Xiaobo Quan, Ph.D, EDAC is a research associate at the Center for Health Design (CHD). Xiaobo focuses his efforts on special research projects, as well as the CHD’s major research initiative, the Pebble Project. Working closely with director of research, Anjali Joseph, Ph.D, EDAC and Pebble Project partners, planners, designers and other researchers, he examines the impact of the built environment on human behaviors and healthcare outcomes.
What was the inspiration for your research?
The patient room is indisputably the most important space in the hospital — and all hospital design teams spend a significant amount of time and effort to make sure they get the design of this space right. This is where the majority of direct patient care is provided and where complex interactions among patients, families, staff, equipment and the environment take place. Further, this unit is repeated multiple times within a hospital — so it is critical to get this space right. We believed we could support design teams by developing a standardized set of evidence-based design considerations for patient room design. The patient room checklist will enable teams to understand the range of issues they must consider and then weigh the benefits of different features. The patient room post-occupancy evaluation tool will help teams understand how well key goals of patient safety, worker effectiveness and quality were met through the design of the patient room.
Throughout the research, have you had any unexpected findings?
One of the findings from our work has been that the research on the inpatient room, while extensive, is not comprehensive. There is still no consensus, for example, on the efficacy of same-handed rooms, use of antimicrobial treatments on finishes, and use of copper alloys in fixtures to reduce risk of infection. These areas have therefore been left out of the scope of this iteration of the tool. While multiple strategies have been implemented in the design of the inpatient room, there is no research to prove that a specific layout is better than another or a specific room shape is better than another. On the one hand there is a great level of detail known about hand-washing compliance and design of sinks and faucets (going all the way to the level of using electronic sensor reminders). On the other hand, we know little about fundamental room design issues like surface finishes and the design of fixtures and furniture.
This varying level of knowledge about inpatient rooms is both a challenge and an opportunity for design. What emerged from the literature is that designers need to be clear on the key considerations for design and on possible design features to meet these considerations. As technology advances and the market place changes, new design products and strategies will emerge. By hinging the tool on key considerations, which are linked to both design and health outcomes, we have attempted to build a framework that will stay robust and allow the incorporation of new information in research and design.
Looking beyond the findings, what do you hope to accomplish through this research?
We hope this project results in an easy to use, actionable tool that will be widely used by healthcare design teams. Our goal with this study was to develop a tool that will help focus the discussions in design teams on key goals they hope to achieve through the facility design project — such as reducing falls, reducing healthcare acquired infections, etc. We hope that that this tool will get multidisciplinary teams on the same page regarding the important goals for patients and staff and then help the teams figure out creative design solutions to achieving those goals.
What has been the most rewarding part of your project?
The most rewarding part of this project has been working with a very passionate and knowledgeable group of industry experts and partners. The advisory committee has been deeply involved at every step of the way providing input, helping us refine the tools and helping us ensure that this tool will be useful to the end user. Davis Partnership Architects has helped us pilot test the tool, and the feedback from the pilot test has been invaluable. The support from all these individuals and their excitement in the project and what we are creating has been extremely rewarding.
What has been your biggest challenge while collecting data?
One challenge is the lack of research on some topics around patient room design. Even though the evidence base for patient room design is relatively stronger than other types of spaces in acute care hospitals, research gaps do exist. Because of these gaps and the variation in the level of details that are available in the evidence about individual design features, some design considerations and design features included in the tools are based on relatively weaker evidence and/or non-research knowledge from best practices.
The patient room interior design checklist enables design teams to prioritize specific design considerations and utilize evidence to weigh the pros and cons of different design solutions.
How do you see the results implemented or used by interior designers?
The patient room interior design checklist and post-occupancy evaluation (POE) tool developed in this project will provide easy access to the patient room design evidence base in a practical and actionable format. The checklist will enable design teams to prioritize specific design considerations and utilize evidence to weigh the pros and cons of different design solutions from the perspective of their impacts on patient, staff and organizational outcomes. The POE tool will be used to evaluate whether existing patient room environment supports effective work practices and patient outcomes. It includes a checklist for conducting a walk-through of a patient room and a structured questionnaire to facilitate interviews and focus groups with the users. The design teams may use the collected data to verify the effectiveness of design implementation and apply lessons learned in future projects.
How do you see the results implemented or used by healthcare facilities?
By using the patient room design tools developed in this project, healthcare facilities will be able to ensure a process of basing patient room design decisions on credible research to achieve the best possible outcomes. The tools may be used as an essential part of design process to clarify the goals, priorities and anticipated outcomes of patient room design and to facilitate the communication among multidisciplinary design team members, including the healthcare facility representatives, designers and other professionals. The results of design can be empirically evaluated post-occupancy using the standard tool to allow benchmarking against other similar facilities and contribute to organizational learning. The POE results can also be used to identify weaknesses in the existing design for the purpose of continuously improving the patient room environment.
The feature image is of a patient room at St. Anthony Hospital. Photo courtesy of ESa. Photo Credit: Michael Peck
