Evidence- based Co- design of Healthcare Architecture

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1 CVA Centrum för Vårdens Arkitektur Centre for Healthcare Architecture Evidence- based Co- design of Healthcare Architecture Peter Fröst, Architect, PhD, Artistic professor

2 CVA Centrum för Vårdens Arkitektur Centre for Healthcare Architecture 1. Background why? 2. EBD - Evidence Based Design, very short 3. DD - Design Dialogues 4. EBCP - Evidence Based Concept Programs 5. An example of EBD + DD 6. (Master courses in Healthcare Architecture at Chalmers)

3 How do we know what we should design?

4 The Kitchen During the 60s, the Swedish Building Research Institute undertook kitchen studies and measured f ex load / oxygen uptake during dish washing and movement patterns for different activities.

5 Norms and standards - kitchen From research, a kitchen standard was designed. The standard became the condition for loans and building permits.

6 Standard Kitchen Functional and efficient. Based on research. Kitchen design

7 Hospitals

8 Norms and standards - Hospitals

9 The kitchen - customer driven, experience, recreation, consumer goods, status symbol, dream... Kitchen of the furure

10 Healthcare of the future New therapies, new medical technology, ICT, demography

11 The Real Estate Market Deregulation Many players Implementation difficult Fragmented aim & objectives Increasing complexity Constant change The Energy Market The Railway Industry What has characterized these sectors over the past 50 years? Source: Peter Lindroos, 2012

12 Normative Dynamic Integrated planning model Normative Standards Guideline Knowledge development is handled centrally Dynamic Staffparticipation Tailored solutions Knowledge development is handled locally Integrated planning model Dialogues about Space and Activity based on knowledge from research (evidence) and practice

13 Evidence Based Design Evidence- based design, which bases design decisions on the best available current research evidence, is gaining traction among architects. Expanding the field from its origins in healthcare to other building types such as education, criminal justice, commercial, industrial, and offices.

14 Effects of nature window view on pain following surgery. Roger Ulrich, Science 1984 Reduced pain Fewer adverse effects Shorter length of stay Analgesic NATURE WALL Strength patients patients Strong Moderate Weak Number of Pain Drug Doses (days 2-5 after surgery)

15 Research results Well designed healthcare environments can improve patient safety One example is patient falls. Proximity between the bed and bathroom, Short walking distance, handrails. Staff overview over wardroom. Possibilities for next of kin to stay with the patient. Ulrich, R (2012). Evidensbas för vårdens arkitektur 1.0. Chalmers tekniska högskola, Göteborg

16 Research results Attractive healthcare architecture has a positive influence on perceived care quality The attractiveness and comfort of a waiting room, noise in a patient room, and privacy experienced during an examination all are concrete, immediately understandable evidence and accordingly have a disproportionately strong impact on patients satisfaction with their care experiences. Chang, J. T et al(2006). Patients global ratings of their health care are not associated with the technical quality of their care. Annals of Internal Medicine 144(9),

17 Research results Communication and knowledge sharing Healthcare architecture is not just "efficiency" machines. Space can enable (and prevent) knowledge sharing and communication between different groups of staff. Koch, D et al (2012) Program re- configuration: Hospital buildings, internal and external workflow conditions and communicatory benefits. Proceedings ARCH12, Gothenburg

18 Research results Single- patient rooms has several important advantages Support to prevent the spread of infections. Improving patient safety and quality of care - reducing the number of patient transfers, reduced noise levels, improve the integrity and privacy of the patient and increase positive awareness of their health situation. Teltsch, D. Y., Hanley, J., Loo, V., Goldberg, P., Gursahaney, A., and Buckeridge, D. L. (2011). Infection acquisition following intensive care unit room privatization. Archives of Internal Medicine, 171(1),

19 Thesis for the degree of Licentiate of Architecture Healing Architecture: Evidence, Intuition, Dialogue. Stefan Lundin Department of Architecture Chalmers University of Technology Gothenburg, Sweden 2015

20

21 Research results Architecture can reduce aggression in psychiatric care. Aggression and violence (incidents) in psychiatric care can be reduced by good architecture. Sahlgrenska new psychiatry building in Gotehnburghas a bundle of architectural qualities that are hypothised to reduce patient stress and aggression. Restraints and injections has been reduced by 21 % and 44 % respectively. Ulrich, R et al (2012) TOWARD A DESIGN THEORY FOR REDUCING AGGRESSION IN PSYCHIATRIC FACILITIES. Proceedings ARCH 12, Gothenburg

22 Design Dialogues Design Dialogues in Early Phases of Building Projects Doctoral Thesis Chalmers 2004 Based in Design Research - describes a collaborative design method in the early phases of building projects. Today more than 100 consultancy projects have been executed within different fields - office design, health care, R&D, industry, urban planning etc

23 Design Dialogues A linear and primarily fact- based design process is insufficient to handle both complexity and simultaneous change of requirements. Instead, the process ought to be interactive and collaborative to address more open objectives and constantly changing programmatic requirements

24 Design Dialogues Design as reflection in/on action A designerly approach means that you try something, consider how it works, reflect on other possibilities and then change and improve what you've done. Design methodology is supportive in handling large and complex spatial situations while at the same time review, discuss and reinvent how work is done.

25 Dialogues The validity of a proposed solution is something that to a great part is confirmed via dialogue. The core of the Design Dialogues is the conversation that takes place around different design materials (design games, sketches, models, drawings, 3D visualizations etc. Design game CAS IBM Toronto, Canada

26 What are they doing here actually? Design game Emergency Department, Sahlgrenska University Hospital

27 Design In design commissions you seek a valid solution in a complex situation where many parameters and interests are weighted together Wicked problems. Design methodology is supportive in handling large and complex spatial situations while at the same time review, discuss and reinvent how work is done.

28 Design Designers work with some sort of design material. With the design material the designer builds a representation of an imagined reality which can be examined and manipulated as if it was real. Chalmers Architecture, Year 2

29 Design The design work can be seen as a reflective conversation with this design material. Chalmers Architecture, Year 2

30 Design You get hold of the problem by developing solutions (before all prerequisites are identified). Chalmers Architecture, Year 2

31 Design Solutions are tested against the problem and are analysed/tested/evaluated and then condensed in an iterative process. Chalmers Arkitektur, Åk 2

32 Design Dialogues Design Dialogues are planned as a carefully structured process with clear purpose, content and expected results in each step. Active participation of customer, users and other stakeholders.

33 Design Dialogues Design methodology. The participants are invited to work designerly with complex commissions. This supports an open process where organizational development and architecture can develop in parallel. 46

34 Design Dialogues Visual tools and methods. At the workshops different tools such as photo, video, game design and interactive computer tools are used to support dialogue.

35 Planning of new Buildings and Facilities = opportunity for organisational development and innovation Lean game - organisational development Integrated planning process The planning process for new buildings and facilities, iforganised in a proper way, becomes an important arena for organisational development and innovation

36 Design Dialogue Integrated in the design process Design Dialogue

37 How can an Integrated planning model, which builds on collaborative design dialogue around systematically processed knowledge from practice and research, be arranged?

38 Evidence Based Concept Programs (EBCP) Experience from construction projects Benchmarking of regional user councils Research and collaboration Laws, rules and regulations Coordination of knowledge Innovation = Dialogue National network

39 Collaboration Chalmers and PTS Forum "Evidence- based concept program for healthcare facilities" Conducted by the Center for Healthcare Architecture at Chalmers on behalf of and funded by the PTS Forum

40 Implementation "Evidence- based concept programs" consists of knowledge from practice and research that are processed through a multi professional stakeholder group. The results are visualized as concepts possible solutions - for different healthcare rooms and units. The material should be used as a knowledge and inspiration material not as standards or guidelines - in the collaborative design process concerning individual healthcare projects.

41 Evidence based concept programs The Good Hospital Ward

42 Evidensbas för vårdens arkitektur Evidence- Base for Healthcare Architecture Compiled by Professor Roger Ulrich for EBCP The Good Ward and followers Widely implemented among Swedish County Councils and Architectural firms

43 Design of single- patient rooms

44 3D

45

46 Design of the functional unit

47 Care module with eight rooms

48 High Tech Healthcare Environments for Intensive Care (ICU) and Operation (OP) Evidence based concept programs

49 Operation

50 Research about OP Environment one example Hygiene It is the staff and the patient in the operating room which are the main sources of infection. With modern operating standards, hygiene, clothing and good ventilation system you can achieve high air purity. To achieve good results, human factors and procedures are at least as important as technical solutions. (Erichsen 2013, Dharan, 2002, Chow 2005)

51 OP- room

52

53 OP- unit

54 OP- unit

55 ICU Intensive care

56 Research about ICU - one example Finishing and interior materials Many of the symptoms of ICU- delirium can be caused by improperly designed physical environment around the patient. Examples of interior design that can affect patient experience negative during ICU stay can be - perforated or patterned ceilings, ceiling hoists, ceiling- mounted scales, lighting fixtures, ventilation, light from computer screens, etc.. (Bergbom Fridh, Forsberg, Eriksson, 2009).

57 Functional space requierments

58 IVU- module A, plan This option enables antechamber (and airlockwithout bed transport).

59 ICU - unit

60 View from the single- patient room into neighboring room through the sliding glass door

61 View from the monitoring / workstation into the patient room

62 View from the ICU bed with the outlook and the ability to family/relative contact

63 Evidence based concept programs for administrative workplaces in healthcare

64 Doctors in Sweden spend 50% of their work time on administration Edvardsson, J, Arnholdt- Olsson, A och Jeppson, B. Mer tid för patienten hos läkare i England En jämförande tidsstudie av svenska och engelska läkares arbetsdag. Läkartidningen. 2014;111:CUWE

65 Research about administrative work - one example Noise One of the most prominent problems in open office is noise and lack of privacy. Research have shown that what is most bothering is not the loudest noise but voices, phones and other meaningful information from other colleagues etc Sundstrom, E., Town, J. P., Rice, R. W., Osborn, D. P., & Brill, M. (1994). Office noise, satisfaction, and performance. Environment and Behavior, 26(2),

66 Concepts We introduce a new approach where also the administrative workspaces are designed to be activity- based and needs- driven, just like clinical spaces. We call these activity- based administrative workplaces for healthcare. From private offices and meeting rooms to a palette of features for different needs

67 Concepts The report surveys indicate that utilization of integrated administrative workstations are relatively high. This need where also identified through observation studies. Person- centered care involves teamwork around the patient. Rooms for this need to be created close to the direct care work. Patient - integrated administrative workplaces for direct patient work needs to be developed by adding both more concentrated workplaces as well as new types that supports collaboration and team work.

68

69

70 Concepts The project's survey indicates that utilization of non- patient integrated workplaces is very low. These premises consists today mainly of cellular offices (mostly private) or shared rooms. The concept therefore propose that administrative areas for the indirect care work can be streamlined and made more efficient through a more activity- based design.

71 Activity based multi- professional administrative area

72 You can find the Evidense Based Concept Programs here (in Swedish):

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