Health Environments Research & Design (HERD) Journal

Summer 2008 VOL. 1, NO. 4

Conceptual and Theoretical Models for Evidence-Based Design Research and Projects

Conceptual and theoretical models explain the relationship among variables of interest in a research study and provide a framework to guide decision making in healthcare design projects.  With a new and emerging discipline in evidence-based healthcare design, it is important to develop and test conceptual and theoretical frameworks that can be used in research to test hypothesized relationships among variables that are believed to affect organizational, patient, and provider outcomes.

The Systems Research Organizing Model: A Conceptual Perspective for Facilities Design

Barbara Brewer, Joyce Verran, and Jaynelle Stichler

Grounded in systems science and adapted from the Quality Health Outcomes Model, the SROM was originally designed to assist in the organization of nursing systems research.  It is useful for research in other fields as well because it serves as a potential framework for new investigations, allows delineation of key factors in previous research studies, and allows for the synthesis of a body of research knowledge.  By means of the latter function, it helps identify knowledge that is ready to be translated to the practice environment.  The purpose of this article is to (1) demonstrate the utility of the Systems Research Organizing Model (SROM) for evidence-based design; (2) explicate the SROM; and (3) demonstrate how the SROM can advance the science of healthcare design.

Buildings and Organizations: The Shaping and the Shaped

Susan FitzMaurice Gibson

The words of Winston Churchill, spoken in 1943, provide the philosophical basis for this study of the social implications of the built environment: "We shape our buildings and afterward, our buildings shape us."  Using the work of ecological psychologists, sociologists, and organizational design theorists, this paper explores the reciprocal relationship between buildings and the organizations that create and occupy them.  Although no comprehensive theory of the social implications of building design has been developed, these theorists provide concepts that are useful for understanding the organizational processes of shaping and being shaped by the build environment.  Insights from the modernist, symbolic-interpretive, and postmodernist perspectives are applied to the experience of design and construction of a medical center in the creation of the Center for Advanced Healing.

Ambulatory Facility Design and Patients' Perceptions of Healthcare Quality

Franklin Becker and Kelley Parsons

Despite the high and increasing percentage of healthcare dollars for care delivered on an outpatient basis, relatively little research has examined the relationship between the design of ambulatory facilities and patient outcomes.  Few studies have examined how patients' perceptions of healthcare quality differ in the same outpatient practice before and after a move to a new facility designed to be patient-centered.  This study is the second phase of a study comparing patients' perceived quality of care in ambulatory facilities that differ markedly in physical attractiveness.  This research examines whether the physical attractiveness of an outpatient practice influences patients' perceptions of healthcare quality, including patient and staff perceptions of the quality of staff-patient interaction.

A Retrospective Evaluation of the Impact of the Planetree Patient-Centered Model of Care on Inpatient Quality Outcomes

Susan Stone

Patients and their families have described a more patient-centered approach as key to meeting their needs.  The Planetree model of care provides a framework and operational guidance on how to implement programs targeting these key areas.  The link between patient-centered care and quality outcomes such as patient satisfaction, length of stay, readmission, cost per case, and productive nursing hours per patient day has been postulated; however, to date little to no research has been conducted examining this issue.  This retrospective quasi-experimental study evaluated the Planetree patient-centered model of care on inpatient quality outcomes.  The research questions to be addressed were: What is the impact of the Plantree patient-centered model of care (1) on patient satisfaction, (2) on clinical outcomes (length of stay and readmission), and (3) on the cost of providing care (cost per case and productive nursing hours per patient day)?

Analysis of Hospital Facility Growth: Are We Super-Sizing Healthcare?

H. Scott Latimer, Hillary Gutknecht and Kimmey Hardesty

A retrospective analysis of space planned for selected clinical areas in acute healthcare facilities between the years 1980-2008 was conducted.  Findings revealed that, during the 28-year period, incremental growth occurred in both room size and departmental square feet in adult inpatient units as well as interventional services.  This observed growth and--in many instances--super-sized or excessive growth may be attributed to various factors, depending on the year of construction, regional variability, or level of urbanization.  However, at a macro level, growth may be attributed to changes in patient care and operational models; consumer-driven healthcare and market competition; demographics and patient acuity; technology; and regulation and building codes.  In the future, forces including but not limited to capital availability, an increased desire for efficiency, and continued escalation in the cost of construction are likely to play an increasing role in offsetting the desire for sizing excess.

Book Review: A Visual Reference for Evidence-Based Design

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