'Enabling health, care and well-being through design research' is the title of ARCH22 – the 5th Architecture Research Care and Health conference – organised at the the department of Architecture and the Built Environment in Delft as the main venue and Erasmus MC in Rotterdam as co-location – the Netherlands – 22nd until 24th of August 2022.
Aim: To determine the effect of relocating to a hospital with only single-occupancy rooms on environmental contamination with highly resistant microorganisms (HRMO). Introduction. In May, 2018, the Erasmus MC University Medical Center in Rotterdam, the Netherlands, relocated from an old hospital building with mainly multiple-occupancy rooms with shared bathrooms to a newly constructed hospital with 100% single-occupancy rooms and private bathrooms. Methods. Environmental sampling took place twice in the old building and fifteen times in the new building, from two weeks before to thirty-six months after relocating patients. At each sampling moment, samples were taken from 13 locations (e.g. nightstands) in 40 different patient rooms. Samples were screened for different HRMO, e.g. Escherichia coli. Additionally, the total bacterial load was determined. Results. Environmental sampling revealed that 24 of 724 locations (3.3%) were positive for HRMO in the old building, with five locations positive for multiple HRMO. In the new building, five of 4269 locations (0.1%) were positive for HRMO; a significant decrease (P<0.001). In the old building, HRMO were mainly identified from sink drains (87.5%), in the new building from shower drains (60.0%). In the first nine months after opening, an increase in bacterial load was observed. Thirty-six months after relocating, no major differences in bacterial load were identified between the old and the new hospital building. Discussion. This study shows that a newly constructed hospital with 100% single-patients rooms has a positive effect on the presence of HRMO lasting at least 36 months after opening.
This paper presents an ongoing research to define the framework of a computational design approach based on the idea of spatial analysis and spatial synthesis to implement multi-criteria evaluations and provide evidence of the performance of the design alternatives in the specific case of home adaptation for healthcare at home. The European health systems place among the priority objectives the strengthening of the provision of healthcare at home to guarantee the aging in place of elderly people and to limit, at the same time, the unnecessary use of resources. Therefore, existing homes must provide adequate safety, comfort, and accessibility features to ensure a high quality of life for the care receivers and facilitate the caregivers' tasks. To address the complexity of the requirements to be met, we propose a spatial decision support system (SDSS) to implement multi-criteria assessments to ergonomic design problems at a spatial scale of apartment homes. The system is intended to streamline and assist designers and homeowners in planning interventions for home adaptations for healthcare. Such design problems can be formulated as decision problems with costs and benefits modeled within constraints of validity and quality criteria/objectives. Concerning the specific field of study, the system evaluates the degree of compliance with the accessibility and visibility quality criteria of each design alternative. The reiteration of the evaluation mechanism allows for the classification and supports the selection of satisfactory technical solutions identified with an in-formed and well-balanced trade-off between the relevant quality criteria.
For most patients with an incomplete spinal cord injury, gait rehabilitation plays a key role in functional recovery. However, few methods are available to reliably assess gait function during rehabilitation. Therefore, a study was initiated to develop a gait assessment interface that is user-friendly, time-efficient, and based on objective data and intuitive data visualizations helps physicians and physiotherapists select and evaluate interventions for patients. The paper focuses on the first phase of the design process, user research, and how user-centered design was used to identify users’ needs and expectations, and the context wherein the gait assessment interface would be used. This was done through conducting focus group sessions with professional users (physicians and physiotherapists) and using interactive activity boards to obtain answers and facilitate discussion. The information obtained, as well as user-centered design practices, will be used throughout the further development of the gait assessment interface.
Aim: We will present our ongoing experiments on home makeovers of private rooms of people with intellectual disabilities and severe behavioural problems living in a Dutch long-term care facility to demonstrate that a tailored environment contributes to a better quality of life. Background: Eight years ago, the transformation of ‘D’s room’ changed the life of D, a person with severe intellectual disabilities and behavioural problems. This was done in close collaboration between a Dutch care facility and an architect. It is because of D’s drastically and positively changed behaviour that the care facility decided to transform the physical environment of twelve of its most vulnerable patients and to study the impact on patients and staff. Methods: A project is started to transform the rooms within a four-year period and to open up a knowledge platform. To streamline and replicate the transformation process, it is broken down into ten steps. Part one of the multiple case study consists of a narrative representation of the four completed room transformations. Results: An open cooperation between caregivers, architect, and family seemed to be very important in the process. The study shows a reduction in behavioural problems of patients and improved working conditions. Conclusions: A new approach to the living environment of people with intellectual disabilities and severe behavioural problems in long-term care can have remarkable results for patients and staff. It is important to raise public awareness of the importance of a suitable living environment as an integral part of disability care.
When in a hospital environment, whether for medical consultation, visiting a loved person, or even starting a new job, many people might experience stress and frustration. Those negative feelings and emotions impact well-being and are not necessarily or solely the consequence of the motive people go to the hospital. The experience of people needing help finding their way through the hospital campus or buildings instigates those feelings. Although many healthcare environments and hospitals often invest a lot of money and effort to implement a proper signage system, as it represents one of the critical aspects of their "identity", many challenges remain. A good wayfinding strategy is fundamental to all users involved in the daily functioning of a healthcare environment, as it can dramatically impact their well-being. In this paper, we highlight the importance of wayfinding as a crucial element for a comfortable hospital atmosphere and, consequently, a positive experience for the public. We illustrate our point of view by discussing the applied methodology to gain insight into the wayfinding system of a Belgian hospital to nurture the design process of developing a new wayfinding strategy for this client. We highlight different perspectives considering the understanding of various user groups and their difficulties and challenges encountered when trying to find their way in hospitals: the public, the architecture, the local culture, complex buildings and sites, stress and vulnerability of the people, routes and many other aspects. Together, these insights nurtured the strategy and design of an effective wayfinding system for the concerned healthcare facility.
The purpose of this research is to provide insight into the various ways stroke patients use and interact with the built environment during their inpatient stay in rehabilitation clinics. Re-habilitation clinics are multi-story buildings where stroke patients live for weeks or months to re-ceive intensive individualised therapies. Regardless of their impairments and abilities, patients are commonly accommodated in the same ward types with shared therapy rooms. They are generally inactive during rehabilitation, and the built environment's impact on patient experience and recov-ery is still unclear. Five stroke patients (LOS on the observation day ranging from 7 to 128 days) were shadowed for one whole day, each in a different clinic. They were all wheelchair users in the same rehabilitation phase. Patients' movements in the clinic, their comments, the spaces they vis-ited, and the challenges they encountered were recorded. A patient survey accompanied shadowing. The physical barriers that patients encountered, the level of dependence on staff members, how much they relied on various built environment elements (e.g., handrails) for mobility support, and their spatial preferences varied considerably. Their use of free time during the day and amount of socialisation with others also differed. While some patients may greatly benefit from a supportive and barrier-free environment, others may find that a more challenging environment with training opportunities contributes better towards their recovery. These differences in patients' behaviours and experiences may help to inform the design of rehabilitation environments.
The design of a new hospital is typically used as a catalyst for change, redesign and implementation of new work processes to improve health services. Perceived outcomes after relocation may be linked to the success of co-design and stakeholder engagement processes. Especially in striking the right balance between the building (Bricks), processes and supporting IT (Bytes) and work processes (Behavior). Even when stakeholders are engaged in the design that is not to say that their needs will be safeguarded during trade-offs in various phases of decision-making. Furthermore, the time window between engagement and project delivery may contribute to a mismatch in perceived outcomes after relocation. This study aims to gain insight into the possible causes for the perceived mismatches as expressed by ward managers some 12 months after relocation. This was altogether some 6 years after the design of the facility was completed. It will increase our understanding of the complexity of design, construction and transition processes that have to deal with a gap in time between design and use. We adopt an interpretive case study approach in which in-depth interviewing has been combined with an extensive analysis of documents collected over time. We found transformative change requiring an integrative approach to the Bricks and Bytes throughout the whole process of designing, constructing and taking into use, with stakeholder engagement as a key element. Additionally we found Health Care Worker Behavior not well enough considered in a predominantly rational design and implementation process focusing on patient centeredness.
Administrative non-patient workstations of medical staff are often rarely occupied, as physicians use various spaces in their daily routine. Occupancy data for administrative workplaces in hospitals are scarce but needed as a basis for planning for costly projects. Thus, the objective of this secondary data analysis was to compare the occupancy rate of traditional administrative offices to medical offices in hospitals. Additionally, the activities performed at the workstation are compared. Occupancy data resulting from Space Utilization Surveys in 14 offices were compared with data from for hospitals projects. The data results from multi-moment observations that were conducted twice per hour on three days while presence and activity patterns were collected. The office data and the hospital data were analyzed descriptively. Average occupancy and activities were studied and recognised that compared to offices, workstations in the hospitals have significantly lower occupancy rates. Activities at workstations in hospitals and activities in offices are significantly different. The results show more communication activities in hospitals and less computer work compared to offices. According to this analysis space efficiency poten-tials exist. The results indicate that the way workstations are used in hospitals is different from traditional offices. Medical staff spend a large part of the working day away from their backstage desks. However, the use of desks is less plannable as in offices and changes of room take place frequently. Therefore, it’s unclear whether the efficiency potentials can be realized in a way as for administrative offices.
There is an urgent need for further research in hospital design and delivery to understand the integrative, nuanced and intricate nature of healthcare project delivery and design management. Historically, each new hospital programme develops a new delivery model that takes a different approach to the management of design. However, this approach is not sustainable. Hospitals have a significant complexity, which may be impacted by role changes and procurement methods which can result in significant errors, costly delays and lack of ability to learn from failure. A retrospective abductive, auto-ethnographic case study approach was taken in the examination of five major hospital projects of similar size and complexity reflecting five temporal periods was carried out by a project architect who subsequently became a construction design manager spanning a career of over 30 years. This variant of action research involved a retrospective mode of abductive reasoning applied retrospectively. An approach to hypothesis testing (using literature) is used to explain and theoretically frame historical practices. It was found that National delivery models (and their change over time) have had a significant influence on hospital project delivery and particularly on design and engineering systems integration. The role standards have played in design have also played a significant role, and in part may have constrained innovation and unduly increased cost. Recommendations are made for a new integrated healthcare delivery model that supports an approach to innovative design and construction of new hospitals responding to advanced clinical and technology approaches.
In planning an urban hospital, the complex priority-setting of goals often neglects how landscape designs impact ecosystem quality and threatens public health. As a result, the difficulty in counteracting the urban heat island effects and reaching sustainable development goals on time exponentially increases. In this context, a research workshop conducted with facility managers, planners, designers, and various groups of hospital users helped to analyze and propose actions to solve climate and health environmental issues for the future redevelopment of the Sahlgrenska University Hospital campus. The groups participated in community-led research and applied landscape planning tools to visualize and problem-solve climate, energy, and urban environmental health issues that affect outdoor campus users and pedestrians. This research is an illustrative case study that depicts how the methods employed in the four-session research workshop and the development of its results on (i) visualizing the street environment and spatial inequities in urban scenes, (ii) reviewing heat, runoff, and biotope data at the pedestrian level, (iii) applying prioritized planning at critical urban scenes, and (iv) proposing spatial design solutions centered on vulnerable hospital outdoor users. The results are descriptions of the group dynamics and their outputs on how public transportation stops, street crossings, free-seating areas, and spaces at building en-trances affect the local urban ecosystem, the energy balance of buildings, and mobility of vulnerable pedestrians, including outdoor workers.