Herd-Health Environments Research & Design Journal最新文献

Background: The rising demand for outpatient care, fueled by improved efficiency, technology, and patient-centered models, necessitates reevaluating clinic design and healthcare delivery. This reassessment should align with evolving patient expectations to enhance care continuity and outcomes. Objective: This research explores how targeted design features affect patient behaviors, movement dynamics, and staff perceptions in outpatient clinics. The goal is to enhance patient experience, improve operational efficiency, and elevate care quality by identifying strategies to boost clinic performance and patient outcomes. Methods: This study utilizes behavior mapping, shadowing observations, surveys, and Gemba walk-throughs across four outpatient clinics to examine how design affects patient experiences and operational workflows. Behavior mapping collected 1179 data points, revealing that waiting for appointments and making phone calls were the most common activities. Shadowing 13 patients identified navigation inefficiencies, particularly the lengthy route from exam rooms to exits and the frequent movement between the scale and waiting area. Surveys and Gemba walk-throughs with 95 staff members highlighted critical design elements that enhance experiences, including aesthetics, acoustics, and room sizes. Feedback indicated a demand for improvements in accessibility, privacy, wayfinding, reduced staff travel distances, and child-friendly features to boost clinic efficiency and patient satisfaction. Conclusion: This study highlights the importance of patient-centered design in outpatient clinics. It shows that improving waiting areas, clinic navigation, privacy measures, and technology integration can enhance patient experience and operational efficiency.

Nature-based interventions (NBIs) in healthcare settings have the potential to enhance physical and mental wellbeing of patients, healthcare staff, and visitors but are often underutilized. Knowledge about factors influencing effective implementation of NBIs in healthcare settings is scarce. This study aimed to develop a framework for identifying implementation factors relevant to NBIs in hospitals, long-term care facilities for elderly, and rehabilitation centers. A two-round Delphi study was conducted. In the first round, potential implementation factors were identified based on input from 33 experts from the following groups: healthcare managers, landscape designers, nature and health consultants, and healthcare staff. These factors were then supplemented with additional factors identified from previous studies and the Consolidated Framework for Implementation Research (CFIR). In the second round, 21 experts rated the importance of these factors. The items that reached expert consensus were included in the new implementation framework. In the first round, an initial set of 99 implementation factors was identified. Most factors derived from experts and literature were design related. These factors were complemented with factors derived from the CFIR. In the subsequent round, 98 implementation factors were considered important by experts and retained. These factors were incorporated into a new framework, the Green Implementation Framework (GreenIF). The GreenIF provides an overview of factors that contribute to the successful design and implementation of NBIs in healthcare settings and can be used to enhance their usage and maximize their benefits.

ObjectivesThis study aims to identify key factors influencing residential satisfaction and sense of belonging among residents in Shanghai's "moving-merging" rural-urban resettlement communities, with a particular focus on variations across different age groups.BackgroundUrban expansion globally impacts rural populations, with China experiencing rapid urbanization. Shanghai's unique "moving-merging" strategy consolidates villagers into new sites near their original locations, preserving social ties while improving physical environments. This study examines how this strategy influences residents' place attachment, focusing on person, place, and process dimensions.MethodA mixed-methods approach was adopted, integrating quantitative surveys with qualitative data collection. A structured questionnaire was administered to 245 residents (133 younger individuals <60 years, 112 older individuals ≥60 years) in the DX Community, Shanghai. The survey assessed residential satisfaction, sense of belonging, and perceived changes before and after relocation. Factor analysis with oblique rotation and binary logistic regression were employed for data analysis.ResultThe study revealed that while living conditions improved, overall resident satisfaction did not significantly increase, especially among younger residents. Older residents perceived greater benefits but encountered adaptation challenges. Social ties and belongingness were strengthened in higher-density settings,ConclusionThe "moving-merging" strategy enhances residential satisfaction and fosters a sense of belonging, particularly benefiting older adults by preserving social networks. However, challenges persist in improving physical environments. Findings highlight the necessity of differentiated policies addressing specific needs and preferences of different age groups.

Background: The work of Human Factors and Ergonomics (HFE) engineers and healthcare architects may overlap when it comes to designing the physical environments of healthcare facilities. Both disciplines are tasked with improving healthcare efficiency, promoting experience and safety, and reducing medical errors. Both disciplines adopt evidence-based and human-centered approaches in the design and evaluation of their work. However, it remains unclear to healthcare design professionals why, when, and how to incorporate HFE engineers' expertise into the architectural design project. Objectives: This opinion paper aims to reintroduce HFE to healthcare design by revisiting the core concepts, comparing essential approaches, and explaining the benefits of integrating HFE expertise into the evidence-based design (EBD) of healthcare projects. Methods: Literature review and case studies have demonstrated that simulation and mock-ups, as effective tools, should be integrated into the design and prototyping phases; therefore, they provide feedback to adjust the design concepts and inform design decisions with the engagement of HFE perspectives. Results: A conceptual framework for the HFE-integrated EBD process was proposed to facilitate the evaluation and improvement studies for healthcare design.

ObjectivesTo explore the time spent on nursing tasks and the extent of multitasking in a hospital with multi-bedded rooms compared to single-occupancy rooms.BackgroundSingle-occupancy patient rooms in hospitals have become popular because of the privacy they offer. However, little is known about the impact of different hospital designs on time spent performing on nursing tasks.MethodsA before-after time motion study was conducted in a former hospital which featured multi-bedded rooms and a new hospital with 100% single-occupancy rooms. Trained observers shadowed nurses during day and evening shifts using an online shadow application distinguishing eleven main categories of nursing tasks (e.g., direct patient care, indirect care, and professional communication). Data was analyzed using descriptive statistics. Tasks performed concurrently (multitasking) are described in terms of (overlapping) duration and frequency.ResultsIn total, 60 and 107 nurses were shadowed for 225 and 450 hours in the former and new hospital, respectively. The top three tasks on which nurses spent most the time in the former and new hospital concerned: direct care 40% versus 40%, training and supervision 27% versus 25%, communication 25% versus 25%, respectively. In the former hospital, nurses performed on average 32.8% of their time on multitasking versus 34.8% in the new hospital.ConclusionsContrary to our expectations, the 100% single-occupancy rooms hospital design hardly affected nursing time spent in nursing tasks and multi-tasking compared to a multi-bedded patient rooms setting.

Purpose: This study evaluates the relaxation effects of viewing a Chinese classical garden and a Chinese-style public park in reality and virtual reality (VR) environments by focusing on their psychological and physiological impacts. Background: The experiment examined two landscapes: the culturally rich and elaborately designed Humble Administrator's Garden and the Hefeng Pavilion. Methods: Twenty-eight participants participated in four sessions, each consisting of a 5-minute viewing session of the Humble Administrator's Garden and the Hefeng Pavilion under Conditions A (real) and B (VR). Each session was evaluated using the Profile of Mood States (POMS) questionnaire, the Semantic Differences Scale, the Supplemental Questionnaire, and eye tracking technology. Results: In Condition A, POMS scores, Semantic Differential Scale ratings, the Supplemental Questionnaire results, and eye movement patterns indicated that viewing the Humble Administrator's Garden resulted in greater relaxation compared to the Hefeng Pavilion. Similar findings were observed in Condition B, reinforcing the Humble Administrator's Garden's relaxing effect. However, there was a noticeable disparity in the relaxation effects between Conditions B and A, with real settings offering more pronounced benefits. Conclusions: This study demonstrated that the culturally rich Humble Administrator's Garden significantly improves mood more effectively than the Hefeng Pavilion, whether viewed in real or VR environments. This study suggests that although VR can offer an immersive experience, it may not fully capture the sensory richness and therapeutic benefits of actual garden environments. Real settings delivered more substantial relaxation effects compared to VR settings.

Purpose: This study examines the economic benefits of innovative design in a hospital ward with the capital and operational costs and societal and government benefits. Background: An economic view of health care delivery options considers both the costs and benefits of an intervention for the economy, funders, and patients. Previous studies have focused on the financial costs of capital as an asset class for hospital development. Methods: Four hypothetical stroke rehabilitation units were designed within a larger Living Labs program (the NOVELL project). A standard stroke rehabilitation hospital ward design was compared to three alternative designs. The alternative designs expanded areas for therapy, social engagement, communal activities, and staff wellbeing, included activated corridors and enabled access to outdoor and recreational areas based on clinical evidence and expert advice. Results: The alternative designs are predicted to achieve A$3.3 million in savings annually for rehabilitation ward operational costs (a saving of 26%). Economy-wide benefits from the alternative designs are estimated to be A$12 million plus savings to government of between A$3.93 million and A$5.4 million per ward per annum. Conclusions: Adoption of innovation in design, clinical practice and evidence identification has the capacity to improve clinical effectiveness and patient outcomes. Economy wide benefits and cost improvements for health funders from the adoption of innovative design have been identified through micro- and macro-economic evaluation.

Objective: There is a need for a more theoretical understanding of human behavior to inform the decision-making related to how technology should be integrated into healthcare environments. Background: Healthcare systems are transforming with more technology embedded within the built environment of healthcare facilities. The placement of these technologies, however, only sometimes considers the needs or workflow of patients, visitors or staff. Despite similarities, evidence-based design, smart building design and human-building interaction research rarely intersect. However, each relies on multi-disciplinary insights to enhance these fields. In this paper, we contextualize human-building interaction with building technology through an analytical framework inspired by mediation theory. Methods: Based on five case examples from previous studies and site visits, we present the interaction and explain how mediation theory provides insight into the interaction. Results and Conclusions: Looking at human-building technology interaction from the lens of mediation theory, it is apparent that the specific decisions taken in spatial and technological design impact the behaviors of building occupants. This paper provides examples of how technology in healthcare environments is used unintendedly, resulting in adapting the use to meet the user's needs. Mediation theory provides a framework to contextualize such encounters which will allow researchers to anticipate user needs and avoid disruptive building technologies in the future.

Objective: A secondary analysis of community health needs assessment data was used to determine access and barriers to primary, specialty and hospital-based care in a rural, frontier-designated Montana critical access hospital (CAH) to establish alignment between the physical healthcare facility infrastructure design approach and community healthcare service needs. Background: The lack of physical infrastructure and integrated equipment/technological resources in CAHs can be a contributing factor in closures when means are absent to be responsive to the needs of an ageing population, updated technology, and heightened acuity level of care. Method: Inferential and predictive analyses of a cross-sectional survey was used to understand the care access based on the community members demographics as well as perceptions of their personal health, the community's health, knowledge of health services, and insurance coverage. Results: Important associations and predictors for the use of primary, hospital-based and specialty care among the rural residents were positive perceptions of health of themselves and their community (60%+) and good to excellent insurance coverage (70%+). Predictive decision tree modeling determined notable variation in access and use of specialty care and current employment status. These results indicate most respondents did not delay care due to transportation, distance, childcare or work. Insurance coverage and its cost were critical in accessing all types of care but especially specialty care. Conclusions: Community health needs assessments are conducted to retain tax status for CAHs, and as such are available sources of stakeholder perspectives that may expedite design approaches and strategic planning.