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
University Buildings | Jul 1, 2021
Texas A&M University’s new Engineering Medicine program receives a new, unique space
EYP designed the project.
Healthcare Facilities | Jun 29, 2021
New Flagler Health+ Campus breaks ground in Durbin Park
Gresham Smith designed the project.
Healthcare Facilities | Jun 25, 2021
Hospital serving New Hampshire’s largest metro is expanding its ED
A pandemic delay led the design-build team to rethink the addition’s reception, waiting, and triage areas.
Resiliency | Jun 24, 2021
Oceanographer John Englander talks resiliency and buildings [new on HorizonTV]
New on HorizonTV, oceanographer John Englander discusses his latest book, which warns that, regardless of resilience efforts, sea levels will rise by meters in the coming decades. Adaptation, he says, is the key to future building design and construction.
Healthcare Facilities | Jun 10, 2021
Abrazo Cave Creek Hospital completes in Cave Creek, Ariz.
E4H Architecture designed the project.
Digital Twin | May 24, 2021
Digital twin’s value propositions for the built environment, explained
Ernst & Young’s white paper makes its cases for the technology’s myriad benefits.
Healthcare Facilities | May 20, 2021
California Veteran Home, Skilled Nursing Facility and Memory Care project set for Yountville, Calif.
A team of Rudolph and Sletten and CannonDesign will design and build the facility.
Market Data | May 18, 2021
Grumman|Butkus Associates publishes 2020 edition of Hospital Benchmarking Survey
The report examines electricity, fossil fuel, water/sewer, and carbon footprint.
Healthcare Facilities | May 12, 2021
New pet ER under construction in Vancouver, Wash.
The project will serve the Portland metro area 24 hours a day.
Healthcare Facilities | May 7, 2021
Private practice: Designing healthcare spaces that promote patient privacy
If a facility violates HIPAA rules, the penalty can be costly to both their reputation and wallet, with fines up to $250,000 depending on the severity.