Xiaobo Quan

A Review of the Research Literature on Evidence-Based Healthcare Design

Objective: This report surveys and evaluates the scientific research on evidence-based healthcare design and extracts its implications for designing better and safer hospitals. Background: It builds on a literature review conducted by researchers in 2004. Methods: Research teams conducted a new and more exhaustive search for rigorous empirical studies that link the design of hospital physical environments with healthcare outcomes. The review followed a two-step process, including an extensive search for existing literature and a screening of each identified study for the relevance and quality of evidence. Results: This review found a growing body of rigorous studies to guide healthcare design, especially with respect to reducing the frequency of hospital-acquired infections. Results are organized according to three general types of outcomes: patient safety, other patient outcomes, and staff outcomes. The findings further support the importance of improving outcomes for a range of design characteristics or interventions, including single-bed rooms rather than multibed rooms, effective ventilation systems, a good acoustic environment, nature distractions and daylight, appropriate lighting, better ergonomic design, acuity-adaptable rooms, and improved floor layouts and work settings. Directions for future research are also identified. Conclusions: The state of knowledge of evidence-based healthcare design has grown rapidly in recent years. The evidence indicates that well-designed physical settings play an important role in making hospitals safer and more healing for patients, and better places for staff to work.

A Conceptual Framework for the Domain of Evidence-Based Design

The physical facilities in which healthcare services are performed play an important role in the healing process. Evidence-based design in healthcare is a developing field of study that holds great promise for benefiting key stakeholders: patients, families, physicians, and nurses, as well as other healthcare staff and organizations. In this paper, the authors present and discuss a conceptual framework intended to capture the current domain of evidence-based design in healthcare. In this framework, the built environment is represented by nine design variable categories: audio environment, visual environment, safety enhancement, wayfinding system, sustainability, patient room, family support spaces, staff support spaces, and physician support spaces. Furthermore, a series of matrices is presented that indicates knowledge gaps concerning the relationship between specific healthcare facility design variable categories and participant and organizational outcomes. From this analysis, the authors identify fertile research opportunities from the perspectives of key stakeholders.

Impact of the Physical Environment of Residential Health, Care, and Support Facilities (RHCSF) on Staff and Residents A Systematic Review of the Literature

The physical environment of residential health, care, and support facilities (RHCSF) is a critical component in providing supportive and resident-centered care for the elderly. Although past reviews of the literature have focused on specific settings for the elderly or specific residential populations of the elderly, a systematic literature review that covers the range of settings and populations has been lacking. This article provides an overview and synthesis of the most recent empirical evidence addressing the impact of the physical environment on residents and staff of RHCSFs. The review also identifies gaps where future research is needed. This review found 66 studies examining the relationship between the built environment and outcomes in three broad domains of resident quality of life, resident safety, and staff and organizational outcomes. The studies address a range of topics including the impact on elderly residents of the facility scale and size, outdoor environments, and environmental quality.

Impact of Imaging Room Environment: Staff Job Stress and Satisfaction, Patient Satisfaction, and Willingness To Recommend

Background: The built environment significantly affects the healthcare experiences of patients and staff. Healthcare administrators and building designers face the opportunity and challenge of improving healthcare experience and satisfaction through better environmental design. Objective: The purpose of the study was to evaluate how a novel environmental intervention for imaging rooms, which integrated multiple elements of healing environments including positive distractions and personal control over environment, affects the perceptions and satisfactions of its primary users—patients and staff. Methods: Anonymous questionnaire surveys were conducted to compare patient and staff perceptions of the physical environment, satisfaction, and stress in two types of imaging rooms: imaging rooms with the intervention installed (intervention rooms) and traditionally designed rooms without the intervention (comparison rooms). Results: Imaging technologists and patients perceived the intervention rooms to be significantly more pleasant-looking. Patients in the intervention rooms reported significantly higher levels of environmental control and were significantly more willing to recommend the intervention rooms to others. Conclusions: The environmental intervention was effective in improving certain aspects of the imaging environment: pleasantness and environmental control. Further improvement of the imaging environment is needed to address problematic areas such as noise.

Building a knowledge base for evidence-based healthcare facility design through a post-occupancy evaluation toolkit

Background: Post-occupancy evaluation (POE) can play a critical role in evidence-based healthcare design (EBD) by evaluating design effectiveness and adding to the knowledge base. However, its potential has not been fully realized due to the lack of standardized tools, inaccessibility of findings, a focus on technical performance instead of patient-centred outcomes, and irrelevance to healthcare processes. Objective: To strengthen the EBD knowledge base by developing standardized POE tools. Methodology: A conceptual framework was created from a review of over 100 research publications. A standardized POE toolkit was developed, including questionnaires on design strategies, healthcare outcomes, and staff perception. Pilot testing was conducted at five healthcare construction projects. This toolkit is being further augmented by additional on-site audit POE tools. Findings: From the pilot testing of the first POE tool, significant variations were found among the five pilot facilities in terms of the design strategies adopted. Satisfaction with the indoor environment was higher among occupants at facilities with more sustainable design strategies implemented. Patients reported high satisfaction (65–83% top ratings) and high willingness to recommend facilities (71–85% ‘definitely recommend’). The general satisfaction of staff with building ranged from 0.88 to 2.2 on a scale from −3 to 3. Conclusion: A robust framework and a set of standard tools for obtaining broad building-level data related to healthcare design have been established to comprehensively evaluate building performance and to enable quick dissemination and easy access to new knowledge created.

Improving Pediatric Radiography Patient Stress, Mood, and Parental Satisfaction Through Positive Environmental Distractions: A Randomized Control Trial

UNLABELLED To evaluate how a positive environmental distraction intervention impacted pediatric radiography patient behavioral stress-responses, mood states, and parental satisfaction. METHODS Behavioral observation, rating scales, surveys on 182 pediatric patients and their parents randomly assigned to three positive distraction levels (minimum, light, light and animation). RESULTS Under interventional conditions, patients exhibited less low-stress coping behaviors (ps<0.001-0.007) and more verbal behaviors indicating positive affect (p=0.003); parents more favorably rated environmental pleasantness (ps<0.001), sense of environmental control (ps=0.002), and willingness to return and recommend the facility (ps=0.001-0.005). CONCLUSION The intervention improved pediatric radiography experience but needs further investigation in more stressful settings.