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- Herausgeber: John Wiley & Sons
- Kategorie: Geisteswissenschaft
- Sprache: Englisch
HEALTHCARE DESIGN BASICS An approachable and robust treatment of designing and planning spaces for use in healthcare settings In Healthcare Design Basics, a team of distinguished interior architecture practitioners and educators delivers an up-to-date text covering the critical aspects of healthcare design, preparing students for a specialty rapidly growing in importance and size. The book adopts an approach designed to crystalize the most important elements of broad range of ambulatory facilities for healthcare design students and new professionals in a clear, concise, and approachable way. The authors combine a broad overview of numerous ambulatory healthcare typologies with exercises that allow students to prepare detailed plans for many of the most commonly used rooms and typologies in the healthcare industry, thus preparing them for the demands of professional positions. The book also includes: * Step by step studio guidance outlining the basic design elements required for a wide range of ambulatory healthcare facilities and rooms * Comprehensive explorations of the demands of new and improved healthcare facilities that meet the needs of an aging population * Practical discussions of the space planning challenges involved in designing rooms and facilities for use during public health crises, including pandemics * Dozens of full-color images that illustrate and highlight important concepts, examples, and design solutions Written for students of interior design, architecture, and emerging professionals, Healthcare Design Basics also benefits professionals tasked with the initial planning and design of ambulatory facilities, and other healthcare settings.
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Veröffentlichungsjahr: 2023
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HEALTHCARE DESIGN BASICS
MARK KARLEN,
PhD, AIA, NCIDQ (deceased)
SAGLINDA H ROBERTS,
Assistant Professor, Interior Architecture, Chatham University, PA, USA
KYRA K TUCKER,
Program Chair and Director, Interior Architecture Program, Chatham University,PA, USA
Copyright © 2023 by John Wiley & Sons Inc. All rights reserved.
Published by John Wiley & Sons, Inc., Hoboken, New Jersey.
Published simultaneously in Canada.
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Library of Congress Cataloging-in-Publication Data
Names: Karlen, Mark, author. | Roberts, Saglinda, author. | Tucker, Kyra Krotec, author.
Title: Healthcare Design Basics/ Mark Karlen, Saglinda H. Roberts, Kyra Krotec Tucker.
Description: Hoboken, NJ: John Wiley & Sons, 2023. | Includes bibliographical references and index.
Identifiers: LCCN 2023000320 (print) | LCCN 2023000321 (ebook) | ISBN 9781119813675 (paperback) | ISBN 9781119813736 (pdf) | ISBN 9781119813729 (epub)
Subjects: LCSH: Sustainable design—Textbooks
Classification: LCC QR111. P333 2023 (print) | LCC QR111 (ebook) | DDC 579/.1757--dc23/eng/20230602
LC record available at https://lccn.loc.gov/2023000320
LC ebook record available at https://lccn.loc.gov/2023000321
Cover image(s): Courtesy of Saglinda H Roberts
Cover design: Wiley
CONTENTS
Cover
Title page
Copyright
About the Authors
Acknowledgements
Chapter 1
Introduction
Organization
Design Exercises
Additional Resources
Getting the Most Out of This Book
Companion Website
Additional Resources
Chapter 2
Evidence-based Design
What Is Evidence-based Design (EBD)
Origins of Evidence-based Design – A Brief History
Importance to Design
Principles and Process
Attributes of Evidence-based Designers
Associated Organizations
Additional Resources
Chapter 3
General Elements of Healthcare
History of the US Medical System
Codes, Regulations and Industry Standards
Specialized Facility and Mechanical Requirements
Specialized Demands on Healthcare Workers
The Built Environment’s Role
Additional Resources
Chapter 4
Holistic Analysis
Stakeholders
Operating Standards, Codes, Profitability + Administrator’s Perspectives
Holistic Analysis
Holistic Analysis of the Typology and Its Stakeholders
Case or Precedent Studies
Interviewing and Observation
Integrative Design
Summary
Additional Resources
Chapter 5
Room Requirements
Prototypical Space Requirements for Areas Found in Most Healthcare Facilities
Technology
Resilience
Additional Resources
Chapter 6
Major Specialties
Pediatrics
Dentistry
Gerontology
Palliative Care
Psychological + Psychiatric Practice
Orthopedic Offices
Internal Medicine
Alternative + Naturopathic Medicine
Additional Resources
Chapter 7
Group Practices
Single Specialty Group Practices
Multiple Specialty Group Practices
Employed Physician Practices
General Considerations
Typical Shared Functions and Components
Additional Resources
Chapter 8
Clinic Practices
Community Health or Care Clinics
Urgent Care Facilities
Facility Specific Treatment Spaces
Additional Resources
Chapter 9
Specialized Ambulatory Centers
Ambulatory Surgery
Physical Therapy
Cancer Treatment Centers
Dialysis or Kidney Treatment Centers
Additional Resources
Chapter 10
Architectural Considerations
Sustainability
Structural Systems
Shell or Exterior Envelope
Mechanical Equipment + Technology
Interior Construction
Materials
Medical Equipment + Technology
Adaption + Resilience
Codes
Additional Resources
Chapter 11
Lighting
Review of Basic Lighting Principles
Natural Light
Artificial Light
Occupant Concerns
Additional Resources
Chapter 12
Interior Finishes + Furniture
Healthcare-Specific Considerations
Interior Finishes
Furniture
Additional Resources
Chapter 13
Biophilia
What It Is...and What It’s Not
Why Biophilia Is Important
Integrating Biophilic Elements
Attributes + Elements of Biophila
Application in Healthcare Facilities
Additional Resources
References
Chapter 14
Health + Well-Being
What Is Well-Being + Why Is It Important
Implications for Medical Facilities
Elements + Strategies in Healthcare Settings
Rating Systems that Address Well-Being
Foundations of a Healthy Building
Long-term Implications
Additional Resources
Appendix I Base Plans
Appendix II Assignments and Exercises
Glossary
Index
End User License Agreement
List of Illustrations
CHAPTER 03
Figure 3.1 Sample of Stakeholder...
CHAPTER 05
Figure 5.1 Basic Elements...
Figure 5.2 Optimal Elements...
Figure 5.3 Optimal Elements...
Figure 5.4 Check-in and...
Figure 5.5 Intake Area...
Figure 5.6 Exam Rooms...
Figure 5.7 Basic Elements...
Figure 5.8 Optimal Elements...
Figure 5.9 Basic Business...
Figure 5.10 Optimal Elements...
Figure 5.11 Consultation...
Figure 5.12 Optimal Elements...
Figure 5.13 Basic Elements...
Figure 5.14 Optimal Elements...
Figure 5.15 Basic Elements...
Figure 5.16 Optimal Elements...
Figure 5.17 Basic Elements...
Figure 5.18 Optimal Elements...
Figure 5.19 Restrooms Adjacent...
Figure 5.20 Restrooms with Easy...
CHAPTER 06
Figure 6.1 Pediatric Office...
Figure 6.2 Optimal Treatment...
Figure 6.3 Alternate Layouts...
Figure 6.4 Potential Hygienist...
Figure 6.5 Dental Office Floor...
Figure 6.6 Gerontology...
Figure 6.7 Psychiatry...
Figure 6.8 Orthopedic...
Figure 6.9 Internal...
CHAPTER 07
Figure 7.1 Schematic Diagram...
Figure 7.2 Schematic Diagram...
Figure 7.3 Schematic Diagram...
Figure 7.4 Multispecialty Group...
CHAPTER 08
Figure 8.1 Community...
Figure 8.2 Urgent Care...
Figure 8.3 Facility...
CHAPTER 09
Figure 9.1 Ambulatory...
Figure 9.2 Physical...
Figure 9.3 Open Plan...
Figure 9.4 Private...
Figure 9.5 Rainier...
CHAPTER 10
Figure 10.1 Wind and...
Figure 10.2 Passive...
Figure 10.3 Section...
CHAPTER 11
Figure 11.1 Window with...
Figure 11.2 Clerestory...
Figure 11.3 Monitor or...
Figure 11.4 Skylight...
Figure 11.5 Sawtooth...
Figure 11.6 Monitor or...
Figure 11.7 Lighting...
Figure 11.8 Elevation...
Figure 11.9 Lighting...
Figure 11.10 Elevation...
Guide
Cover
Title page
Copyright
Table of Contents
About the Authors
Acknowledgements
Begin Reading
Appendix I Base Plans
Appendix II Assignments and Exercises
Glossary
Index
End User License Agreement
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ABOUT THE AUTHORS
Mark Karlen (1929–2022) was an architect, educator, and author with extensive experience working in and teaching in the field of interior architecture. His other titles include Lighting Design Basics, Space Planning Basics, and Sustainable Design Basics.
Saglinda H Roberts is an Assistant Professor in the Interior Architecture program at Chatham University and has over 30 years of extensive experience in a broad range of project typologies. Her focused research is on the holistic analysis and integration of stakeholder needs.
Kyra Krotec Tucker is Chair of the Interior Architecture & Immersive Media programs at Chatham University and the principal of Kyra Tucker + Associates Interior Design. She has over sixteen years’ experience working in commercial and healthcare design.
ACKNOWLEDGEMENTS
We would like to acknowledge:
All the support from the team at Wiley Publishing especially all those in the editorial, production departments. You saw value in expanding the Basic series yet again, and walked with us through the whole process.
All the wonderful collaborators. We are grateful for all your insight, talent, time and willingness to be involved.
The students at all our respective university who helped to vet the work, show us how to improve it, and how to create a step-by step process to start to understand the complexities of beginning healthcare design.
All the clients over all the years that helped us explore and understand the multitude of requirements, aspects, and experiences from a broad range of spaces and typologies. You have made us the educators, designers, and researchers that we are today.
I would especially like to acknowledge the insight, knowledge, experience, and great stories of the masters from Mark Karlen, who was a dear friend and colleague. This book was originally his idea. I consider it a privilege to work have worked with him over many years in many different capacities. He will be greatly missed by all that knew him.
Chapter 1 INTRODUCTION
The purpose of this book is to provide a single resource aimed at upper-level undergraduate or beginning graduate students in interior design or architecture programs wishing to understand healthcare design in a conventional studio setting. It is the hope that it can also provide a resource as the student moves into their professional career.
The book primarily examines ambulatory facilities and the spaces that are typically included within those facilities. It covers a variety of typical medical specialties, clinics, and ambulatory care facilities within the 5,000 square foot range. Hospital settings or large long-term care facilities are not covered here.
The book is set up to lead the student step-by-step through the design of a range of typical healthcare facilities. The chapters are organized to logically establish a design process starting with the underlying rationale or goals of specialized practices and then move on to holistically analyze the needs of the patients, medical and general staff, as well as visitors. This approach enables the designer to develop spaces that efficiently accommodate the functional aspects required to provide optimum medical treatment as well as meet the emotional, psychological, and physiological needs of all stakeholders.
The users of this book are expected to possess basic knowledge and skills of design, drafting, and space planning. Design exercises can be completed either as hand drawings or with the use of computer drafting. Projects are designed to be developed and used in a studio classroom setting or independently.
Note should be made regarding terminology used throughout this book. Every effort has been made to use standard professional terminology, but that in itself is misleading. Many words or phrases such as “criteria matrix,” “relationship diagram,” “block plan,” or “barrier free” are used by some professionals and not others. Professionals can use the same word to mean different things and students may not have had the opportunity to come across some of the terms that are used. Do not allow this lack of universality in terminology to become a stumbling block in the learning processes. Exploring unfamiliar terms and phrases helps in developing a strong professional process.
ORGANIZATION
The book is organized in 14 chapters that provide a holistic overview of the basic information required for healthcare design projects.
Evidence-based Design
, its origins, underlying philosophies, and its importance to healthcare, along with procedures and strategies, are reviewed in
Chapter 2
General Elements
that should be present in every healthcare project like ergonomics, wayfinding, infection control, and how the design of healthcare facilities can reduce turnover and medical errors and how the history, governmental, business, and administrative aspects of healthcare shape design are covered in
Chapter 3
Holistic Analysis Methodology
that encourages the inclusion of all stakeholders including the facility administrator, client, patient, medical staff, maintenance staff, community, the site, cultural context, and profitability is illustrated in
Chapter 4
Typical space planning requirements
for the most common spaces within each medical typology are examined along with space planning exercises to provide practice and reinforce learning are in
Chapter 5
Major specialties
such as pediatrics, dentistry, gerontology, psychological, palliative and hospice, rehabilitation and substance abuse, and alternative and neuropathic medicine are covered in
Chapter 6
Group Practices
including single specialties practices and multiple specialty practices are examined in
Chapter 7
Community Care Clinics
that also serve as community centers, urgent care facilities, and facility-specific treatment spaces like college dispensaries are covered in
Chapter 8
Specialized Ambulatory Care Facilities
such as cancer treatment centers, dialysis, physical therapy, and outpatient surgery centers in
Chapter 9
General Architectural Considerations
including a brief overview of codes are covered in
Chapter 10
Lighting design
as it applies to healthcare design in
Chapter 11
Interior finishes and furniture
, including bariatric considerations, are covered in
Chapter 12
Biophilic Design
and strategies for incorporating it at a deep level in
Chapter 13
Well-Being
in regards to lifestyle and the built environment and the new focus of healthcare focusing on prevention in
Chapter 14
DESIGN EXERCISES
The examination of each practice is accompanied by design exercises of varying complexity and scope that are used throughout the book interchangeably in each section. These exercises are meant to provide valuable practice, reinforcement, and exploration, as well as increase overall knowledge. Applying newly learned information in a practical way provides important opportunities to learn further and embed information and processes more deeply.
ADDITIONAL RESOURCES
Each chapter includes a list of additional resources for further study. These resources have proved valuable to the authors as they have written this book, taught, or researched for healthcare projects. They are meant to supplement the subjects covered in this text and are provided for those who wish to explore topics at a deeper level, or have more specialized information.
GETTING THE MOST OUT OF THIS BOOK
The book was specifically designed to be used in a Healthcare Studio, though the information here would be just as useful for the individual learner at the beginning of designing healthcare projects. The information in this book is meant to be applied, not just read. Putting newly acquired knowledge to work shortly after reading is at the heart of learning and can greatly increase comprehension.
In the classroom setting, the value of this book is enhanced by the exchange of ideas among students working in collaborative groups, instructor’s comments, and open-classroom critiques and discussions. Beyond the classroom, the reader should take advantage of every opportunity to evaluate existing and published projects and talk with experienced design professionals.
Although this book prescribes a particular approach to designing healthcare projects, it should be understood that there are a range of successful methodologies in existence. In the professional community of healthcare designers, the problem-solving process can be varied. It is expected that the individual, after repeated experience with actual problems, will develop personalized methodologies for themselves.
COMPANION WEBSITE
A companion website to this book has a variety of tools and resources not found in the printed text. Please explore for additional resources and information.
Additional Resources
Design Drafting
by Francis Ching
Form, Space + Order
by Francis Ching
Evidence-Based Healthcare Design
by Rosalyn Cama
Medical and Dental Space Planning
by Jain Malkin
Space Planning Basics
by Mark Karlen and Rob Fleming
Chapter 2 EVIDENCE- BASED DESIGN
WHAT IS EVIDENCE-BASED DESIGN (EBD)
Evidence-based design is an iterative and integrative approach that bases its decisions on findings from current best practices, the organization and its occupants, and knowledge gained through the scientific study of human interaction with spaces, environments, materials, acoustics, and visual stimuli. The design team looks for deep-level connections between the physical world and the inner psychological and neurological workings of human beings to inform the guiding principles, objectives, and strategies. With the overriding focus on improving design outcomes and providing dignity and support for everyone within system, the profession highly values sharing and publishing data to further industry knowledge and provide credible measurable changes in health, behavior, and learning capability directly related to the built environment.
ORIGINS OF EVIDENCE-BASED DESIGN – A BRIEF HISTORY
Florence Nightingale
Florence Nightingale was one of the first people to acknowledge and address the importance of the built environment in healthcare and healing. The Environmental Theory, first presented in 1859, is based on her observations and experiences as a nurse during the 1850s cholera outbreak and the Crimean War field hospital in the 1860s. This was the period in history when “Germ Theory” was just being accepted, and handwashing started to be viewed as an important factor in preventing cross contamination. Sanitation was one of the biggest concerns with more people dying of cross-contamination infection than their original injury.
In 1862 she published Notes on Nursing: What It Is and What It Is Not, where she proposed that healing increased when patients had access to clear air, water, bedding and bandages, light or daylight, effective removal of waste, and the patient’s body, as well as the doctors’ and nurses’ hands were regularly cleaned.
She also believed that it was important for the patient to have a view outside and that controlling the noise in and around the patient was beneficial. Florence Nightingale’s Environment Theory went on to influence hospital design, patient care, and sanitary conditions for the rest of the nineteenth and twentieth centuries. They are still the basis for design, nursing, and infection control practices today. Her observations and suggestions were considered to be the beginning of healthcare reform.
Alvar Aalto – Paimio Tuberculosis Sanatorium
Alvar Aalto was a Finish Architect who had an active practice from the 1920s through 1970. One of his most famous projects was the Paimio Tuberculosis Sanatorium. It has been studied and admired for its innovative and beautifully simple, yet effective design solutions since it opened in 1933. Aalto viewed the building as an instrument of healing and approached the design program as a logical scientific problem, not purely as an aesthetic expression. He was new to healthcare design, therefore collaborated heavily with the medical professionals running the sanatorium.
To respond, the buildings are very long, tall, and thin with an orientation allowed all 145 patient rooms to have access to south–southwest exposure for optimal sun and daylight through floor to ceiling windows. These windows were designed as two separately framed panels that were slightly offset. This allowed fresh air to enter each room without a direct draft as well as conditioning it in the winter before it entered the space. The social spaces were designed to allow individual control over personal contact for infection control and social preferences. The building configuration and its details respond to the needs and purpose of the occupants, not a preconceived footprint or idea. It’s still an excellent example of holistic collaboration and configuring a building to fit its purpose based on research that serves it occupants.
Roger Ulrich
Roger Ulrich is perhaps the most well-known and influential evidence-based design researcher. He brought Evidence-based Design to the forefront of the design industry in 1984 with his now seminal study showing positive differences in patient recovery based on the view outside their hospital window. Evidence-based Design has grown as a profession since then and includes the fields of neuroscience, psychology, science, and architecture. It is also known as human-centered design and is based on an iterative process involving a broad range of interdisciplinary researchers, engineers, designers, and all the stakeholders.
IMPORTANCE TO DESIGN
There is a large body of research that connects the built environment with human behavior, health, and well-being. The configuration, materials, and composition of the built environment have been shown to affect patient stress, healing rates, staff effectiveness, and perceived quality of care. The basis of Evidence-based Design (EBD) is to improve the quality of health and well-being and the built environment based on credible research. It strives to be constantly evolving to meet the needs of clients, society, and emerging research. It’s focused on improving design protocol and performance outcomes through innovation based on knowledge and experience. It helps designers understand their clients and occupants better, while possibly discovering and solving potential issues that were unknown. The EBD process possesses an incredible opportunity to improve life for a large number of people and serve society by creating the best possible environment for them to work, play, and heal in.
PRINCIPLES AND PROCESS
EBD strives to look at projects from each occupant’s perspective. Interviews, mapping, research, observations, surveys, actual performative data, and established research from all related fields need to be analyzed by the whole interdisciplinary team. The process may reveal shifts in design objectives or opportunities for innovative approaches to solve issues or improve occupant outcomes that were previously unseen. The focus is on the outcome not preconceived or specific solutions, especially at the beginning.
8 Principles of Evidence-based Design
According to the Center for Healthcare Design Evidence-based Design (EBD) should follow 8 basic principles:
DEFINE goals, vision, directions, and objectives for the team to articulate and pursue
FIND resources with relevant research through existing sources or create basis for new studies
INTERPERT findings and assess credibility and applicability to current project
CREATE preliminary conclusions, concepts, and guidelines to influence design directives
HYPOTHESIZE outcomes directly related to design strategies/directives and establish testing or performance criteria
COLLECT information and data from baseline strategies and compare with preliminary guidelines
MONITOR application and implementation of research, established guidelines, and design strategies
MEASURE postoccupancy satisfaction and occupant input to revise and adjust future design directives
Iterative Process
Evidence-based Design (EBD) is an iterative process. Meaning that information and solutions are continually examined, analyzed, tested, and reworked rather than the traditional linear process. The following are steps to better define that process:
GATHER Information and External Intelligence
REVEAL Possible Design Solutions
QUESTION and Analyze
EXPLORE Possibilities
DECIDE to duplicate existing research or innovate
PREMEASURE Critical Features for Positive Outcomes
ALIGN Strategic Objective or Stated Outcomes
Types of Research
Qualitative Research
Qualitative research focuses on understanding or discovering the deeper aspects of human behavior by collecting and analyzing nonnumerical data. It seeks to understand or explore experiences, behavior, and interactions for valuable information that cannot be gained with measurements alone. The five main types of qualitative research are:
ETHNOGRAPHY – The researcher embeds themselves into the life or routine of the occupants. The researcher can take a purely observational role, or be an active participant in the function of the organization or space actively experiencing single or multiple perspectives.
NARRATIVE – Interviews, journals, or documents are used to gather data from one or multiple subjects over time to gain a fuller picture of occupant experience.
PHENOMENOLOGY – Experiential or perceptual based view using observations, interview, video, or on-site visits to gain insight or perspectives from users/occupants.
GROUNDED THEORY – Systematic data collection and analysis based on a question or data set. Repetitive ideas, elements and data are grouped, categorized, or coded to form new theories or directives.
CASE STUDY – Gathers detailed and in-depth information based on existing project or topic to gain best practices, design strategies, approaches, or outcomes.
Quantitative Research
Quantitative research is the systematic gathering of information that is transferred or converted into numerical or statistical form. The numerical data represents choices or activity in an unbiased way to identify patterns or to verify or refute a hypothesis. Data collection can be conducted on larger samples or populations to produce generalized results. The four main types of quantitative research are:
DESCRIPTIVE – Looks to understand an event, situation, or population through observation and measuring characteristics, trends, or categories through case studies, observations, and surveys
CORRELATIONAL – Used to identify the relationship between two variables. Positive correlation shows both variables change in the same direction; a negative correlation shows both variables change in opposite directions
EXPERIMENTAL – Aims to measure the effect of one or more independent variables by using the scientific method of only varying one variable at a time. Exacting records are kept to identify the effects
QUASI-EXPERIMENTAL – Looks to determine a cause-and-effect relationship like experimental research, but the groupings are less random and is more plausible in real-world situations.
ATTRIBUTES OF EVIDENCE-BASED DESIGNERS
Designers can apply evidence-based design principles and strategies regardless of the project typology, the formality of the process, or the client’s desire. Credible research, occupant experience, functional needs, and the input of an interdisciplinary team should be part of every project. The following attributes drive the EBD process but should be qualities that all designers should strive to make part of their professional analytical skills.
BE CURIOUS – Choose to look deeper at every aspect, use the Japanese principle of 5-Whys which progressively asks why five times to reveal the underlying or root cause of a problem or issue.
BE OPEN to information and new ideas – Approach the design problem free of preconceived solutions and freely welcome information that may initially contradict your initial thoughts.
INCLUDE EVERYONE – Look at all stakeholders and their position and concerns. Understanding all sides of a design problem is essential if a holistic solution that truly solves the problem and increases positive outcomes is to be found.
VALUE ALL INPUT AS VALUABLE AND VALID – All stakeholders have something to contribute regardless of their professional standing. Many times, the best ideas come from outside the profession; these can give the fullest view of the project.
UNDERSTAND IT’S A PROCESS – All stakeholders may not be at the same place. Uncovering deeper patterns and more holistic solutions takes time and multiple iterations. Being willing to explore the projects and its needs will yield the best results for everyone.
ASSOCIATED ORGANIZATIONS
These are organizations that are especially associated with Evidence-based Design in healthcare settings. They provide valuable information, certification, and networking opportunities.
Center for Health Design (CHD)
American Association on Health Disability (AAHD)
American Academy of Healthcare Interior Designers (AAHID)
National Library of Medicine
Agency for Healthcare Research and Quality
Healthcare Associated Infections Organization
The Journal of Healthcare Infection Society
Healthcare Design Expo + Conference
Facilities Guidelines Institute
Institute for Patient Centered Design
Nursing Institute for Healthcare Design
Society for Advancement of Gerontological Environments
Additional Resources
Books
A Pattern Language
by Christopher Alexander
Brain Landscape
by John Paul Eberhard
Evidence Based Healthcare
by Rosalyn Cama
Environmental Psychology for Design
by Dak Kopec
Place Advantage
by Sally Augustin
The Architecture of Health: Hospital Design and the Construction of Dignity
by Michael Murphy with Jeffrey Mansfield and MASS Design Group
The Memory of Place
by Dylan Trigg
The Poetics of Space
by Gaston Bachelard
Topophobia
by Dylan Trigg
Articles ± Websites
Academy of Neuroscience for Architecture (ANFA) Website:
anfarch.org
Applying Evidence Based Design to Healthcare Facilities
. Retrieved from HMC Architects Website:
hmcarchitects.com/news/applying-evidence-based-design-to-healthcare-facilities-2018-09-21
Evidence Based Design Accreditation and Certification Study Guide. Retrieved from The Center for Health Design Website:
www.healthdesign.org/clinic-design/solution-library/resources/evidence-based-design-accreditation-and-certification-study
The New Standard for Making Hospitals More Hospitable
, Hospitality Healthscapes. Retrieved from Boston University School of Hospitality Administration Website:
www.bu.edu/bhr/2017/06/07/hospitality-healthscapes
The Center for Healthcare Design Website:
www.healthdesign.org/topics
The Center for Health Design, Ambulatory + Clinic Design. Retrieved from the Center for Health Website:
ambulatory.healthdesign.org
The Center for Health Design, Insights + Solutions. Retrieved from The Center for Health Design Website:
www.healthdesign.org/insights-solutions?f%5B0%5D=field_resource_type%3A1088
Think Better- Neuroscience: The Competitive Advantage
. Retrieved from Steelcase Website:
www.steelcase.com/eu-en/research/articles/topics/open-plan-workplace/think-better
University of North Carolina Institute for Healthcare Quality Improvement, University of North Carolina School of Medicine Website:
www.med.unc.edu/ihqi/about-us
Why Architectural Education Need to Embrace Evidence-Based Design, Now
. Retrieved from ADPro Website:
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Chapter 3 GENERAL ELEMENTS OF HEALTHCARE
Healthcare is an industry that is influenced by many factors including a nation’s governmental view of its importance or applicability to certain populations. As the authors are from the United States and that is their main point of reference, a brief history of how the US medical system came to be follows. The point is to understand that there are many factors that influence medical and healthcare facilities across the world, and sometimes even within a single country. Being aware of history and all the resulting factors for the location of the project can provide illumination of design directives, or governmental and/or agencies requirements, making the process more streamlined.
HISTORY OF THE US MEDICAL SYSTEM
1800s –
Lumber companies in the Northwest were some of the first to have compensated physicians to care for their workers. This would be one of the earliest precedents for employer-provided health insurance as we know it today.
1900s –
National Convention of Insurance Commissioners introduced a model for other states to follow to regulate health insurance. A few years later, the American Association for Labor Legislation proposed a bill for mandatory health insurance.
1929 –
Baylor University Hospital in Dallas, Texas, collaborated with area schools to provide healthcare to teachers, forming the beginnings of Blue Cross health insurance plans.
1930s
– The Great Depression highlighted the need for health coverage. Aqueduct workers were given fixed rates for healthcare at a local hospital. This evolved into a managed care system, which is what we refer to today as HMOs and PPOs.
Late 1930s to mid-1940s
– The Social Security Board recommended national health insurance to be included in the Social Security system.
Early 1950s
– A federal reinsurance fund was proposed so that private insurance companies could help expand health coverage to its policyholders; around the same time, the Federal Security Agency proposed health insurance benefits for Social Security beneficiaries.
1965
– Medicare was enacted providing insurance for senior citizens (age 65 and older).
1973
– Disabled citizens under the age of 65 became eligible for Medicare.
1996
– Health Insurance Portability and Accountability Act (HIPAA) created additional protections for people with preexisting health conditions.
2010
– Affordable Care Act (ACA) was signed to increase the affordability of health insurance and protect citizens with preexisting conditions. It also enabled children up to 25 years old to remain on their parents’ health insurance plan. The ACA has lowered the amount of uninsured in the US.
Healthcare design is certainly influenced by its political and historical evaluation. Understanding this evolution sheds light onto current requirements, legislation, and codes. An understanding of these issues aids in designing and guiding the client through the creation of new facilities. Healthcare legislation does have an impact on the built environment and design directives, similar to how the Affordable Care Act created the need for more primary care clinics, or HIPPA requiring modifications for privacy or changing the way certain areas within a healthcare facility are configured.
CODES, REGULATIONS AND INDUSTRY STANDARDS
Building codes are laws that dictate the minimum guidelines when designing a healthcare facility. There are multiple codes that apply to healthcare projects as well as industry standards or other rating systems. The client will have an understanding of other regulatory agencies that must be included or approve design solutions or if there are rating systems they wish to pursue. The Facility Guidelines Institute (FGI) standards are heavily utilized in healthcare design and are considered an industry standard. Federal facilities have additional guidelines, standards, codes, and regulations that must be followed. There are outside accreditation bodies that rate facilities, direct design strategies, and construction protocols to assure quality of care and are required for certain government funded medical coverage. An example would be The Joint Commission (TJC) which is a United States-based nonprofit organization that accredits healthcare organizations and is considered the standard for healthcare design. Another example would be the Commission on Accreditation of Rehabilitation Facilities (CARF) which is an international nonprofit organization concerned with setting standards for rehabilitation and behavioral health institutions. As a design professional, it is important to understand the client’s accreditation, or desired accreditation goals, as many of these have standards for the design of the physical environment. For more detailed information see The Center for Health Design website regarding safety standards.
SPECIALIZED FACILITY AND MECHANICAL REQUIREMENTS
Healthcare facilities regardless of their typology should embody all the standard principles of design. They should seek to meet the experiential, functional, social, and cultural needs of the project, consider the site and ecosystem, and work as an integrated whole while being beautiful and resonating deeply with its occupants. In addition to all fundamental aspects of design, there are specialized or expanded requirements present in all healthcare projects that need to be at the forefront of the design process.
Identifying and Including Stakeholders
Stakeholders are any person, group, or agency that would or could be affected by, has an interest in, or could affect the project or its design. In healthcare projects this includes providers, staff, maintenance and cleaning staff, patients, families, administration, owners, designers, architects, engineers, equipment dealers, contractors, neighbors, government officials, the community, donors, or associated outpatient centers. Identifying all the stakeholders is a process that takes place during the initial project phases and is based on collaboration and research. Establishing this can result in a list, but many times a chart or map is created that shows all the stakeholders and their relationships, very similar to systems thinking mapping. By illustrating the relationships with a diagram or map, deeper patterns and connections, or areas of concern are more easily seen and can be addressed; see Figure 3.1.
Figure 3.1 Sample of Stakeholder Mapping.
Source: Saglinda H Roberts
The next step is to assemble a diverse interdisciplinary team that represents the broad perspective of the stakeholders that is focused on collaboration and finding the best possible outcomes. They need to be willing to think outside the box to find solutions to problems revealed by interdisciplinary examination, research, and design. The holistic analysis process is covered in more detail in Chapter 4.
Infection Control
Inflection control is of utmost importance and the primary focus in any healthcare facility as healthcare-associated infections (HAI) and other easily transmittable illnesses or diseases are of primary concern. The objects, surfaces, and healthcare workers themselves are constantly exposed to multiple pathogens from multiple sources and these can be transported between patients or areas of the built environment without the person’s knowledge. Infection that happens outside of person-to-person contact can be linked with surfaces, materials, environmental conditions, design and layout, cleaning and disinfection processes, and education, with hand hygiene the most important component. Many of the pathogens can persist on surfaces for days or months, and some are even present after cleaning products have been applied. The surfaces, sometimes referred to as vehicles of transmission or pathogen reservoirs, can be elements of the built environment, equipment, clothing, or patient care items. Cross contamination or cross infection also depend on how much physical contact there is, type of surface material, cleaning methods, and environmental conditions. The main ways to prevent cross-contact infection or contamination are to increase hand hygiene, create physical barriers to transmission and areas of isolation, make informed surface selections, and institute-educated cleaning protocols. The three main ways the built environment can affect or help deter cross-contact infection are:
Surfaces
Surfaces are constantly touched by patients and healthcare workers and can be potential reservoirs for all types of pathogens. Surfaces are classified as either hard or soft. Examples of hard surfaces would include doors, door knobs, counters, equipment, floors, keyboards, etc. Soft surfaces typically include upholstery, privacy curtains, clothing, linens. Both types of surfaces can be the root of cross infection. Researching the chemical composition of a surface and the ability of pathogens to adhere to it can be of great help in determining its best use. There is a growing body of materials that have surface coated or impregnated antimicrobial treatments, natural elements like silver or copper in them, or have fine textural configurations that reduce the ability for pathogens to adhere or grow on their surface. The research and long-term effects on human health of all of these options need to be carefully examined and weighted against cross infection.
Environmental Conditions
Environmental conditions are determined by the HVAC (Heating Ventilation Air-Conditioning) systems. Codes and Facility Guidelines for medical and healthcare facilities all have HVAC requirements. These requirements need to be complied with to satisfy the law, but whereever possible increasing their performance matrix should be considered. How air flows between spaces needs to be carefully analyzed as well as which sections of a facility should be zoned separately, or on separate HVAC systems. These considerations are essential to controlling cross contamination through environmental means. For more detailed information, see Harvard T.H. Chan School of Public Health, or The Center for Health design.
Cleaning and Disinfection
Cleaning and disinfection are as much about the operations and organizational policies as they are about the cleaning products and staff. Employing education or training, monitoring and compliance systems, and clear procedures and chains of responsibility can increase disinfection. These are not typically the responsibility of the design professional, but being aware of them allows a fuller understanding of the need, the chance to help educate, and the ability to collaborate with infection professionals from the beginning of the process. Areas that typically do fall within the responsibility of design professionals are material selection, room layout, sink or handwashing locations, surface or component configurations, and HVAC systems.
Studies have shown that even surfaces that appear clean, or that have recently been cleaned still contain pathogens whether they are considered hard or soft surfaces. Soft surfaces or things like privacy curtains or upholstery are a huge reservoir for pathogens, and hard surfaces like window sills or keyboards are commonly overlooked areas in the cleaning routines. Understanding material specification and the compounds best used for cleaning is paramount along with helping to establish cleaning responsibility, protocol, easy ways to determine if they are clean, and ways to measure compliance are all imperative to disinfection and true cleaning. Looking into alternate methods of disinfection like UV light or other emerging techniques can increase effectiveness without chemicals and decrease labor.
