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 | Apr 15, 2019
It’s official: China opens first green hospital, designed by HMC Architects
Shunde Hospital of Southern Medical University is the official pilot green hospital for development of China’s green guide for hospital design.
Healthcare Facilities | Apr 12, 2019
New health pavilion completes on the Health Education Campus at Case Western Reserve University
Foster + Partners designed the facility.
Healthcare Facilities | Apr 9, 2019
How healthcare organizations can leverage design and culture's symbiotic relationship
The relationship between workplace design and company culture isn’t all that different from a tango.
Healthcare Facilities | Apr 3, 2019
Patients will actively seek out lower-cost and virtual healthcare in the future
Mortenson’s latest study finds that Millennials’ inclinations toward technological solutions are changing how care is and will be delivered.
Healthcare Facilities | Apr 3, 2019
Children’s Hospital at Sacred Heart addition includes 175,000 sf of new construction
HKS Architects designed the addition.
Healthcare Facilities | Mar 29, 2019
Former grocery store becomes a cancer care center in New Jersey
Francis Cauffman Architects (FCA) designed the adaptive reuse project.
Healthcare Facilities | Mar 27, 2019
Working to reduce HAIs: How design can support infection control and prevention
For many health systems, seeking ways to mitigate HAIs and protect their patients is a high priority.
Healthcare Facilities | Mar 6, 2019
What is the role of the architect in healthcare data security?
Safeguarding sensitive data is top of mind for healthcare administrators across the country, and, due to the malicious intents of hackers, their security efforts are never-ending.
Healthcare Facilities | Feb 20, 2019
A new hospital in Qatar reflects local culture in its design
Three ceramic-clad sails transport its exterior.
Healthcare Facilities | Jan 31, 2019
First phase of SickKids campus redevelopment plan unveiled
The Patient Support Centre will be the first project to comply with Toronto’s Tier 2 Building Standards.