A POE of the design of University of Kentucky's Hospitals

H E A LT H C A R E D E S I G N Un i v e r s i t y o f K e n t u c k y An Assessment of UK HealthCare’s Cardiovascular Unit through a collaborative pre- and post-occupancy evaluation.

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The field of healthcare design is situating itself as an industry leader in the use of pre- and post-occupancy evaluations as a means to inform future design decisions. The post-occupancy evaluation (POE) as a research initiative is focused on evaluating and measuring the performance of the built environment relative to design objectives with the ultimate goal of improving future designs and processes. The research completed at the UK Chandler Medical Center has demonstrated a collaborative effort between UK HealthCare, the College of Design, and the College of Communication and Information to conduct a pre- and post-occupancy evaluation of the cardiovascular service line as it made the move from Pavillion H to the new Pavillion A. It is our hopes that this research has yielded great benefits to the staff, patients, faculty, and students of the University of Kentucky.

Lindsey Fay Assistant Professor, College of Design

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F O R W A R D When the cardiovascular floor in Pavilion A opened in December 2014, we had one purpose in mind: to optimize our physical surroundings to promote healing of patients hospitalized with heart and vascular illness. At the Gill Heart Institute, our talented physicians and staff provide the most advanced care as part of their daily routine − they do it with proficiency, compassion, and optimism that instills hope and confidence.

With the design of the new floor, we had the opportunity to create an environment that matched our consummate delivery of the highest care. The goal was to create a space in which the most complex services could be provided in a soothing and accommodating atmosphere to foster wellness and to begin the road to recovery. To realize the potential of the floor, the cardiovascular team worked with groups across the university to integrate the physical layout with functional operations. An important part of the year-long process included collaboration with the College of Design, College of Communication & Information, and Statistics who conducted pre- and post-occupancy assessments.

In the cardiovascular arena, we strive to incorporate the best practices into everything we do, which included the design of the floorplan. This project will better help us recognize our achievements and identify gaps in our processes with the ultimate goal of optimized care.

Dr. Susan Smyth Chief, Division of Cardiovascular Medicine Medical Director, Gill Heart Institute

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Design at all scales is more comprehensive and cross-disciplinary than ever before. Witness design for health – during the past 20 years, product, interior and architectural design have expanded to include service (or experience) design as we try to better understand what it means to move through a healthcare system. Hospitals and the Affordable Care Act are two different but related systems of human interface.

As designers we solve problems, and we are at our best with process. We are experts at seeing patterns in human interface with everything, from nano- to urban scale. Thanks in no small part to forces like Apple, design in general has a significantly bolder role with consumers. Consequently, we can expect patients, their families and caregivers to no longer be passive users of medical treatment. In an era of CXOs (chief experience officers) in healthcare organizations, who better to assess all scales of human interface systems than design teams?

The University of Kentucky is fortunate to have a cross-disciplinary team from UK HealthCare, the College of Design, and the College of Communication & Information engaged together in assessing and elevating the new Cardiovascular Unit of the Chandler Medical Center. This project of peering into a developing new system of cardiovascular care is a model of the expanding role of curation for designers and collaborative teams thinking through all manners of human systems.

Dean, Mitzi Vernon

College of Design

As Dean of the College of Communication and Information and a health communication researcher myself, it is rewarding to witness the innovative research program springing from the interdisciplinary team representing the College of Design, UK HealthCare, and the College of Communication and Information. We know that communication is an important component of care quality in healthcare delivery.

The Institute of Medicine (IOM) has recognized that healthcare professionals practice in complex environments characterized by time pressure, multiple decision-makers, rapidly changing, ambiguous situations, information overload, and serious consequences for error. Healthcare design research offers an innovative approach to understanding the complexity of communication in healthcare organizations.

Studying design and communication is especially important in hospitals because patients often do not feel qualified to judge the clinical quality of care. However, they do assess their care based on perceptions of what they can evaluate.

These perceptions could include the quality of interactions with providers, provider empathy, and the degree to which their environment is well-designed, physically safe, comfortable, and clean. It is important to understand how hospital built environments can facilitate interactions that improve clinical outcomes and reassure people that they or their families are receiving good care.

Dean, Dan O’Hair

College of Communication and Information

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PRINCIPAL MEMBERS

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Lindsey Fay

Kathy Isaacs

Principal Investigator

Principal Investigator

Lindsey Fay (Assistant Professor, School of Interiors, College of Design) utilizes pre- and post-occupancy evaluations to assess the design of healthcare spaces and their impact on care delivery. She implements this methodology as a learning tool and immersive learning experience for interior design students. Fay has been published in a number of peer-reviewed journals, and is a frequent presenter at national and international conferences.

Kathy Isaacs, Ph.D., (Director of Nursing Professional Development, UK HealthCare) received her doctoral degree from the University of Kentucky College of Nursing in December 2013. She used qualitative methods and Grounded Theory investigation to understand how a mother attains her mother role while her baby is in the Neonatal Intensive Care Unit. She is a registered nurse with 30 years of experience in caring for patients.

Kevin Real

Allison Carll-White

Aric Schadler

Co-Investigator

Co-Investigator

Co-Investigator

Kevin Real, Ph.D, (Associate Professor of Health and Organizational Communication, Department of Communication) Dr. Real’s primary scholarship is communication in healthcare organizations. He is interested in understanding how communication shapes patient care processes, facilitates collaboration, and leads to better patient outcomes.

Allison Carll-White Ph.D., (Professor, School of Interiors, College of Design) has experience in both qualitative and quantitative research methodologies, resulting in an extensive number of peerreviewed publications and presentations. Her articles have focused on the state of the interior design profession, interior design pedagogy, as well as her most recent research surrounding of healthcare facilities.

Aric Schadler (Healthcare Statistician) has fourteen years of experience working with a variety of researchers. His area of focus is in multivariate statistics.

He has also dedicated six years to healthcare research, and analyzed data from the pre- and postoccupancy evaluations for this project.

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CONTRIBUTORS

Shannon Knoch

Amy Schlachter

Grace Snider

Shannon (B.A. in Interiors, May 2016) hopes to practice healthcare design in her professional career. She was drawn to the impacts design can have in a healthcare setting. Shannon became interested in healthcare design in her senior studio, taught by assistant professor Lindsey Fay and Dr. Allison Carll-White. She hopes to create an impact through design during her professional career with one important goal in mind, to create environments that evoke positive feelings that can communicate with the users. Her primary role for this project was to interpret data that was collected, and create infographics that represent the data from different studies involving UK HealthCare.

Amy (B.A. in Interiors, May 2016) fostered an interest in healthcare design by assisting Lindsey Fay in her research with UK HealthCare.

She then participated in the healthcare design studio and spent her last semester of her senior year continuing to assist with this research project. She is passionate about healthcare design because it has a higher purpose in that it can produce a more efficient and positive healing environment and process for all users. Amy’s part in this project includes observations, data entry, behavioral mapping, and literature research, while providing input to the graphics of this book.

Grace (B.A. in Interiors, May 2016) holds an interest in creating environments that can evoke feeling.

In the rhealm of healthcare design, the feeling of ease and comfort promotes healing among patients, and fosters relationships among all users in a healthcare environment.

Her involvement with UK HealthCare first began by graphically entering mapping patterns of staff members in a pre-occupancy evaluation. She later participated in the post-occupancy evaluation by mapping the walking patterns of staff members in the newly designed space. Working alongside her fellow contributors, Grace served as the design leader to produce this book. She hopes to further design spaces that ultimately promote user health and wellness.

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Erin Taylor

Marissa Wilson

Carly Zembrodt

Erin’s (B.A. in Interiors, May 2016) interests in the design field include research and design implementation for healthcare and hospitality.

Providing designs to enhance life and experience to a wide variety of users is a satisfying and crucial way to dedicate a career path. Erin began her involvement with UK HealthCare by digitally documenting information about user travels through the original cardiovascular unit. She has since been involved in the observation of travel and communication for the new UK hospital. After understanding the value of evidence-based design and decisions, she plans to continue lifelong research and implementation towards improving what her design role can provide to the healthcare and healing design profession.

Marissa (M.A. in Interiors, December 2016, B.A in Interiors, May 2014) became interested in healthcare design after participating in Lindsey Fay’s healthcare studio her senior year.

As a research assistant for this UK HealthCare project, she participated in behavioral mapping observations, entered and analyzed a variety of data, and created infographics representing the data. She also utilized her graphic design skills to edit and finalize this book. Her master’s work has focused on how to design environments and products for people with Alzheimer’s Disease. She hopes to continue designing and researching how to improve healthcare environments and products in her future design career.

Carly’s (expected B.A. in Interiors, May 2018) interests include branded environments, research of interior environments, and graphic design.

Her involvement in this research began in Spring of 2016. She assisted with graphic design and data entry for the post-occupancy evaluation.

She hopes to further research in the area of healthcare design, and overall user experiences in interior environments.

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TABLE OF CONTENTS Forward

p. 01

Guiding Principles

Methods & Preliminary Findings

p. 61

Areas We Serve Questionnaires

Demographics

Focus Groups

Building Layout Cardiovascular Unit

Pedometer Data Behavioral Mapping

Research Overview

Communication Documentation

p. 25

Pre/Post - Occupancy Evaluations Research Statement

Time in Room Data Acoustical Measures Room Usage Data

Research Goals Timeline

Studio

Collaborations

Healthcare Design Studio

Student Involvement

Next Steps

Literature

p. 121

p. 33

Summaries

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SITE CONTEXT In response to increased demand for medical services, UK HealthCare developed a plan for phased replacement of the original Chandler Hospital that was constructed in 1955.

The new twelve-floor medical center includes an emergency department, two towers of private patient rooms, operating, imaging and surgery centers, and a cafeteria, gift shop, and waiting areas for use by the public.

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GUIDING PRINCIPLES The guiding principles for design focused on patient access and care, the academic mission of the university, as well as integration of clinical services, efficiency, flexibility, and image.

PRINCIPLE

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PRINCIPLE

Accessibility

Academics

Services

Wayfinding is a key component in directing individuals where they need to go. Providing a comforting and welcoming environment that is easy to navigate, and is convienient for patients and families can offer the highest quality of care.

The Chandler Hospital serves as an academic facility striving to be a top 20 academic medical center. As a result, the facility must support patient-centered care, which fosters flourishing academic and research programs.

The services provided vary from a range of medical professionals and healthcare staff. Designing for this multidisciplinary care is done by integrating both inpatient and outpatient services with adjacent facilities - thus providing seamless care.

PRINCIPLE

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PRINCIPLE

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PRINCIPLE

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PRINCIPLE

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Efficiency

Flexibility

Image

Improvement is always a goal. In this case, the goal was to improve communication, working conditions, and staff health to create a more efficient work environment. This results in the highest quality of care for patients by enhancing the care process.

Technology is changing often, especially in the world of healthcare. In response to this everchanging world of medical equipment, the new unit is designed to be flexible to future needs in both design layout and technology.

Opening in 1962, the old unit was darker, smaller, and less efficient. The new hospital is designed with a timeless aesthetic that is open and welcoming.

Overall, it provides a comforting environment for patients and their families.

The care team station - also refered to as the “fishbowl” of each patient floor.

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AREAS WE SERVE

UK HEALTHCARE at the heart of Kentucky

Out of the 120 counties in Kentucky, Chandler Medical Center provides care to each, along with surrounding states. The center supports a total culture of care by meeting the needs of the patients, visitors, and staff.

LEXINGTON

Fayette County

COMMONWEALTH OF KENTUCKY

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UNIVERSITY OF KENTUCKY UK Campus

UK CHANDLER HOSPITAL UK HealthCare

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DEMOGRAPHICS Residents of Kentucky, in the midst of the “Coronary Valley” suffer from a high rate of coronary heart disease.

of this growing patient population. The design features a flexible space with areas to accomodate the growing need for care.

Overall, 27% of Kentucky’s adult population smokes. This makes Kentucky the state with the highest percentage of smokers in the nation. Moreover, the state ranks number two in the United States for adults reporting no physical activity.

In addition to the expanding patient population, the Medical Center aesthetically captures the rich spirit of Kentucky. The new unit showcases a digital wall that incorporates pictures of local individuals, events, and scenes.

The combination of smoking and lack of physical acitivity contribute to cardiovascular disease as the leading cause of death in the state. UK HealthCare’s cardiovascular unit had to meet the needs

These are interchangable images that rotate on constant display. This wall symbolizes the population, which the medical center in turn serves.

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BUILDING LAYOUT

PAVILION A

Pavilion A opened in 2011 with space designed to support patient care for the next 100 years. The 12-story patient care complex includes 1.2 million square feet of public and clinical spaces focusing on patient safety and quality. The phased design incorporates a four-story podium topped with two eight-story patient care towers and a total of 512 private patient rooms.

KEY

THE GROUND FLOOR, opened in 2011, provides a home to the UK HealthCare Emergency Department, which includes a Level I Trauma Center, an Adult Emergency Center, the Makenna David Pediatric Emergency Center, and Express Care.

THE FIRST FLOOR provides space for the public, includes surgery waiting, a health education center, gift shop, outdoor terrace, cafeteria, and an installation celebrating Kentucky through photography and videos.

THE SECOND FLOOR is dedicated to eight operating rooms and one of the country’s largest hybrid ORs. FLOORS THREE AND FOUR house electrical and mechanical systems to support the building and are topped off with a rooftop garden.

FLOORS SIX AND SEVEN, also completed in 2011, house the neuroscience services for patient care and the dedicated trauma and surgical services, each containing 64 patient rooms.

THE EIGHTH FLOOR, completed in 2014, is home to the cardiovascular unit with 32 beds dedicated to ICU patients and 32 dedicated to telemetry and progressive care.

THE NINTH AND TENTH FLOORS, completed in 2016, house the medicine service line.

FLOORS 11-15 are shelled for future expansion of patient care, including the Markey Cancer Center.

FLOOR 12 is not yet assigned at this time.

All patient floors are designed to accommodate acute, progressive and intensive care patients, minimizing the need to transfer patients to other areas. Additionally, all patient rooms are the same size and design with the goal of improving staff efficiency.

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Completed Under Planning/Construction Study/Future Phase

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11 10 9 8 7

6 5

NOT YET A

SSIGNED

MARKEY C

ANCER CE

NTER

MEDICINE

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NOT YET A

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MARKEY C ANCER

SSIGNED

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MEDICINE

CARDIOVASCU

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MEDICINE

TRAUMA

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CARDIOVASCU

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TRAUMA

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NEURO SCIENCES

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PRE-PLANNING

MEDICINE

LAR

NEURO SCIENCES

PRE-PLANNING

MECHANICAL

CENTER

LAR

BLOOD BANK/PT/RT/OT

PHARMACY, SURGICAL SUPPORT, MECHANICAL

SURGERY

PHASE 1 - 3A

FUTURE PHASE

CAFETERIA

INTERVENTIONAL STUDY PROGRAM UNDERWAY

LOBBY & AMMENITIES

RADIOLOGY PHASE 1, HYOERBARIC

EMERGENCY, SUPPORT SERVICES, LOBBY & AMMENITIES

FUTURE PHASE

KITCHEN, CENTRAL STERILE

SUPPORT SERVICES

FUTURE PHASE

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Tower 1 - Progressive Tower 2 - ICU

CARDIOVASCULAR UNIT 8th Floor UK Chandler Medical Center

“The opening of the eighth floor of UK Albert B. Chandler Hospital marks the next step in UK HealthCare’s mission to provide patients with the latest advances in heart care in an environment carefully designed to promote healing” (Gill Heart Institute).

The move of the Cardiovascular Services floor to the new pavilion took place on December 7th 2014. The new unit provides 64 private patient rooms consistent in size and design, thus improving staff efficiency and promoting safety. The unit includes a 32-bed cardiovascular intensive care unit (ICU), making it one of the largest of its kind in the nation, as well as a 32bed unit for telemetry and progressive care.

The design of the unit creates a positive experience for patients and visitors. The rooms incorporate art of Kentucky nature scenes and wall-mounted flat screen TVs. In addition to providing a positive distraction, these display important health information and help caregivers clearly communicate to patients. For visitors, the patient rooms offer a work desk with wireless Internet access and a built-in sleeper sofa for overnight stays. Large windows provide natural light and outdoor views.

Caregivers work within a variety of environments in the new unit. Decentralized workstations situated outside each patient room offer direct views to the patient bed. Centralized care team stations provide private offices and desks for interdisciplinary team members, promoting a greater sense of collaboration in the care delivery process.

“Locating heart patients in one area enables our team of expert doctors, nurses and other care providers to easily communicate and share knowledge and resources.

Patients benefit from an experienced team that provides around-the-clock care for heart disease” (Gill Heart Institute).

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Decentralized units and the care team station of the cardiovascular unit.

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Progressive care patient room with integrated family/visitor zone.

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RESEARCH OVERVIEW Only a limited amount of design research has included both a pre- and post-occupancy evaluation to determine the sources of design problems, how the new design responds to these issues, and the effectiveness of the design responses. An even smaller number of studies specifically examine the pre- and post-occupancy impacts of moving from a centralized to a decentralized care delivery model. With the completion of this POE, the collaborative team could evaluate the findings and disseminate results among external and internal outlets with the ultimate goal of informing operational processes and future designs.

The research team began with a pre-occupancy evaluation in the summer of 2014 and completed the post-occupancy evaluation 6 months after the move to the new unit in the summer of 2015.

The research outcomes will help to support a better understanding of how operational processes and future designs might be enhanced to better a culture of healing.

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RESEARCH STATEMENT The past decade of healthcare design has seen an increased demand for meaningful designs based upon solid research. Healthcare environments designed on the basis of research evidence improve patient safety, reduce stress, increase care delivery effectiveness, and enhance quality of care. As a result, new healthcare facilities now incorporate private rooms and increased square footage to facilitate the work of multidisciplinary team members including nurses, physicians, therapists, social workers, and family members. With these changes, there has been a shift from the centralized nursing station model to a decentralized model, which places the caregiver in closer proximity to the patient.

The decentralized model was implemented with the goals of increasing patient visibility, caregiver time with the patient, and efficiency. However, current research suggests that nurses in decentralized stations feel more isolated from their colleagues and lack team connection. These differing views suggest the need for more research to determine the advantages and disadvantages of the two models.

The interdisciplinary team of UK researchers from the College of Design, College of Communication and Information, UK HealthCare, and GBBN Architects conducted a pre- and post-occupancy evaluation of the UK Cardiovascular service line. Prior to the December 2014 move to the new UK HealthCare Pavilion A, the service line was housed in four separate units, each containing a centralized nursing station.

The decentralized model of the new hospital unified the entire department on one floor with two-person stations outside each room.

The research team analyzed the effects of the differing models on staff efficiency, communication, privacy, safety, and satisfaction. The team captured metrics such as walkability, communication patterns, time spent with patients, acoustic levels, and staff satisfaction.

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RESEARCH GOALS The overarching goal of this study was to analyze the impact of the newly constructed UK Cardiovascular Unit and its decentralized care delivery model on patient, staff, and visitors. To achieve this goal, four specific objectives were outlined by the research team.

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12 To analyze the impact of decentralized hospital design layout on the delivery of efficient care.

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To determine design impact on caregivers and the resultant level of satisfaction.

To gain a richer understanding of design decisions to help impact future investigations of healthcare facilities through a pre- and post-occupancy study.

To share findings, design implications, and recommendations in both clinical and academic venues.

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Fall 2014: Pre-Move Data Collection Phase

Fall 2015: Post-Move Data Collection Phase

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Summer 2014: Research Planning Phase

Spring 2015: Pre-Move Data Analysis Phase

05 Spring 2016: Post-Move Data Analysis & Reporting Phase

TIMELINE 01

The Research Planning Phase consisted of pre-planning, research design development, IRB approval, a literature review, and instrument approval. All members of the team collaborated to complete these tasks and as a result, the reseaarch plan was developed.

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During the Pre-Move Data Collection Phase, a pre-move study, dedicated studio, instument refinement, data collection, analysis of move, and process documentation took place. In addition to communication, design, and UK HealthCare, sixteen students joined the team. This phase resulted in data entry.

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The Pre-Move Data Analysis Phase incorporated the premove summary, post-move prep, and instrument refinement.

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The Post-Move Data Collection Phase consisted of a post-move study, data collection, data entry, and process documentation. During this phase, a new group of 28 design students and 2 communication students assisted with the data collection and analysis.

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The Post-Move Data Analysis and Reporting Phase will result in a series of scholarly works that consist of a pre-/postanalysis, presentations, and article preparation, as well as design reccomendations for improvement.

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DESIGN RESEARCH Planning for the research study first began with a literature review, which included an extensive search for existing literature and an analysis of each study’s methodologies and tools. The team assessed literature on topics such as healthcare design, evidence-based design, post-occupancy evaluations, nursing station design, as well as staff and patient issues relative to walkability, efficiency, safety, and privacy and confidentiality.

The review found a growing body of research on these topics, but no pre- and post-occupancy evaluations specifically of a cardiovascular unit.

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TRANSCENDING PROJECT TYPE: High Performance Interiors + Evidence-based Design

Collaborative Spaces, Modularity, Flexibility, Sustainability, and Daylighting all have positive effects on interior spaces.

The authors from Perkins + Will describe how collaborative spaces, modularity, flexibility, sustainability, and day-lighting all lead to improvements in wellness, productivity, and learning. Although it is hard to measure and link each performance factor to wellness, productivity and learning, the study results concluded overall improvements in environmental design. Day-lighting was easily measured and linked to satisfaction, wellness, and productivity. Modularity and flexibility were linked with greater efficiency

and financial benefits. The authors found that sustainability leads to financial savings and better air quality, which increases wellness.

The authors also found that collaborative spaces can have positive sociological impacts on health, wellbeing and satisfaction, and physical design features can promote health fitness and wellness. Designing high performance interiors can have a positive effect on human health and wellness, and all of these performance factors can lead to overall improvement of an environment.

KEY POINTS

Blumenfeld, J., BaRoss, C., & Dufner, S. (2009). Transcending project type - Principles for high performance interior design: High performance interiors + evidence-based design. PERKINS +WILL RESEARCH JOURNAL, 1(2), 83-111.

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Collaborative Spaces Modularity/Flexibiliby Sustainability Daylighting The 4 factors listed above increase wellbeing and improve interior spaces.

Reflection space for families and visitors with day-lighting and handcrafted art.

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THE EVIDENCE-BASED DESIGN WHEEL Healthcare environments that are based around evidence-based design are reducing stress and fatigue, showing improvements in patient safety, increasing the delivery of care, and positively impacting overall healthcare quality.

The evidence-based design wheel includes; ergonomics, single patient rooms, noise, windows, light, access to nature, positive decoration and furniture arrangement, air quality, flooring materials, way-finding, and building layout. Evidence-based design (EBD) is defined by the author as “an approach to environmental design (architectural, interior, and landscape) that aspires to base design decisions on documented research and deep-rooted best practices, with the aim of improving outcomes�. Healthcare environments that are based around

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EBD are reducing stress and fatigue, showing improvements in patient safety, increasing the delivery of care, and overall healthcare quality. The EBD wheel factors contribute to a better healing environment. A healing environment is a multisensory setting that incorporates physical, emotional, and social aspects that rebuild and maintain health. A therapeutic healing environment involves restoring health for patients, family, staff and anyone else who inhabits a healthcare environment.

Geboy, L. (2007, March 1). The evidence-based design wheel. Healthcare Design, 1-5.

KEY POINTS

Accessible nature space for patients, staff, and visitors.

EBD in Healthcare has: Reduced Stress and Fatigue Improved Delivery of Care Improved the Quality of Care Improved Overall Health for Patients, Family, and Care Staff 37

CENTRALIZED VS. DECENTRALIZED NURSING STATIONS: Effects on Nurses’ Functional Use of Space and Work Environment Designing a “hybrid” nursing station model that utilizes both centralized and decentralized nursing station designs should allow nurses to complete daily tasks in a more efficient and functional way.

There is a debate on whether centralized or decentralized nursing stations are more efficient and functional for nursing staff. Authors concluded from this study that designing a “hybrid” model, which utilizes both centralized and decentralized nursing stations might be the key to solving this design challenge. This study was designed to compare the two nursing station models by understanding how each affects use of space, patient visibility, noise levels, and nurse perceptions of the work environment. The study revealed that nurses on all units were observed spending more time completing computer, telephone, and administrative tasks than spending time with patients. These numbers were higher in centralized nursing stations. Social interactions and consultations

with medical staff happened less frequently in decentralized nursing stations. The study also recorded sound levels, in which all surpassed the recommended noise level during a nursing shift. There was no indication to whether a decentralized or centralized nursing station provided better views of patients, and there were no indications of nurse perceptions of work control-demand-support in the different nursing stations. Current healthcare design trends are creating more flexible and adaptable nursing units that allow nurses to complete their duties in a more safe, comfortable, and efficient way. The key is to involve nurses in the design process in collaboration with architects and designers to create the most efficient and functional nursing station design.

KEY P OINTS

Zborowsky, T., Bunker-Hellmich, L., Morelli, A., & O’Neill, M. (2010). Centralized vs. decentralized nursing stations: Effects on nurses’ functional use of space and work environment. Health Environments Research & Design Journal, 3(4), 19-42.

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Nurses were spending more time completing daily tasks than being with patients in both nursing station models, but numbers were significantly higher in centralized nursing stations.

Results revealed that a “hybrid” nursing station that combines both centralized and decentralized nursing stations may solve this challenge for nurses and staff.

Centrailized “fishbowl” care team station.

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THE ROLE OF THE PHYSICAL AND SOCIAL ENVIRONMENT IN PROMOTING HEALTH, SAFETY, & EFFECTIVENESS IN THE HEALTHCARE WORKPLACE. The physical environment, social support, work culture, and technology can improve health, safety, effectiveness, & satisfaction of a healthcare team.

The Authors explained that the physical environment plays a major role in the health and safety for healthcare staff. Many physical problems in the healthcare work environment include staff injuries, hospital-acquired infections, medical errors, operational failures, and waste issues. Improving these issues and providing social support in a work culture environment can help decrease staff turnover and increase retention rates. This study tested how the physical environment, work culture, and social support influenced the health and safety of the healthcare

team, the effectiveness of the healthcare team in delivering care and reducing medical errors, and patient and practitioner satisfaction. Results concluded that a successfully designed healthcare environment, and a work culture that has strong policies and values in promoting health and safety can decrease the risk of disease and injuries to healthcare staff, can provide proper support to accomplish critical tasks, which can overall create more job satisfaction, health and safety for the healthcare team.

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KEY P OINTS

Joseph, A. (2006, November). The role of the physical and social environment in promoting health, safety, and effectiveness in the healthcare workplace. The Center for Health Design, (3), 1-17.

Physical problems in the healthcare work environment include staff injuries, hospitalaquired infections, medical errors, operational failures, and waste issues.

Designing a successful healthcare environment can reduce injuries, disease, and medical errors.

Social support and a work culture that values health and safety will create more satisfaction for healthcare staff.

Gingko installation anchoring the UK Chandler Medical Center entry.

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Patient room with nature art and family zone.

PATIENT ROOMS: A Positive Prognosis Designing multi-functional patient rooms that give patients and family choice, control, and comfort are the three key elements in creating a customizable and positive healing experience.

Steelcase researchers and other design professionals have taken into perspective a human-centered design approach for the patient room design. For over 70 years, the patient hospital room design and experience has remained the same. However, a huge movement towards building new healthcare facilities and renovating existing ones has influenced healthcare environments today. The main concern of healthcare professionals is patient safety. This means designing multi-functional rooms to meet the needs not only for patients, but also for family and staff.

At Steelcase, they understand that the patient room takes on many functions. It’s a healing space, bedroom and dining room

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for patients, a workspace and procedural space for healthcare staff, and a living room, bedroom, and even an office for family members. It is also important that the patient room can become a classroom for educational interactions between healthcare staff, patients, and family members. Having to go into the hallway to have a discussion due to lack of comfortable space in a patient room creates privacy issues. Steelcase believes giving the patient and family member choice, control, and comfort are the three key elements in creating a customizable and positive healing experience in the new multi-functional patient room design.

Steelcase. (2015, June 14). Patient rooms: A positive prognosis. 360 Magazine, (70).

KEY POINTS

Patient rooms are multi-functional spaces not only for patients, but family and healthcare staff as well.

Human-centered design has transformed the patient room and recognizes the importance of giving patients and family members choice, control, and comfort in a healing environment.

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DOES THE DECENTRALIZED NURSING MODEL DELIVER? The decentralized nursing station has had many positive outcomes, but studies reveal it may be performing worse than anticipated.

The design of decentralized nursing stations began over 10 years ago, and was expected to increase positive outcomes for staff, however; many negative outcomes have also resulted with this model. The authors stated that the decentralized model was aimed to help improve efficiency, safety, culture workplace, and quality of care.

Studies showed positive outcomes from the decentralized model which included increased patient satisfaction, and improved nurse response time to patient calls, which in turn lead to a reduction in fall rates due to the close proximity of the nurses. Although these are all positive outcomes, other studies revealed inconsistent findings and showed no difference in nurse time with patients, and no difference in staff wellbeing or levels of stress and energy. Studies also showed

little differences between the decentralized and centralized nursing station models in regards to sound levels, perception of the work environment, productivity levels, and clinical outcomes. Negative outcomes from studies revealed that walking distance increased due to larger floorplans in the decentralized design. Peer-to-peer visibility and contact is an important part of the nursing culture especially for consultations, mentoring and socialization purposes. It was also found that nurses were spending more time in medication rooms, which might be linked to the need for socializing and mentoring due to isolation at decentralized nursing stations. Overall results from these studies conclude that the decentralized nursing stations might be performing worse than anticipated.

KEY POINTS

Pati, D., & Redden, P. (2015, August 6). Does the decentralized nursing model deliver? Healthcare Design.

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The decentralized nursing station has increased patient satisfaction, and improved nurse reponse time to patient calls, which in turn has lowered patient fall rates due to close proximity of nurses.

The decentralized design has also contributed to negative outcomes including an increase in walking patterns of nurses.

Decentralized alcove positioned outside each pair of patient rooms.

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AN EMPIRICAL EXAMINATION OF THE IMPACTS OF DECENTRALIZED NURSING UNIT Studies measuring the impacts of decentralized nursing unit design focused on five main issues including how nurses spend their time, walking distance, acute stress, productivity, and teamwork.

The physical design of decentralized nursing units were intended to increase positive work-flow operations by creating productive use of nursing time, reducing staff stress and walking distances, and enhancing teamwork, among other nursing concerns. Authors of this article conducted studies to examine the influence of a decentralized nursing unit on operational efficiency, staff wellbeing, and teamwork. The studies focused on five main issues including how nurses spend their time, walking distance, acute stress, productivity, and teamwork. The results showed constant variations in

nurse station use, documentation processes, medication room use, and supply room use in all units. Negative outcomes consisted of an increase in walking distance and a decrease in staff communication, collaboration, and interaction – although assessments revealed for an increase in collaboration in the physical facility. Decentralized nursing unit design has shown improvements in work tasks, but this design has also lead to many unexpected issues with walking, staff collaboration and teamwork.

KEY P OINTS

Pati, D., Harvey, T., Spira, P., Redden, P., & Summers, B. (2015). An empirical examination of the impacts of decentralized nursing unit. Health Environments Research & Design Journal, 8(2), 56-70.

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Negative outcomes from decentralized nursing units consisted of an increase in walking distance, and a decrease in staff communication and collaboration.

Positive outcomes revealed improvements in work related operational tasks.

Decentralized nursing station providing visibility to patient rooms.

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BUILDING NEW EVIDENCE FOR NURSING DESIGN UNITS The key to designing more efficient hospitals is to incorporate experienced healthcare providers and nurses into the design process.

Decades ago, nursing units were just long rows of beds. Many changes in hospital design have occurred since then with emphasis on patient rooms and nursing station design. The author explains that these changes have affected the workflow and communication between healthcare staff and patients, the observation of patients, the distribution of supplies, and the medical documentation procedures. It is also mentioned that the new patient room design includes private rooms, large windows with nature views, patient controlled lighting options, TVs for entertainment or for personal health information, and n area designed for family members. All of these features are designed to create positive distractions to reduce

patient anxiety and comfort family. Electronic documentation systems have eliminated paper records and technology has allowed for changes in the workflow process. The author states that one of the main issues of healthcare design today is the debate between whether a centralized or decentralized nursing station is more efficient.

Other issues include whether or not having patient rooms grouped in clusters is a good idea, or figuring out the size and where support spaces should be to be most efficient. The author believes that the most critical piece to this design puzzle is incorporating experienced healthcare providers and nurses into the design process, and educate them about design in order to improve hospital workflow and patient experience.

KEY POINTS

Stichler, J. (2012). Building new evidence for nursing design units. Health Environments Research & Design Journal, 6(1), 3-7.

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Patient room design, along with nursing unit and support area design have become important in the design of hospitals.

Figuring out how to create the most efficient design for each area is a challenge, but can be solved with the input of healthcare providers and nurses in the design process.

Central core of the emergency department demonstrating innovative nursing unit design.

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Intensive care unit patient room in the cardiovascular unit.

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FACTORS IMPEDING FLEXIBLE INPATIENT UNIT DESIGN Flexibility is critical for future healthcare facility design in order to improve financial, workflow, and medical processes.

The authors of this article believe it is crucial for future healthcare facilities to create flexibility in the design to allow for the ongoing need for improved workflow and medical processes. Flexibility is also critical for financial reasons because it leaves room for a variety of care, which is important for future healthcare organizations running on cost curtailment. The authors conducted studies to investigate factors that are irrelevant to the design decisionmaking process of flexible inpatient units. Flexibility was measured in four domains broken down into systemic, cultural, human, and financial. The study discovered

nine factors relating to flexibility that were irrelevant to the design process. The nine factors are: (1) peer lines of sight, (2) patient access, (3) multiple division and zoning options, (4) proximity of support, (5) resilience to move services across physical units, (6) ease of movement between units and departments, (7) multiple patient population/service expansion options, (8) adjustable support core elements, and (9) expandable support core. Flexibility and efficiency strategies are necessary for improving workflow and medical procedures, and reducing costs for future healthcare facilities.

KEY POINTS

Pati, D., Evans, J., Harvey, Jr, T.E., Bazuin, D. 2012. Factors impeding flexible inpatient unit design, Health Environments Research & Design Journal, 6(1), 83- 104

Flexible and efficient design is important for healthcare environments.

Flexibility can be hindered by factors such as visibility, access, support coves, and zoning.

Designing flexible healthcare facilities will provide financial benefit for hospitals that are run on day-to-day costs.

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DESIGNING HEALTHCARE SPACES FOR THE HUMAN EXPERIENCE Designing for the human experience means understanding the user needs for an environment and incorporating those needs into the predesign process.

It is fundamental to understand the human experience when designing spaces to meet the needs of users, especially in healthcare environments. The author notes that users in healthcare settings include staff, patients, and family members, however; this article focuses on staff experience in relation to design. In order to identify the human experience for the staff, the article explains three different areas that must be considered from the beginning.

They are satisfaction (overall building design features), wellbeing (overall sense people have while in an environment), and productivity/job performance (how the environment supports staff to efficiently provide care). With these three areas in consideration, collecting data in the pre-design, or pre-occupancy phase will also help gather valuable information to inform

proper design decisions. For example, the author mentions a survey that was distributed to a group of healthcare staff members that addressed questions based on overall satisfaction, along with satisfaction related to air quality, thermal comfort, ergonomic layout, space planning, adjacencies, acoustics, lighting conditions, day-lighting, furniture and finishes, cleanliness and maintenance, aesthetics, and access to outdoor spaces. By gathering valuable information from the users of the environment and using that to design for the human experience, designers can create more functional and efficient healthcare environments that can then be improved upon by utilizing post-occupancy evaluations (POE) for future designs.

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KEY POINTS

Freihoefer, K., Thibaudeau, P., (2015, February 10). Designing healthcare spaces for the human experience, Healthcare Design.

The three areas that must be considered when designing for the human experience: Satisfaction - overall building design features Wellbeing - overall sense people have while in an environment Productivity/Job performance - how the environment supports staff to efficiently provide care

Gingko installation and ambient lighting in the entry of the UK Chandler Medical Center.

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MOVING BEYOND TRADITIONAL STAFF WORKPLACES IN HEALTHCARE Creating a design that provides flexibility and mobility for clinical staff and encourages interaction among clinic staff can lead to a successful healthcare workplace.

The author mentions the transformation of the workplace environment, and how it is moving away from the traditional model to a more interactive and interdisciplinary model. The author discusses The University of Minnesota Ambulatory Care Center and how it was designed with this concept in mind. The university wanted a comfortable environment for clinical staff that minimized office space due to other academic buildings on campus having available space for offices.

The work environment was designed to provide a variety of work settings, including both open and shared areas to allow for more interaction among clinical staff.

Collaboration areas for patients, care staff,

and research teams were designed for caregiver meetings, patient record meetings, and teaching. They are located in the middle of each clinic module. Collaboration and touchdown spaces were designed to have flexible and mobile components in order to meet each user’s needs. Touchdown spaces are located around the perimeter of the building and were designed to allow the care staff to focus on doing daily work tasks, such as charting in a quiet, naturally lit area.

The procedure and exam rooms also have natural light and outside views to relieve stress for both patients and care staff, and are located in the core of the building.

KEY POINTS

DiNardo, A., (2015, January 12). Moving beyond traditional staff workplaces in healthcare, Healthcare Design.

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Collaboration and touchdown spaces encourage interaction among clinical staff and patients.

Providing both staff work areas and patient rooms with natural light and views of outdoors can lower patient and staff stress levels.

8th floor cardiovascular unit interdisciplinary care team station.

55

Signage for the cardiovascular unit care team station .

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POINT-OF-CARE WORKSTATIONS CONTRIBUTE TO IMPROVED NURSING WORKFLOWS Technological advances, point-of-care storage, and decentralized nursing stations were designed to help improve work efficiency and quality of care in healthcare environments.

Time is an important thing in any healthcare environment. The author states that on average, a nurse is performing some type of task every 1 to 1 ½ minutes. The problem is that nurses are spending on average only 18 percent of their time with patients.

The majority of their time (82%) is spent documenting patient health records, or they are walking back and forth between patient rooms and storage areas to get medicine and supplies. This current model indicates that a new model needs to be created that allows nurses to spend more time with patients.

Centralized nursing station models can effect nurse time away from patients and can disrupt workflow patterns due to only having one storage area. Medication and

documentation errors can also affect both nurses and patients. The author found that it was beneficial to have point-of-care storage can reduce errors, theft, and loss, and can improve care. A study conducted with 6 different hospitals revealed that the 5 most common error types involved medications, orders, supplies, staffing, and equipment. The solution is to create a design that can minimize these errors, improve workflow efficiency, and improve quality of care. Technological advances, point-of-care storage, and the decentralized nursing station model were all designed to improve work efficiency and the healthcare environment.

Pierson, J., (2015, March 18). Point-of-care workstations contribute to improved nursing workflows

KEY POINTS

Healthcare Design.

Studies revealed nurses spent an average of 18% of their time with patients.

82% of nurses spend time doing other work-related tasks.

Point-of-care storage has shown a decrease in medical errors and has improved care.

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ENHANCING WORKFLOW, MOBILITY IN THE OUTPATIENT ENVIRONMENT A student design team created mutlifunctional “care control stations” for an outpatient cancer center.

The author discusses the idea of a student design team from Texas Tech University, in which they created a mobile solution for the working environment of healthcare facilities today. The team first had to become familiar with understanding the interactions between the medical processes, actors, culture, physical design, and technology.

Once the team understood those actions, they could then begin to come up with a solution to the main problems, which consisted of a lack of privacy, information, organization, workspace and technology at nursing stations. The team then prepared

design objectives for the project that included enhancing workflow, mobility, and communication in an outpatient cancer center. The design team then came up with the idea of “care control stations”. The stations have public areas that allow patients and care staff to interact, a multifunctional area that has adjustable features including rotating partitions and smart glass. The team also designed small mobile work stations that can be wheeled around to work areas, patient rooms, and other areas of care; and a GPS smart watch that can track patients within the facility updating digital files.

Kovacs-Silvis, J., (2011, January 11. Enhancing workflow, mobility in the outpatient environment,

KEY POINTS

Healthcare Design.

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Students worked to solve the issues of lack of privacy, information, organization, workspace, and technology by designing care control stations.

Flexibility and mobility were important factors in the care control station design.

Two-story lobby at UK Chandler Medical Center

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METHODS & OUTCOMES The research team captured metrics such as walkability, communication patterns, time spent with patients, acoustic levels, and staff satisfaction. Data collection methods included staff and patient questionnaires, focus groups, behavioral mapping, pedometer measurements, and time studies, yielding qualitative and quantitative outcomes.

Participant groups included managers, nurses, physicians, technicians, therapists, pharmacists, and other professionals, as well as patients.

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QUESTIONNAIRES STAFF QUESTIONNAIRES

PATIENT QUESTIONNAIRES

The research team electronically administered a variety of

The research team provided questionnaires

questionnaires to healthcare professionals including physicians,

to patients in paper format and were

nurse practitioners, registered nurses, nursing care technicians,

given to the progressive and acute care

therapists, pharmacists, clerks, managers, and patient services

cardiovascular patients by a patient care

assistants, among others. The questionnaires included a total of

manager. The questionnaire consisted of

66 questions divided among 7 categories. The categories included:

10 questions focused on staff accessibility,

Efficiency of Unit Configuration, Communication, Privacy, and

furniture, privacy, communication, design,

Safety in the Unit Configuration, Physical and Environmental

and acoustics. Patient outcomes from the

Variables, Patient Rooms, Patient and Staff Communication, Staff

pre-move yielded 62 usable surveys and the

Satisfaction, and questions regarding the Old Unit vs. the New Unit.

post yielded 49 surveys.

Staff outcomes from the pre-move yielded 45 usable surveys and the post yielded 98 surveys.

Overall, patients in the post-study reported significantly higher levels of satisfaction

Overall, staff surveys reflected a significant negative change from old

with patient room design and personal

to new regarding teamwork, efficiency of patient care, and face-to-

privacy. Patients reported no change in

face and interdisciplinary communication, but positive change in

communication, receiving information, or

the overall perception of the environment from old to new.

getting staff help when needed.

QUESTIONNAIRE FORMAT The research team formatted questions using a 5-point Likert scale, with 5 being strongly agree, 3 being neutral, and 1, strongly disagree. By averaging across respondents, a mean less than 3 indicates on average they disagree with the statement, while an average above 3 indicates on average they agreed with the statement. The farther the mean is from 3, the stronger the group’s feelings are about the question.

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PATIENT QUESTIONNAIRE: PATIENT QUESTIONNAIRE: Satisfaction

KEY PRE: TOP BAR

Satisfaction

POST: BOTTOM BAR

KEY

SIGNIFICANT POSITIVE CHANGE

Likert scale questions on a 5 point scale, with 3 a neutral choice. By averaging across

PRE: TOP PRE:BAR TOP BAR

respondents, a mean less than 3 indicates on average they disagree with the statement, while

POST: POST: BOTTOM BAR BAR BOTTOM

an average above 3 indicates on average they agreed with the statement. The farther the mean is from 3, the stronger the group’s feelings are about the question.

SIGNIFICANT CHANGES PRE: TOP BAR POST: BOTTOM BAR

3.74

The furniture in the room meets my needs.

4.31 3.74

The room is quiet.

4.41 2.41

I could hear the staff talking about other patients while I was in my room.

1.92 2.52

I feel like the other people could hear my private information.

1.86 4.26

It was easy to get staff help when I needed it.

4.24 3.93

There were no delays in getting the information I needed.

3.86 4.20

Overall, I was satisfied with my communication with the staff.

4.20 3.23

The overall design of this room helped reduce my stress.

3.92 3.50

Overall I was satisfied with the design of the room.

4.31

0

64

1

2

3

4

5

STAFF QUESTIONNAIRE: Satisfaction STAFF QUESTIONNAIRE: Likert scale questions on a 5 point scale, with 3 a neutral choice. By averaging across

Satisfaction

KEY PRE: TOP BAR POST: BOTTOM BAR SIGNIFICANT POSITIVE CHANGE

PRE: TOP BAR

respondents, a mean less than 3 indicates on average they disagree with the statement, while

KEY

an average above 3 indicates on average they agreed with the statement. The farther the mean

POST: BOTTOM BAR

is from 3, the stronger the group’s feelings are about the question.

PRE: TOP BAR POST: BOTTOM BAR SIGNIFICANT CHANGES PRE: TOP BAR POST: BOTTOM BAR

3.65

The design of the unit is conducive to my sense of well-being.

3.48 3.13

The design of the unit helps to alleviate my stress.

3.23 2.53

There are private places within the unit I can go to alleviate my stress.

3.47 3.49

Overall, I am satisfied with the design of the unit.

3.32 3.73

Overall, I am satisfied with the design of the service line.

3.51

0

1

2

3

4

5

65

PATIENT & STAFF COMMUNICATION STAFF QUESTIONNAIRE: Patient/Staff Communication

KEY PRE: TOP BAR POST: BOTTOM BAR SIGNIFICANT CHANGES PRE: TOP BAR POST: BOTTOM BAR

4.15

It is easy to communicate with other staff in this unit when I need to.

3.25

I am able to ask questions or get advice from other staff when I need it in this unit.

4.33 3.71 2.10

I often feel isolated from other staff in the unit.

3.51 3.92

It is easy for me to take the time to explain information to my patients.

3.86 4.05

I have the capability to talk with my patients (and/or their family) when I need to.

4.03

0

66

1

2

3

4

5

STAFF QUESTIONNAIRE: STAFF QUESTIONNAIRE: Communication, Privacy, & Safety Communication, Privacy, & Safety

KEY PRE: TOP BAR POST: BOTTOM BAR KEY SIGNIFICANT POSITIVE CHANGE

Likert scale questions on a 5 point scale, with 3 a neutral choice. By averaging across

PRE: TOP BAR PRE: TOP BAR

respondents, a mean less than 3 indicates on average they disagree with the statement, while

POST: BOTTOM BAR POST: BOTTOM BAR

an average above 3 indicates on average they agreed with the statement. The farther the mean

SIGNIFICANT CHANGES

is from 3, the stronger the group’s feelings are about the question.

PRE: TOP BAR POST: BOTTOM BAR

3.02

The unit provides a variety of places to talk privately.

3.17 3.43

Places exist that allow me to talk confidentially with other staff members.

3.39 3.31

Places exist that allow me to talk confidentially with patients' families.

3.71 2.76

The location of the workstations allows me to privately discuss patient issues.

2.89 4.12

I feel safe and secure within the unit.

3.83 3.05

The design of the unit provides secure places to store my possessions.

3.67 4.51

I am satisfied with my ability to get assistance from my co-workers when needed.

3.26 4.17

The design of the unit contributes to effective face to-face communication.

3.31 3.90

The design of the unit contributes to good interdisciplinary communication.

3.32

0

1

2

3

4

5

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STAFF QUESTIONAIRE:

PHYSICAL & ENVIRONMENTAL Physical & Environmental Variables VARIABLES

PRE: TOP BAR POST: BOTTOM BAR

3.51

The furnishings selected support the needs of my job.

SIGNIFICANT CHANGES

3.63

PRE: TOP BAR

2.56

Sufficient personal storage is provided in staff work areas.

POST: BOTTOM BAR

3.34 3.00

Personal storage is conveniently located and easily accessible.

3.40 3.12

Sufficient work-related storage is provided for the unit to function efficiently.

3.70 3.20

Work-related storage is conveniently located and easily accessible.

3.73 3.22

The number and location of electrical outlets support the needs of my job.

3.83 3.41

The furnishings can be easily adjusted to meet my physical requirements.

3.77 2.90

The unit flooring helps to reduce leg fatigue.

2.94 3.63

The provided technology supports my working needs.

3.86 3.32

The noise level in the unit is distracting.

2.86 3.56

The lighting levels in the unit are adequate.

3.60 2.10

I am satisfied with the amount of natural daylight in the unit.

3.89 2.88

The temperature in the unit is comfortable.

3.55 3.12

The physical environment reduces the spread of infections.

3.46 2.27

I am satisfied with the cleanliness of the unit.

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KEY

3.07

0.0

1.0

2.0

3.0

4.0

5.0

STAFF QUESTIONAIRE: Patient Rooms

PATIENT ROOMS:

KEY PRE: TOP BAR POST: BOTTOM BAR SIGNIFICANT CHANGES PRE: TOP BAR POST: BOTTOM BAR

4.18

I am satisfied with my ability to visually monitor patient rooms.

3.76 3.58

The layout of the patient rooms promotes efficient care.

3.62 3.26

The location of supplies inside the patient rooms promotes efficient care.

3.71 2.88

The location of the sinks inside the patient rooms promotes efficient patient care.

3.99 2.72

The patient bathroom size supports the use and size of equipment.

4.26 3.61

Within the patient rooms, the location of the families/visitors hinders my ability to do my job

3.24 2.05

The patient room provides adequate space for families/visitors.

4.15

0

1

2

3

4

5

69

STAFF QUESTIONAIRE: Efficiency STAFF QUESTIONAIRE: Efficiency

KEY PRE: TOP BAR

KEY

POST: BOTTOM BAR

PRE: TOP BAR

Likert scale questions on a 5 point scale, with 3 a neutral choice. By averaging across

SIGNIFICANT CHANGES

POST: BOTTOM BAR

respondents, a mean less than 3 indicates on average they disagree with the statement, while an average above 3 indicates on average they agreed with the statement. The farther the mean is

PRE:POSITIVE TOP BAR SIGNIFICANT CHANGE

from 3, the stronger the group’s feelings are about the question.

POST: BOTTOM BAR PRE: TOP BAR POST: BOTTOM BAR 3.947

The unit layout facilitates my ability to work efficiently.

3.424 4.211

The unit layout supports my ability to work as a team.

2.939 3.974

The unit layout supports my ability to work as an individual.

3.833 3.632

The unit corridors are easily navigated.

3.737 4.158

The staff break areas are conveniently located.

3.626 4.027

The staff bathrooms are conveniently located.

3.434

Patient data is easily accessible within the unit.

3.947

The unit layout provides reasonable walking distances.

4.026

3.969

3.255 4.000

The unit design supports efficient patient care.

3.250 4.000

The location of the medication rooms is convenient and easily accessible.

3.919 3.763

The location of the nourishment stations is convenient and easily accessible.

3.909 3.622

The location of the soiled utility room is convenient and easily accessible.

3.536 3.921

The location of supplies is convenient and easily accessible.

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3.768

0

1

2

3

4

5

STAFF QUESTIONNAIRE: STAFF QUESTIONNAIRE: Overall OverallSatisfaction SatisfactionOld Oldvs.vs.New New Likert scale questions on a 5 point scale, with 3 a neutral choice. By averaging across respondents, a mean less than 3 indicates on average they disagree with the statement, while an average above 3 indicates on average they agreed with the statement. The farther the mean is from 3, the stronger the group’s feelings are about the question.

Overall, I prefer the new unit over the old.

3.99

Overall, I prefer the design of the new unit layout over the old.

3.64

I prefer the new unit’s storage options over the old unit.

4.32

I prefer the new unit’s design relative to saftey over the old.

3.73

I prefer the new unit’s furnishings over the old.

4.44

IIprefer preferthe thenew newunit’s units design design relative relativeto to privacy and confidentiality confidentiality over over the theold. old.

3.91

I prefer the size of the new unit over the old unit.

4.11

I prefer the new unit’s patient rooms over the old unit’s patient rooms.

4.38

I prefer the new unit’s design relative units design to to patient patient communication. communication

3.88

0

1

2

3

4

5

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FOCUS GROUP OUTCOMES During the pre-occupancy evaluation, the research team conducted 7 focus groups with 30 healthcare professionals from six provider groups. All

FOCUS GROUPS

groups were homogenous by profession: Two from Nursing (7 RNs), and one each of Nurse Managers (6), Nurse Care Technician (3), Physicians (5), Advanced Practice Nurses (2), and a group from Occupational, Physical and Respiratory Therapy (6).

The research team conducted 9 focus groups during the post-occupancy phase with 60 healthcare professionals from 11 provider groups. Three from Nursing (26), and one each of Nurse Managers (2), Nurse Care Technician (X), Physicians (10), Advanced Practice Nurses (5), and Occupational, Physical and Respiratory Therapy (6). A Care Team station comprised of 11 professionals from 5 different provider groups (e.g., Pharmacy, Transplant) was conducted.

72

73

Therapist Focus Group

Nurse Focus Group

74 Research Team

GBBN Focus Group

75 Nurse Focus Group

FOCUS GROUP OUTCOMES: Pre

The intensive care unit nurses (CTVICU) highly favor the centralized nursing station because it

ICU Nurses

allows for good face-to-face communication with coworkers, excellent proximity to their patients, and plenty of visibility. The storage and supplies are within a decent walking distance but the consistency and organization is very poor. While the patient rooms are relatively safe (except for some tripping hazards for staff), the aesthetics, lighting, and cleanability need much improvement.

The progressive care nurses prefer centralized nursing stations because they provide a private space

Progressive Care Nurses

for coworkers to communicate with each other. The staff primarily use pagers for communication, but they believe a more direct line of communication is necessary. These nurses believe that the efficiency, safety, and dependability of care could be increased if the patient rooms were larger and private, as the cluttered semi-private rooms are hazardous for patients, staff, and visitors.

The nurse care technicians expressed concern about the semi-private patient room design due to

Nurse Care Technicians

the lack of privacy and security for the patients who share the room. The rooms are too small and there is too much equipment in each room, causing tripping hazards for both staff and patients. Environmental issues such as temperature, light, and noise are all areas for concern – the temperature is always too hot, the lighting is not natural, and the noise level is too high for patients’ comfort. The alarms in the unit also concern the techs because they constantly sound, causing “no sense of urgency”. The techs fear that in the new unit the alarms will be similarly problematic.

This group of therapists are very concerned about their workflow throughout the day. The lack of

Therapists

storage for their supplies and equipment requires that they have to travel long distances every day to gather what they need, wasting time and energy. They would also like to have more access to computers because they have to spend so much time finding a computer simply to chart. Ultimately, this group desires a location with more proximity to their supplies and technology.

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The close proximity of this unit carries benefit because when people are nearby, both staff and

Physicians

patients, there tends to be more communication between these individuals. The inefficient communication and information technology create problems for many physicians accessing simply records for patients. Many nurses have problems reaching physicians or other staff members because of the paging system. The semi-private rooms create stress for patients because they have to deal with sharing space during recovery.

Nurse Practitioners

This group of nurse practitioners appreciate the visibility provided by the unit layout - citing ease of monitoring patients as well as locating other staff members. They fear that the new location will not be conducive to good visibility. The semi-private rooms create problems because they are too small and they also compromise privacy of other patients because it is easy to overhear conversations or even have physical altercations with the other patient in the room in one form or another. The staff have to share their spaces with other staff from different areas, which can be problematic and inefficient.

Nurse Managers

The nurse managers feel too spread out from their staff because with offices outside the unit and are therefore hindered from communicating with their staff or doing their job effectively. They also believe the patient rooms lack sufficient privacy and size, causing HIPPA violations if staff have to talk to patients in the rooms while another patient is also present.

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FOCUS GROUP OUTCOMES: Post From the beginning of the design process, GBBN had the UK mission, goals, and objectives in mind

GBBN

and did their best to maintain those ideals as they moved forward with the design process. GBBN designed the 8th floor to be flexible, using principles such as visibility of the patient, accommodation of the family, separation of staff, and public flow to further guide the design. The decentralized nursing stations in the design resulted from the advent of the electronic health record, which allows staff to chart and access data without being in a central location. However, the designers were aware that decentralizing the nurse station did take away from some of the staff ’s social interactions.

The new unit has most of the staff very spread out, and many nurses claim that they walk an entire

ICU Nurses

shift without even knowing who might be walking the same shift. While they acknowledge that they can easily communicate with patients and visitors, they feel their relationships and mentoring opportunities with their coworkers have suffered. Being so spread out has also proved dangerous to staff. In one instance, a patient attacked a staff member but with no one in close proximity, it took several minutes before anyone heard the call for help. The random and disorganized location of supplies results in each supply room having different equipment than the next, which increases the distance staff have to walk to find what they need.

The layout of the unit makes it difficult to pinpoint the location of alarms or call lights, and many

Progressive Care Nurses

nurses spend time searching the unit when the patient alarm sounds. Face-to-face communication is difficult because the staff sit in isolated locations. Computers outside each room provide an increase in face-to-face communication with the patients. In the old unit, the nurses felt that almost every patient they had developed some form of ICU psychosis, but because of the lighting and aesthetics in the new unit, this problem has become virtually obsolete.

The therapists appreciate the new private patient room designs as they are cleaner, bigger, and more

Therapists

private – all details that increase patient outcomes and the delivery of efficient and dependable care.

However, staff communication has been altered so there is less face-to-face communication because of the decentralized nursing stations. Staff do more walking in order to reach computers to chart with or access supplies as things are much more spread out in the new unit.

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The nurse practitioners appreciate the increase in space from the old unit to the new unit. This

Nurse Practitioners

group of staff indicate a desire for more rooms like in the new unit, keeping them from returning to the old unit for the other patients. They appreciate their central location in the unit because they feel more easily accessible to staff and patients alike. While the communication technology improved after the move (staff can now page each other directly to their phones), access to computers for charting or other tasks decreased and many staff would like to have more computers or tablets that they can move around with.

While the centralized location of the care team stations makes it easier for staff to access patients

Care Team Station

and communicate with coworkers, they have to deal with a high level of noise and other people stopping in the offices throughout the day, interrupting their work. Ideally, they would like the barriers to go all the way from floor to ceiling. They believe that patient outcomes have improved because everyone is cohorted in the same area, increasing visibility and communication between disciplines. Ultimately, the staff perceived proximity and cohorting as both positive and negative aspects of the new unit.

Comparing the old unit to the new unit, the unit director Lacey, believes that the old unit fostered

Unit Director

communication between staff members because of the centralized nursing station and the new unit fosters communication between staff and patients because of the decentralized nursing stations.

The private rooms of the new unit are much better than the semi-private rooms because there are less privacy issues and there is more space for equipment and people. The old unit’s environment is simply older than the new unit, meaning that its cleanability, lighting, noise, and aesthetics are all much more problematic than the new unit.

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PEDOMETER DATA The research team collected the walking distance of nurses and technicians using pedometers. The data collection took place over all hours of the day and collected data based on 12- hour shifts. Staff members first completed a survey to gather demographic information and were additionally asked to complete a short survey after the completion of each shift to enter their steps taken.

80 80

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PEDOMETER DATA Overall outcomes of walkability from the pedometer

69 4.

measures prior to the move indicated a mean walking distance per hour among participants of 0.347 miles

s ile

M

or 4.16 miles based on a 12-hour shift, while in the

iles

M 4.45

es 4.07 Mil s Mile 4.16

new unit the mean walking distance per hour of 0.339 miles or an average of 4.07 miles per 12-hour shift.

For the matched pairs, the average difference in miles walked per individual (post- minus pre-) dropped to 0.020 miles per hour or 0.245 miles based on a 12hour shift. When comparing walking distances of nurses and technicians, nurses walked an average of 3.75 miles in the old unit and 4.00 miles in the poststudy over the course of a 12-hour shift. Technicians walked an average of 7.19 miles in the pre- while only 3.88 miles in the post-study. The team compared the walkability between the progressive care and intensive care cardiovascular units. In the progressive unit, all

ALL PARTICIPANTS

participants in the pre-study averaged a total of 3.71 miles per 12-hour shift as compared to 4.21 miles in the

PRE: 24 Participants POST: 21 Participants

post-study. Interestingly, in the ICU walking decreased

MATCHED PAIRS

from 4.55 miles to 3.64 miles in a 12-hour shift.

PRE: 11 Participants POST: 11 Participants

ICU - Unit Comparisons ICU - Unit Comparisons All Participants

4.55 4.11

82

# of Entries: 97

3.64 3.30

# of Entries: 44

PRE: 205 Entries POST: 179 Entries PRE: 119 Entries POST: 114 Entries

PROGRESSIVE - Unit Comparisons PROGRESSIVE - Unit Comparisons All Participants

3.75 3.71

4.21 4.12

# of Entries: 86

# of Entries: 134

83

BEHAVIORAL MAPPING

84

To better understand how the design of the cardiovascular unit impacted staff workflow and operational efficiencies, the research team conducted behavioral mapping. Observations occurred in all four areas of the cardiovascular unit in the pre-evaluation and in both towers of the cardiovascular unit during the post-occupancy evaluation. Preobservations were completed over the course of four-hour shifts and encompassed a total of 48 hours. Post-observations were also completed over four-hour shifts and encompassed a total of 68 hours.

The team completed the mapping by hand on instruments that included a floor plan, key, instructions, and additional space to document impromptu observations or relevant staff comments. Color coding was used to record the movement of physicians, nurses, and technicians in fifteen-minute increments of time.

Behavioral mapping occurred in all four areas of the cardiovascular unit in the pre-evaluation and in both towers of the cardiovascular unit during the post-occupancy evaluation. When layered, outcomes help identify where traffic patterns within each unit are at their greatest and how design of the unit is contributing to efficiency of care.

85

BEHAVIORAL MAPPING: PRE PAV H 10/8/2014 - CTVICU

e KEY: Communications

e Size

d: 7+

d: 5-6

Time: 13:00- 14:00

P: Patient N: Nurse D: Doctor T: Tech F: Family H: Housekeeping Pr: Practitioner R: Respiratory A: Administration E: EMT C: Catering/Food Service

WEEK

:

Date: 10/8/2014

Shift Time:

Observer:

1300-1700

Time in Patient

Registered Nurs SOILED UTILITY

P

MEDS

S

NCS OFFICE

BREAK

x

xxx

SUPPLY

O

LINENS SUPPLY

x x

CLOSET S S

LINENS

N

M

e Size

d: 7+

d: 5-6

Time: 13:00- 15:00

P: Patient N: Nurse D: Doctor T: Tech F: Family H: Housekeeping Pr: Practitioner R: Respiratory A: Administration E: EMT C: Catering/Food Service

S

10/8/2014 Notes / Observations / Limitations: WEEK : Date:

Shift Time:

S

S

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RN Pink remaind in room HA182 forObserver: entire 15 min Side P: Morgan Black + Katy Albert ; Side A: Lindsey Fay + Leanna Taylor

1300-1700

Time in Patient

Registered Nurs SOILED UTILITY

KEY Nurse PPracticioners:

ID #

MEDS

Interactions: O

Nurse Technicians:

Registered Nurses:

S

ID #

NCS OFFICE

BREAK

x

xxx

SUPPLY

O

x x x

LINENS SUPPLY CLOSET

S S

LINENS

N

x

xx

d:1-2 S

M

S

L

K

Notes / Observations / Limitations: tech Lauren (teal) is still in break room on lunch - came back at 2:58.

RN (orange) in 181 is showing another nurse how to use a piece of equipment.

RN (pink) remained in HA 182P - prepared and moved new patient into HA177K tech enters break room at 2:24 for lunch

J

Patient Nurse Doctor Tech Family

Housekeeping PRactitioner

S

I RN Pink remaind in room HA182 for entire 15 min

S

:

#

#

: # Sitting:# X Observer #

:

#

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Registered Nurs

xx

MEETING

d: 3-4

86

:

#

Registered Nurs

x

d:1-2 S

#

xx

MEETING

d: 3-4

e KEY: Communications

C

Side P: Morgan Black + Katy Albert ; Side A: Lindsey Fay + Leanna Taylor

#

:

#

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:

#

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#

Traveled: 7+

Nurse Practicioners

Traveled: 5-6

Registered Nurses

Traveled: 3-4 Nurse Technicians

Traveled:1-2

WEEK

:

Date: 10/8/2014

Shift Time:

Observer:

1300-1700

CTVICU

Side P: Morgan Black + Katy Albert ; Side A: Lindsey Fay + Leanna Taylor

Time in Patient Rooms: Registered Nurse:

P

:

#

#

:

#

#

:

#

#

:

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#

:

#

MEDS

xxx

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x

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S

NCS OFFICE

BREAK

x

SUPPLY

O

x x x x x

LINENS SUPPLY CLOSET

S S

LINENS

N

x

xx

S

M

S

10/8/2014 WEEK : Date: Notes / Observations / Limitations:

Shift Time:

I

J

K

L

S

S

Interactions: O

Nurse Technicians:

ID #

MEDS

ID #

NCS OFFICE

BREAK

x

Patient Nurse SDoctor Tech Family

xxx x x x x x x x

SUPPLY

O

LINENS SUPPLY CLOSET

S S

LINENS

N

S

S

L

K

Notes / Observations / Limitations: tech Lauren (teal) is still in break room on lunch - came back at 2:58.

RN (orange) in 181 is showing another nurse how to use a piece of equipment.

RN (pink) remained in HA 182P - prepared and moved new patient into HA177K tech enters break room at 2:24 for lunch

:

: : :

#

:

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CTVICU

J

Housekeeping PRactitioner

#

:

: # Sitting: #X Observer:

x

S

I RN Pink remaind in room HA182 for entire 15 min

S

:

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# #

:

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xx

MEETING xx

M

:

Registered Nurse:

Registered Nurses:

Service

:

Time in Patient Rooms:

SOILED UTILITY

P

:

RN Observer: Pink remaind inSide room P:HA182 Morgan Black + Katy Albert ; Side A: Lindsey Fay + Leanna Taylor for entire 15 min

1300-1700

tech Lauren (teal) is still in break room on lunch - came back at 2:58.

RN (orange) in 181 is showing another nurse how to use a piece of equipment.

RN (pink) remained in HA 182P - prepared and moved new patient into HA177K tech enters break room at 2:24 for lunch

KEY Nurse Practicioners:

:

Registered Nurse:

xx

MEETING

:

Time: 13:00- 16:00

#

SOILED UTILITY

Service

ions

Line Colors

Line Size

Time: 13:00- 17:00

tions

KEY

#

:

#

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87

BEHAVIORAL MAPPING: PRE PAV H 10/8/2014 - POE 6 East

KEY: Communications

WEEK

P: Patient N: Nurse D: Doctor T: Tech F: Family H: Housekeeping Pr: Practitioner R: Respiratory A: Administration E: EMT C: Catering/Food Service

:

Date: 10/8/2014

Shift Time:

Observer:

1300 - 1700

6

Clare Henson + Chelsey Gahm

Time: 13:00- 14:00

Time in Patient Room Registered Nurse:

BREAK

WAITING LINENS

S

KITCHEN

TECHS

KEY: Communications

Time: 13:00- 15:00

P: Patient N: Nurse D: Doctor T: Tech F: Family H: Housekeeping Pr: Practitioner R: Respiratory A: Administration E: EMT C: Catering/Food Service

Notes / Observations / Limitations: : Date: 10/8/2014 Shift Time:

WEEK

Observer:

1300 - 1700

NURSES STATION

#

:

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6

Clare Henson + Chelsey Gahm

Time in Patient Room

KEY Nurse Practicioners:

BREAK

Interactions: O

Nurse Technicians:

Registered Nurses: ID #

ID #

WAITING LINENS

S

S

S

KITCHEN

TECHS

88

: :

Registered Nurse:

S

S

# #

Notes / Observations / Limitations:

NURSES STATION

Patient Nurse Doctor Tech Family

Housekeeping PRactitioner

Registered Nurse:

Sitting: X : Observer: # #

:

#

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KEY Line Colors

Line Size Traveled: 7+

Nurse Practicioners

Traveled: 5-6

Registered Nurses

Traveled: 3-4 Traveled:1-2

WEEK

:

Patient : Nurse : Doctor Tech Family : Housekeeping r: Practitioner Respiratory : Administration EMT Catering/Food Service

Date: 10/8/2014

Shift Time:

Observer:

1300 - 1700

6EAST

Clare Henson + Chelsey Gahm

Time in Patient Rooms: Registered Nurse:

BREAK

WAITING LINENS

S

KITCHEN

TECHS

:

#

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S

# #

Time: 13:00- 16:00

EY: Communications

Nurse Technicians

NURSES STATION

#

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:

Date: 10/8/2014

Shift Time:

Observer:

1300 - 1700

6EAST

Clare Henson + Chelsey Gahm

Time in Patient Rooms:

KEY Nurse Practicioners:

Interactions: O

Nurse Technicians:

Registered Nurses: BREAK ID #

ID #

WAITING LINENS

S

S

S

KITCHEN

TECHS

Notes / Observations / Limitations:

NURSES STATION

Patient Nurse Doctor Tech Family

Housekeeping PRactitioner

Registered Nurse: Sitting: X Observer:

Time: 13:00- 17:00

Communications

atient urse octor ch amily ousekeeping Practitioner espiratory dministration MT atering/Food Service

WEEK

#

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89

BEHAVIORAL MAPPING: PRE PAV H 10/8/2014 - POE 6 West

WEEK

:

Date:

Shift Time:

10/8/2014

Observer:

1300-1700

6W

Elizabeth + Micah Johnson

Time in Patient Roo

Time: 13:00- 14:00

Registered Nurse:

SUPPLY

NURSES STATION

S

S

LINENS

KITCHEN BREAK ROOM

Notes / Observations 10/8/2014 WEEK : Date:/ Limitations: Shift Time:

Observer:

1300-1700

:

#

#

:

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#

:

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:

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Registered Nurse:

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6

Elizabeth + Micah Johnson

Time: 13:00- 15:00

Time in Patient

KEY Nurse Practicioners:

Interactions: O

Nurse Technicians:

Registered Nurses: ID #

ID #

Patient Nurse Doctor Tech Family

Registered Nu

Housekeeping PRactitioner

SUPPLY

NURSES STATION

S

S

LINENS

KITCHEN BREAK ROOM

90

Notes / Observations / Limitations:

:

#

:

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Registered Nu

S

S

#

Sitting: X #Observer: :

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KEY Line Colors

Line Size Traveled: 7+

Nurse Practicioners

Traveled: 5-6

Registered Nurses

Traveled: 3-4 Traveled:1-2

WEEK

:

Date:

Shift Time:

10/8/2014

Observer:

1300-1700

Nurse Technicians

6WEST

Elizabeth + Micah Johnson

Time in Patient Rooms:

Registered Nurse:

S

S

LINENS

KITCHEN BREAK ROOM

Notes / Observations / Limitations: WEEK : Date: 10/8/2014 Shift Time:

Observer:

1300-1700

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Time: 13:00- 16:00

SUPPLY

NURSES STATION

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6WEST

Elizabeth + Micah Johnson

Time in Patient Rooms:

Interactions: O

Nurse Technicians:

Registered Nurses: ID #

ID #

Patient Nurse Doctor Tech Family

Registered Nurse:

Housekeeping PRactitioner

SUPPLY

NURSES STATION

S

S

LINENS

KITCHEN BREAK ROOM

Notes / Observations / Limitations:

:

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S

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Sitting: X Observer:

Time: 13:00- 17:00

KEY Nurse Practicioners:

#

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91

BEHAVIORAL MAPPING: POST PAV A 09/11/2015

Time: 13:00- 14:00

16 236

7:00

235

234

233

232

231

229

230

228

227

226

225

224

223 20

19

18

17

27

28

29

222

237 21

zone 2

30 zone 3 zone 4

DN

UP

221

238

239

220

zone 1

31

22 zone 5

240

26

32

241

242

211

212

213

216

215

214

219

23

217

218

111 1 1 11 1

142

141

24

25

112

113

114

116

115

117

118

E 16

4

3

2

1

140

119 zone 5

5 15 zone 1

120

139

138

UP

zone 4

14

zone 2

137

13

136

92

121

DN

zone 3

11

12

135

134

133

132

10

131

130

8

9

E

129

128

127

126

125

124

6

122

7

123

KEY Line Size

Line Colors Traveled: 7+

Therapists

Traveled: 5-6

Physicians

Traveled: 3-4

Registered Nurses

Traveled:1-2

Technicians

Time: 13:00- 15:00

16 236

7:00

235

234

233

232

231

229

230

228

227

226

225

224

223 20

19

18

17

27

28

29

222

237 21

zone 2

30 zone 3 zone 4

DN

UP

221

238

239

220

zone 1

31

22 zone 5

240

26

32

241

242

211

212

213

216

215

214

219

23

217

218

111 1 1 11 1

142

141

24

25

112

113

114

116

115

117

118

E 16

4

3

2

1

140

119 zone 5

5 15 zone 1

120

139

138

UP

zone 4

121

DN

zone 3

14

zone 2

137

13

136

11

12

135

134

133

132

10

131

130

8

9

EE

129

128

127

126

125

124

6

122

7

123

93

BEHAVIORAL MAPPING: POST PAV A 09/11/2015

Time: 13:00- 16:00

6 236

7:00

235

234

233

232

231

229

230

228

227

226

225

224

223 20

19

18

17

27

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222

237 21

zone 2

30 zone 3 zone 4

DN

UP

221

238

239

220

zone 1

31

22 zone 5

240

26

32

241

E

242

211

212

213

216

215

214

219

23

217

218

111 1 1 11 1

142

141

24

25

112

113

114

116

115

117

118

E 16

4

3

2

1

140

119 zone 5

5 15 zone 1

120

139

138

UP

zone 4

14

zone 2

137

13

136

94

121

DN

zone 3

11

12

135

134

133

132

10

131

130

8

9

EE

129

E

128

127

126

125

124

6

122

7

123

KEY Line Size

Line Colors Traveled: 7+

Therapists

Traveled: 5-6

Physicians

Traveled: 3-4

Registered Nurses

Traveled:1-2

Technicians

Time: 13:00- 17:00

16 236

7:00

235

234

233

232

231

229

230

228

227

226

225

224

223 20

19

18

17

27

28

29

222

237 21

zone 2

30 zone 3 zone 4

DN

UP

221

238

239

220

zone 1

31

22 zone 5

240

26

32

241

E

242

211

212

213

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215

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111 1 1 11 1

142

141

24

25

112

113

114

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118

E 16

4

3

2

1

140

119 zone 5

5 15 zone 1

120

139

138

UP

zone 4

121

DN

zone 3

14

zone 2

137

13

136

11

12

135

134

133

132

10

131

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Empty at 4:29

8

9

EE E

129

6

122

7

E

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123

95

COMMUNICATION DOCUMENTATION

96

The research team documented observations of verbal interactions among various user groups in four-hour shifts in various zones of the old and new cardiovascular units. The method utilized the developed instruments to record where and with whom conversations were occurring in the core of the progressive and ICU units. Outcomes indicated that the centralized model aided in better containing conversations within the core of the unit.

However, the design of the new unit contributed to an increase in interdisciplinary conversations.

97

98

COMMUNICATION: Average Frequency of Communication Circles Located in Hallways per Four-Hour Shift The research team documented observations of verbal interactions in the core of the cardiovascular unit in both the pre- and postoccupancy studies. Outcomes revealed that the new unit contributed to almost double the number of conversations being held in the corridors. This can be attributed to the lack of a centralized nursing station, which also raises provacy concerns.

Pre

Post

111.94

Interactions

63.69

Interactions

99

16.94%

16.94%

COMMUNICATION: Percent of Participants in Communication Circles, Pre vs. Post The research team documented observations of verbal interactions in the core of the cardiovascular unit in both the pre- and post-occupancy studies. Outcomes revealed nurses, doctors, and technicians were the most frequent participants in conversations in both the pre- and post-occupancy studies. Interestingly, the frequency of respiratory therapists and physicians involved in the conversations increased for the post-study. This can be attributed to the integration of interdisciplinary team stations present in the new cardiovascular unit.

E

PRE

C

N - Nurse 75.44%

NP

H

R

A

D - Doctor 16.94%

F

T - Tech 27.98%

T

N

H

NP

F - Family 9.27% H - Housekeeping 3.58% NP - Nurse Practitioner 1.42%

D

R - Respiratory 5.25% A - Administration 3.29%

(T) Tech

(NP) Nurse Practitioner

(C) Catering/Food Service

(D) Doctor

(H) Housekeeping

(E) EMT

(N) Nurse

(F) Family

(A) Administration (R) Respiratory

100

E - EMT 68.73% 0.59% 17.94% C - Catering/ 26.23% Food Service 0.05% 6.46%

(N) Nur

(D) Doc

(T) Tech

(F) Fam

E

POST

H

C

N - Nurse 64.73% D - Doctor 17.94%

A

NP

R

T - Tech 26.23%

F

F - Family 6.46%

N

H - Housekeeping 1.79%

T

NP - Nurse Practitioner 0.72%

D

R - Respiratory 12.15%

Doc

A - Administration 7.98%

68.73% (N) Nurse

1.79%

17.94% (D) Doctor

0.72% (NP) Nurse Practitioner

(E) EMT

26.23% (T) Tech

12.15% (R) Respiratory

C - Catering/ (C) Catering/Food Service Food Service 2.16%

6.46% (F) Family

(H) Housekeeping

(A) Administration

E - EMT 0.10%

Tech

101

COMMUNICATION MAPPING: PRE PAV H Observations of verbal interactions among various user groups were concurrently documented with the behavioral mapping in four-hour shifts in various zones of the old and new cardiovascular units. The method utilized the developed instruments to record where and with whom conversations were occurring in the core of the progressive and ICU units. Conversations were indicated on the maps by a red circle with letters noted inside indicating if a patient (P), doctor (D), nurse (N), technician (T), family member (F), or housekeeping (H) personnel was participating in face-to-face communication. Data was later entered and analyzed by the team’s statistician.

10/8/14 - POE 6 East

ircle Size

KEY: Communications

p: 5+

p: 3-4

p:1-2

Time: 13:00- 14:00

P: Patient N: Nurse D: Doctor T: Tech F: Family H: Housekeeping Pr: Practitioner R: Respiratory A: Administration E: EMT C: Catering/Food Service

WEEK

:

Date: 10/8/2014

Shift Time:

Observer:

1300 - 1700

6

Clare Henson + Chelsey Gahm

Time in Patient Room Registered Nurse:

BREAK

WAITING

LINENS S

NN

KEY: Line Size

Traveled: 7+

ET

NN

NF

Traveled: 5-6

Traveled: 3-4 KITCHEN

Traveled:1-2

+

4

2

KEY: Communications P: Patient N: Nurse D: Doctor T: Tech F: Family H: Housekeeping Pr: Practitioner R: Respiratory A: Administration E: EMT C: Catering/Food Service

Y: Line Size

veled: 7+

veled: 5-6

Time: 13:00- 15:00

e Size

TECHS

Notes / Observations / Limitations: WEEK : Date: 10/8/2014 Shift Time:

NURSES STATION

Observer:

1300 - 1700

#

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:

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:

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:

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:

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6

Time in Patient Room

KEY Nurse Practicioners:

BREAK

Interactions: O

Nurse Technicians:

Registered Nurses: ID #

ID #

WAITING

LINENS S

NN NP FNN

TT

ET

NF S

S

KITCHEN

102

#

:

Clare Henson + Chelsey Gahm

veled: 3-4

veled:1-2

:

#

Registered Nurse:

S

S

#

Notes / Observations / Limitations:

TECHS

NURSES STATION

Patient Nurse Doctor Tech Family

Housekeeping PRactitioner

Registered Nurse: # X : Observer: # Sitting: #

:

#

#

:

#

#

:

#

#

:

#

#

:

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:

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:

#

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:

#

Registered Nurse: #

:

#

#

:

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:

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:

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:

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:

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:

#

#

:

#

Circle Size

WEEK

:

Communications

xxx xx

xx xx

xx

Group: 5+

Group: 3-4

Group: 1-2

Date: 10/8/2014

Shift Time:

Observer:

1300 - 1700

P: Patient N: Nurse D: Doctor T: Tech F: Family H: Housekeeping

Pr: Practitioner R: Respiratory A: Administration E: EMT C: Catering/ FoodService

6EAST

Clare Henson + Chelsey Gahm

nt e tor

Time in Patient Rooms:

mmunications

WAITING

LINENS NT NN

S

DD

RP

NP FNN

FT

TT PT H

ET

FF

NF TT S

S

KITCHEN

TECHS

Notes / Observations / Limitations: WEEK : Date: 10/8/2014 Shift Time:

FF

NURSES STATION

Observer:

1300 - 1700

PN H

#

:

#

#

:

#

#

:

#

#

:

#

#

:

#

#

:

#

#

:

#

#

:

#

: : : : : : : :

:

Registered Nurse: #

:

#

#

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

:

6EAST Time in Patient Rooms:

r

ng/Food Service

:

#

Clare Henson + Chelsey Gahm

t

ekeeping tioner atory nistration

#

Time: 13:00- 16:00

ring/Food Service

Registered Nurse:

BREAK

ly sekeeping titioner iratory inistration

KEY Nurse Practicioners:

BREAK

Interactions: O

Nurse Technicians:

Registered Nurses: ID #

ID #

Patient Nurse Doctor Tech Family

Housekeeping PRactitioner

WAITING

LINENS NN

NT NN

FT

KITCHEN

Notes / Observations / Limitations:

S

RP

NP FNN S

TECHS

TT PT H

RN NT TT

DD ET

FF FF

NF TT S

NURSES STATION

PN H

Registered Nurse: # X :Observer: # Sitting: #

:

#

#

:

#

#

:

#

#

:

#

#

:

#

#

:

#

#

:

#

#

:

#

Time: 13:00- 17:00

ommunications

KEY

: : : : : : : :

:

Registered Nurse: #

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

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:

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:

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:

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:

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:

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:

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:

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:

103

COMMUNICATION MAPPING: PRE PAV H 10/8/14 - POE 6 North

KEY: Communications

WEEK

:

Date: 10/8/2014

Shift Time:

7+

Time: 13:00- 14:00

P: Patient N: Nurse D: Doctor T: Tech F: Family H: Housekeeping Pr: Practitioner R: Respiratory A: Administration E: EMT C: Catering/Food Service

Size

Observer:

1300-1700

6NORTH

Susana + Brittany Holian

NURSES STATION

BREAK

CLEAN SUPPLY

MEDS LINENS TT S

wow

NN TT

TT

wow

NPr

NN TT

FF

S

NF S

TT

S

NE

NP OFFICE

5-6 3-4

1-2

Time: 13:00- 15:00

P: Patient N: Nurse D: Doctor T: Tech F: Family H: Housekeeping Pr: Practitioner R: Respiratory A: Administration E: EMT C: Catering/Food Service

7+

Registered Nurse:

WEEK

:

Date: 10/8/2014

KEY Nurse Practicioners:

Shift Time:

:

#

:

#

:

#

:

#

:

#

:

#

: :

#

: :

#

#

#

: :

#

#

: :

#

#

: :

: :

: : # Susana + Brittany Holian : : #

#

:

#

:

#

:

#

#

:

#

:

#

:

#

#

Observer:

1300-1700

#

#

Interactions: O

Nurse Technicians:

Registered Nurses: ID #

ID #

NURSES STATION CLEAN SUPPLY

MEDS

TT S

TT

NT NN N TT

wow

NPr

wow

NN TT

FF

Registered Nurse:

# #

KEY: Communications

Size

Time in Patient Rooms:

Time in Patient Rooms:

Notes / Observations / Limitations:

FF NF S

NP N

Patient Nurse Doctor Tech Family

Housekeeping PRactitioner

#

: 6NORTH :

Sitting: X Observer:

BREAK

NT N FN NN

NN

NT TN N FN

NT NTN N

LINENS NN

NN NT N

TT

S

S

TT

TT

NP N NT HTT

NN

NT NE N

NP OFFICE

5-6

3-4

1-2

Time in Patient Rooms:

Time in Patient Rooms:

104

Notes / Observations / Limitations:

Registered Nurse:

Registered Nurse:

#

:

#

:

#

:

#

:

#

:

#

:

#

#

#

: :

#

#

: :

#

#

: :

#

#

: :

#

#

: :

#

: :

#

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

Circle Size

:

xxx xx

xx xx

xx

Group: 5+

Group: 3-4

Group: 1-2

Date: 10/8/2014

Shift Time:

CLEAN SUPPLY NPr N

on

MEDS

d Service TT S

TT

NT NN N TT

NT NN FF NT NPr N NNN NTTNT NNN NT TPr TT

wow

wow

FF NFNN S

NP N

NN

Pr: Practitioner R: Respiratory A: Administration E: EMT C: Catering/ FoodService

6NORTH

Susana + Brittany Holian

NURSES STATION

ng

ations

Observer:

1300-1700

P: Patient N: Nurse D: Doctor T: Tech F: Family H: Housekeeping

Time: 13:00- 16:00

WEEK

Communications

BREAK

NT N

FN NN NN NPr NT TN NT NT N FN N NN NT

LINENS NN

N

NN TT NT N

TT

S

NT N

S

TT

TT

NP N NT HTT

NN

NT NE N

NP OFFICE

Time in Patient Rooms:

Time in Patient Rooms:

Notes / Observations / Limitations:

Registered Nurse: :

#

:

#

:

#

:

#

:

#

:

#

: :

#

: :

#

#

#

: :

#

#

: :

#

#

: :

: :

: : # Susana : + Brittany # Holian:

#

:

#

:

#

:

#

#

:

#

:

#

:

#

#

WEEK

:

Date: 10/8/2014

KEY Nurse Practicioners:

Shift Time:

#

Observer: #

1300-1700

#

Interactions: O

Nurse Technicians:

Registered Nurses: ID #

ID #

NURSES STATION

g

CLEAN SUPPLY NPr N

on

MEDS

d Service

ND Pr

TT S

TT

NT NN N TT

wow NT P NN D FF NT NPr N NNN NTTNT NNN NT TPr TT

wow

NN FF NFNN NN T

Registered Nurse:

#

NN NP S N

NN NT NN N Pr FN NN NN NPr NT TN NT NN NNNTNPr N FN N NN NN NT NT NF NN N

Patient Nurse Doctor Tech Family

Housekeeping PRactitioner

#

:

6NORTH :

Time: 13:00- 17:00

ations

KEY

Sitting: X Observer:

BREAK

LINENS NN

NN TT NT NNN

NN TTNN

S

NT N

S

TT

TT

NP N NT HTT

NN

NT NE N

NP OFFICE

Time in Patient Rooms:

Time in Patient Rooms:

Notes / Observations / Limitations:

Registered Nurse:

Registered Nurse:

#

:

#

:

#

:

#

:

#

:

#

:

#

#

#

: :

#

#

: :

#

#

: :

#

#

: :

#

#

: :

#

: :

#

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

105

COMMUNICATION MAPPING: PRE PAV H 10/8/14 - POE 6 South

cle Size KEY: Communications

3-4

-2

:

Date: 10/8/2014

EY: Line Size

aveled: 7+

Shift Time:

Observer:

1300-1700

MEDS

NCS OFFICE

BREAK LINENS SUPPLY

NN CLOSET S

NR

NN

MEETING

NT

#

:

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

AA

#

:

#

:

NN

#

:

#

:

#

:

#

:

#

:

#

:

ND S

Registered Nurse:

NN NN

S

S

I

J

K

S

NT

S

L

NN

NN

NT RP

M

NN NN

NT

LINENS

N

aveled:1-2

#

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

Notes / Observations / Limitations:

ircle Size KEY: Communications P: Patient N: Nurse D: Doctor T: Tech F: Family H: Housekeeping Pr: Practitioner R: Respiratory A: Administration E: EMT C: Catering/Food Service

Time: 13:00- 15:00

:1-2

:

#

NT

aveled: 3-4

: 3-4

# S

SUPPLY

O

Registered Nurse:

NT RP

SOILED UTILITY

P

aveled: 5-6

: 5+

CTVIC

Side P: Morgan Black + Katy Albert ; Side A: Lindsey Fay + Leanna Taylor

Time in Patient Rooms

P: Patient N: Nurse D: Doctor T: Tech F: Family H: Housekeeping Pr: Practitioner R: Respiratory A: Administration E: EMT C: Catering/Food Service

Time: 13:00- 14:00

5+

WEEK

WEEK

:

Date: 10/8/2014

Shift Time:

KEY Nurse Practicioners:

UTILITYID #

MEDS

S

NN

BREAK

SUPPLY

O

LINENS SUPPLY

NN ND

N

NR

Traveled: 3-4

NR NN NN

ND

NN MEETING

NN F

Notes / Observations / Limitations:

J

NN

NNNT DD NN NT S

NT

K

NNNN NT DH RP

S

L

NN DN NN NN NN NR DD DD N

NT

LINENS ND

S

M

NT NN

CLOSET

S

Traveled:1-2

RP

ID #

NCS OFFICE

Patient Nurse Doctor Tech Family

Interactions:NTO

Nurse Technicians:

Registered Nurses: SOILED

P

Traveled: 7+

106

CTVIC

Side P: Morgan Black + Katy Albert ; Side A: Lindsey Fay + Leanna Taylor

Time in Patient Rooms:

KEY: Line Size

Traveled: 5-6

Observer:

1300-1700

I

DD NN D NA

NFAA RN NN RN DD DN NN

DD D S

DD

NN NN

DD

DN NN

S

Housekeeping PRactitioner

Registered Nurse:

Sitting:# X Observer: : #

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

Registered Nurse: #

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

Circle Size

WEEK

:

Communications

xxx xx

xx xx

xx

Group: 5+

Group: 3-4

Group: 1-2

Date: 10/8/2014

Shift Time:

Observer:

1300-1700

P: Patient N: Nurse D: Doctor T: Tech F: Family H: Housekeeping

Pr: Practitioner R: Respiratory A: Administration E: EMT C: Catering/ FoodService

y sekeeping titioner ratory inistration

Registered Nurse:

NT RP

SOILED UTILITY

P

S

NF DD NN DD DD NT

ing/Food Service

ND

NT

O

DD N

NN

NN NN

NT S

N

ND

MEDS

NCS OFFICE SUPPLY

ND

LINENS SUPPLY NN NN

CLOSET NN

NN F NN

NN NN

BREAK

NR

NN DN NN DD NN NN DD N NR DD DD NN N NNDD D NN NADD NN NNNN NNNTDD NN N NN NN DD NN NN NT DH DD RP NT

DD D S

NT

LINENS TN NN ND NR NDNN NNNN N

MEETING

NN F

NN NN

NN ND

NT NN

NFAA RN NN RN DD DN NN

S

S

NN

S

DN S

NT

M

Notes / Observations / Limitations: : Date: 10/8/2014 Shift Time:

WEEK

I

J

K

L

Observer:

1300-1700

:

#

#

:

#

#

:

#

#

:

#

#

:

#

#

:

#

#

:

#

#

:

#

#

:

#

: : : : : :

: : :

#

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

CTVICU

Side P: Morgan Black + Katy Albert ; Side A: Lindsey Fay + Leanna Taylor

Time in Patient Rooms:

ent se tor

ly sekeeping ctitioner piratory ministration

#

Registered Nurse:

DD

NN

Time: 13:00- 16:00

Time in Patient Rooms:

nt e or

ommunications

CTVICU

Side P: Morgan Black + Katy Albert ; Side A: Lindsey Fay + Leanna Taylor

KEY Nurse Practicioners: P NF DD FF DD NN DN DD FF NT

ring/Food Service

O

NNNF

N

ND

UTILITY

ID #

DD DD DD D

NN NN

NT NN S

ND

ND NN MEDS NNDD NN N

ND NT

NN F NN

Nurse Technicians:

SOILED Registered Nurses:

S

ID #

NCS OFFICE

NN NN

BREAK

SUPPLY

NN ND

LINENS SUPPLY NN NN

CLOSET

NN NN NNNNN N R NDT NR

NNNN ND NT

LINENS TN NN NDNN NN NR NN NDNNNNN NN NN NN NF NN NN NN NN F F

MEETING

S

S

NN

NT

M

L

Notes / Observations / Limitations:

NT

Interactions:RPO

K

J

I

NT

NFAA RN ND NN RN DD DD DN D NN

NN NN DN NN DD NN NN NT DD N NN NR DD NN N NNDD DD D NN NADD NN NNNN NNNTDD NN N NN NN DD NN NN NT DH NN DD RP NT NN S

S

DD

DN S

Patient Nurse Doctor Tech Family

Housekeeping PRactitioner

Time: 13:00- 17:00

mmunications

KEY

Registered Nurse: : # Sitting:# X Observer: #

:

#

#

:

#

#

:

#

#

:

#

#

:

#

#

:

#

#

:

#

#

:

#

: : : : : :

: : :

Registered Nurse: #

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

#

:

107

COMMUNICATION MAPPING: POST PAV A The research team conducted observations of communication interactions, which revealed that nurses, doctors, and technicians comprised the most frequent participants in conversations in both the pre- and post-occupancy studies. However, the centralized unit design observed prior to the move provided a location to more strongly contain conversations in and around the nurses’ stations than the decentralized design. The decentralized design also saw an increase in the amount of conversations that were being held outside the patient rooms.

09/16/2015 Time: 13:00- 14:00

236

235

234

233

232

229

230

231

228

227

226

225

224

223 20

19

18

17

27

28

29

222

237 NC NN NT

30

DD

NN NN NN NNNN

DDDNNNND FN NT TP DD N+5 NF NN F RN

ND NR NNN ND R N+5 NN ND NN NN NN D

NN

FN NN NT TF NT F RR

DDD DD

RR RR

NT

NT DN NNNN NN DN NT N N+8 Students NN N

NN

NR

NN

NN

TT

NN

NN RT

NNN NN NN NN

NT

NT

RR

NNN NN NN NN RR R

21

zone 2

zone 3

zone 4 UP

DN

238

221

RR

NR

239

DD RR

NN NT NN

220

CR NT

31

DD

NN

ND RN

AA

CA

DD NN CT NN NN

DF

NNN NNNN

PP

NN

DD

NN NT ND

DD

NN zone 1 PA N ND TR PP

NC

RT N NN NN NN N

DD NH NN

ND N

NN

NN T

RT N

NT

NC

NN NN T T NT NN NN T NN NN NN NTNN NN NT NN NT

NT

NN NDNN NN NN

NN

22

zone 5

240

241

DDD DD

26

32

242

NH NT NH H 212NN

211

24

25

NP

NP NP

NP

NP

NP

213

NP NN NP

216

215

214

219

23

NP

217

218

TP NP

112

113

16

N? NN TT zone 5 TN DN NN TN

118 PR

3

4

NN NN N

TN

2

1

PT

119

FF NN RN R

TN

15

RN

NN

DD

RR

TN ND

NN

NN

TN RP

RN TN

NNNA ND NN DA

NN

NN

NN

NN

NN

NR

RP R

5

NNNN

zone 1

AN

RN R

NN

TA

TN

RR

NS

120

PR

NN TN

NN NN NP

NN

N?

139

TN

NR

138

SR

NN

TF CP

DN

RN DN T NT NN DNDN DN NN DN

RN T

zone 4

NTNT DN ND N DN

zone 3

HH

DT

NT PH DH NN RN NN A

NT NN

DT

RN

HH

RN

NP

AA DT TN TT

TT TN

TN

HA

TN NN

TN 13

NP NP

136

DD

135

NP D

DP NP

134

11

12

NP

133

CP AP

NP

132

AP

10

NN P TP

131

130

NP NP TP

129

AP

TN

AA NN

AN TN

TP

DA

NR

DD NN A RN NN NN AA NN

TN RP

TT NN ND NN NN

NT

AR

127

126

DD zone 2

NC

6

122

7

NP

128

DD

HH

8

9

DD

121

DN

UP

DN RP RP T

14

137

108

117

116

115

114

RP

N?

140

111 1 11 11

142

141

125

124

123

KEY Circle Size

Communications

xxx xx

xx xx

xx

Group: 5+

Group: 3-4

Group: 1-2

P: Patient N: Nurse D: Doctor T: Tech F: Family H: Housekeeping

Pr: Practitioner R: Respiratory A: Administration E: EMT C: Catering/ FoodService

Time: 13:00- 15:00

236

235

234

233

237

NN NN NNNN NNNN NNNN RN NNNN

DD

229

230

231

228

227

226

225

224

223 20

19

18

17

27

NN NN NF NC NN TP RP NFNNN NN NANNFN NF NT N FN NT NNRNTP NN NH NT DDDNNNND TFRN NT NNTP DD N+5 DDD NA HA NF NP NR NH NT F NT TP NT RR NF NN NN DD RN RR RT F RR NT HARR NT RR A HN RNNN DN RR NT DD T

NN

30

232

28

29

222 ND ND NN NR NNN ND DND DN R DD N+5 NNT D D NT NN DD DDD NNNN FD ND NN NN DDD NN NN DNN D DD

FD

NNNN RN NT DN NNDN NT FN NN FN NN N N+8

NN

DD

NT

Students

NN

NN NN NN NN DN NNNT RT

FNTT NN RR D

NN N

RR zone 3

NN NNN NN NNN NT NR NN NN NN NN NN NN RR R TT TT T T

NTNN DN

NT NT

NF

RR N

RT

zone 4

DN

DR

UP

DN

238

21

zone 2

221

RR NN NR

DD RR RR

239

NN NN NN NN NN DN NT NN NN

220

CR

31

DD

NATA TN

RR NN RR NN ND RN DN NN NT NT NN CTRN DD DNNNRR NN NN NN RN NN NN NNNN

AA

CA

DF

PP NNN P NNNN

PP TT NP NN NN DD DD TN NN NN P NDD NT NH NN DD T ND

NN NNN ND PP

zone 1 PA

NN NA NA TR NT P RT TNTN N NNNN NN TTNNNNN DN N

TT

NC

DN NN ND N TN N

NP

TT RT N NC

NN T

CN NN NT

TN NT T

NT

NN TN NNNN NDNN TN NNNN NN

NN

NN

NT NN NN NTNN NN NT NT

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22

zone 5

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NP DDD DN DD DT NP NH P NT D NH HDD NN 212NN

26

32

242

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24

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RT NP P NP NP TP NP

NP NP NP NP

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RP

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TP NP NP NT NP P

NP NP NRNN

216

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23

217TN

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NP TP TP NP

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140

15

139

NN TN RN NN TN NR TN RN NN NR TNTN DNR DD NN T PF

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138

DN

NA

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112

113

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117

116

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RP 16

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119

zone 1

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120

PR

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TN NN TT TE NA EN TN NNDN TT EE NE NNE TF N CP EN RN T

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NA EN NA NN NN TA A NN N?NN NA NN NR NA AT NN NN NN

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137

111 1 11 11

142

141

121

DN

UP

14:00- 15:00?

LAINEY

NT

DD DN RP T RPDD DN

DNDD

RN NN DN N NTNT DN T NT NN DN DN NN NN DN ND NN DN N T DN DN N N NNNNDN DN N 13

NP NP

136

NP NP DD ND P NP

135

NP NP

NT

zone 4

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DT NT NN DT

DN

NP NDDP NPP DDP NP

134

NT RN NR NN PH DH DN NN RN RN NN NN A

NN NN

11

12

NP

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133

CP AP

NP

132

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130

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131

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129

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128

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AA AA NN

NT

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8

9

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109

COMMUNICATION MAPPING: POST PAV A 09/16/2015

Time: 13:00- 16:00

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NP NF

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NN TN RN NF NN TN NNTN N TN NNNN NCFPNNNN TN TN NN NNNNRN NP NN TP RPNN NNFNNFNT N NN NT NTNNN NA NF ND TP N DDDNNN FN NN TN NF NR N NT RN NN TP NH TF NNNNT NNTP DD N DDD NAPD NFPF NP NAN+5 HA NF NR NH NT RD F NT TP NT RR TP NF NN NN DD RD RN RR RT T TN F RR TNNT HARR NT RR A N DN NN DN HN RNNN RR NT NNAN DD NN T R zone 4

AA

225

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NN

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ND NNN NN TN TN NN ND DTD ND NNNN NR DN NN NDTNNTAN NF FD NT RN NNN DH D DD DP NT N+5 NNT NNTN NN D DD DDD NN TD DD NNNN FDN ND DNAA DD DD DA NN NN TP DDD AA NN NN A AH FF NN DNN D DD

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Students

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DN NN DN NT NT DN NF

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21

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NN DNN

UP

DN

238

222

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221

RR NN FF

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239

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31

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zone 5

240

26

32

241

242

211 NP

220

NN DT NATA TN NN zone 1 PA NN NT NNN ND DD HA NA NA TR TP P FFPP RT TNTN NNN NNNN NN TTNNNNN NN NN NNN DN

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TTNN NC NT P

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213

NP

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24

25

NP AN NP NP NP NP NP NP

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DN

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NP NPTP RR NP TP

TP

215

NP 216

NP

22

219

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FP NP NPNP NRNN TN FN DP 217 P

218 FP

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140

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14

113

114

117

116

115

118

RP

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PN DN R

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RP R

5

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NP NP DD ND P NP

135

NPNPTP NP

NN TN NN AN PN NN NP TN

NN TP UP

121

DN

14:00- 15:00?

LAINEY

NT NA NT

zone 4

TN DT NT NN DT FT

HH DN

NP NDDP NPP DDP NP

134

NP TP NP

120

PR FP R

NN

13

NP

NNNN

NNNA DANN NA NN NA TA NA NA AANN NA NP NNFA NA NA NN AA NN ND

NRDD NN RR RRSR D NRN DD NR DD DD NR RR RN EN N NN DN N N FN DN NT FF NNDN EE NT DN T NT RP T TT RPDD NN NE DN NN TR TPDN NN DN DN NN ND NNE TNN NN DN N TF N TNDN DN DN N N NN N NDN NN N CP EN RN T

NP

119 NN

DD D

FF

DNDD

PT FF

TNTT TT TTNN TN TT TE NA TT TN TN

136

110

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DNN?DT 16 NNDT NN N? AT NA TNTTNP NN TN DNRT zone 5 TN NNDN TN DN TNTN NA RR TN DR AR NN TN DT TN NN DD NA 15 DNNN TANR ND DTNN RR NA NN NN NA TR CT AD TANA TN TA AANA RNTN TNNNNN NF TN NR NA TN TN NA RN NN NR TN NNNA EN DR TN NN TA TN R DD NN TN DN RANNATAAAA A T NN NN N? TA NN N NR NA TA NA DR DD DD NN AT TN NA NN NN NA NR PF RR AD TN AR RR NN NS TN

138

137

111 1 11 11

142

141

PHNN NT CR RN NR NN DH DNAR NN RN FP NNNN NN NN NRRN N TN ATN

FT

NN NN

12

11

TP HP NP TP DP NP NPNP TD NP 133 CP RRR RP

CP AP

NP

132

AP TN

NN P TP

131

TN

zone 3

ND NN NN NN AANNNA TT NA RR NN DD NP DT AA HH DNNN NN NN RN TT AA NN NN NN TT NNNA TN RN NN NN DR DT T TN NP NNTTTNNTNFNN TC TN NT TN NN NA NT HA DD TN DD NNAN NP TN NN TN DA CP TN TN AA NN TPNN TT AA NA RRCP CP NN CP TT AN PT DA RATP NP TN NP TP 10 9 AP AP NP NP CP NPNT TP

130

129

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127

TN NN RR AA TN NT NN AA NN NN TN DD N RP TA NP NN A DD NA NN F NA NNNN NRRN N NR NN RN NN NNNDN DA CP AADN NNCPHH NNNT

TN RP

8

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DD

NN ND

NT NN NN AN NTNC

AR

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DD zone 2

TT NN

6

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123

KEY Circle Size

Communications

xxx xx

xx xx

xx

Group: 5+

Group: 3-4

Group: 1-2

P: Patient N: Nurse D: Doctor T: Tech F: Family H: Housekeeping

Pr: Practitioner R: Respiratory A: Administration E: EMT C: Catering/ FoodService

Time: 13:00- 17:00

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NN NN NN NN NN NNNN N NNNN RN FN NNNN

NN

NN D

DD

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RN NP

17

NN

NN TN NDNNNNNNN NTNN RN NF NN TN NN NNNN TN NNTN NNN NN NN DN NN NR NN NN TN NNN NN NN ND ND TN NN NN TPNN RPNN NNFNNF DN NN PF NN NNRNTP DTD DP NN NN ND TNDDD NNNNNT TNTNNNT NT NDTNNT NRNCFP FD NTNNN NT NA NF NPNPNN TN FD NF AN NT N ND TP FN NN T NNN TN DHDN NT NF FN NN DP NT NR N N NT TRN NN RN DD NH N NP N+5 NNT NTDN DNN+5 TF D NNNNT NNFN NNTP DD N NT RR NN TN NN D DD DDD NAPD NP TP NN NA HA TD T PF DDD NF T NF NR NH NT RD FNN DD NNNN FDN NN TP NN FN ND DNAA NF NN NN DD DF DD DD RD NTRN PN RR RT NT DD DA T TN NN F NN TP RR TN HARR NT DDD AA AA NA NT RR FNN RN TT A NN NNT NA NN A AH FF DD DD DN NN DNN NN D NN DN HN RNNN RR NN NT DD NN AN T T R zone 4

NN

30

27

28

29

DN NT NTNN TN NF NT NNN N NNNN RN DN NT DNRN NNRN NN NN FN NNNF N+8 FN N R NT Students NN NN NN DN NN DN FF DD N

NN 18

226 PN NP

FP NF F

225

PT NN NN NP TTNN NN NN NNTTNN DN NN RT T NNNT NNNN FR NT DN NN

FNTT DD TT DN NN DN RR D

RR zone 3

224

223

RP 20

19

AP

NP

DN NN T

RT

NN NF NN NN NN NNN NNN NT NTDN NR NT DN NNNNN NN DD NNNN P NNNDN NN RR NNN R TT TT T T

DN NF NA NT NN NN DN NT TT NT NT NT NN DN HH

RR N

NF

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NN NN NNN NNDN N

RR RR

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NT NN NA FA AA NA TA TN NN NN zone 1HA PA NA NT AA PP TT NNDD NF NNN ND TT TTNN NC NN TR NN FF DD NA TP NP NN NT N P TT PP N DD DD FF N NN NN RT DN P DD FN NT TNTN PP NTNN DD NT TT NNN NN TN P NNNN NN NNN NN NN NDD NNNN NN TTNN NN NN NN NNN ND P N NN NNNN NN NN NN NN RN NT NH NN DD T NT NN NN NNN DDN NN FNND ND NN DP D NP DP 26 DDD 25 NP NH NP DD DN NN NPRT P NP NP NP DT NPPNP NN NH AN NP P NP P NT NP NPNT TP NP PNH HD D NPNPNP NP NP NP NN FP DD NP NP NPNP NF 211 213 NN DP 214 FP P F 212

31

DD CR

DD

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RR TNNN RR NN ND RN DN NN NT NT NN CTRN DD DD DNNNRR NNN NR NN NN RN NN NN NNNN

DD CA

DF

zone 5

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32

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DT

ND NN NN NN NN NNNN DN NTTN NN NN

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NN FF DD

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NP NP F

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222 21

AF

NR

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NP NP

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AP NP NPNP NRNN FP TN FN DP 217 P

NP RP 216

NNAT NN NN T T TNT NT NN NN NN NN NTNT P T N TNT NT NA NN T NN NN A NN NN NTNN NT NN NT NN NT NT NN

218 FP

NP

TP TP NPRP NP

141

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111 1 11 11

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DNN?DT 16 NNDT NN N? AT NA TNTTNP NN TN DNRT zone 5 TN NN DN TN TN TN DN TN TN NA RR DR PF AR NN TN F DT TN NP NN DD FF DD PF AANNRR RN NA 15 FF DNNN D NP TANR ND DTNN DS FF NN RR T NA NN NN NA TR CT ADTN TN AT TANA TN TA AANA RNTN NN TNNNNN NF NN TN TA TN NR TN TT TN DR N NA RN NN NR EN NA TN NNNP TN NA NN TA TN R DD NN TN NN DN D RA ATAAAA A T RN NN N? TANNNN N NNNN NR NA TA NA DR DD DD AT NN TN NA NN NN PF TN NA TN NR NA RR AD TN AR RR NN NS TN NN NRDD NN TN RR DN FF TN RRSR D NRN DD TN NRRN DD DD NR TNTTNP TT DN zone 4 RR RN TTNN EN R TN N NN NA NN TT TN TT TE DN N N FN TN DN HH AH HH DT TN NT TN FFTN NNDN NT DN FH T NT RP T FT TT DT TT EE RPDD 14 NT H NN NE AH DN NN TR TPDN N DN NN DN NN DN NN NN NN ND NNE TNN NN DT FT DN N TF TNDN DN DN NN N N NN N NDN FN TN NN N CP EN RN T NP DNDD 13 12 TP NDDP NPNP NP HP NPP NP NP TP DP TP NP DDPHP NPTP DD ND NPNPAP NPNP NP PNPNP TD NP CP

136 TP

134

135

NPNPTP NP

NP TP NP

133

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113

114

117

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RP

PR 4

3

2

1

PT

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FF PN DN R

NN TNNN N RN NR R NN

DN ND

NN RR CN

DNNN DN NN TN FN RANN AC NA DA NRRN NN RA NN ND TN RP NANN NANN NA NN DA DATA NN NN A ANNA

RR AR R NN NN NN NA NN NN NN NN RR NN NPAP NN DH N zoneDP 1

NRRN NN

NN

NPNN TN RR AN F TN NN NN TA NT NN N DD D NN A

RP AA R

5

NT NNNN NTTN NN NN AN PN NN NT NP

NNNA DANN NA NN NA AA TA NA NA NN NN NA NP NNFANNA NA NN AA NN ND NN

PR FP R

NN

DN NT TN

120

NN TP UP

PHNN NT CR RN NR NN DH AR FN ND DN NN RN TN FP NNNN NN NN NN NRRN N TNTN NP ATN

11

TP NP CP NP AP 132 FNAPTN

TP

NN NPP NP TP

131

TP

130

NP CP NPNT TP

129

14:00- 15:00?

LAINEY

TT

TN zone 3 ND NN NN NN AANNNA TT NA RR NN DD NT NP DT AA HH DNNN NN NN RN TT AA NN NN NN TT NNNA TN RN TN NN DN NN DR DT T TN NP NN NNTTTNNTNFNN N TN TC DD TN DD NNAN NA TN NT NP TNNT NN NA NT AAHA TN NT DA NN CP TN TN AA CP NN TPNN TT AA NA RRNN CP NN CP TT AN PT DA RATP NP NP TN 10

121

DN

NT NA NT

NP AP AP NP

128

TN NN RR AA TN NT NN AA NN NN TN DD N RP TA NP NN A DD TA NA NN F NA NNN NNNN NRRN NR NN NT RN NN NNNDN DA CP AADN NNCPHH NNNT

TN RP

8

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NN ND NT NN NN AN NTNC NN

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NURSE TIME IN ROOM NURSE TIME IN PATIENT ROOM The research team conducted observational studies to measure the amount of time nurses were spending in the patient room during their four-hour shifts. Using a stopwatch, nurses were timed from the moment they entered the patient room to the moment they exited the room. The time reported represents the average time per fourhour shift.

NURSE TIME AT NURSE STATIONS The research team also conducted observational studies to measure the amount of time nurses were spending at the nurse stations during their four-hour shifts. Using a stopwatch, nurses were timed from the moment they arrived at their desks to the moment they left. Data was recorded by two person teams over the course of four hours. The time reported represents the average time per four-hour shift.

112

+

113

NURSE TIME IN PATIENT ROOMS Cardiovascular Unit Totals This data represents the average time nurses spent in the patient room per four-hour shift for the entire 8th floor unit. In the old unit, nurses spent on average 18 minutes, 40 seconds in patient rooms. The post data

0:18:40 PRE

0:23:53 Post

0:33:02 PRE

0:28:48 Post

0:14:14 PRE

0:18:27 Post

shows a 28% increase in time spent in the patient room with an average of 23 minutes, 53 seconds.

Intensive Care Unit # of Participants Pre: 405 Nurses Post: 1,184 Nurses

Progressive Care Unit # of Participants Pre: 996 Nurses Post: 929 Nurses

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NURSE TIME AT STATIONS Cardiovascular Unit Totals This data represents the average time nurses spent at their nurse stations per four-hour shift for the entire 8th floor unit. In the old unit, nurses spent on average one hour, four minutes at the nurse station. The post data

1:04:01 PRE

0:51:44 Post

N/a PRE

0:47:19 Post

1:04:01 PRE

0:56:52 Post

shows a 19% decrease in time spent at nursing stations with an average of 51 minutes, 44 seconds.

Intensive Care Unit # of Participants Pre: N/A Post: 852 Nurses

Progressive Care Unit # of Participants Pre: 43 Nurses Post: 913 Nurses

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ACOUSTICS The World Health Organization suggests that hospital noise levels should not exceed 35 dB(A) during the day and 30dB(A) at night, although research shows that these levels are frequently not met within the inpatient setting. In a 2013 investigation of sound levels on intensive care units with reference to the WHO guidelines, the average sound levels always exceeded 45 dB (A) and for 50% of the time exceeded between 52 and 59 dB (A) in individual ICUs. Outcomes from this study reflected a slight increase in the new environment’s acoustic levels from the pre-study, however averages aligned with the 2013 study. Overall, the acoustic level ranged from 59.74 dB (A) to 61.21 dB (A).

116

ACOUSTIC MEASUREMENTS ACOUSTIC MEASUREMENTS

Likert scale questions on a 5 point scale, with 3 a neutral choice. By averaging across respondents, a mean less than 3 indicates on average they disagree with the statement, while an average above 3 indicates on average they agreed with the statement. The farther the mean

Acoustical measurements were taken throughout the entirety of the ICU and Progressive cardiovascular units in both the pre- and

is from 3, the stronger the group’s feelings are about the question.

post-occupancy evaluations. Data was collected using a digital sound level meter over the course of one week. Measurements were taken in the corridors of each unit at various locations.

Intensive Care Unit

59.92 dB

61.21 dB

PRE

POST

Progressive Care Unit

59.74 dB

59.79 dB

PRE

POST 117

ROOM USAGE Overall outcomes from the room usage data revealed that the number of visits per patient room increased per 4-hour observational shift. Specifically, a 67% increase in visits to patient rooms was observed in the decentralized model.

Regarding nursing station usage, the number of visits to nursing stations increased by 9% in the decentralized model.

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PRE & POST ROOM USAGE:

Nurses Station vs. Patient Room The research team conducted observations to determine frequency of staff usage of patient rooms and nurse stations. Room usage was tallied each time a staff member entered a room or station over the course of 4-hour observational periods or shifts.

To analyze the patient room data, observations were averaged per room per observational shift. The centralized nusring station model included only one station per unit compared to one nurses’ station for every two patient rooms in the decentralized model.

To account for this difference, data was analyzed by averaging visits to the nursing station during an observational shift. A total of 48 hours of observation, 12 shifts, occurred during the pre-study while post-observations encompassed a total of 68 hours or 17 shifts. A single four-hour shift had between one and ten observational pairs.

KEY

20 2020

PRE: FIRST BAR

15

1515

15.64

POST: SECOND BAR

15.64 15.64

1010

9.36 9.36

10

9.36 5

5 5

Nurses Station

0 0

-

The number of visits to

nurse stations increased

0

9% from 61.15 to 66.55 per

Overall Patient Room Visits by Staff

observational shift.

Intensive Care Unit

Progressive Care Unit

2020

15 15

13.58 13.58

12 12 9 9

9.43 9.43

1010

6 6

20 3 3

13.58

0 0

Patient Room Visits by Staff

17.41 17.41

1515

15

9.11 9.11 5 5

0 0

17.41

Patient Room Visits by Staff

119

120

HEALTHCARE STUDIO The study consistently aligned with an annual healthcare design studio taught in the College of Design. As part of the studio, students were tasked with evaluating the cardiovascular unit and utilizing the practice of evidence-based design to more successfully design healthcare facilities.

121

STUDENT INVOLVEMENT Undergraduate and graduate students from the University of Kentucky’s College of Design and College of Communication and Information have been key contributors to this study.

Students not only assisted in conducting pre- and post- occupancy evaluations for the UK Chandler Medical Center’s cardiovascular units, but also participated in a Healthcare Design Studio focusing on the design of cardiovascular units.

Through participation in evidence-based design research and experiential learning opportunities, students can identify the source of design problems and prioritize solutions, test innovations, and support strategic decision-making.

122

123

STUDENT PERSPECTIVES Morgan Black “My involvement in the healthcare design studio was not only beneficial for my growth as a student, but also built a foundation of design processes that have carried through to my career today. Because the healthcare studio was rooted in research, I gained an appreciation of the need for the incorporation of evidence-based design.

Observation in the UK Albert B. Chandler Hospital reinforced the importance of better understanding users to better design for them while emphasizing

The healthcare design studio successfully integrated research, observation, and other methods of evidence-based design in a learning environment that challenged students and encouraged growth, and because of it, I am confident that I am a better designer today.”

Jessica Funke

Shannon Knoch

“Getting to watch how nurses, doctors, and techs interacted within their environments helped me understand why what we are doing is so important, and how we can better design these spaces. Seeing how they work is invaluable to the design process.

“The senior healthcare studio experience really changed my perspective on what healthcare design has to offer. One of the things that makes the spaces that we as designers create so unique, is the people that occupy them. I’ve always had a passion for helping people and making a difference.

Most of us have had experiences in hospital rooms as a patient or a family member, so we can relate to the patient’s experience. None of us have ever worked in a hospital, so to get the perspective of a caregiver is so helpful in the design process. Marrying the patient/ family space with the caregiver space is a unique challenge, but I believe now that I have observed I can make educated decisions about the design.”

124

the value of documenting findings in a manner to incorporate and convey information in a meaningful way.

Having had the experiences from participating in the healthcare studio, I’ve realized that the healing spaces that we create can have a major impact on the healing process. As designers we are impactful and creative.

Through healthcare design, we also have the power to be healers.”

Amy Schlachter

Grace Snider

“The healthcare studio semester I completed was an extremely beneficial and enjoyable one because of the amount of research conducted, observations done, and progression in design skills. It was a major turning point in improving as a designer and further developing my design identity.

“The amount of knowledge I have gained from my year in healthcare design will stay with me throughout all areas of design my future might entail

I had already been interested in the healthcare design field, but what I like most about healthcare design is that it has a higher purpose than just designing a space for a user.”

This process as a whole has opened my eyes to a new realm of interior design. I have gained a greater understanding of the inner-workings of the healthcare environment and the empathetic design process that goes along with it.”

Erin Taylor

Josh Santiago

“Healthcare Design impacts human experience in the most intense of times. Understanding how to design a space to accommodate for those moments and users is something unique from other design situations.

“As a Communication research assistant on this health-related organizational communication project, I was able to witness firsthand the process in which physical design impacts communication in the healthcare field. I was also able to examine how physical design impacts important communication processes in healthcare organizations and teams. It was interesting for me to learn about and examine communication processes within an evidence-based design framework.

Healing and inspiration are opportunities that occur different for everyone, and learning how to provide for that is something special designers can offer.

Throughout healthcare studio, we learned and applied strategies and techniques to become healers through design and truly provide a spaces for workplace, hospitality, and healthcare in one facility.”

Since I plan to utilize qualitative research methods in my future career in communication, I benefited from the opportunity to experience and learn how to conduct a focus group, properly transcribe the content gathered in the focus group, and utilize a framework to analyze the data. From this information, I can conclude what factors are important to the providers, especially with regard to design elements that facilitate or hinder communication. I thought the focus on communication was important because ineffective communication between providers resulting from flaws within the physical design can directly affect patient outcome.”

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Nurse Stations and Corridor by: Tarah Carnefix

126 Centralized Nurse Station by: Erin Taylor

Decentralized Nurse Stations and Corridor by: Jessica Funke

127 Decentralized Nurse Station and Corridor by: Amy Schlachter

Family Respite Area by: Lucas Brown

128 Family Waiting Room by: Shannon Knoch

Library/Media Room by: Amber Bowman

129 Family Respite Area by: Samantha Herman

Patient Room by: Grace Snider

130 Patient Room by: Tarah Carnefix

Patient Room by: Samantha Herman

131 Patient Room by: Katie Abushanab

The use of a pre- and post-occupancy evaluation offered a unique opportunity to engage with UK HealthCare staff, patients, and visitors to better understand how the design of our built environment can impact effective and efficient delivery of care for the Commonwealth. Outcomes from the examination of the cardiovascular service line have allowed the researchers to better understand both positive and negative design attributes of the centralized and decentralized models and the implications of each of these for efficiency, communication, teamwork, and staff satisfaction. Moving forward, this research will more specifically identity correlations between these factors so that future designs might be enhanced.

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T H A N K S A special thanks to all collaborators of this project including UK College of Design, UK HealthCare, UK College of Communication and Information, GBBN Architects, and to the students, staff, and faculty who contributed time and resources to the project.

All images courtesy of Scott Pease Photography, UK Healthcare, and Lindsey Fay

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University of Kentucky College of Design - School of Interiors College of Communication and Information UK HealthCare GBBN Architects 2014-2016 138