An evidence-based design furniture checklist
An interview with Eileen Malone, RN, MSN, MS, EDAC, Senior Partner, Mercury Healthcare Consulting, LLC, and Barbara Dellinger, MS, AAHID, IIDA, EDAC, MDCID, Director, Health Care Interiors, East Coast, HDR, Inc.
Healthcare leaders are often confronted with a massive number of furniture choices as part of the ongoing investments required over a healthcare facility's lifespan. But are there any tools out there to aid these leaders in furniture selection?
Two healthcare design leaders in their own right-Eileen Malone, RN, MSN, MS, EDAC, Senior Partner, Mercury Healthcare Consulting, LLC, and Barbara Dellinger, MS, AAHID, IIDA, EDAC, MDCID, Director, Health Care Interiors, East Coast, HDR, Inc.-have risen to the challenge of creating just such a tool. Taking into account current healthcare industry quality (safety), cost, and access challenges, as well as the evidence-based design (EBD) research that links furniture features as additional tools to battle problems like healthcare-associated infections, patient falls, and medical errors, Malone and Dellinger have developed an Evidence-Based Design Furniture Checklist, to help healthcare leaders make the best furniture investments for their facilities; the duo will be presenting their findings at the forthcoming HEALTHCARE DESIGN.10 conference in Las Vegas on Sunday, November 14. HEALTHCARE DESIGN Editor-in-Chief Todd Hutlock spoke with Malone and Dellinger about the checklist and their upcoming presentation.
Let's start at the beginning: What was the genesis of the Evidence-Based Design Furniture Checklist?
Eileen B. Malone, RN, MSN, MS, EDAC: It actually began in December 2009, when three separate events took place. My father was in the hospital for 10 days, so I had a personal experience in a semiprivate room with a terrible patient chair that gave me the worst case of sciatica I've ever had.
At the same time, I had been invited by a large healthcare furniture manufacturing company to come and talk with their team in January 2010 about some of the challenges that healthcare leaders face, and the factors that were shaping the healthcare industry in light of the then-pending healthcare reform legislation. I also had just read a wonderful book by Dr. Atul Gawande called The Checklist Manifesto: How to Get Things Right, which I would strongly recommend to the entire HEALTHCARE DESIGN reading audience for application in many ways.
So between having that personal experience and getting ready to speak with some furniture experts, I realized how much I didn't know about furniture. My background is as a healthcare leader, and as a nurse practitioner; I've also been intensively involved in EBD for the last five years. But most of my energy had focused on the building itself and the digital environment, without paying quite as much attention to the objects in the room and their role in healthcare outcomes. In addition, the Agency for Healthcare Research and Quality released their annual report on patient safety, which indicated that in spite of all of the recent efforts to reduce healthcare-associated infections, particularly catheter-associated bloodstream infections, we still had not made significant progress.
It dawned on me that this was because we were still not thinking about all the pieces to the quality care puzzle. It isn't just the physical environment or technology or re-engineered processes or even transformed culture; quality care depends on all of these variables, including all of the objects used in care delivery, like furniture. So I started looking back through the literature in closer detail. First, I reviewed some EBD checklists that I had prepared as part of a project that Barbara and I had worked on, and I thought, “Okay, there are a few things in here about furniture features, but not very much.”
After my review, I found that there was not much published research or discussion about furniture and its relationship to patient safety issues. The furniture industry had done a marvelous job of looking at the psychosocial aspects of furniture and the key role that it can play, how to integrate it with nature themes, how to foster communication, and certainly how to provide respite. I didn't see much about helping to reduce healthcare-related infections, reduce falls or associated injuries, or reduce medication errors. Clearly as objects in the room that influence human behavior, furniture must play a role in these things.
That was the beginning of what has been an eight-month intensive inquiry with Barbara. We've had a lot of fun, but we realize how much remains to be done. After my presentation to the furniture company in January and receiving such a positive response to the first draft of this checklist, we thought a furniture checklist might be a valuable tool for healthcare leaders.
“It isn't just the physical environment or technology or re-engineering processes or even transforming culture; it's all the other things that are in the room.”
- Eileen B. Malone
Barbara Dellinger, MS, AAHID, IIDA, EDAC, MDCID: At the same time, I was working on the United States Army Corps of Engineers (USACE) Northern Virginia Ft. Belvoir Community Hospital project (1.27 million square feet) with the military health system. Our client had asked me to give them a checklist as we were moving into the furniture package. So when Eileen shared the checklist with me, the whole world just came together. I think we've hit on something that hasn't been addressed before, and there is a real need for this checklist out there.
It seems like such a common sense thing, because furniture is in the patient room, directly impacting that patient experience. It's somewhat surprising to me that nothing like this has been written before.
Malone: Like you, I was very surprised to find that there wasn't a checklist of sorts out there. In fact, the articles that I found that came closest to addressing this topic were from the furniture industry itself, but were not often tied to specific research. Information could be found in their sales brochures, but most healthcare outcome links were suggestive rather than based on published research findings, which as a healthcare leader, would give me comfort knowing that the furniture features were research based, without bias, to help achieve desired healthcare outcomes and represent the best investment.
My background is in military healthcare and I'm also a nurse, so between the two, I've been using checklists my whole professional life. Healthcare is very complicated, and it is impossible to keep memory, attention, and thoroughness of all the details. Humans like novelty and excitement; we really don't like to perform due diligence. We know, however, in the patient safety arena, that it is due diligence at the end of the day that makes all the difference, especially when it is based on research.
That's what we're hoping to do here-to begin sharing what we have discovered across eight common EBD goals in a one-page checklist with furniture feature variables tied to published research and standards that healthcare leaders can use to make the best furniture investment decisions. We will encourage users to apply the checklist across the facility and furniture lifecycle and hopefully help to refine it through their own published research. We're excited about it!
What types of furniture are specifically addressed on the checklist?
Malone: The checklist is written generically so that one could use it when, for example, looking at a particular chair or table for an organization. We purposefully excluded the patient bed because in my mind, it has become a piece of medical equipment rather than a furnishing. The idea is that the checklist can be used both for individual objects or it can be used to evaluate individual design plans or proposals. We did not want to be overly prescriptive, but obviously our research is tied to furniture objects, such as chairs and other seating, tables, and the like.
We did include lighting, but only as it figures into furniture that features built-in lighting fixtures, linking illumination, visual acuity, and medication error research. We also tied in sound absorption qualities in much the same way, sharing the relationship between noise and distractions with medication errors.
An Evidence-Based Design Furniture Acquisition Checklist for Healthcare Leaders will be presented as one of the many Educational Sessions at the HEALTHCARE DESIGN.10 conference on Sunday, November 14, 2010. For more information, visit www.hcd10.com.
Dellinger: The most exciting thing about the list to me is that it can be used right away. Whether I am using it internally with my interior design group looking for furniture for a project, or with a manufacturer to tweak something that is customized, or by the end user to evaluate the package we have assembled for them, the checklist can be applied at any point from start to finish.
Malone: Those are applications that I had not considered when we started working on this project; I was really only looking at it from my own selfish viewpoint as a CEO emeritus who approved furniture packages. But then it dawned on me that every time I go to a large trade show like HEALTHCARE DESIGN and look at all the furniture, it is dizzying how much furniture is out there to choose from, and I had no framework to use when making an informed decision. I wouldn't buy a car without having some sort of decision-making framework, and yet we expect people to make these enormous furniture investments without providing them with information that helps them to understand furniture features and their link to healthcare outcomes.
“A four-story hospital could potentially spend $2 million, and a large hospital could spend up to $20 million on furniture. To do that blindly is simply illogical.”
- Barbara Dellinger
Dellinger: A four-story hospital could potentially spend $2 million, and a large hospital could spend up to $20 million on furniture. To do that blindly is simply illogical. Designers spend a great deal of time coordinating styles, finishes, and colors but we begin by selecting the right product for the situation before we get into the asthetics issues. We need to look at each item through our EBD eyes.
So the checklist can be equally useful to facility staff and decision makers, as well as interior designers.
Malone: Exactly. It has applicability across a number of different spectrums. We're anxious to get it into the hands of users. We just sent the checklist out to a broad group of expert colleagues-healthcare leaders, facility managers, interior designers, product evaluators, manufacturers, and academicians and researchers-for review. We particularly want to hear from those in academia and research because we want to make sure we're not neglecting something and to ensure that the tool itself is practical, clear, and useful. We will refine the tool after we get their feedback.
We plan to provide the audience at our session at the HEALTHCARE DESIGN conference with a copy of the tool for use in the Exhibit Hall, and then ask for feedback from that experience. We can't wait to hear their feedback.
Healthcare Design 2010 September;10(9):24-28