"We Have Outgrown Our Space; Our Facility Is Old and Falling Apart": Physical Design Implications to Address the Needs and Priorities of a Critical Access Hospital (CAH).

OBJECTIVE: This exploratory study examines a rural critical access hospital (CAH) staff's perception of current obstacles and needs concerning the physical environment. BACKGROUND: CAH intends to improve access to healthcare, coordinate with experts and providers, and serve as the rural population's healthcare hub. It is imperative to understand environmental qualities that impact the quality of care to develop effective policies and design guidelines for rural healthcare. Nevertheless, a limited number of studies have focused on user or organizational outcomes related to the physical environment of rural healthcare settings. METHODS: This cross-sectional exploratory qualitative case study was conducted as part of the facility planning process for a CAH in rural North Carolina. Hospital staff participated in a survey exploring their satisfaction with the overall physical environment privacy, space allocation, and department adjacency. An open-ended question asked staff to elaborate on needed improvements and changes in their department. RESULTS: Findings show low satisfaction levels for space allocations for emergency department, lab, surgery, and wound care. Safety and quality were the two emerging outcomes of the physical environment's shortcomings. Two clusters emerged from the content analysis, representing facility needs (rightly sized spaces, functional needs, COVID-19 needs, and improved access) and ambient conditions (clutter, visibility, flooring quality, noise, privacy, cleanliness, aesthetics, and temperature). CONCLUSION: The findings from this study suggest that the interior and exterior facility and ambient conditions of the CAH play a key role in quality and safety outcomes.

Balancing Support for Staff and Patient Centeredness Through the Design of Immediate and Relational Space: A Case Study of Ambulatory Care Center Layouts.

PURPOSE: This descriptive case study of ambulatory care center typologies builds a layout-based approach to patient-centered care and care team work using theory and methods from space syntax and a recently developed approach to floorplan analysis focused on visibility. BACKGROUND: Calibrating support for care team work and patient centeredness is a persistent dilemma in ambulatory care settings. METHOD: A review of literature and floorplan layout analysis are used. RESULTS: The center-stage layout more strongly integrates staff and patients, while the onstage-offstage layout provides greater privacy to the care team. The integration values for exam rooms in each layout were roughly equivalent. Analysis of variations on each floor plan demonstrates ways relatively small variations can modulate visibility conditions without altering integration patterns. CONCLUSION: Decoupling design of immediate visual properties and relational layout properties can act as a strategy to address competing demands.