Body Of Evidence For Research-based Solutions
The Research Initiatives Committee of the American Institute of Architects Academy of Architecture for Health (AIA-AAH) was formed in 2009 to support research-based architectural practice. At the time, the committee found that existing research had a strong focus on patient safety and the patient experience. However, studies in other areas that are significant to practicing healthcare architects—staff effectiveness, planning typologies, return on investment, impact of design on patient health and business outcomes—were in short supply. The Research Initiatives Committee of the American Institute of Architects Academy of Architecture for Health (AIA-AAH) was formed in 2009 to support research-based architectural practice. At the time, the committee found that existing research had a strong focus on patient safety and the patient experience. However, studies in other areas that are significant to practicing healthcare architects—staff effectiveness, planning typologies, return on investment, impact of design on patient health and business outcomes—were in short supply.
Over the years, the committee has encouraged research into a range of topics that architects could use to inform their work. We recently looked at how healthcare design research has evolved, reviewing new studies published over the last five years from the AIA-AAH’s Academy Journal, the Academy of Architecture for Health (AAH) Foundation, Health Environments Research and Design Journal (HERD), and The Center for Health Design’s Knowledge Repository. Reviewing these notable sources, we found a new focus on topics tied to efficiency, safety, and staff and patient satisfaction. Here are highlights of what was found and a few of the latest studies worth checking out.
1. The study “The Decentralized Station: More Than Just Patient Visibility,” by Christina Grimes and Louis A. Meilink Jr., published in 2016 in the Academy Journal, compared inpatient units with decentralized and centralized staff stations. The decentralized units scored 13-18 percent higher on certain HCAHPS scores, with a 91 percent increase in patients feeling cared for. Additionally, the layout resulted in up to a 71 percent reduction in walking distance for staff and 16 percent more time for nurses spent at the bedside. Architects can use this study to help clients understand the specific benefits of decentralized staff stations, which can be a controversial concept.
2. The 2014 study “Designing Team Rooms for Collaboration in the Outpatient Clinics,” by Jennifer DuBose, Lisa Lim, and Ross Westlake, was funded by an AAH Foundation grant and focused on clinical care team configurations and how well they support staff effectiveness and efficiency. The findings showed a clear preference by care staff for providing straight views to clinic corridors and exam room doors for continuous visual control, as well as dedicated spaces for documenting. This is highly relevant to architects’ current work, which includes an increase in outpatient projects.
3. The 2011 study “Optimizing Toilet Location for Assisted Toileting,” by Jon Sanford and Sheila Bosch, was supported by an AAH Foundation grant and researched optimum toilet configurations for caregiver-assisted toileting, finding that caregivers preferred space on both sides of the toilet, with folding grab bars. This result has implications for reducing staff injuries and frustration.
4. Another AAH Foundation grant study, “Mental and Behavioral Health Environments: Critical Considerations for Facility Design,” by Mardelle Shepley, Angela Watson, Francis Pitts, Anne Garrity, Elizabeth Spelman, Janhawi Kelkar, and Andrea Fronsman, reviewed physical environment features that positively affect psychiatric patients and staff in terms of social interaction and safety. The findings showed a staff preference for less institutional settings, open nurses’ stations, and access to nature. Designers of behavioral health facilities often face conflicting dictates regarding therapeutic environments versus patient and staff safety; this study may help clients better understand the importance of balancing both needs in the built environment.
5. The study “Restorative Design Features for Hospital Staff Break Areas: A Multi-Method Study,” by Adeleh Nejati, Mardelle Shepley, Susan Rodiek, Chanam Lee, and James Varni, published in 2016 in HERD, found the most effective means of increasing nurses’ performance and satisfaction via break room design included proximity of break areas to their work areas, access to outdoor spaces, and opportunities for both socialization and privacy. These findings are important, because staff respite areas are frequently given low priority on healthcare building projects.
6. The study “Are Split Flow and Provider in Triage Models in the Emergency Department Effective in Reducing Discharge Length of Stay?” by Beth A. Pierce and Denise Gormley, published in 2016 in Journal of Emergency Nursing with a summary available in The Center’s Knowledge Repository, compared the performance of two different emergency departments to determine whether an ED using a split-flow model will see a reduced length of stay when compared to one that doesn’t. The paper reported a reduction in length of stay of 16.3 minutes on average, which increased to 28.5 minutes when a “provider in triage” system was used. This has significant design implications for how EDs are planned, suggesting that architects should consider including space for initial evaluation to help facilitate a smoother flow throughout the triage process.
7. Another study, “Impact of Healthcare Design on Patients’ Perception of a Rheumatology Outpatient Infusion Room: An Interventional Pilot Study,” by Gunhild Bukh, Anne Marie Munk Tommerup, and Ole Rintek Madsen, published in 2015 in Clinical Rheumatology and summarized in the Knowledge Repository, examined the impact of certain room modifications on patients’ perception of an outpatient infusion room used for rheumatologic disease treatment. The findings showed that patient satisfaction was directly linked to every sensory aspect of the healthcare environment, indicating that designers should consider how personal privacy, interior décor, and color help achieve rooms that don’t feel institutional and that can improve patient satisfaction.
What’s still needed
Each year, the AIA-AAH Research Initiatives Committee discusses trends in healthcare project types to better understand areas of research needed to inform our practices, then recommends focus areas for soliciting proposals for the AAH Foundation’s annual research grants. This year’s top five recommended research topics based on those trends include:
• Research related to the Facilities Guidelines Institute’s (FGI) Guidelines for Design and Construction of Hospitals and Outpatient Facilities, to be coordinated with FGI’s own priorities, including patient safety-related issues
• Clinic environments: Effectiveness of different team centers, collaboration spaces, and communication approaches
• Surgery environments: Efficiency improvements (especially in outpatient settings), planning issues (induction rooms, prep/recovery flow), errors and omissions, and infection control issues
• Behavioral health inpatient environments: Effects of design on safety and therapeutic care effectiveness
• Patient- and family-centered care: Concepts and their impacts on healing and satisfaction surveys, and implications of cultural and human factors.
As the research industry continues to perform studies that can directly inform healthcare design, architects will have better tools to provide smarter solutions and deliver desired patient, staff, and business outcomes.
For access to the Academy Journal library, visit https://www.aia.org/resources/21501-aah-academy-journal. For information about the AAH Foundation research grants and to view its library of research, visit aahfoundation.org. For access to the Knowledge Repository, visit network.aia.org/academyofarchitectureforhealth/home or healthdesign.org.
Tom Clark is the 2017 president of the AIA-AAH. He can be reached at email@example.com. Byron Edwards is chair of the AIA-AAH Research Initiatives Committee. He can be reached at firstname.lastname@example.org. Lindsey Stang is co-chair of the AIA-AAH Research Initiatives Committee. She can be reached at email@example.com.