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.

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.

The COVID-19 pandemic placed healthcare design at the heart of the crisis. Hospitals faced challenges such as increasing their ICU-capacity and enabling physical-distancing measures to prevent infectious spread. They also needed to co-house (suspected) COVID patients and non-COVID patients with different requirements enforced separate entrances and routes to keep staff and patients safe. It is suspected that even in a fully vaccinated world other pandem-ics are waiting in the wings. In a design brief, flexibility is typically mentioned as an important target, and single occupancy in-patient accommodation may be considered as a way to enhance flexibility. To gain insight in and to inform future hospital design, this study evaluated what oper-ational coping strategies and design solutions were considered important enablers to increase ICU capacity and to support different patient flows and what design solutions enabled physical distancing. We have collected data from 30 Dutch hospital organizations, including from some recently opened hospitals, with 100% single occupancy in-patient accommodation. Using a practice-based approach, in-depth interviewing was combined with document and multimedia analyses to analyze and compare successful operational strategies and design elements that helped provide the flexibility needed in this recent crisis. As we looked at existing facilities and alterations made to allow hospitals to operate in ‘crisis mode’ during the COVID-19 pandemic, we present emerging design considerations for future healthcare facilities that, preferable, can also be implemented in renovations of refurbishments. We add the perspective of staff as a limiting factor to a hospital’s pandemic preparedness.

In 2015 a profound change in the financing of the Dutch health care system was initiated. Pur-pose of the reforms was also to enable elderly to live at home as long as possible. One of the consequences of the 2015 reforms was that care providers closed care homes. It was argued that care providers could use vacant care homes to house independent living elderly of lower and middle income groups seeking a break out from loneliness, and willing to live their live in the vicinity of other elderly without abolishing the independence, thus in a cohousing group for elderly. This mixed methods study aims to gain insight into the conditions that influence the continuity of cohousing groups for elderly. A survey was sent to 114 cohousing groups for elderly, yielding a net response of 52%. The out-comes were then used to select 6 cohousing groups who participated in in-depth interviewing. Informal care is in all interviewed group provided by family caregivers and it was not the co-housing’s responsibility to look after chronically ill members. For elderly, an important motive to live in cohousing was the social connection with others in the group. This also creates a feeling of safety. However, a main reason for cohousing groups in highly urbanized areas appears to be the possibility to bypass the regular waiting list for social housing. The continuity of cohousing groups seems to depend on the regular organization of activities, and therefore membership fees need to be included in the rental agreements.