Influence of Evidence-Based Design Strategies on Nurse Wellness.

OBJECTIVES: The purpose of this study was to understand how specific evidence-based design strategies are related to aspects of nurse wellness. BACKGROUND: Addressing burnout among the healthcare workforce is a system-level imperative. Nurses face continuous and dynamic physical and emotional demands in their role. Greater insight into the role of the physical environment can support efforts to promote nurse wellness. METHODS: This exploratory qualitative study was conducted at new Parkland Hospital in Dallas, TX. We conducted five focus groups with nursing staff in July 2018. These sessions covered five topics related to nursing work in the facility which had been redesigned nearly 3 years earlier: (1) professional and social communication, (2) workflow and efficiency, (3) nurses' tasks and documentation, (4) ability to care for patients, and (5) nurses' overall health. We conducted a thematic analysis and first identified different aspects of wellness discussed by participants. Then, we examined how nurses related different design elements to different aspects of their wellness. RESULTS: Participants included 63 nurses and nurse managers. They related environmental factors including facility size, break rooms, and decentralized workstations to social, emotional/spiritual, physical, intellectual, and occupational aspects of wellness. CONCLUSIONS: It is critical to inform and integrate nurses at all levels into planning, design, and activation of new healthcare environments in order to ensure the well-being of nurses and, therefore, their ability to effectively support patients.

From Competition to Collaboration: How a Multi-Firm Research Coalition Is Realizing Rigorous Facility Evaluation at Parkland Hospital.

This case study presents the process of developing a multi-entity Research Coalition to evaluate the new Parkland Hospital. The field of evidence-based design has made progress in systematically investigating relationships between healthcare facility design and a range of human outcomes. Yet healthcare facility evaluation is not typically included in the scope of building contracts. Lack of clear responsibility for evaluation and limited funding have been long-term barriers that the industry has yet to overcome. Firms engaged in design research at Parkland Hospital agreed with hospital representatives to collaborate on an integrated facility evaluation. Each participating entity contributed resources toward the effort. To formalize shared goals and priorities, the group developed a Research Coalition Charter. Goals included streamlining evaluation efforts to minimize burden on the hospital, leveraging multiple expertise areas to vet research aims and approaches, contributing knowledge to inform healthcare design, and innovating a model for multi-firm collaboration. The Coalition also developed guidelines for sharing data and disseminating research findings. To date, the Research Coalition has achieved key milestones including institutional review board exemption, data use and research collaboration agreements, and data collection. The research aims encompass patient and staff outcomes hypothesized to improve in the new facility. Both primary and secondary data are being analyzed to test the hypotheses. Publications of findings are forthcoming. Collaborative research among competitors may be a viable approach to realizing evaluation that is critical to learning for healthcare facility decision makers and design practitioners.

Buildings, Barriers, and Breakthroughs: Bridging Gaps in the Health Care Enterprise.

Health care architecture and design are critical resources that are often underestimated and overlooked. As we seek to extract every available resource at our disposal to serve patients and sustain the bottom line, it is vital that we consider the influence the building imposes on the patient and caregiver experiences. Buildings impact both caregiver behaviors and the economic enterprise and are, therefore, the business of health care executives. This understanding is not only an executive obligation, it is an executive opportunity. Furthermore, the built environment can be a source for innovation in an industry whose future depends on nurse leaders to champion ingenuity with simplicity and relevance. Nurse leaders are ideally positioned to bridge health care building design and best practice.

If I were a band-aid, where would I be? Researching the use and location of supplies on two patient units.

OBJECTIVE: The purpose of this study was to gain insight into the use and storage of supplies in the neonatal intensive care and women's health units of Parkland Hospital in Dallas, Texas. BACKGROUND: Construction of a new Parkland Hospital is underway, with completion of the 862-bed, 2.5-million square feet hospital in 2014. Leaders from the hospital and representatives from one of its major vendors collaborated on a research study to evaluate the hospital's current supply management system and develop criteria to create an improved system to be implemented at the new hospital. METHOD: Approach includes qualitative and quantitative methods, that is, written survey, researcher observations, focus groups, and evaluation of hospital supply reports. RESULTS: Approaching the ideal location of supplies can be best approached by defining a nurse's activity at the point of care. Determining an optimal supply management system must be approached by understanding the "what" of caregivers' activities and then determining the "where" of the supplies that support those activities. CONCLUSIONS: An ideal supply management system locates supplies as close as possible to the point of use, is organized by activity, and is standardized within and across units.

Lessons learned: clinicians' post-occupancy perspective of facility design involvement.

OBJECTIVE: The research was conducted to determine clinician knowledge needs for competent involvement with the facility design process as well as to gather lessons learned on building stronger design teams. BACKGROUND: As clinical stakeholders are invited to the healthcare facility design table, the question arises as to the ability of professionally diverse team members to translate each other's comments and ideas accurately. In the past, hospitals were designed by a handful of hospital leaders and architects. More recently, multiple players have become involved throughout the design and construction of new healthcare facilities. Clinical consultants from two international healthcare companies observed that many clinicians were unprepared to effectively translate their needs to the architectural community or to competently utilize architectural tools and documents. METHODS: A qualitative, post-occupancy cross-case study was conducted to understand how clinicians could increase their competencies for successful involvement in facility design. Focus group interviews were held with teams from healthcare facilities occupying their new facility for more than 6 months and less than 2 years. RESULTS: Curriculum topics were validated and additional areas recommended based on the interviews. Open-ended questioins on lessons learned provided several new dimensions to the research. CONCLUSIONS: Although validating the curriculum was the initial intent, the feedback from the focus groups on lessons learned provided rich concepts for practice implications and further research on post-occupancy. KEYWORDS: Decision-making, design process, interdisciplinary, planning, post-occupancy.