Marie Elf

Shared decision making in designing new healthcare environments—time to begin improving quality

BackgroundSuccessful implementation of new methods and models of healthcare to achieve better patient outcomes and safe, person-centered care is dependent on the physical environment of the healthcare architecture in which the healthcare is provided. Thus, decisions concerning healthcare architecture are critical because it affects people and work processes for many years and requires a long-term financial commitment from society. In this paper, we describe and suggest several strategies (critical factors) to promote shared-decision making when planning and designing new healthcare environments.DiscussionThis paper discusses challenges and hindrances observed in the literature and from the authors extensive experiences in the field of planning and designing healthcare environments. An overview is presented of the challenges and new approaches for a process that involves the mutual exchange of knowledge among various stakeholders. Additionally, design approaches that balance the influence of specific and local requirements with general knowledge and evidence that should be encouraged are discussed.SummaryWe suggest a shared-decision making and collaborative planning and design process between representatives from healthcare, construction sector and architecture based on evidence and end-users’ perspectives. If carefully and systematically applied, this approach will support and develop a framework for creating high quality healthcare environments.

Sustainability in nursing: a concept analysis.

Aim The aim of this study was to describe, explore and explain the concept of sustainability in nursing. Background Although researchers in nursing and medicine have emphasised the issue of sustainability and health, the concept of sustainability in nursing is undefined and poorly researched. A need exists for theoretical and empirical studies of sustainability in nursing. Design Concept analysis as developed by Walker and Avant. Method Data were derived from dictionaries, international healthcare organisations and literature searches in the CINAHL and MEDLINE databases. Inclusive years for the search ranged from 1990 to 2012. A total of fourteen articles were found that referred to sustainability in nursing. Results Sustainability in nursing involves six defining attributes: ecology, environment, future, globalism, holism and maintenance. Antecedents of sustainability require climate change, environmental impact and awareness, confidence in the future, responsibility and a willingness to change. Consequences of sustainability in nursing include education in the areas of ecology, environment and sustainable development as well as sustainability as a part of nursing academic programs and in the description of the academic subject of nursing. Sustainability should also be part of national and international healthcare organisations. The concept was clarified herein by giving it a definition. Conclusion Sustainability in nursing was explored and found to contribute to sustainable development, with the ultimate goal of maintaining an environment that does not harm current and future generations′ opportunities for good health. This concept analysis provides recommendations for the healthcare sector to incorporate sustainability and provides recommendations for future research.

Using system dynamics for collaborative design : a case study

BackgroundIn order to facilitate the collaborative design, system dynamics (SD) with a group modelling approach was used in the early stages of planning a new stroke unit. During six workshops a SD model was created in a multiprofessional group.AimTo explore to which extent and how the use of system dynamics contributed to the collaborative design process.MethodA case study was conducted using several data sources.ResultsSD supported a collaborative design, by facilitating an explicit description of stroke care process, a dialogue and a joint understanding. The construction of the model obliged the group to conceptualise the stroke care and experimentation with the model gave the opportunity to reflect on care.ConclusionSD facilitated the collaborative design process and should be integrated in the early stages of the design process as a quality improvement tool.

An audit of the content and quality in briefs for Swedish healthcare spaces

Purpose: Initial briefs (programs) were examined in order to obtain an overview of current practice in documenting the briefing process for new health care buildings in Sweden. Methodology: An audit instrument was developed and used to examine briefs for the content and quality of information and to determine whether and to what extent the information was comprehensive and patient oriented. Findings: The results indicate that few strategic briefs make use of evidence to support their statements. Moreover, few briefs had an explicitly patient-focused goal for the project or measurable outcomes. Implication for practice: This new audit approach can be applied in various organisations and over time to improve the briefing process and create clearer goals and guidelines. Originality/value: The present study contributes with an audit of written briefs. The question of whether the use of briefing and a systematic brief make a significant contribution to the high quality of design solutions remains unanswered, as is also the case of whether the brief, in general, reflects the briefing process. Despite the recent focus on improving the quality of the briefing process, there is a lack of knowledge concerning the documentation resulting from the briefing process. Studies are needed that employ different approaches in order to accept or reject the assumption that the briefs are an accurate reflection of the briefing process.

The case of value-based healthcare for people living with complex long-term conditions

BackgroundThere is a trend towards value-based health service, striving to cut costs while generating value for the patient. The overall objective comprises higher-quality health services and improved patient safety and cost efficiency. The approach could align with patient-centred care, as it entails a focus on the patient’s experience of her or his entire cycle of care, including the use of well-defined outcome measurements. Challenges arise when the approach is applied to health services for people living with long-term complex conditions that require support from various healthcare services. The aim of this work is to critically discuss the value-based approach and its implications for patients with long-term complex conditions. Two cases from clinical practice and research form the foundation for our reasoning, illustrating several challenges regarding value-based health services for people living with long-term complex conditions.DiscussionAchieving value-based health services that provide the health outcomes that matter to patients and providing greater patient-centredness will place increased demands on the healthcare system. Patients and their informal caregivers must be included in the development and establishment of outcome measures. The outcome measures must be standardized to allow evaluation of specific conditions at an aggregated level, but they must also be sensitive enough to capture each patient’s individual needs and goals. Healthcare systems that strive to establish value-based services must collaborate beyond the organizational boundaries to create clear patient trajectories in order to avoid fragmentation.SummaryThe shift towards value-based health services has the potential to align healthcare-service delivery with patient-centred care if serious efforts to take the patient’s perspective into account are made. This is especially challenging in fragmented healthcare systems and for patients with long-term- and multi-setting-care needs.

Self-Reported Fatigue and Associated Factors Six Years after Stroke

Several studies have found that fatigue is one of the most commonly reported symptoms after stroke and the most difficult to cope with. The present study aimed to investigate the presence and severity of self-reported fatigue six years after stroke onset and associated factors. The cohort “Life After Stroke Phase I” (n = 349 persons) was invited at six years to report fatigue (Fatigue Severity Scale 7-item version), perceived impact of stroke and global recovery after stroke (Stroke Impact Scale), anxiety and depression (Hospital Anxiety and Depression Scale), life satisfaction (Life Satisfaction Checklist) and participation in everyday social activities (Frenchay Activities Index). At six years 37% of the 102 participants in this cross-sectional study reported fatigue. The results showed that in nearly all SIS domains the odds for post-stroke fatigue were higher in persons with a higher perceived impact. Furthermore, the odds for post-stroke fatigue were higher in those who had experienced a moderate/severe stroke and had signs of depression and anxiety. Fatigue is still present in one-third of persons as long as six years after stroke onset and is perceived to hinder many aspects of functioning in everyday life. There is an urgent need to develop and evaluate interventions to reduce fatigue.

Assessing the physical environment of older people’s residential care facilities: development of the Swedish version of the Sheffield Care Environment Assessment Matrix (S-SCEAM)

BackgroundThere is emerging evidence that the physical environment is important for health, quality of life and care, but there is a lack of valid instruments to assess health care environments. The Sheffield Care Environment Assessment Matrix (SCEAM), developed in the United Kingdom, provides a comprehensive assessment of the physical environment of residential care facilities for older people. This paper reports on the translation and adaptation of SCEAM for use in Swedish residential care facilities for older people, including information on its validity and reliability.MethodsSCEAM was translated into Swedish and back-translated into English, and assessed for its relevance by experts using content validity index (CVI) together with qualitative data. After modification, the validity assessments were repeated and followed by test-retest and inter-rater reliability tests in six units within a Swedish residential care facility that varied in terms of their environmental characteristics.ResultsTranslation and back translation identified linguistic and semantic related issues. The results of the first content validity analysis showed that more than one third of the items had item-CVI (I-CVI) values less than the critical value of 0.78. After modifying the instrument, the second content validation analysis resulted in I-CVI scores above 0.78, the suggested criteria for excellent content validity. Test-retest reliability showed high stability (96% and 95% for two independent raters respectively), and inter-rater reliability demonstrated high levels of agreement (95% and 94% on two separate rating occasions). Kappa values were very good for test-retest (κ = 0.903 and 0.869) and inter-rater reliability (κ = 0.851 and 0.832).ConclusionsAdapting an instrument to a domestic context is a complex and time-consuming process, requiring an understanding of the culture where the instrument was developed and where it is to be used. A team, including the instrument’s developers, translators, and researchers is necessary to ensure a valid translation and adaption. This study showed preliminary validity and reliability evidence for the Swedish version (S-SCEAM) when used in a Swedish context. Further, we believe that the S-SCEAM has improved compared to the original instrument and suggest that it can be used as a foundation for future developments of the SCEAM model.

An assessment of briefs used for designing healthcare environments : a survey in Sweden

The brief is a central document in decision-making during the early stages of the planning and construction (briefing/programming) of healthcare environments. Thus, the demand on the content and quality of these documents is high. The content and quality of initial briefs developed in Sweden were assessed to obtain an up-to-date picture of current practices of writing project statements in the early stages of designing healthcare environments. A new instrument called the Content and Quality of Brief Instrument (CQB-I) was used to study 29 initial briefs. In many cases, the documentation in the briefs was incomplete and the information did not adequately address users’ needs. In addition, the briefs often did not include any measurable outcomes or explicitly evidence-based information. These findings have implications for identifying areas for improvement in design teams’ documentation practices. Assessment can have a real impact on the quality of briefs and can raise awareness of the need to improve the briefing process itself. This is one of the first studies to assess the content and quality of briefs and it provides a starting point for both practitioners and future researchers to explore the role of briefs in briefing process quality improvement.

Questioning context: a set of interdisciplinary questions for investigating contextual factors affecting health decision making

Objective  To combine insights from multiple disciplines into a set of questions that can be used to investigate contextual factors affecting health decision making.

A comparative study of patients' activities and interactions in a stroke unit before and after reconstruction-The significance of the built environment.

Early mobilization and rehabilitation, multidisciplinary stroke expertise and comprehensive therapies are fundamental in a stroke unit. To achieve effective and safe stroke care, the physical environment in modern stroke units should facilitate the delivery of evidence-based care. Therefore, the purpose of this study was to explore patients’ activities and interactions in a stroke unit before the reconstruction of the physical environment, while in a temporary location and after reconstruction. This case study examined a stroke unit as an integrated whole. The data were collected using a behavioral mapping technique at three different time points: in the original unit, in the temporary unit and in the new unit. A total of 59 patients were included. The analysis included field notes from observations of the physical environment and examples from planning and design documents. The findings indicated that in the new unit, the patients spent more time in their rooms, were less active, and had fewer interactions with staff and family than the patients in the original unit. The reconstruction involved a change from a primarily multi-bed room design to single-room accommodations. In the new unit, the patients’ lounge was located in a far corner of the unit with a smaller entrance than the patients’ lounge in the old unit, which was located at the end of a corridor with a noticeable entrance. Changes in the design of the stroke unit may have influenced the patients’ activities and interactions. This study raises the question of how the physical environment should be designed in the future to facilitate the delivery of health care and improve outcomes for stroke patients. This research is based on a case study, and although the results should be interpreted with caution, we strongly recommend that environmental considerations be included in future stroke guidelines.