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