Critical Issues in Healthcare Environments

[Pages:71]Research Coalition

SPONSORED BY

Bayer MaterialScience Herman Miller Frank Zilm Inc.

Critical Issues in Healthcare Environments

Uriel Cohen, D Arch, Project Principal University Of Wisconsin, Milwaukee, Wisconsin

David Allison, AIA, Co-Principal Clemson University, Clemson, South Carolina

James Witte, PhD, Survey Research Consultant Clemson University, Clemson, South Carolina

Critical Issues in Healthcare Environments

Acknowledgements

Principal Researchers Uriel Cohen, D Arch, Project Principal David Allison, AIA, Co-Principal

Research Institutions University of Wisconsin, Milwaukee, Wisconsin Clemson University, Clemson, South Carolina

Special Thanks from the Principal Researchers It took more than a village to complete this project. We would like to thank all the people and organizations who made this initiative possible:

Produced with support from: Bayer MaterialScience, Herman Miller, and Frank Zilm, for their generous support.

Members of CHD Research Coalition (formerly Coalition for Health Environments Research, or CHER) for their input, insights, and help in recruiting participating organizations.

Special thanks to Frank Zilm for his work on the preliminary explorations of this project, to Jane Rohde for her tireless recruiting of participants, to Kirk Hamilton for his practice wisdom, and to Roger Call for his continuing support.

Thanks to Debra Levin and CHD staff for their support; special thanks to Carolyn Quist for providing invaluable, superb logistical support; Stacey Grant, for helping conduct the preliminary study and prepare the recruiting campaign; Ruth Cohen, for spending many hours reviewing, critiquing, and editing materials for this project.

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We are indebted to the following organizations and their respective contact persons who agreed to distribute the survey:

Institute for Family-Centered Care International Facility Management Association (IFMA) Healthcare Council American Society for Healthcare Engineering (ASHE) Accreditation Association for Ambulatory Healthcare (AAAHC) Institute for Healthcare Improvement (IHI) AIA Academy of Architecture for Health (AAH) American College of Healthcare Architects (ACHA) International Interior Design Association (IIDA) American Academy of Healthcare Interior Designers (AAHID) Environmental Design Research Association (EDRA) Environmental Gerontology Network [EDRA< IAPS] AdvaMed Center for Universal Design American Association of Homes and Services for the Aged (AASHA) Academy of Neuroscience for Architecture (ANFA) Healthcare Without Harm (HCWH) Hospitals for a Healthy Environment (H2E) Healthy Building Network (HBN) Texas A&M Center for Health Systems Pioneer Network Research Design Connections

Finally we would like to thank the hundreds of respondents who have participated in the survey.

CHD Research Coalition Frank Weinberg, Co-chair Paul Barach, MD, MPH, Co-chair David Allison, MArch, AIA Frank Becker, PhD Roger Call, AIA, ACHA, LEED AP

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Uriel Cohen, MArch, ArchD, FGSA, Chairman Emeritus Bart Franey, Co-chair Emeritus Mark Goodman Debra Harris, PhD, AAHID Kathy Hathorn, MA Anjali Joseph, PhD, EDAC Roger Leib, AIA, ACHA, LEED AP Debra Levin, MA, EDAC Eileen Malone, RN, MSN, MS, EDAC Mark Patterson, AIA AAH, LEED AP Debajyoti Pati, PhD, FIIA, LEED AP Jane Rohde, AIA, ACHA, AAHID, IIDA, NCARB, LEED AP Mardelle Shepley, DArch, AIA W.H. (Tib) Tusler, FAIA, FACHA, Chairman Emeritus Roger Ulrich, PhD, EDAC Jean Young, ASID, CID, AAHID Frank Zilm, DArch, FAIA, FACHA Craig Zimring, PhD, EDAC

The Center for Health Design (CHD) is a 501(c)(3) organization. CHD is dedicated to the development of evidence-based design research to improve healthcare environments. The objective of the Research Coalition is to create, promote, fund and disseminate research that contributes to therapeutic, safe, efficient, and effective healthcare settings.

Published by The Center for Health Design

? Copyright 2009 by The Center for Health Design. All rights reserved. No part of this work covered by the copyright may be reproduced by any means or used in any form without written permission of the publishers except to make a single project copy and a single archival copy for the sole use of the individual or organization purchasing this report.

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Critical Issues in Healthcare Environments

Contents

List of tables and figures............................................................................... vi

Abstract......................................................................................................... viii

1. Introduction............................................................................................... 1

1.1 What are the most important, high-priority research questions in

healthcare environments?..................................................................................

1

1.2 Why do we need to know what and where unresolved problems and issues are?.................................................................................................... 2

1.3 What is the link between domains of information and research questions relevant to healthcare environments?................................................ 2

1.4 An exploratory study............................................................................................ 3

1.5 A framework for the survey ................................................................................ 4

2. The survey................................................................................................. 5

2.1 The study's research questions........................................................................... 5 2.2 Methods............................................................................................................... 5 2.3 The respondents ................................................................................................. 10

3. Findings: A Summary................................................................................ 12

3.1 Analysis................................................................................................................ 12 3.2 Summary of Findings.......................................................................................... 13

4. Top Issue: Which domains and topics are identified as the most pressing problem areas in healthcare environments......................................................... 14

4.1 Hospitals.............................................................................................................. 16 4.2 Ambulatory Care Settings.................................................................................... 19 4.3 Long-term Care Settings...................................................................................... 21 4.4 The Single Most Critical Issue............................................................................. 23

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5. Top Issue: Which locations are associated with more and/or greater problems?........................................................................... 27 5.1 Key Findings......................................................................................................... 28

6. Top Issue: How similar or different are the patterns of responses regarding issues in acute care settings vs. ambulatory settings vs. long-term care settings?......... 30 6.1 Key Findings......................................................................................................... 30

7. Top Issue: How different stakeholders assess issues in healthcare environments?........................................................................... 33 7.1 Key Findings.......................................................................................................... 33

References...................................................................................................... 35 Appendix A: Tables and Figures...................................................................... 37 Appendix B: The Survey Instrument................................................................ 51

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List of Tables and Figures

Table 1: Information levels and topic examples.............................................................. 2 Table 2: Issues in healthcare environments: Basic domains and selected topics........ 4 Table 3: Affiliation of identified respondents................................................................... 11 Table 4: Hospital setting: Top ranked issue by domain.................................................. 17 Table 5: Hospital setting: Top issues in open-ended responses.................................... 18 Table 6: Ambulatory Care setting: Top ranked issue by domain.................................... 20 Table 7: Ambulatory Care setting: Top issue in open-ended responses........................ 20 Table 8: Long-term Care setting: Top ranked issues by domain..................................... 22 Table 9: Long-term Care setting: Top issue in open-ended responses.......................... 22 Table 10: Hospital setting: Single most critical problem................................................. 23 Table 11: Ambulatory Care setting: Single most critical problem................................... 25 Table 12: Long-term Care setting: Single most critical problem...................................... 26 Table 13: Summary of locations identified as most problematic.................................... 29 Table 14: Top problem settings: Across all domains in each of the three settings........ 31 Table A1: Hospital Setting: Ranking of most pressing problems by type of problem..... 38 Table A2: Ambulatory Care Setting: Ranking of most pressing problems by

type of problem................................................................................................ 40 Table A3: Long-Term Care Setting: Ranking of most pressing problems by type

of problem........................................................................................................ 41 Table A4: Top problems across all domains in each setting........................................... 43 Table A5: Hospital Setting: Ranking of most problematic locations............................... 44

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Table A6: Ambulatory Care Setting: Ranking of most problematic locations................. 45 Table A7: Long-term Care Setting: Ranking of most problematic locations.................... 46 Table A8: Statistically significant differences in the assessment of problems in

hospitals according to respondent type........................................................... 47 Table A9: Statistically significant differences in the assessment of problems in

long-term care facilities according to respondent type.................................... 48

Figure 1: Hospital setting: Percentage of respondents that define patient care problems as serious.......................................................................................... 16

Figure 2: Ambulatory Care setting: Percentage of respondents defining user satisfaction problems as serious...................................................................... 19

Figure 3: Long-term Care setting: Percentage of respondents defining user satisfaction problems as serious...................................................................... 21

Figure 4: Comparison of serious patient care problems across settings......................... 31

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