My observations/ideas based on site visit September 3, 2007
1) The emergency department is unbelievable small and crowding. The check-in desk is behind a close door. For the emergency case, someone may miss it. The ED has a complicated layout. The visibility is limited by narrow hallways and many turns. There are some traffic mirrors on the corridor intersections. A simplified layout with great visibility is preferred for the ED design, not only for the staff efficiency, but also for the legibility of the built environment.
2)In the patient-centered care paradigm, a user-friendly wayfinding environment including both indoor and outdoor environment, seems legitimate. However, it is not a easy task to achieve. HKS design team proposes to use single entrance to reduce users' confusing and walking distance between different departments. For instance, a patient think he should go to ED, while he only needs to see the primary care. Whether the solution is good, we need further investigation. A simulated environment could be use to test these hypothesis proposed by the design team.
3) A large body of literature suggests the physical environment has a great impact on wayfinding, including floor plan configuration, spatial differentiation, visual accessibility, and the signage and room numbers system. I am not entirely sure whether the design team considers all these aspects. For the new layout, it seems still lack consideration of research findings. Is there any method to simplify the layout, within the other constraints, such as site, movement flows, and functions?
4) From the environment and behavior study perspective, is there any difference in spatial cognition between a child and an adult? Child may have limited spatial ability, and thus may need different environmental cues to find their way. How to meet the need of both children and adults in the design?
5) According to the design team, the hospital will move into the new site in one weekend and still remain operation. How to make staff familiar with the new environment before they move into it? The training in simulated virtual environment is a good solution. some research support subjects who received training in virtual environment have better wayfinding performance than those who visited the site. All staff members can get adequate training in virtual environment to reduce wayfinding problem and the movement disorder.
6) What is the positive environmental distraction for child? How to integrate it into design?
7) If there any possibility to model the movement of patients from a mathematic/Industrial Engineering perspective? We can verify the model in real life or virtual environment. How to optimize the spatial layout by using the model and other consideration?
0904 children's hospital lecture
physical design---->care processes Technology--->culture
who are the stakeholders? administrator, healthcare professionals, child and family, donors, facility managers,
Institute of Medicine Targets: The big 6 1.safe-avoid injury 2.effective-Evidence-based,a avoid underuse and overuse 3.patient-centered 4.timely-reduce waits and delays 5.efficient-avoid waste including equipment, supplies, ideas, energy 6.equitable-does not vary in quality due to personal characteristics, eg gender, ethnicity, location, SES
what do children and their families want from health care? (foundation for accountability)
- stay healthy
- get better quickly when ill
- live a good life with chronic illness
- die comfortably and supported
Patient-centered care? (1.what the patient think, 2.what pa need to know, 3.personal preference-pros & cons of different choices), Espezel & Canam (2003) Patient-nurse interactions To customize care to the specific need and circumstances of each individual, that is, to modify, the care to respond to the person, not the person to the care. IOM, Crossing the quality Chasm p51
physical comfort, emotional comfort involvement of family and friends
staff shortage, 100,000 nurses needed average 20 Sec you will be interrupted by physicians
- how to support better systems/processes with design and technology
care processes assess, build relationships, plan, intervene, coordinate, educate, motivate, monitor, evaluate
patient and family self care- at home, school Diet, exercise, sleep, treatments, medication, symptom monitoring, see care in a timely way
child & family centered care- child & family centered environment
- important research
18 patient centered care search shields 2007 Family centered care for children in hospital Weinstein 2007, Informed patient choice Horne 2007, Can asthma be controlled by understanding the patient's perspective Butz 2007, Shared decision-making
The degree of simplicity of floor plan affects wayfinding performance
Best, G. A. (1967). Direction-finding in large buildings : a summary report. Manchester: University of Manchester Industrial Design Technology.
abstract:high correlation between the lostness and number of choices in that route.(r=.93). the 'lostness' of subjects is defined by deviation from the most direct route (the shortest path).
Weisman, J. (1981). Evaluating architectural legibility: wayfinding in the built environment. Environment and Behavior, 13(2), 189-204.
abstract:A significant relationship was found between judged simplicity of Building plan configuration diagrams and reported frequency of disorientation across 10 Buildings. simplicity judgments, provided by a group of independent raters, were able to account for 56% of the variance in reported frequency of disorientation data.
O'Neill, M. J. (1991). Effects of Signage and Floor-Plan Configuration on Wayfinding Accuracy. Environment and Behavior, 23(5), 553-574.
abstract:plan configuration was found to exert a significant influence regardless of signage, because the wayfinding performance of participants with access to signage in the most complex settings remained equivalent to, or significantly poorer than, those in the simplest settings with no signage.
Haq, S., & Zimring, C. (2003). Just down the road a piece: The development of topological knowledge of building layouts. Environment and Behavior, 35(1), 132-160.
Peponis, J., Zimring, C., & Choi, Y. K. (1990). Finding the building in wayfinding. Environment and Behavior, 22(5), 555-590.
abstract:Space Syntax measures of connectivity and integration were good predictors of the use of spaces during both open and directed search.
people with Virtual Environment training performance better in wayfinding than people without VE training, even people with site visit experience.
Hunt, M. E. (1984). Environmental Learning without Being There. Environment and Behavior 16(3), 307-334.
abstract: To evaluate the simulation technique, a field experiment was conducted. The sample was divided randomly into three groups: simulation group; site visit group; and control group. A person's working knowledge was defined operationally by assessing the following: confidence in way-finding ability; the mental image of the building; and way-finding ability in the building. The evaluation demonstrated that the working knowledge provided by the simulation technique was actually more useful than that provided by actual visits to the building.
Foreman, N., Stanton-Fraser, D., Wilson, P. N., Duffy, H., & Parnell, R. (2005). Transfer of spatial knowledge to a two-level shopping mall in older people, following virtual exploration. Environment and Behavior, 37(2), 275-292.
abstract: Experimental group with in a VE training shows greater accuracy in making pointing judgments toward targets not visible from the pointing site, took shorter times to perform route tasks on foot, made better left-right directional judgments, and sketched better maps of the mall, than the control group without VE training.
difference in spatial cognition/wayfinding ability between children and adults
Siegel, A. W., & White, S. H. (1975). The Development of Spatial Representations of Large-Scale Environments. In Advances in Child Development and behavior (pp. 9-55). New York: Academic Press.
abstract: The authors concentrate their review on large-scale space, and show a strong parallel between a child's acquisition of spatial competence and an adult's acquisition of the spatial structure of a new environment. Landmarks are first noticed and remembered. The child acts in the context of these landmarks, and given landmarks and action-sequences, route formation is accomplished. Landmarks and routes are formed into clusters, but until an objective frame of reference is developed, these clusters remain uncoordinated with each other. Survey representations appear as a system of routes arising from and embedded in an objective frame of reference.
Allen, G. L. (1982). The organization of route knowledge. In R. Cohen (Ed.), New Directions in Child Development: Children's Conceptions of Spatial Relationships. San Francisco, CA: Jossey-Bass.
abstract: (1) adults and children do not spontaneously select the same environmental features as reference points after viewing a route; (2) college students exhibit more accurate spatial knowledge of the route than do seven- or ten-year-old children when all subjects are tested with scenes selected by their age peers on the basis of potential landmark value; and (3) the older children, but not the younger children, reflect more accurate spatial knowledge of the route when tested with reference scenes selected by their age peers.
Jansen-Osmann, & P. Fuchs, P. (2006). Wayfinding behavior and spatial knowledge of adults and children in a virtual environment - The role of landmarks. Experimental Psychology, 53(3), 171-181.
abstract: Existence of landmarks has more influence on younger children compared to adults in their wayfinding performance.
Jansen-Osmann, P., Schmid, J., & Heil, M. (2007). Wayfinding behavior and spatial knowledge of adults and children in a virtual environment: The role of the environmental structure. Swiss Journal of Psychology, 66(1), 41-50.
abstract: In almost all measurements of wayfinding performance and spatial knowledge an overall developmental progress from younger children to adults was found. In contrast, exploration behavior did not differ between adults and children Furthermore, the environmental structure tended to influence only the wayfinding performance of younger children, but did not have any effect on the exploration behavior and the spatial knowledge of children or adults.
people navigating in virtual environment have similar spatial performance to people navigating in the equivalent real-world environment
Jansen-Osmann, P., & Wiedenbauer, G. (2004). The representation of landmarks and routes in children and adults: A study in a virtual environment. Journal of Environmental Psychology, 24(3), 347-357.
Ruddle, R. A., & Lessells, S. (2006). Three levels of metric for evaluating wayfinding. Presence-Teleoperators and Virtual Environments, 15(6), 637-654.
evidence 5: stress in relation to the staff's environment
Anjali Joseph, Ph.D. and Roger Ulrich, Ph.D. (2007). Sound Control for Improved Outcomes in Healthcare Settings Funded by the Robert Wood Johnson Foundation
Joseph, Anjali. (2006). The role of the physical and social environment in Promoting Health, Safety, and Effectiveness in the Healthcare Workspace. Robert Wood Johnson Foundation.