Weighing Your Furniture Options
Furniture—like heating and lighting—remains indispensible to delivering quality healthcare. These common objects are expected to support many healthcare tasks, such as providing patients and family members with support from stress and fatigue, enabling caregivers to work safely and effectively as a team, and reflecting a healthcare organization’s vision and brand. Together, it can be quite a tall order.
Healthcare leaders from every type of clinical facility, ranging from ambulatory clinics to long-term care facilities, must purchase and maintain furniture in order to deliver care. Individuals charged with evaluating and recommending furniture purchases may be challenged by the overwhelming number of furniture choices and feature options.
Creation of an EBD furniture checklist
An Evidence-Based Design (EBD) Furniture Checklist (To view the authors' Evidence-Based Design Furniture Checklist and Healthcare Facility Lifecycle Phases, please use the links at the bottom of this page), which follows at the end of this article, was created to provide healthcare leaders and the designers who support them with an evidence-based tool that can assist in making the best furniture investments for the patients and organizations they serve. The one-page checklist is primarily designed to facilitate a consistent approach during furniture product inquiry and evaluation, to enable effective design team and client communication, and to provide an evidence-based framework for comparing products and evaluating the best return on investment.
It may be useful when:
• Evaluating manufacturer product brochures and websites;
• Meeting with manufacturers and furniture dealers to evaluate furniture;
• Working with interior designers to evaluate proposed furniture features, room layout, and product specification;
• Examining and evaluating existing furniture for life expectancy;
• Conducting a return-on-investment analysis;
• Developing contract specifications for furniture purchase or rental; and
• Conducting a postoccupancy evaluation.
The EBD Furniture Checklist (Malone, E. B., & Dellinger, B. A. (2011). Furniture Design Features and Healthcare Outcomes. Concord, California: The Center for Health Design) is divided into eight sections that correspond to common EBD goals for which furniture has been shown to play a role. The first three EBD goals pertain to key patient safety concerns that can result in significant patient harm.
The next three goals focus on the use of furniture to provide respite and social support, and to enable safe and effective care delivery. Environmental safety is the seventh goal; and, finally, considerations for making furniture investments are found in the eighth goal. Each goal section includes recommended furniture feature variables based on research, industry standards, and Facility Guideline Institute requirements, the citations for which are found in the references appendix.
A detailed review of the research literature and standards that underpin each furniture feature variable can be found in the white paper “Furniture Design Features and Healthcare Outcomes” on The Center for Health Design’s (CHD) website at www.healthdesign.org/chd/research.
Checklist scale and value
A findings scale is provided to indicate if a feature is present, if more information is needed before a determination can be made, or if the feature does not apply to the furniture being evaluated. A brief description of the checklist’s purpose also is detailed along with instructions for use and additional information explaining the importance of each variable. Although patient safety goals are prioritized first, at this time, there is no point system that rates one variable as more important than another, nor are there a certain number of “present” findings needed to recommend a product.
During multiple reviews of the checklist by expert healthcare leaders, facility managers, designers, manufacturers, clinicians, researchers, and academicians, as well as during checklist trials by design practitioners, we learned that the most important role of the checklist was to foster communication using an evidence-based framework to inform furniture decision-making activities across the furniture life cycle.
The furniture life cycle and checklist application
Countless furniture decisions will have to be made over the course of a typical healthcare facility’s more than 30-year lifespan. Healthcare furniture investments represent on average about 2-4% of the capital budget for any new project. Although most furniture has been replaced after 25 years, some furniture is replaced sooner. Systems furniture typically depreciates over seven years, although much of it will be used for another decade or so, and some furniture in high-use public spaces like emergency department waiting rooms is replaced in even less time.
The healthcare furniture life cycle model depicted portrays facility life cycle phases, with accompanying furniture-related activities. The checklist can be used to facilitate these activities during each life cycle phase as summarized in Table 1. The transition planning phase begins the moment a decision has been made to begin a project and involves all of the activities necessary to move from the current state across all of the project phases into occupancy and the future state.
Ways to use the checklist
The checklist can be applied in a variety of ways. A design practitioner or facility manager can use it to evaluate myriad furniture options as a means of identifying those products that best meet their requirements. Interior designers have used it to evaluate furniture options to support design specification activities and share the evaluation and recommendations with clients and project team members. One user proposes to engage a variety of design practitioners and healthcare team members who will assume responsibility for evaluating the furniture using the checklist section that corresponds to their area of responsibility and expertise.
A checklist use scenario might look something like this: For a team choosing a patient chair, the interior designer conducts an overall screening of available chairs, using the checklist to identify three chairs that most meet the needs of the population expected to use it. Then, expert hospital staff further evaluate the three chairs, using the checklist items they know most about.
For instance, the environmental services staff, who are responsible for cleaning and disinfecting furniture, evaluate the chairs for their features associated with an ability to reduce surface contamination, as well as assessing the chairs for environmental safety; the clinicians evaluate the other patient and staff safety variables; and the administrators determine which chair provides the best investment. Patient and family groups representing the demographics of those individuals expected to use the chair also could participate by evaluating the chairs for comfort and attractiveness. The composite results are reviewed and discussed by the client and design team, and a chair is selected.
We imagine that additional practical uses of the checklist will emerge and encourage checklist users to share their experience and recommendations through the CHD’s website (www.healthdesign.org). In addition, we plan to use this first checklist version as the basis for creating additional specialized evidence-based furniture checklists specific to furniture type and for particular medical specialty practice environments, such as cancer care.
Hospitals are not hotels
Furniture used in healthcare settings must achieve a higher standard than the furniture used in other work environments or in the hospitality industry. The research that underpins the checklist confirms that furniture plays an important role in the complex choreography that healthcare delivery represents. However, much more research remains to be done to fully understand the additional ways in which furniture can positively contribute to improved patient, staff, and resource outcomes, as summarized in the CHD white paper previously mentioned.
Sir Oliver Wendell Holmes (1872) said, “Science is a first-rate piece of furniture for a man’s upper chamber, if he has common sense on the ground floor.” Combining science and common sense in an evidence-based tool provides a practical means to make first-rate furniture investments an important component in the efforts to improve healthcare outcomes. HCD
Eileen B. Malone, RN, MSN, MS, EDAC, is a senior partner with Mercury Healthcare Consulting LLC and can be reached at firstname.lastname@example.org. Barbara A. Dellinger, MA, AAHID, IIDA, CID, EDAC, is associate vice president and director of healthcare interiors-East Coast at HDR Architecture. She can be reached at Barbara.email@example.com.