understand the perspectives of ED staff about how spatial design influences team communication, and (3) validity testing of preliminary findings with executives and ED managers at the participating sites.

Informal communication with peers and within discipline groups on nonspecific areas of the ED was most common. Three key factors influenced the extent to which ED workspaces facilitated informal communication: (1) staff perceptions of privacy, (2) staff perceptions of safety, and (3) staff perceptions of connectedness to ED activity.

Our research supports the proposition that ED physical environments influence informal team communication patterns. To facilitate effective team communication, ED workspace spatial designs need to provide visibility and connectedness, support and capture “case talk,” enable privacy for “comfort talk,” and optimize proximity to patients without compromising safety.

To examine the magnitude of impact of two nature-themed window murals on physiological processes, as measured by heart rate and blood pressure, of pediatric patients.

Many children and adolescents find at least one aspect of the hospitalization process frightening or anxiety provoking. One physical feature linked to stress reduction is access to positive distractions. Views of nature are one of the most common forms of positive distractions in healthcare environments. Patient room windows are the most common way patients are exposed to natural elements. Exposure to views of nature is linked to a number of positive impacts on physiological outcomes. Unfortunately, not every patient room will be able to provide a nature-filled window view. In situations where nature scenes do not occur, enhanced nature views may be utilized to replicate many of the same benefits as actual nature views.

Pediatric patients were randomly assigned to one of the three room conditions: aquatic window mural, tree window mural, or control condition. The medical data of participants (n = 90) who stayed in the rooms were gathered and evaluated for differences.

Data analysis supports the notion that patient stress is heightened at the time of admission. Patients in the rooms with murals were found to have improvements in heart rate and systolic blood pressure in comparison to patients in control rooms, suggesting that the murals had an impact on physiological processes. Data also suggest that subject matter played a role, as patients in tree murals rooms had the most health-related outcomes.

Ulrich’s (1991) definition of “positive distraction” includes that which “elicits positive feelings and holds attention,” implying that the capacity of an environmental feature to hold attention is a necessary component. This article examines whether, in the context of a pediatric hospital, a distraction needs to “hold attention” to secure positive benefits for patient well-being.

Data collected from 246 patients at Melbourne’s Royal Children’s Hospital (Australia) revealed a discrepancy between what children and young people told us they did, and valued, within the hospital, relative to the time they spent engaging in, or paying attention to, these same features. This motivated a closer interrogation of the relationship between well-being, distraction, and socialization within the pediatric context.

Data were collected using a mixed-methods approach that included 178 surveys, 43 drawings contributed by patients/siblings within the outpatient waiting room, 25 photo-elicitation interviews with patients, and 100 hr of spatial observations within public and waiting room spaces. This was supplemented by interviews with architects and hospital staff.

The mechanism by which we have understood positive distraction to contribute to well-being within the pediatric hospital environment is more complex than existing models accept. Within this context, environmental features that can positively transform expectations of visiting the hospital—that can ignite the imagination and incite a desire to return—can offer significant benefits to well-being. This is particularly relevant in the context of absenteeism from outpatient appointments and in reducing patient resistance to future, or ongoing, treatments.

The objective of this study is to determine the optimal allocation of budgets for pairs of alterations that reduce pathogenic bacterial transmission. Three alterations of the built environment are examined: handwashing stations (HW), relative humidity control (RH), and negatively pressured treatment rooms (NP). These interventions were evaluated to minimize total cost of healthcare-associated infections (HAIs), including medical and litigation costs.

HAIs are largely preventable but are difficult to control because of their multiple mechanisms of transmission. Moreover, the costs of HAIs and resulting mortality are increasing with the latest estimates at US$9.8 billion annually.

Using 6 years of longitudinal multidrug-resistant infection data, we simulated the transmission of pathogenic bacteria and the infection control efforts of the three alterations using Chamchod and Ruan’s model. We determined the optimal budget allocations among the alterations by representing them under Karush–Kuhn–Tucker conditions for this nonlinear optimization problem.

We examined 24 scenarios using three virulence levels across three facility sizes with varying budget levels. We found that in general, most of the budget is allocated to the NP or RH alterations in each intervention. At lower budgets, however, it was necessary to use the lower cost alterations, HW or RH.

Mathematical optimization offers healthcare enterprise executives and engineers a tool to assist with the design of safer healthcare facilities within a fiscally constrained environment. Herein, models were developed for the optimal allocation of funds between HW, RH, and negatively pressured treatment rooms (NP) to best reduce HAIs. Specific strategies vary by facility size and virulence.