When evidence-based design collides with conventional wisdom, the outcome will sometimes be disruptive.
Take, for example, the generally accepted advantages in patient care and observation related to decentralizing nurses’ stations in hospitals, which is becoming standard practice for healthcare clients and their AEC partners.
A recent evaluation of a renovated Missouri hospital, conducted by University of Kansas faculty members, raised questions about the impact of decentralization on patient satisfaction and the communication among nursing teams within the facility.
The St. Louis-based architectural firm Lawrence Group retained the Institute for Health + Wellness Design (IHWD) at KU’s School of Architecture, Design, and Planning to provide a third-party review of the firm’s 2014 remodeling of the orthopedic unit at SSM St. Mary’s Hospital in Jefferson City. That healthcare system was about to embark on an expansion of its St. Joseph Hospital West in Lake St. Louis.
Lawrence Group is an affiliate member of IHWD.
The Institute assessed the unit using an evidence-based design checklist developed by the nonprofit Center for Health Design in California. Its survey included a “space syntax” evaluation that generated a heat map, which showed how the unit’s layout might affect patient satisfaction.
“We wanted to see does moving into a new facility improve patient satisfaction scores, which is one of the most important things for hospital owners today,” said Hui Cai, Assistant Professor at KU, who with Professor Kent Spreckelmeyer and Frank Zilm, IHWD’s chairman, presented findings from the Institute’s nursing unit study at the Healthcare Design Conference 2016 in Houston last November.
The study found, perhaps not surprisingly, that the facility itself showed “statistically significant increase[s]” in scores after the renovation. But patient-quality scores mostly stayed the same, and one score—nurses’ responses to patient calls—actually dropped slightly.
The Institute hypothesizes that decentralization was the culprit, due to the physical distance and visual disconnection of decentralized nursing unit design, which necessitates that nurses must move farther to get from station to station. The Institute suggests these distances might be an impediment to interaction among nurses that might also delay responses to patients.
“This design trend needs to be further investigated before it is accepted as standard for every hospital,” said Cai. “We have to see how to modify the design to achieve balance between shorter walking distance, better patient surveillance and better staff communication and collaboration.”
This is one of the first research studies to link decentralized nurse station design with organizational performance and patient outcomes. The Institute has conducted a second phase of study to evaluate further the degree to which decentralized design affects nurses’ teamwork and patients’ perception of care. In late 2017, IHWD plans to present and publish the results of this study, which included a second hospital, the University Medical Center of Princeton at Plainsboro, N.J.
Related Stories
Healthcare Facilities | Feb 10, 2022
Respite for the weary healthcare worker
The pandemic has shined a light on the severe occupational stress facing healthcare workers. Creating restorative hospital environments can ease their feelings of anxiety and burnout while improving their ability to care for patients.
Coronavirus | Jan 20, 2022
Advances and challenges in improving indoor air quality in commercial buildings
Michael Dreidger, CEO of IAQ tech startup Airsset speaks with BD+C's John Caulfield about how building owners and property managers can improve their buildings' air quality.
Healthcare Facilities | Jan 7, 2022
Supporting hope and healing
Five research-driven design strategies for pediatric behavioral health environments.
Healthcare Facilities | Dec 20, 2021
Stantec will design the new Queensway Health Centre
The project is located in Toronto.
Healthcare Facilities | Dec 16, 2021
Leo A Daly designs mental health clinic for veterans in Tampa
The new facility will consolidate all mental health services the VA offers into one clinic.
Healthcare Facilities | Dec 15, 2021
COVID-19 has altered the speed and design of healthcare projects, perhaps irrevocably
Healthcare clients want their projects up and running quicker, a task made more complicated by the shortage of skilled labor in many markets.
Healthcare Facilities | Dec 15, 2021
MEP design considerations for rural hospitals
Rural hospitals present unique opportunities and challenges for healthcare facility operators. Oftentimes, the infrastructure and building systems have not been updated for years and require significant improvements in order to meet today’s modern medical demands. Additionally, as these smaller, more remote hospitals are acquired by larger regional and national healthcare systems, the first step by new ownership is often to update and rehabilitate the building. But how can this be done thoughtfully, economically, and efficiently in ways that allow the engineering and facility staff to adapt to the changes? And how can the updates accurately reflect the specific needs of rural communities and the afflictions with which these areas most commonly face?
Healthcare Facilities | Dec 7, 2021
Wheeler Kearns Architects completes Howard Brown Health’s Broadway Youth Center in Chicago
The new facility will provide medical and social service programs to LGBTQI+ youth.
Healthcare Facilities | Nov 23, 2021
Why vertical hospitals might be the next frontier in healthcare design
In this article, we’ll explore the opportunities and challenges of high-rise hospital design, as well as the main ideas and themes we considered when designing the new medical facility for the heart of London.
Healthcare Facilities | Nov 12, 2021
Centro Hospitalario Serena Del Mar is Safdie Architects’ first project in Latin America
The hospital project is characterized by its connectivity to nature.