OVERVIEW OF HOSPITAL / OVERVIEW OF HOSPITAL / HEALTH FACILITY HEALTH FACILITY BUILDING NEEDSBUILDING NEEDS

ContentsContents Introduction Introduction

Type of Health Facilities in MOHType of Health Facilities in MOH

General Hospital Set – UpGeneral Hospital Set – Up

Health Building NeedsHealth Building Needs

EBDEBD

IntroductionIntroduction

Health / Hospital Building is complexHealth / Hospital Building is complex

Requires talents and expertise of many professionalsRequires talents and expertise of many professionals

Complexity of practice = complexity of designComplexity of practice = complexity of design

Need to understand hospital functions, operations which Need to understand hospital functions, operations which are complex and evolvingare complex and evolving

Complex variation of needs of various department Complex variation of needs of various department

IntroductionIntroduction Interdependence of departmentsInterdependence of departments

Controlled environmentsControlled environments

Compliance to Acts, standards, and other governmental Compliance to Acts, standards, and other governmental regulationsregulations

Need concerted and coordinated effort in designNeed concerted and coordinated effort in design

Types of Health Facilities in MOHTypes of Health Facilities in MOH HospitalHospital

Specialised Hospitals/Institutions eg. NCI, Specialised Hospitals/Institutions eg. NCI, Rehabilitation Hospital, Women & Children Rehabilitation Hospital, Women & Children HospitalHospital

Major Specialist Hospital – hospital with at Major Specialist Hospital – hospital with at least 14 specialties and 6 subspecialties least 14 specialties and 6 subspecialties eg. State Hospitals, some District Hospitalseg. State Hospitals, some District Hospitals

Minor Specialist Hospital – hospital with 10 Minor Specialist Hospital – hospital with 10 specialtiesspecialties

Non-Specialist Hospital / Hospital with Non-Specialist Hospital / Hospital with visiting specialists – no specialtiesvisiting specialists – no specialties

Standard MOH Hospital Scope / SizeStandard MOH Hospital Scope / Size

Purpose : to expedite the project implementationPurpose : to expedite the project implementation- standard MBOR- standard MBOR- standard costs- standard costs- standard plans?- standard plans?

Types :Types :

76 beds76 beds

108 beds108 beds

268 beds268 beds

306 beds306 beds

500 beds500 beds

Types of Health Facilities in MOHTypes of Health Facilities in MOH Health Clinics – run by Doctor / Medical Assistant Health Clinics – run by Doctor / Medical Assistant

& Nurses& NursesKK Type

Expected Workload (attendances)

Main Scope of Services

1 >800 OPD, MCH, Dental, Pharmacy, X-Ray, Lab, Rehab, Home Nursing, Admin, FMS

2 500-800 OPD, MCH, Dental, Pharmacy, X-Ray, Lab, Rehab, Home Nursing, Admin, FMS

3 300-500 OPD, MCH, Dental, Pharmacy, X-Ray, Lab, Rehab, Home Nursing, Admin, FMS

4 150-300 OPD, MCH, Dental, Pharmacy, X-Ray, Lab, Rehab, Home Nursing, Admin

5 100-150 OPD, MCH, Dental, Pharmacy, Lab, Home Nursing, Admin

6 <100 OPD, MCH, Pharmacy, Lab, Home Nursing, +/- ABC & Observation Bed

7 <50 OPD, MCH, Dental, Pharmacy, Lab, +/- ABC & Observation Bed

Types of Health Facilities in MOHTypes of Health Facilities in MOH

Rural Health Clinics / Klinik Rural Health Clinics / Klinik Desa (KD)Desa (KD) Run by Rural Health NurseRun by Rural Health Nurse

I Malaysia ClinicI Malaysia Clinic Run by Medical AssistantRun by Medical Assistant

GENERAL HOSPITAL GENERAL HOSPITAL Set-UpSet-Up

General Hospital Set-UpGeneral Hospital Set-Up Will depend various factors:Will depend various factors:

Level of medical servicesLevel of medical services secondary, tertiary, specialisedsecondary, tertiary, specialised primary care servicesprimary care services

Operational policies Operational policies privatisation privatisation outsourcingoutsourcing

Special needs Special needs hospitalhospital community community

General Hospital Set-UpGeneral Hospital Set-UpOutpatient ServicesOutpatient Services

Emergency Dept.Emergency Dept. Clinic – GOPD, Specialist ClinicClinic – GOPD, Specialist Clinic Day CareDay Care Dialysis (Haemo-dialysis & PD)Dialysis (Haemo-dialysis & PD)

General Hospital Set-UpGeneral Hospital Set-UpInpatient ServicesInpatient Services

WardsWards Standard ward for various discipline Standard ward for various discipline

22ndnd & 3 & 3rdrd Class Class Paeds ward – classless & with MAC facilitiesPaeds ward – classless & with MAC facilities

Multidiscipline 1Multidiscipline 1stst Class & VIP, Royal Class & VIP, Royal Intensive Care (ICU,CCU,HDW, NICU, SCN)Intensive Care (ICU,CCU,HDW, NICU, SCN) Special Ward ie isolation wardSpecial Ward ie isolation ward

Operating Theatre SuitesOperating Theatre Suites Double corridorDouble corridor Single corridorSingle corridor

Labour & Delivery SuitesLabour & Delivery Suites Single roomSingle room

General Hospital Set-UpGeneral Hospital Set-UpDiagnostic & TreatmentDiagnostic & Treatment

General Hospital Set-UpGeneral Hospital Set-UpDiagnostic & TreatmentDiagnostic & Treatment

Imaging (X-Ray)Imaging (X-Ray)

Pathology (Lab)Pathology (Lab)

Forensic Forensic (Mortuary)(Mortuary)

Rehabilitation Rehabilitation (OT & PT)(OT & PT)

General Hospital Set-UpGeneral Hospital Set-UpMedical Support ServicesMedical Support Services

PharmacyPharmacy Inpatient Inpatient Out-patient PharmacyOut-patient Pharmacy

Medical StoreMedical Store

General Hospital Set-UpGeneral Hospital Set-UpMedical Support ServicesMedical Support Services

Central Sterile Central Sterile Supply (CSSD)Supply (CSSD)

Haemodynamic Haemodynamic RespiratoryRespiratory

General Hospital Set-UpGeneral Hospital Set-UpMedical Support Services – Medical Support Services –

cont…cont… Medical RecordMedical Record ITDITD Medical Social ServicesMedical Social Services Infant Nutrition (Milk Infant Nutrition (Milk

Kitchen)Kitchen) DietaticsDietatics

General Hospital Set-UpGeneral Hospital Set-UpNon-Medical Support ServicesNon-Medical Support Services

Catering/KitchenCatering/Kitchen

Linen holdingLinen holding

Waste disposalWaste disposal GeneralGeneral Clinical/BiohazardClinical/Biohazard ChemicalChemical

General Maintenance/Cleaning General Maintenance/Cleaning & Housekeeping& Housekeeping

EngineeringEngineering

Porter/TransportPorter/Transport

HelipadHelipad

General Hospital Set-UpGeneral Hospital Set-UpTraining Education & ResearchTraining Education & Research

CME – seminar room, auditoriumCME – seminar room, auditorium LibraryLibrary Clinical ResearchClinical Research Quality AssuranceQuality Assurance

General Hospital Set-UpGeneral Hospital Set-UpAdministrationAdministration

General AdministrationGeneral Administration Nursing AdministrationNursing Administration Admission & Revenue CollectionAdmission & Revenue Collection Telephone Operator & PABXTelephone Operator & PABX

General Hospital Set-UpGeneral Hospital Set-UpStaff FacilitiesStaff Facilities

Specialist & Doctors OfficesSpecialist & Doctors Offices On-call complexOn-call complex Staff changeStaff change Staff restStaff rest Prayer roomsPrayer rooms Recreational facilitiesRecreational facilities Staff accommodation – quarters, nurses Staff accommodation – quarters, nurses

hostel & housemen quartershostel & housemen quarters

General Hospital Set-UpGeneral Hospital Set-UpPublic AmenitiesPublic Amenities

Main entrance & hospital streetMain entrance & hospital street Shops & kiosksShops & kiosks Information counterInformation counter CafeteriaCafeteria Visitors loungeVisitors lounge Prayer roomsPrayer rooms Public ParkingPublic Parking Public Phones etc.Public Phones etc.

Health Facility PlanningHealth Facility Planning Most complex Most complex

buildingbuilding Wide range of Wide range of

services & services & functional unitsfunctional units

Governed by Governed by various various regulations, codes, regulations, codes, guidelines etc.guidelines etc.

Health Facility PlanningHealth Facility Planning Requires specialised Requires specialised

knowledge & expertise knowledge & expertise Competing needs & Competing needs &

priorities among various priorities among various functional unitsfunctional units

Ideal & strong individual Ideal & strong individual preference VS mandatory preference VS mandatory requirements, functional requirements, functional needs & financial statusneeds & financial status

Health Facility PlanningHealth Facility Planning Serve & support many Serve & support many

different users & different users & stakeholdersstakeholders

Design process to Design process to incorporated direct input incorporated direct input from owner & key hospital from owner & key hospital staffstaff

Good hospital design Good hospital design integrates functional integrates functional requirements with the requirements with the human needs of its varied human needs of its varied usersusers

Hospital/Health Facility Hospital/Health Facility Building NeedsBuilding Needs

Regardless of their site, Regardless of their site, size, budget, size, budget, hospital/health facility hospital/health facility have certain common have certain common needs :needs : Efficiency & Cost Efficiency & Cost

EffectivenessEffectiveness Flexibility & ExpandabilityFlexibility & Expandability Therapeutic EnvironmentTherapeutic Environment Cleanliness & SanitationCleanliness & Sanitation

Hospital/Health Facility Hospital/Health Facility Building NeedsBuilding Needs

AccessibilityAccessibility Controlled Controlled

circulationcirculation RedundancyRedundancy AestheticAesthetic Security & SafetySecurity & Safety SustainabilitySustainability

Efficiency & Cost-Efficiency & Cost-EffectivenessEffectiveness

Promote staff efficiency Promote staff efficiency eg. reduce walking eg. reduce walking distancedistance

Easy visual supervision of Easy visual supervision of patients by limited staffpatients by limited staff

Efficient logistics system-Efficient logistics system-lifts, pneumatic tube, lifts, pneumatic tube, conveyorsconveyors

Efficient use of space & Efficient use of space & prudent use of prudent use of multipurpose spacemultipurpose space

Efficiency & Cost-Efficiency & Cost-EffectivenessEffectiveness

Group functional Group functional areas with similar areas with similar system requirementssystem requirements

Encourage sharing of Encourage sharing of resources & avoid resources & avoid duplicationduplication

Provide optimal Provide optimal functional functional adjacencies eg. ICU adjacencies eg. ICU next to OTnext to OT

Flexibility & ExpandabilityFlexibility & Expandability Follow modular Follow modular

concepts of space concepts of space planning & layoutplanning & layout

Use generic room sizes Use generic room sizes and plans as much as and plans as much as possiblepossible

Be open ended, well Be open ended, well planned directions for planned directions for future expansion eg. future expansion eg. soft space next to hard soft space next to hard spacespace

Therapeutic EnvironmentTherapeutic Environment Unthreatening, Unthreatening,

comfortable and stress comfortable and stress freefree

Using familiar & Using familiar & culturally relevant culturally relevant materials materials

Using cheerful and Using cheerful and varied colours & varied colours & texture (note: some texture (note: some colours are colours are inappropriate)inappropriate)

Therapeutic EnvironmentTherapeutic Environment Ample natural lightAmple natural light External views for External views for

patient bedpatient bed Designing a ‘way Designing a ‘way

finding’ process – finding’ process – making spaces making spaces easy to find, easy to find, identify and useidentify and use

Cleanliness & SanitationCleanliness & Sanitation Easy to clean & Easy to clean &

maintainmaintain Appropriate & Appropriate &

durable finishesdurable finishes Careful details to Careful details to

avoid dirt-catching avoid dirt-catching and hard to clean and hard to clean surfacessurfaces

Cleanliness & SanitationCleanliness & Sanitation

Adequate & Adequate & appropriately located appropriately located housekeeping spaceshousekeeping spaces

Special materials, Special materials, finishes, and detail of finishes, and detail of spaces for sterile spaces for sterile areasareas

AccessibilityAccessibility Disable friendly facilitiesDisable friendly facilities Does not hinder trolley Does not hinder trolley

movementsmovements Corridors are wide Corridors are wide

enoughenough Marking glass walls & Marking glass walls &

doors to make their doors to make their presence obviouspresence obvious

Direct Vehicular access Direct Vehicular access to eg. A&E, L&D, to eg. A&E, L&D, MortuaryMortuary

Controlled CirculationControlled Circulation Typical outpatient route Typical outpatient route

simple & well definedsimple & well defined Avoid unnecessary Avoid unnecessary

movement through inpatient movement through inpatient functional areas functional areas

Visitors have simple & direct Visitors have simple & direct route to each patient nursing route to each patient nursing unit without penetrating unit without penetrating other functional areasother functional areas

Separate patients & visitors Separate patients & visitors from support services & from support services & engineering areasengineering areas

Controlled CirculationControlled Circulation Dirty material flows Dirty material flows

separated from separated from movement of food movement of food & clean supplies& clean supplies

Transfer of Transfer of cadavers to & from cadavers to & from Morgue should be Morgue should be out of sight of out of sight of patients & visitorspatients & visitors

Redundancy/Back-up PlanRedundancy/Back-up Plan Able to service/maintain Able to service/maintain

systems without greatly systems without greatly affecting serviceaffecting service

Able to tolerate certain Able to tolerate certain degree of system failuredegree of system failure Medical gas zoningsMedical gas zonings Water supplyWater supply Electrical supplyElectrical supply Air-condition systemAir-condition system

AestheticsAesthetics Use natural light, Use natural light,

materials & texturesmaterials & textures Use artworksUse artworks Attention to proportions, Attention to proportions,

colour, scale & detailscolour, scale & details Bright, open, Bright, open,

generously-scaled public generously-scaled public spacesspaces

Homelike & intimate Homelike & intimate scale in patient rooms, scale in patient rooms, day rooms etc.day rooms etc.

Compatible exterior Compatible exterior design with physical design with physical surroundingssurroundings

Security & SafetySecurity & Safety Protection of Protection of

hospital property hospital property & assets& assets

Protection of Protection of patients & staffpatients & staff

Safe control of Safe control of violent or violent or unstable patientsunstable patients

SustainabilitySustainability Operational CostsOperational Costs Maintenance CostsMaintenance Costs Energy saving featuresEnergy saving features

Basic PrincipleBasic PrincipleSmall vs Bigger Hospitals / Non Specialist vs Small vs Bigger Hospitals / Non Specialist vs Specialist HospitalsSpecialist Hospitals

Small Hospital (<150 beds)

Bigger Hospital(>300 beds)

Combine out-patient & inpatient pharmacy

-May be separated-May have satellite pharmacy

Combine L&D with Obstetric Ward on GF

-May be separated-PAC if L&D located on higher floor

Centralised OT Complex -May separate main OT, Daycare OT and Maternity OT

Multidisciplinary Ward eg Obst + Pediatric Ward; Female Ward

- May be dedicated eg. Male Medical, Pediatric, Female Obstetric etc.

Centralised Pathology / Lab

-May have satellite lab

Basic Principle Basic Principle Doctors examine Doctors examine

patient on the right patient on the right side; hence it shall be side; hence it shall be the basis for the the basis for the orientation of patient orientation of patient bed, examination bed, examination couches and procedure couches and procedure table within a room table within a room etc.etc.

Lessons Learned (Architecture)Lessons Learned (Architecture)No wet areas above ‘clean/sterile’ No wet areas above ‘clean/sterile’ areas eg OT, CSSD packing & sterile areas eg OT, CSSD packing & sterile stores, clean roomsstores, clean rooms

Corridors where there are patient Corridors where there are patient /trolley movement shall be wide enough /trolley movement shall be wide enough and with no hindrance eg fire doors.and with no hindrance eg fire doors.

All room doors where patient enters All room doors where patient enters shall be wide enough for wheelchair and shall be wide enough for wheelchair and able to be hold opened.able to be hold opened.

Lessons Learned (Architecture)Lessons Learned (Architecture) Doors into rooms where patients are Doors into rooms where patients are

being examined shall have no glazing.being examined shall have no glazing.

All patient’s toilet with shower facilities All patient’s toilet with shower facilities shall have textured non slipped floor shall have textured non slipped floor tiles.tiles.

ALL sinks (clinical/non clinical/built-in) ALL sinks (clinical/non clinical/built-in) shall have sufficient backsplash.shall have sufficient backsplash.

Provide seamless finishes to floor and Provide seamless finishes to floor and wall in clinical areas.wall in clinical areas.

Lessons Learned (Architecture)Lessons Learned (Architecture)

Use washable paint in all clinical Use washable paint in all clinical areas.areas.

ALL windows shall be lockable.ALL windows shall be lockable.

Avoid ledges (surface) especially Avoid ledges (surface) especially in clean rooms.in clean rooms.

Avoid grey colored flooring in Avoid grey colored flooring in Operating Rooms.Operating Rooms.

Lessons Learned (M&E)Lessons Learned (M&E) Filtered water supply for autoclaves, Filtered water supply for autoclaves,

haemodialysis, kitchen.haemodialysis, kitchen.

Dedicated water tank for haemodialysis.Dedicated water tank for haemodialysis.

Special treatment for laboratory sewer Special treatment for laboratory sewer i.e dilution tanks.i.e dilution tanks.

Task light at nurses counter/stationTask light at nurses counter/station

Sufficient & appropriately located floor Sufficient & appropriately located floor traps.traps.

Easy to maintain materials.Easy to maintain materials.

Avoid sprinkler at ‘clean/sterile’ Avoid sprinkler at ‘clean/sterile’ areas and areas with expensive areas and areas with expensive equipment eg ICU, CCU, Burns etc.equipment eg ICU, CCU, Burns etc.

Digital Calling system shall be Digital Calling system shall be provided for ALL rooms where provided for ALL rooms where patient need to queue eg. CE rooms, patient need to queue eg. CE rooms, Treatment, Procedure, Assessment, Treatment, Procedure, Assessment, ECG etc.ECG etc.

Lessons Learned (M&E)Lessons Learned (M&E) Room air flow shall be from the Room air flow shall be from the

doctor/medical staff to the patient doctor/medical staff to the patient before being exhausted out.before being exhausted out.

Provide dedicated plug point for Provide dedicated plug point for electric beds in 1electric beds in 1stst class. class.

Provide sufficient & appropriate Provide sufficient & appropriate power supply:power supply: eg. essential supply for all medical eg. essential supply for all medical

fridgesfridges eg. UPS for life supporting eg. UPS for life supporting

equipment ie. ventilators, equipment ie. ventilators, angiography etcangiography etc

Dr Maarof SudinPlanning & Development DivisionMinistry of Health Malaysia

EVIDENCE BASED DESIGN (EBD)

Introduction

• Healthcare business is about “selling care experiences”

‘An aesthetically pleasing facility is a key aspect of the perceived quality of care’

• Does health facility design really have impact on patients and staff outcome?

Growing evidence - design can produce positive impact on the desired outcomes

Introduction• Impact of building on people/occupantsImpact of building on people/occupants

““Second to fresh air, I should be inclined to rank Second to fresh air, I should be inclined to rank light in importance for the sicklight in importance for the sick. Direct sunlight, . Direct sunlight, not only light is not only light is necessary for speedy recovery.necessary for speedy recovery. I mention from experience, as quite perceptible I mention from experience, as quite perceptible in promoting recovery, the being able to see in promoting recovery, the being able to see out of a window, instead of looking against a out of a window, instead of looking against a dead wall”dead wall”- Florence Nightingale on Light, 1860- Florence Nightingale on Light, 1860

““First we shape the building; thereafter, they First we shape the building; thereafter, they shape us”shape us”-- Sir Winston Churchill, May 10, 1941 Sir Winston Churchill, May 10, 1941

Well Designed Hospitals

Create a built environment that take into consideration patient and staff requirements that can have positive impact on patient outcome, staff performance and staff and patient safety

No Environment is Neutral• The design of facilities,

organizations, work processes, and equipment impact one another as well as patient outcomes, safety and staff satisfaction

• Either positively or negatively, the design will exert its impact

Connecting Environmental Design to Quality Improvement

Hospital Built Environment

Safety and QualityOf Patients Care

Patient’s PerceptionOf Care Given / Care Experiences

Staffs Job Satisfaction And Stress

How supportive healthcare design improve outcomes?

Ability to alleviate STRESSPromoting stress reduction, buffering and coping

Patient can use their limited energy to get better, instead of having to fight the environment

Stress in itself is a negative health outcome AND detrimental to psychological, physical, and behavioral effects that worsened other outcomes

EVOLUTION OF HOSPITAL DESIGN

Traditional New

Approach

Narrow ‘wellness’ perspective

Emphasis on functional efficiencies

Pathogenic conception-reduction of infection and disease risk exposure-prevent illness and physical harm

Holistic ‘wellness’ perspective

Also include:-psychological needs-social needs-spiritual needs

of patient, staff and improve medical outcomes

HospitalOutlook

Institutional

Stressful

Detrimental to care quality

Patient and Family Centred

Healing Environment

Friendly

Quality Care

Institutional & Stressful

Traditional Hospitals New Hospitals

Patient Centred & Promote Healing

Reasons For Change In Design Approach

• High demand to increase patient satisfaction

• Growing stress, work demands for healthcare staffs– Declining staff / patient ratios– Need to attract and retain quality employees

• Advances in mind/body medicine– Stress and psychological factors impact on

health

• Increase adoption of patient centred and family centred care philosophies

• Mounting scientific researches linking well-designed healthcare environments to improved outcomes

New Health Facility Design Approach

Evidence Based Design / EBD

“Design is less of an art BUT more of a SCIENCE”

- Empirical Approach / Engineering-style Approach“Measure first then fix”

Architects / designers and informed clients make decisionsguided by credible evidence

Evidence Based Design (EBD) DefinitionEvidence Based Design (EBD) Definition

General :

“Evidence based design is the conscientious, explicit and judicious use of current best evidence from research and practice in making critical decisions, about the design of each individual and unique project”

Hamilton, DK & DH Watkins 2009

“A process of basing decision about the built environment on credible research to achieve the best possible outcome”

The Centre for Health Design, 2008

EBD in Healthcare SettingEBD in Healthcare Setting

In Healthcare Buildings,

Built environment = Healing environment

A Healing Environment

is the result of a design that hasdemonstrated measurable improvements in the physical and/or psychological , social and spiritual states of patients and/or staff, physicians, and visitors

- complementary treatment modality

- makes a therapeutic contribution to the course of care

EBD Research Initiatives1. Centre for Health Design

& Robert Wood Johnson Foundation, Chicago

2. Georgia Institute of Technology

3. Rubensi & Golden meta-analysis on 84 studies (1998)

4. Ulrich & Zimring meta-analysis on 600+ studies (2004)

Centre for Health Design

Literature Search 2004by Ulrich & Zimring

• Organizes the substantial research knowledge base on the effects of the environment to various outcomes.

• Findings :Rigorous studies link the environment to outcome in 4 areas :1. Reduce patient stress & improve outcome2. Reduce staff stress & fatigue3. Improve safety4. Improve quality

Literature Search 2004Literature Search 2004by Ulrich & Zimringby Ulrich & Zimring

Research Conclusion / Recommendations

• Provide single bed room• Hospital should be much more quieter to reduce

stress and improve sleep• Provides stress reducing views of nature• Develop efficient way finding systems• Improve ventilation• Improve lighting• Design to reduce staff walking and fatigue

Saint Alphonsus Saint Alphonsus Centre for Advanced HealingCentre for Advanced Healing

Identify evidence based design elements with positive outcomes (in order of the strength of evidence):

1. Single patient rooms2. Installing HEPA filters3. Providing access to nature4. Installing ceiling lifts5. Installing sound-absorbing ceiling tiles6. Family areas within patient care spaces7. Providing access to sunlight8. Promoting the use of visible and accessible hand washing facilities/dispensers9. Promote visual access and accessibility to patient10.Providing areas of respite for staff

Single Patient Rooms

-High HAI-More medical error-Increase patient transfers-Privacy violation-Lack family involvement-Stress-Reduced quality of care-Reduced satisfaction-Reduced staff productivity

-Faster recovery-Lower HAI & medical error-Better privacy-Less noise-Better communication between staff and patient-High satisfaction

Installing HEPA filters

-Control indoor air pollution

-Filter harmful pathogens

-Reduce impact of infections

-Isolation of patient

-During construction and renovation (portable HEPA) to filter m. organism eg. aspergillus from soil

Providing access to nature• View to Nature

-large window

• Healing Garden-visibility, accessibility, familiarity, quiet environment

•Positive Distraction-ARTS, music etc

-Increase satisfaction

-Positive escape & recuperation from stress

-Opportunity for patient-visitors interactions

-Positive mood change

Comforting/Healing

Artwork - ExampleStress Induced

Installing Patient Lifters

- 44% of injuries to nurses that result in lost workdays

- patients becoming heavier & nursesageing( 40% US nurses aged >50 by 2020 )

- integrated with staff education, ergonomic program,& no manual-lifting policy

- reduce staff injuries-reduce staff MCs-reduce medical claims

Installing sound absorbing ceiling tiles

- Acoustic environments - Reduced sound reverberation times & sound propagation-Reduce noise- Reduce stress- Improve sleep- Improve communication

- Reduces perceived work pressure

-High ambient noise levels

- Staff emotional exhaustion and burnout

-Threat to patient confidentiality and safety

- Impeding effective communication

Family areas within patient care spaces

- Space within patient’s room - Family lounge &-Family counseling room

-Encourage active family participation

-Patient-family interaction privacy

-Unfriendly facilities for family

-Intermittent contact with patient

-Unable to participate actively in patient care

-Reduce family involvement & satisfaction in care

Providing access to sunlight

-Reduce depression & stress

- Less pain

-Decrease LOS

-Improve sleep & circadian rhythm

-Less agitation among dementia patients

-Vitamin D intake

- -Patient & staff rooms, family lounge

-Large windows

-No glare

-Able to control light level

Visible and accessible hand washing facilities

Scrub troughs, clinical sinks or hand sanitizers

-Easy access

-Good visibility

-Within easy reach

-Unobstructed access

-Placed at comfortable height

-Minimal effort to use

-All patient rooms

Hand washing frequency among healthcare staffs generally still low

Promote visual access and accessible to patient

-Decentralized nurse stations-Alcoves outside patient rooms-Locating frequent used supplies in / near patient room

-Reduce staff walking distance-More time on direct patient care-Reduce staff fatigue-Reduce patient fall rate

-Centralized nurse base

-1/3 nurse time walking

-Walks 6 miles/shift

-No direct visibility of patients

-Time wasted in hunting & gathering supplies

Providing area for respite for staff

-”non revenue generating space”

-very cramp/compact

-contribute to staff stress

-poor staff satisfaction

-poor staff retention

-Large staff lounge-Windows with view-Respite area-Staff toilets and shower

-Staff satisfaction & retention-Increase staff effectiveness

Nowhere to Rest………

• Environmentally preventable hospital acquired conditions can no longer be tolerated eg. -infections and falls

-injuries to staff, -unnecessary intra hospital transfers

that can increase errors, -increase patient and family anxiety,

stress, -LOS caused by noisy, confusing care environments

• Clear connections between constructing well-designed healing environment and improved health care safety and quality for patients, families and staff as well as long run cost saving

Conclusion

Conclusion

• Cost-effective, evidence based environmental design interventions should be included in all hospital improvement programs

• Evidence-based environmental design intervention should be implemented together with other process improvements for them to be effective

We can show empathy through EBD…..

THANK YOUTHANK YOU