Design of a Cancer Infusion Center: Results from a Pre- and Post-Occupancy Evaluation.

PURPOSE: The current study performed a post-occupancy evaluation on a new cancer infusion center with pod-like layout and compared results to a pre-occupancy evaluation to investigate the impact of different cancer infusion center designs on staff efficiency and patient and staff satisfaction. BACKGROUND: The new cancer infusion center opened in October 2020 and replaced two previously existing infusion centers, in the same healthcare system. METHODS: The study used a similar mixed-method approach as the pre-occupancy research, which included staff shadowing, medication delivery shadowing, and staff and patient questionnaires. RESULTS: The new infusion center improved staff efficiencies by reducing nurse travel time compared to pre-occupancy infusion centers. Results also showed an increase in satisfaction with different aspects of the new infusion center including patient privacy, by both patients and nurses. The pod design allowed for better audio and visual privacy for patients, provided a higher amount of worksurface and availability of workstations, reduced noise levels, and enhanced nurse concentration at workstations. Findings indicated that nurses who had prior experience working in the pre-occupancy infusion centers expressed significantly lower levels of satisfaction in the new infusion center, especially in the ability to connect with nurses in other pods. CONCLUSIONS: Although the new pod design had limitations in terms of collaborative opportunities across pods, it showed to provide a more efficient work environment for the staff and increase staff and patient satisfactions. The results also highlight the importance of effective change management strategies when nurses transition to a new work environment.

The Impact of Infusion Center Layout on Workflow and Satisfactions in Two Cancer Infusion Centers: A Case Study on Staff and Patients.

OBJECTIVE: The objective of this empirical research is to compare nurses' operational workflow and nurses' and patients' satisfactions of two different infusion center designs. One center has a traditional open bay design and the other has semi-private bays. This study also intends to gather baseline data to compare to a future post-occupancy evaluation of a new infusion center where the two existing centers will be combined. BACKGROUND: The increasing number of patients with cancer diagnosis who refer to infusion centers highlights the importance of design of these centers. METHOD: The mixed-method approach of this study involves shadowing nurses and surveying nurses and patients. Data collection captured nurses' activities, activity durations, and nurses' and patients' satisfaction with the design of clinics. RESULTS: Comparison of shadowing data indicated that although the infusion centers have different layouts, there are no significant differences in the activities or time spent by nurses in different areas among the centers. Staff, however, have different satisfaction levels with visual and speech privacy, ability to concentrate without distraction, collaboration with other staff, and the process of medication delivery. Patients also had slightly different satisfaction levels with their ability to communicate with staff and design of bays. CONCLUSION: This research sheds light on operational workflows and satisfaction of staff and patients in two different infusion center design. Considering the limited studies on these settings, this study serves as baseline data to compare to other studies on cancer infusion centers and addresses issues of benchmarking and staff and patient satisfaction.

Implications of a Decentralized Postpartum Unit Design and Clinical Operations.

OBJECTIVES: This postoccupancy study sought to understand whether a decentralized unit design supported a postpartum care delivery model by evaluating nurses' efficiency, staff perception, acoustical conditions, and patient satisfaction. BACKGROUND: Today, standardization and decentralization design concepts are being applied to all types of inpatient unit. There have been many studies that investigated how these concepts influence care delivery on medical-surgical units, but no study has evaluated a postpartum unit. METHODS: This study utilized a mixed-method approach that involved unobtrusive shadowing (roughly 25 hr) and surveying (n = 19) of nursing staff, physical acoustic readings (eight, 24-hr readings), and comparison of patient satisfaction pre- and postmove. RESULTS: On average, nurses spent roughly 36.90% of their time at charting stations. Nurses were observed mostly using the central charting station located at the entry of the unit and adjacent to the well-baby nursery rather than the five decentralized chart stations. This was due to nurses operating with old workflow habits, not fully integrating electronic medical records, and needing to be near the nursery and other nurses. Nurses were satisfied with their ability to interact and their proximity to supplies, patients, and team members while in the central charting station. Additionally, patient satisfaction significantly increased postmove, particularly with the overall hospital's quietness and cleanliness. CONCLUSION: This study highlights the importance of aligning administrative operations of the unit with the design intent. Although standardization and decentralization design concepts aimed to improve nurses' workflow, misalignment with the operations may not deliver the most optimal outcomes.

Setting the Stage: A Comparative Analysis of an Onstage/Offstage and a Linear Clinic Modules.

OBJECTIVE: The purpose of this study was to understand how two different ambulatory design modules-traditional and onstage/offstage-impact operational efficiency, patient throughput, staff collaboration, and patient privacy. BACKGROUND: Delivery of healthcare is greatly shifting to ambulatory settings because of rapid advancement of medicine and technology, resulting in more day procedures and follow-up care occurring outside of hospitals. It is anticipated that outpatient services will grow roughly 15-23% within the next 10 years (Sg2, 2014). Nonetheless, there is limited research that evaluates how the built environment impacts care delivery and patient outcomes. METHOD: This is a cross-sectional, comparative study consisted of a mixed-method approach that included shadowing clinic staff and observing and surveying patients. The linear module had shared corridors and publicly exposed workstations, whereas the onstage/offstage module separates patient/visitors from staff with dedicated patient corridors leading to exam rooms (onstage) and enclosed staff work cores (offstage). Roughly 35 hr of clinic staff shadowing and 55 hr of patient observations occurred. A total of 269 questionnaires were completed by patients/visitors. RESULTS: The results demonstrate that the onstage/offstage module significantly improved staff workflow, reduced travel distances, increased communication in private areas, and significantly reduced patient throughput and wait times. However, patients' perception of privacy did not change among the two modules. CONCLUSION: Compared to the linear module, this study provides evidence that the onstage/offstage module could have helped to optimize operational efficiencies, staff workflow, and patient throughput.

Making the Case for Practice-Based Research and the Imperative Role of Design Practitioners.

The purpose of this article is to justify the need for evidence-based design (EBD) in a research-based architecture and design practice. This article examines the current state of practice-based research (PBR), supports the need for EBD, illustrates PBR methods that can be applied to design work, and explores how findings can be used as a decision-making tool during design and as a validation tool during postoccupancy. As a result, design professions' body of knowledge will advance and practitioners will be better informed to protect the health, safety, and welfare of the society. Furthermore, characteristics of Friedman's progressive research program are used as a framework to examine the current state of PBR in design practice. A modified EBD approach is proposed and showcased with a case study of a renovated inpatient unit. The modified approach demonstrates how a highly integrated project team, especially the role of design practitioners, contributed to the success of utilizing baseline findings and evidence in decision-making throughout the design process. Lastly, recommendations and resources for learning research concepts are provided for practitioners. It is the role of practitioners to pave the way for the next generation of design professionals, as the request and expectation for research become more prevalent in design practice.

Clinic exam room design: present and future.

OBJECTIVE: This article aims to deconstruct various design qualities and strategies of clinic exam rooms, and discuss how they influence users' interaction and behavior in the space. Relevant literature supports the advantages and disadvantages of different design strategies. Annotated exam room prototypes illustrate the design qualities and strategies discussed. BACKGROUND: Advancements in technology and medicine, along with new legislative policies, are influencing the way care providers deliver care and ultimately clinic exam room designs. The patient-centered medical home model has encouraged primary care providers to make patients more active leaders of their health plan which will influence the overall functionality and configuration of clinic exam rooms. Specific design qualities discussed include overall size, location of doors and privacy curtains, positioning of exam tables, influence of technology in the consultation area, types of seating, and placement of sink and hand sanitizing dispensers. In addition, future trends of exam room prototypes are presented. CONCLUSIONS: There is a general lack of published evidence to support design professionals' design solutions for outpatient exam rooms. Future research should investigate such topics as the location of exam tables and privacy curtains as they relate to patient privacy; typical size and location of consultation table as it relates to patient connection and communication; and placement of sinks and sanitization dispensers as they relate to frequency and patterns of usage. KEYWORDS: Literature review, outpatient, technology, visual privacy.