THE EFFECT OF WARD TYPOLOGIES ON QUALITY OF CARE - SALUS · These results are based on 3 case...
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THE EFFECT OF WARD TYPOLOGIES ON QUALITY OF CARE Lessons From the Past to Inform the Future ROYAL COLLEGE OF PHYSICIANS LONDON | 11-13 JUNE 2018 EUROPEAN HEALTHCARE DESIGN UTOPIA OR DYSTOPIA? VISIONING THE FUTURE OF HEALTH Rosica Pachilova // [email protected] // @rpachilova Dr Kerstin Sailer // [email protected] // @kerstinsailer 12th June 2018
Transcript of THE EFFECT OF WARD TYPOLOGIES ON QUALITY OF CARE - SALUS · These results are based on 3 case...
THE EFFECT OF WARD TYPOLOGIES ON QUALITY OF CARELessons From the Past to Inform the Future
ROYAL COLLEGE OF PHYSICIANS LONDON | 11-13 JUNE 2018EUROPEAN HEALTHCARE DESIGN
UTOPIA OR DYSTOPIA? VISIONING THE FUTURE OF HEALTH
Rosica Pachilova // [email protected] // @rpachilovaDr Kerstin Sailer // [email protected] // @kerstinsailer12th June 2018
Predictions for Social Economic Environmental and Technological Changes by 2050
World / Urban Population
Predictions of Social Economic Environmental and Technological Changes by 2050
Technology
Life Expectancy
Artificial Intelligence
Global Warming
Driverless Vehicles
Global Oil Demand
Advances in Medicine
What Are the Predictions for Healthcare?
The Empowered Patient Increased Focus on Acute Care
Design for the Aging Population New Diseases
Rise in Alternative Therapies
Caregivers as Highly RegardedPersonal Control
Prevention of ‘Lifestyle’ Diseases
Introduction
Ancient Greece Middle Ages
Nightingale Ward Mega HospitalsHealing Temple
Christian
Hospitals
1860 - WWI WWII - 2000
Faith as healerDark and cold
Open wardNatural ventilationNatural light
Nature viewsNatural ventilationNatural light
Deep floor planMechanical ventilation
Healing Temple
Ancient Greece
Nature viewsNatural ventilationNatural light
Middle Ages
Faith as a healerDark and cold
1860 - WWI
Open wardNatural ventilationNatural light
WWI - 2000
Deep floor planMechanical ventilation
Nightingale Ward Mega HospitalsChristian Hospitals
Ward Typologies
Nightingale St Thomas Hospital
UK
1867 1963 19731965 1976 19861984
CorridorAiredale Hospital
UK
Duplex Ninewells Hospital
UK
Racetrack High Wycombe Hospi-
tal UK
Courtyard York Hospital
UK
Radial Chesterfield Hospital
UK
Cluster Weston-super-Mare
UK
Why Are There Different Typologies?
Natural light and ventilation in patient and staff areas
Centralised vs decentralised nursing station
Privacy vs supervision (single beds vs bays)
Minimise walking distance
Maximise outside views
Centralised vs decentralised ancillary spaces
Number of beds per nursing unit
Nightingale
Corridor
Duplex
Radial
Racetrack
Courtyard
Cluster
How Do Design Features Influence Healthcare Outcomes?
Metrics
EnvironmentalFactors}noise [51]
ventilation [20]light [24]nature views [19]handwashing [37]single vs multi bed [25].......
2008
460Empirical Studies
Ulrich et al (2008)
Metrics
EnvironmentalFactors
Environmental FactorsEnvironmental&BehaviouralFactors} }
Metrics
noise [51]ventilation [20]light [24]nature views [19]handwashing [37]single vs multi bed [25].......
communicationculture
behaviourshuman experience
2008 2018
460Empirical Studies
Ulrich et al (2008)
Empirical Studies(“ a new literature review is needed”
Ulrich, 2015)
How Do Design Features Influence Healthcare Outcomes?
What are the Spatial Implication of Cultural Differences?
American Wards
Cai, H & Zimring, C (2017) Cultural impacts on nursing unit design: A comparative study on Chinese nursing unit typologies and their U.S. counterparts using space syntax, Environment & Planning B: Urban Analytics & City Science
Chinese Wards
Research Question
How different hospital ward typologies influence work processes and communication and how does this affect the quality of care provided to patients?
Knowing this kind of evidence, would we design differently and can we inform future healthcare design?
Future of HealthcareDesign
Quality of Care
Communication &Work Activities
Hospital Ward Typology
Evidence
?
1 introduction2 case studies3 methodology4 analysis & results5 conclusions
Case Studies
University College London Hospital National Hospital for Neurology and Neurosurgery Chelsea and Westminster Hospital
Racetrack layout
Area - 1420 m2
Number of beds - 43Single rooms - 22
Area - 1380 m2
Number of beds - 20Single rooms - 3
Area - 470 m2
Number of beds - 11Single rooms - 1
Duplex layout Corridor layout
Methods
SPACE SYNTAXSPATIAL LAYOUT
WORK PROCESSES
COMMUNICATION
DIRECT OBSERVATIONS
SOCIOMETRIC BADGES
location of communication instancesnurse
doctor
QUALITY OF CAREPERFORMANCE DATA
diseases & infectionshealth outcomesbuilding maintainancepatient servicesstaff satisfaction
Methods
THE ARCHITECTURAL SPACE AS A NETWORK - THE METHOD OF SPACE SYNTAX
Space Syntax is a theory and method to study spatial configurations developed at UCL in the 70s by Prof Bill Hillier and colleagues.
What is the relationship between the spatial design of buildings and the way they work socially?
Configuration is the way in which spatial elements are put together to form an interconnected system of spaces.
Source: Hillier, B. 1996, Space in the Machine, Cambridge University Press
Analysis & Results
UCLH NHNN CW
Connectivity (what one can see locally)
Connectivity Distribution
Max: 706 Ave: 240Min: 4SD: 139
Max: 1008 Ave: 361Min: 11SD: 240
larger distribution of values smaller distribution of values
Max: 576 Ave: 230Min: 13SD: 124
Racetrack layout Duplex layout Corridor layout
Analysis & Results
Mean Depth (what one can see globally)
Intelligibility - how much the whole environment can be understood from its parts
UCLH NHNN CW
R2 = 0.53 R2 = 0.35 R2 = 0.85
highest correlation
Racetrack layout Duplex layout Corridor layout
Max: 5.1 Ave: 3.3 Min: 2.1 SD: 0.59
Max: 5.1 Ave: 3.3 Min: 2.3SD: 0.48
Max: 4.2 Ave: 2.5Min: 1.7SD: 0.57
How different layouts affect activities and walking distances?
20 staff members [4 NIC, 8 RN, 4 doctors, 3 consultants, 1 runner]Total: 12h 37min
15 staff members [3 NIC, 7 RN, 2 doctors, 3 PT]Total: 8h 10min
17 staff members [3 NIC, 7 RN, 4 doctors, 1 consultants, 2 PT]Total: 14h 11min
racetrack
duplex
corridor
Mean duration of all activities
35sec
40sec
25sec
racetrack
duplex
corridor
Ave duration of conversations
45sec
46sec
32sec
racetrack
duplex
corridor
Ave walking distance per day
4.10km
2.61km
3.47km
Racetrack layout Duplex layout Corridor layout
Are there significant differences between same role in different hospitals?
58’’39’’
32’’
42’’
32’’20’’24’’
48’’34’’
69’’
37’’
30’’
36’’
Mean duration of all activities by role
doctornursenurse in chargeconsultantphysiotherapist
Racetrack layout
Duplex layout
Corridor layout
Are there significant differences between same role in different hospitals?
58’’39’’
32’’
42’’
32’’20’’24’’
48’’34’’
69’’
37’’
30’’
36’’
Mean duration of all activities by role ANOVA Pairwise comparison
doctornursenurse in chargeconsultantphysiotherapist
Racetrack layout
Duplex layout
Corridor layout
Doctor
Racetrack
Racetrack
Racetrack
Racetrack
0.721
0.009**0.088*
0.000**0.000**
0.000**
0.004**0.626
0.337
0.280
0.088*
0.7210.000**
0.009**
0.003**0.626
-
-
-
-
-0.036**
0.000**
0.093*-
0.000**
0.036**-
-
-0.093*0.003**
Duplex Corridor
Duplex
DuplexCorridor
Corridor
CorridorDuplex
Nurse
NIC
Consultant
PT
Analysis & Results
nurse
UCLH
CW
doctorother
Node size: Betweenes centrality - who controls information flowLink: frequency of communication
n=19
n=19
Analysis & Results
nurse
UCLH Distribution of betweenness Differences of betweenness values
CW
doctorother
Node size: Betweenes centrality - who controls information flowLink: frequency of communication
n=19
n=19
hierarchical structure
democratic structure
Analysis & Results
UCLH NHNN CW
Differences of betweenness values
Analysis & Results
UCLH
I feel part of a team where I work [rated on a scale 1 (strongly disagree) to 7 (strongly agree)]
NHNN CW
6.5 6.86.1
Differences of betweenness values
Analysis & Results
UCLH
I feel part of a team where I work [rated on a scale 1 (strongly disagree) to 7 (strongly agree)]
There is good communication in my department [rated on a scale 1 (strongly disagree) to 7 (strongly agree)]
NHNN CW
6.5
6.0
6.8
6.3
6.1
5.7
Differences of betweenness values
Conclusions
Intelligibility
Measures
Duration of Activities
Duration of Conversations
Walking Distance
Hierarchical Culture
Teamwork
Communication
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racetrack
racetrack
racetrack
racetrack
racetrack
racetrack
racetrack
duplex
duplex
duplex
duplex
duplex
duplex
duplex
corridor
corridor
corridor
corridor
corridor
corridor
corridor
Conclusions
These results are based on 3 case studies and more cases are required to varify the results.
The traditional ward typology classification may not be the best predictor of healthcare outcomes. We will continue to explore spatial layout metrics similar to visibility because such a refined method will allow us to compare three different racetrack typologies. This may lead to a different ward classification which is not based on pure architecture shape.
Healthcare outcomes are influences by multiple factors which should be taken into account.
WHAT DO YOU THINK?Can this evidence be used to inform future design guidelines?
Rosica Pachilova // [email protected] // @rpachilovaDr Kerstin Sailer // [email protected] // @kerstinsailer12th June 2018
