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
| Aug 11, 2010
PCL Construction, HITT Contracting among nation's largest commercial building contractors, according to BD+C's Giants 300 report
A ranking of the Top 50 Commercial Contractors based on Building Design+Construction's 2009 Giants 300 survey. For more Giants 300 rankings, visit http://www.BDCnetwork.com/Giants
| Aug 11, 2010
Webcor, Hunt Construction lead the way in mixed-use construction, according to BD+C's Giants 300 report
A ranking of the Top 30 Mixed-Use Contractors based on Building Design+Construction's 2009 Giants 300 survey. For more Giants 300 rankings, visit http://www.BDCnetwork.com/Giants
| Aug 11, 2010
Report: Fraud levels fall for construction industry, but companies still losing $6.4 million on average
The global construction, engineering and infrastructure industry saw a significant decline in fraud activity with companies losing an average of $6.4 million over the last three years, according to the latest edition of the Kroll Annual Global Fraud Report, released today at the Association of Corporate Counsel’s 2009 Annual Meeting in Boston. This new figure represents less than half of last year’s amount of $14.2 million.
| Aug 11, 2010
Jacobs, HDR top BD+C's ranking of the nation's 100 largest institutional building design firms
A ranking of the Top 100 Institutional Design Firms based on Building Design+Construction's 2009 Giants 300 survey. For more Giants 300 rankings, visit http://www.BDCnetwork.com/Giants
| Aug 11, 2010
Nonprofit healthcare providers turn to real estate for liquidity and to preserve capital, says Jones Lang LaSalle report
Long considered to be stable investments immune to recession, hospitals and other healthcare facilities are now feeling the effects of a cash-strapped economy as decreased charitable contributions are forcing nonprofit hospitals to pare back and seek new financing sources, according to Jones Lang LaSalle’s 2009 Healthcare Real Estate Financing Outlook.
| Aug 11, 2010
Gafcon announces completion of Coronado animal care facility
Gafcon, a leading California-based construction management and consulting firm, announced today that construction is now complete on a new $1.6 million animal care facility located at 1395 First Street in Coronado, Calif.
| Aug 11, 2010
Colorado hospital wins LEED Gold
The main building of the Medical Center of the Rockies in Loveland, Colo., is a 136-bed regional medical center offering a full spectrum of services, with specialties in cardiac and trauma care. Constructed primarily of brick, native sandstone, and 85,000 sf of metal panels manufactured by Centria, the 600,000-sf main building, by Denver-based HLM Design, is one of the few hospitals in the nati...
| Aug 11, 2010
Biomedical center to join London's research scene
The UK Centre for Medical Research and Innovation, a partnership of scientific organizations researching new treatments for illnesses such as cancer and heart disease, hopes to attract leading medical scientists to its planned research center. Designed by HOK London, the building will be located on 3.
| Aug 11, 2010
Design ups comfort, care in cancer center
A new cancer center is slated to open in fall 2011 at Banner Gateway Medical Center, Gilbert, Ariz. The three-story, 120,000-sf, $107 million cancer center will contain physician clinics, medical imaging, radiation oncology, infusion therapy, and support services. A/E firm Cannon Design has created a visually open, column-free interior to increase patient comfort and care.