Benchmarking Relevance for Hospital Design and Planning: An International Web-Based Survey

OBJECTIVE

The study aims to investigate what design practitioners and healthcare facility managers deem as important benchmarking metrics worldwide, investigating country differences in benchmarking usage and which metrics are prioritized.

BACKGROUND

Benchmarking is a regular practice in the healthcare sector, both for clinical and managerial aspects to compare, measure, and improve standardized processes. However, limited knowledge is available about benchmarking procedures in hospital planning, design, and construction.

METHODS

A web-based survey was designed, revised, and pilot-tested in five countries; it was adjusted according to local experts' suggestions and submitted globally via SoSci multilingual platform to persons involved in hospital design, research, construction, and facility management. It was composed of closed questions on 5-point Likert-type scale ranking frequency or importance and open-ended questions divided into six sections. Two hundred and eighty full responses have been collected. Statistical analysis was performed via PowerBI and R-Studio, while qualitative analysis was performed via MAXQDA.

RESULTS

The findings reported allow for both specific insights per each country or category as well as enabling general considerations of a practice that is becoming always more international with 30%-50% of respondents working in the international context. The evaluation of the survey highlights the most important benchmarks, among others. For example, for respondents from the top five countries (Sweden, Spain, Germany, Italy, and the United States), the most important metric for benchmark comparability is whether the project was new construction, new construction attached to an existing hospital, or interior renovation. Construction date, client type (public vs. private), and country of location were also generally rated as the most important metrics by respondents. Other metrics that were consistently rated as important globally included inpatient unit layout, walking distances, number of floors, and whether all patient rooms are private. Space-related metrics are considered very important elements in the design and planning of healthcare facilities worldwide. Regarding cost-related metrics, all countries consider the ratio construction cost per building gross area as the most important.

CONCLUSIONS

Benchmarking emerges as a relevant tool for hospital design and planning as it can support efficiency, standardization, and confidence; currently, benchmarking is still underutilized due to the challenge of international comparison, access to data outside each specific company, and variation design metrics nationally. Benchmarking strategies should be further investigated to support knowledge exchange and to ensure reliable and comparable information globally.

A Comparison of Hospital Area Measurement in Germany, Canada, Australia, and the United States: Part 1

Objectives:

This article compares national standards for area measurements of healthcare facilities in four countries and examines the risks and differences that can arise when comparing building areas of healthcare facilities internationally.

Background:

In the planning and management of healthcare facilities, the utilization and comparison of building floor areas plays a major role. Differences in terminology, classification, and methodology help to reduce planning and cost risks when applied on a local and national level. The proper allocation of building floor space is vital in the design of room programs, determination of floor space, construction costs, and operating costs.

Methods:

Each of the four hospital area measurement standards is compared to discern similarities and differences.

Results:

Most countries use a three-tier system of hospital area measurement: building gross area, department gross area, and department net area. Few differences were found between country standards for department area, though the German standards do not fully address this tier. Variation is found in whether a country includes certain functions in the hospital area—such as research space, shell space, or central energy plants—which can have a significant impact on the overall hospital area.

Conclusions:

This article informs further development of individual country standards and highlights principles to consider for international hospital area comparison.

Associations of Patient and Staff Outcomes With Inpatient Unit Designs Incorporating Decentralized Caregiver Workstations: A Systematic Review of Empirical Evidence

OBJECTIVES:

This systematic literature review synthesizes and assesses quality of research addressing associations of patient and staff outcomes with inpatient unit designs incorporating decentralized caregiver workstations.

BACKGROUND:

A current hospital design trend is to include decentralized caregiver workstations on inpatient units. A review of literature addressing decentralized unit design is needed.

METHODS:

The systematic review methodology was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Database searches were conducted for studies published in peer-reviewed journals through October 2017. Included were empirical studies associating patient and/or staff outcomes and unit design with decentralized caregiver workstations. Individual studies were evaluated for quality using established methods, and Grading of Recommendations Assessment, Development and Evaluation (GRADE) and GRADE-Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERQual) guided rigorous inspection of evidence quality and strength for quantitative outcomes and qualitative findings, respectively.

RESULTS:

The search yielded 1,096 records with 36 full-text articles examined and 12 articles included in the final review. This work was dominated by studies with limited analyses. Staff outcomes have been most widely studied, especially collaboration/communication and walking. Overall, studies exploring decentralized nursing as a design intervention have produced limited results for both staff and patient outcomes. Strength of evidence of the current literature with quantitative methods as a whole was rated very low quality.

CONCLUSIONS:

Although varying degrees of caregiver workstation decentralization in inpatient units are now common, the literature addressing the impacts of such designs is of very low quality and shows inconsistency in associated outcomes. Rigorous, well-designed studies with consistently defined design and outcome measures are needed for greater confidence in determining any effects of decentralized unit design.

A comparative evaluation of Swedish intensive care patient rooms

OBJECTIVE

This study investigates how design strategies in three recent intensive care units in Sweden impact patients, families, and staff. The area of focus is the patient room "module," usually consisting of a pair of patient rooms and a joint location for monitoring and documentation.

BACKGROUND

Many countries are expanding their number of intensive care beds and are also in the process of incorporating evidence-based design strategies such as single-bed patient rooms and access to daylight and nature. This situation provides a significant opportunity to review and learn from facilities leading the way in these areas.

METHODS

Three intensive care units completed since 2010 were evaluated in relation to a combination of criteria. Methods included plan drawing analysis, staff questionnaires (n = 72), staff interviews (n = 9), and systematic observation (6 hours).

RESULTS

In some patient rooms, access to daylight and/or outdoor views was excellent, while in other rooms such access was hindered by frosted glass or adjacent bushes or buildings. Single-bed rooms gave family members improved privacy and greater ability to stay in the patient room. Some patient room modules provided efficient patient observation and staff collaboration, but more noise and reduced patient privacy. Other modules provided a calm patient room environment, but caused some staff to feel isolated and have difficulty in getting assistance.

CONCLUSIONS

The evaluation of the three projects reveals variation in whether design strategies successfully achieve their desired outcomes. Varying designs of the patient room module affect users in unique ways and must balance privacy, visibility, quietness, and staff access to assistance.

KEYWORDS

Critical care/intensive care, organizational transformation, outcomes, post occupancy, work environment.

LA LEY DOCENTE Y LA CLASE MEDIA: CONTROLANDO EL DESARROLLO DE LOS PROFESORES CHILENOS

RESUMEN: Utilizando la nueva Ley que Crea el Sistema Nacional de Desarrollo Profesional Docente en Chile como caso, se explora cómo las actuales políticas educativas refuerzan a la clase media profesional y gerencial en el país promoviendo un currículo “legítimo”. La estandarización y la medición ocupan un rol fundamental al respecto controlando el desarrollo profesional de los profesores. También se exploran algunas tareas críticas necesarias para contrarrestar estos efectos.

Toward a Safer and Cleaner Way: Dealing With Human Waste in Healthcare

Organizations must evaluate their infection control plans in a holistic and inclusive manner to continue reducing healthcare-associated infection (HAI) rates, including giving consideration to the manner of collecting and disposing of patient waste. Manual washing of bedpans and other containers poses a risk of spreading infection via caregivers, the environment, and the still-contaminated bedpan. Several alternative disposal methods are available and have been tested in some countries for decades, including options such as bedpan washer-disinfector machines, macerator machines, and disposable bedpans. This article reviews methods and issues related to human waste disposal in healthcare settings. Healthcare organizations must evaluate the options thoroughly and then consistently implement the option most in line with its goals and culture.

Increased tumor cures using combined radiosurgery and BCNU in the treatment of 9l glioma in the rat brain

PURPOSE

Radiosurgery refers to the delivery of high, single focused beams of ionizing radiation to defined intracranial lesions. 1,3 Bis[2-chloroethyl]-1-nitrosourea (BCNU) and cis-diammine-1, 1-cyclobutane-dicarboxylate platinum (II) (carboplatin) are commonly used cytotoxic agents for the treatment of malignant gliomas of the brain. Drug therapies have exhibited a modest enhanced cell killing when combined with radiation in experimental animal tumor systems. The purpose of the present study was to investigate the role of cytotoxic drugs, such as BCNU and carboplatin, in combination with a single high dose of radiosurgery on the tumor control rates of 9L tumors in the rat brain.

METHODS AND MATERIALS

Combined radiosurgery (25 Gy single dose) and/or chemotherapy (a single dose of BCNU, 7 mg/kg, i.p. 1.5 or 16 h prior to or 16 h after irradiation or a single dose of carboplatin, 30 mg/kg, administered either 1 h or 4 h prior to irradiation) was delivered 12 days after stereotactic tumor implantation. For dose escalation study, 4-10 mg/kg of BCNU was used.

RESULTS

The radiation alone group showed a dose-dependent survival. A single dose of 25 Gy to the control group resulted in an increase of the median survival time from 20 days to 42 days, but all animals died of the tumor in 50 days. A significant prolongation of the median survival time of animals was more than 100 days, resulting in animal cures of 50% or more when combined with radiosurgery (25 Gy) and BCNU (7 mg/kg). BCNU alone did not prolong the median survival time of the animal with the 9L brain tumor. In contrast, there was no survival improvement when the animals were treated with combined radiosurgery and carboplatin. None of the long-term surviving animals showed any significant brain tissue damage as evaluated by histopathology and clinical observations.

CONCLUSION

The data clearly suggest that the combined modalities of radiosurgery and concomitant BCNU represent an effective therapeutic regimen in the treatment of radioresistant human malignant gliomas of the brain. This study represents the first experimental report of the effectiveness of combined chemotherapy and radiosurgery.

DSM-IV antisocial personality disorder field trial

The development of the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994) included 12 field trials to assess proposed revisions. This article provides results from the antisocial personality disorder (APD) field trial that was conducted to obtain data of relevance to the proposals for simplification and for the inclusion of more traditional traits of psychopathy. Provided herein are the results from 4 sites that had sampled from populations of particular relevance to the diagnosis of APD (i.e., prison inmates, psychiatric inpatients, outpatients with substance use disorders, and homeless persons). The results indicated that some items from the 3rd revised Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1987) could be deleted without affecting the diagnosis. The field trial provided mixed support for the proposal to include more traditional traits of psychopathy.

DSM-IV antisocial personality disorder field trial

The development of the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994) included 12 field trials to assess proposed revisions. This article provides results from the antisocial personality disorder (APD) field trial that was conducted to obtain data of relevance to the proposals for simplification and for the inclusion of more traditional traits of psychopathy. Provided herein are the results from 4 sites that had sampled from populations of particular relevance to the diagnosis of APD (i.e., prison inmates, psychiatric inpatients, outpatients with substance use disorders, and homeless persons). The results indicated that some items from the 3rd revised Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1987) could be deleted without affecting the diagnosis. The field trial provided mixed support for the proposal to include more traditional traits of psychopathy.

Hemifacial spasm. Occurrence in multiple sclerosis

We present six patients with hemifacial spasm and multiple sclerosis. To our knowledge, this association has not been described previously in the North American literature. Magnetic resonance imaging was obtained in all the patients and plaques consistent with multiple sclerosis were identified. In two patients the plaques were seen in the area of the facial nucleus on the involved side. We suggest that hemifacial spasm can be a manifestation of multiple sclerosis. These cases illustrate the utility of magnetic resonance imaging in the investigation of hemifacial spasm. Our findings also support a central (nuclear) origin in multiple sclerosis associated with hemifacial spasm.