Design for health.

excerpted from full report) This research was commissioned by the Commission for Architecture and the Built Environment (CABE) and carried out by PricewaterhouseCoopers LLP (PwC) in association with the University of Sheffield and Queen Margaret University College, Edinburgh between September 2—3 and April 2004. The primary aim of the research was to explore whether hospital design has an influence on the recruitment, retention and performance of NHS nurses in England, and to further examine which aspects of design matter to nursing staff. The research methodology involved a mix of qualitative focus groups with nurses throughout England and a large scale quantitative survey of Directors of Nursing. Overall the research found that design does matter to nurses, and has the greatest influence on their workplace performance, followed by recruitment and then retention. In terms of specific aspects of design, the internal environment and the functionality of the environment appears to mater most. Examples of specific aspects which are important to nurses include building and unit layout, space in which to work, environmental control and interior design such as lighting and use of colour. Rocky Mountain Institute ♦ Health Care Without Harm Design for Health 67 D-3: The Business Case for Better Buildings (Fable Study) SOURCE: Berry, Leonard L., PhD, Derek Parker, Russell C. Coile, Jr., D. Kirk Hamilton, David D. O’Neill, J.D., and Blair L. Sadler, J.D., “The Business Case for Better Buildings,” Frontiers of Health Services Management, 21(1) pp 4-24. Download the full report from the following web link: http://www.healthdesign.org/aboutus/press/releases/frontiers_0904.pdf Summary (excerpted from full report) The buildings in which customers receive services are inherently part of the service experience. Given the high stress of illness, healthcare facility designs are especially likely to have a meaningful impact on customers. In the past, a handful of visionary “healing environments” such as the Lucille Packard Children’s Hospital at Stanford University in Palo Alto, California; Griffin Hospital in Derby, Connecticut; Woodwinds Health Campus in St. Paul, Minnesota; and San Diego Children’s Hospital were built by values-driven chief executive officers and boards and aided by philanthropy when costs per square foot exceeded typical construction costs. Designers theorized that such facilities might have a positive impact on patients’ health outcomes and satisfaction. But limited evidence existed to show that such exemplary health facilities were superior to conventional designs in actually improving patient outcomes and experiences and the organization’s bottom line. More evidence was needed to assess the impact of innovative health facility designs. Beginning in 2000, a research collaborative of progressive healthcare organizations voluntarily came together with The Center for Health Design to evaluate their new buildings. Various “Pebble Projects” are now engaged in three-year programs of evaluation, using comparative research instruments and outcome measures. Pebble Projects include hospital replacements, critical care units, cancer units, nursing stations, and ambulatory care centers. The Pebble experiences are synthesized here in a composite 300-bed “Fable Hospital” to present evidence in support of the business case for better buildings as a key component of better, safer, and less wasteful healthcare. The evidence indicates that the one-time incremental costs of designing and building optimal facilities can be quickly repaid through operational savings and increased revenue and result in substantial, measurable, and sustainable financial benefits. The one-time incremental costs of designing and building optimal facilities can be quickly repaid. Rocky Mountain Institute ♦ Health Care Without Harm Design for Health 68 D-4: The Role of the Physical Environment in the Hospital of the 21 Century: A Once-in-a-Lifetime Opportunity SOURCE: Ulrich, Roger, Craig Zimring, Xiaobo Quan, Anjali Joseph, Ruchi Choudhary, “The Role of the Physical Environment in the Hospital of the 21st Century: A Once-in-a-Lifetime Opportunity,” 2004. Download the full report at: http://www.healthdesign.org/research/reports/physical_environ.php Summary (excerpted from full report) A visit to a U.S. hospital is dangerous and stressful for patients, families and staff members. Medical errors and hospital-acquired infections are among the leading causes of death in the United States, each killing more Americans than AIDS, breast cancer, or automobile accidents (Institute of Medicine, 2000; 2001). According to the Institute of Medicine in its landmark Quality Chasm report: "The frustration levels of both patients and clinicians have probably never been higher. Yet the problems remain. Health care today harms too frequently and routinely fails to deliver its potential benefits" (IOM, 2001). Problems with U.S. health care not only influence patients; they impact staff. Registered nurses have a turnover rate averaging 20 percent. At the same time, the United States is facing one of the largest hospital building booms in US history. As a result of a confluence of the need to replace aging 1970s hospitals, population shifts in the United States, the graying of the baby boom generation, and the introduction of new technologies, the United States will spend more than $16 billion for hospital construction in 2004, and this will rise to more than $20 billion per year by the end of the decade. These hospitals will remain in place for decades. This once-in-lifetime construction program provides an opportunity to rethink hospital design, and especially to consider how improved hospital design can help reduce staff stress and fatigue and increase effectiveness in delivering care, improve patient safety, reduce patient and family stress and improve outcomes and improve overall healthcare quality. Just as medicine has increasingly moved toward "evidence-based medicine," where clinical choices are informed by research, healthcare design is increasingly guided by rigorous research linking the physical environment of hospitals to patients and staff outcomes and is moving toward "evidence-based design". This report assesses the state of the science that links characteristics of the physical setting to patient and staff outcomes: What can research tell us about "good" and "bad" hospital design? Is there compelling scientifically credible evidence that design genuinely impacts staff and clinical outcomes? Can improved design make hospitals less risky and stressful for patients, their families, and for staff? In this project, research teams from Texas A&M University and Georgia Tech combed through several thousand scientific articles and identified more than 600 studies most in top peer-reviewed journals that establish how hospital design can impact clinical outcomes. The team found scientific studies that document the impact of a range of design characteristics, such as single-rooms versus multi-bed rooms, reduced noise, improved lighting, better ventilation, better ergonomic designs, supportive workplaces and improved layout that can help reduce errors, reduce stress, improve sleep, reduce pain and drugs, and improve other outcomes. The team discovered that, not only is there a very large body of evidence to guide hospital design, but a very strong one. A growing scientific literature is confirming that the conventional ways that hospitals are designed contributes to stress and danger, or more positively, that this level of risk and stress is unnecessary: improved physical settings can be an important tool in making hospitals safer, more healing, and better places to work. Rocky Mountain Institute ♦ Health Care Without Harm Design for Health 69 Appendix E: Presentations Most of the following presentations can be downloaded from the Design for Health Summit website: http://www.noharm.org/designforhealth. Tuesday, September 28, 2004 Samuel H. Wilson, M.D. “Environmental Health: A Response Based on Partnership, Planning, and Environmental Stewardship” Amory B. Lovins “The Triple Bottom Line for Hospitals: healthier people, healthier environments, healthier financials” Robert P. Moroz, AIA “Case Study: The LEED Initiative at the Dell Children’s Medical Center of Central Texas: The business case for high performance hospitals” Barbra Batshalom “Statewide Trends for Green Building: The Context for Emerging Sustainability” Robin Guenther, AIA “Green Guide for Health Care” Breakout Group 1: Precautionary Principle; Samuel H. Wilson M.D. Breakout Group 2: Indoor Air Quality, Infection Control, Risk Management; John D. Spengler, PhD. Breakout Group 3: Energy/Resource Efficiency & Energy Waste; Amory Lovins and George Player Breakout Group 4: Site/Community/Footprint; Arthur Mombourquette Breakout Group 5: Lighting Healing Environments; Nancy Clanton Breakout Group 6: The Healing Environment; Robin Guenther Breakout Group 7: Economics of Water; David Del Porto Breakout Group 7: Water Supply and Usage; Robert Loranger Wednesday, September 29, 2004 Douglas Foy “Developing the Common Wealth” Sandra Steingraber “The Pirates of Illiopolis” Breakout Group 1: Inpatient Unit; Arthur Mombourquette Breakout Group 2: Surgical Suites; Chuck Labins Breakout Group 3: Labs; Jessica Wooliams and Jack Spengler Breakout Group 4: Personal Protection; Louis DiBerardinis Breakout Group 5: Clinical Laboratories; Anand K. Seth Breakout Group 6: Management and Operation; Greg Doyle and George Player Comments from participants of the Design for Health Summit: “Ground breaking work! “[A] very important beginning.” “Culture change is the next step.” “Make sure as broad an audience as possible sees and learns the results, attitudes, [and] recommendations of this Summit.” “This is an excellent conference – very well organized and focused on drawing conclusions elicited from participants.” “This was a terrifi