Designing for flexibility in hybrid care services: lessons learned from a pilot in an internal medicine unit.

Digital transformation in healthcare during the COVID-19 pandemic led to the development of new hybrid models integrating physical and virtual care. The ability to provide remote care by telemedicine technologies and the need to better manage and control hospitals' occupancy accelerated growth in hospital-at-home programs. The Sheba Medical Center restructured to create Sheba Beyond as the first virtual hospital in Israel. These transformations enabled them to deliver hybrid services in their internal medicine unit by managing inpatient hospital-care with remote home-care based on the patients' medical condition. The hybrid services evolved to integrate care pathways multiplied by the mode of delivery-physical (in person) or virtual (technology enabled)-and the location of care-at the hospital or the patient home. The study examines this home hospitalization program pilot for internal medicine at Sheba Medical Center (MC). The research is based on qualitative semi-structured interviews with Sheba Beyond management, medical staff from the hospital and the Health Maintenance Organization (HMO), Architects, Information Technology (IT), Telemedicine and Medtech organizations. We investigated the implications of the development of hybrid services for the future design of the physical built-environment and the virtual technological platform. Our findings highlight the importance of designing for flexibility in the development of hybrid care services, while leveraging synergies across the built environment and digital platforms to support future models of care. In addition to exploring the potential for scalability in accelerating the flexibility of the healthcare system, we also highlight current barriers in professional, management, logistic and economic healthcare models.

Inpatient Telemedicine and New Models of Care during COVID-19: Hospital Design Strategies to Enhance Patient and Staff Safety.

The challenges of the COVID-19 pandemic have led to the development of new hospital design strategies and models of care. To enhance staff safety while preserving patient safety and quality of care, hospitals have created a new model of remote inpatient care using telemedicine technologies. The design of the COVID-19 units divided the space into contaminated and clean zones and integrated a control room with audio-visual technologies to remotely supervise, communicate, and support the care being provided in the contaminated zone. The research is based on semi-structured interviews and observations of care processes that implemented a new model of inpatient telemedicine at Sheba Medical Center in Israel in different COVID-19 units, including an intensive care unit (ICU) and internal medicine unit (IMU). The study examines the impact of the diverse design layouts of the different units associated with the implementation of digital technologies for remote care on patient and staff safety. The results demonstrate the challenges and opportunities of integrating inpatient telemedicine for critical and intermediate care to enhance patient and staff safety. We contribute insights into the design of hospital units to support new models of remote care and suggest implications for Evidence-based Design (EBD), which will guide much needed future research.

Telemedicine Implementation in COVID-19 ICU: Balancing Physical and Virtual Forms of Visibility.

OBJECTIVE: This case study examines the implementation of inpatient telemedicine in COVID-19 intensive care units (ICUs) and explores the impact of shifting forms of visibility on the management of the unit, staff collaboration, and patient care. BACKGROUND: The COVID-19 crisis drove healthcare institutions to rapidly develop new models of care based on integrating digital technologies for remote care with transformations in the hospital-built environment. The Sheba Medical Center in Israel created COVID-19 ICUs in an underground structure with an open-ward layout and telemedicine control rooms to remotely supervise, communicate, and support the operations in the contaminated zones. One unit had a physical visual connection between the control room and the contaminated zone through a window, while the other had only a virtual connection with digital technologies. METHODS: The findings are based on semistructured interviews with Sheba medical staff, telemedicine companies, and the architectural design team and observations at the COVID-19 units during March-August 2020. RESULTS: The case study illustrates the implications of virtual and physical visibility on the management of the unit, staff collaboration, and patient care. It demonstrates the correlations between patterns of visibility and the users' sense of control, orientation in space, teamwork, safety, quality of care, and well-being. CONCLUSIONS: The case study demonstrates the limitations of current telemedicine technologies that were not designed for inpatient care to account for the spatial perception of the unit and the dynamic use of the space. It presents the potential of a hybrid model that balances virtual and physical forms of visibility and suggests directions for future research and development of inpatient telemedicine.

Evidence-Based Design in Architectural Education: Designing the First Maggie's Centre in Israel.

OBJECTIVE: The study examines the integration of the Evidence-based Design (EBD) approach in healthcare architecture education in the context of an academic design studio. BACKGROUND: Previous research addressed the gap between scientific research and architectural practice and the lack of research on the use of the EBD approach in architectural education. METHODS: The research examines an undergraduate architectural studio to design a Maggie's Centre for cancer care in Israel and evaluates the impact of the EBD approach on the design process and design outcomes. The research investigates the impact of the integration of three predesign tasks: (1) literature review of healing architecture research, (2) analysis and comparison of existing Maggie's Centres, and (3) analysis of the context of the design project. RESULTS: The literature review of scientific research supported the conceptual design and development of the projects. The analysis of existing Maggie's centers, which demonstrated the interpretation of the evidence by different architects, developed the students' ability to evaluate EBD in practice critically, and the study of the projects' local context led the students to define the relevance of the evidence to support their vision for the project. CONCLUSIONS: The research demonstrates the advantages of practicing EBD at an early stage in healthcare architectural education to enhance awareness of the impact of architectural design on the users' health and well-being and the potential to support creativity and innovative design. More studies in design studios are needed to assess the full impact of integrating EBD in architectural education.

Building for Change: Comparative Case Study of Hospital Architecture.

OBJECTIVE: This study assesses how architectural design strategies impact the flexibility of hospitals to change over time. BACKGROUND: Most hospitals are designed for highly specialized medical functions, which is often in conflict with the need to design the hospital facility to accommodate evolvement and change of functions over time. Architectural design strategies provide different approaches to the need to design for a specific medical program while planning for its future change. METHODS: The study compares two hospital buildings with a very similar configuration and medical program but with significantly different architectural design strategies: One was designed for an unknown future medical function, and the second was designed for a specific medical function. The study analyses the two hospital buildings by their design strategy, planning, design process, and construction by phases and compares their change in practice over the last twelve years. RESULTS: The design strategy to fit a specific function limited the hospital affordance to make changes during the design process, construction, and occupancy phases. Systematic design of system separation for an unknown function, in contradiction to a "tailor-made" approach in the design for a specific function, was found to support a variety of changing medical programs. CONCLUSIONS: Architectural design strategies developed in an early stage of the design process has a major impact on the future evolution of the hospital facility. The different results between the two projects also demonstrate the greater influence of healthcare policies, hospital organization culture, and infrastructure funding models on the architecture and flexibility of hospitals.

A study of human behavior simulation in architectural design for healthcare facilities.

INTRODUCTION: Current tools and methods in architectural design do not allow predicting and evaluating how people will use designed environments before their actual realization. OBJECTIVE: To investigate how computational simulation can help in evaluating design proposals as far as their use by people is concerned. METHODS: Simulation of a medicine distribution procedure in a general hospital facility, while accounting for serendipitous social interactions made possible by the presence of different users in the same space, at the same time. DISCUSSION: The simulation shows how use patterns are influenced by the social and physical context in which actors are situated, and demonstrates the significance of the proposed method of evaluating hospital designs before construction. The system allows simulating use patterns with different degrees of complexity, and enables architects to ask new types of questions related to the interactions between people and physical settings.