Foreword xvii

About the Editors xix

Preface xxi

Acknowledgments xxiii

Section I The Context of Healthcare: Problems, Opportunities, and Disruptors 1

1.1 Evidence-Based Design: Addressing the Challenges and Changes in Healthcare 3
Craig Zimring, Lisa Lim, and Robert Stroebel

References 9

1.2 Chasing Value: Exploring How the Built Environment Can Contribute to Healthcare Value 11
Lorissa MacAllister and Robert Stroebel

1.2.1 Introduction 11

1.2.2 Defining VALUE 12

1.2.3 Examples: Designing VALUE 14

1.2.3.1 Industry-Value-Based Healthcare Buildings – Building the Connection to the Component 14

1.2.3.2 Industry-Value-Based Buildings – Building the Connection to the Perspective 15

1.2.4 Designed to Improve Value: Illustration of Practice 16

1.2.5 Conclusions 17

References 17

1.3 Evidence-Based Design: History, Issues, and Opportunities 19
Craig Zimring, Lisa Lim, and Robert Stroebel

1.3.1 Introduction 19

1.3.2 The Context of EBD and Its Rapid Adoption 19

1.3.2.1 Rapid Adoption of EBD 19

1.3.2.2 Examples of EBD Impact 20

1.3.3 Disciplinary and Methodological Roots of EBD 20

1.3.3.1 Architectural Research and Systems Engineering 20

1.3.3.2 Environmental Psychology and Environment-and-Behavior Studies 21

1.3.3.3 Space Syntax and Network Analysis 21

1.3.3.4 Human-Centered Design and Co-Design 21

1.3.4 Key EBD Findings 22

1.3.4.1 Single-Patient Rooms: Multiple Mechanisms, Strong Evidence 22

1.3.4.2 Environmental Quality: Stress Reduction Through Sensory Mechanisms 23

1.3.4.3 Strategic Facility Features: High-Impact, Cost-Effective Interventions 24

1.3.4.4 Population-Specific Applications 24

1.3.5 Challenges in EBD Research and Implementation 24

1.3.6 Implementation Barriers and the Need for Systematic Approaches 25

1.3.6.1 Financial and Organizational Constraints 25

1.3.6.2 Institutional Resistance and Cultural Inertia 25

1.3.6.3 Limited Stakeholder Engagement 25

1.3.6.4 Inadequate Change Management and Transition Support 26

1.3.6.5 Challenges in Translating Evidence into Actionable Guidance 26

1.3.6.6 Gaps in Post-Occupancy Evaluation and Continuous Learning 26

1.3.7 A Framework for Embedding EBD in Practice 26

1.3.7.1 Consolidated Framework for Implementation Research (CFIR) 26

1.3.7.2 Five-Phase Framework for EBD Implementation: Linking Design, Innovation, and Evidence 27

1.3.8 Future Challenges and Opportunities 29

1.3.8.1 Building an Effective Evidence Base 29

1.3.8.2 Strategies for Collaborative Evidence-Building 30

1.3.8.3 Emerging Technologies 30

1.3.9 Conclusion 31

1.3.9.1 Broadening EBD Practice Through Diverse Evidence Methods 31

1.3.9.2 Taking Action: Next Steps for Key Stakeholders 32

References 33

Section II Providing and Receiving Care More Effectively and Safely 39

2.1 Designing Safer and More Human-Centered Operating Rooms 41
Anjali Joseph, David Allison, and Scott Reeves

2.1.1 Introduction 41

2.1.2 Key Trends, Opportunities, and Problems in OR Design 41

2.1.3 The Evidence-Base for OR Design 42

2.1.3.1 OR Size 42

2.1.3.2 OR Configuration 43

2.1.3.3 OR Door Design and Location 43

2.1.3.4 Workspace Design and Ergonomics 44

2.1.3.5 Sightlines and Visibility in the OR 44

2.1.3.6 Ventilation and Air Quality 44

2.1.3.7 Noise 44

2.1.3.8 Lighting 45

2.1.3.9 OR Surfaces and Materials 45

2.1.4 Designing a Human-Centered OR 45

2.1.4.1 Systems Engineering Approach 45

2.1.4.2 Evidence-Based OR Design Prototype 46

2.1.5 Actions for Designers, Researchers, and Health Systems 52

2.1.6 Future Trends 53

References 54

2.2 Harm Reduction by Design: Optimizing Patient Rooms to Reduce Infection 59
Lindsey B. Gottlieb, Craig Zimring, and Kari L. Love

2.2.1 Introduction 59

2.2.2 Background 59

2.2.2.1 Contact Pathogen Considerations 59

2.2.2.2 Waterborne Pathogen Considerations 60

2.2.2.3 Airborne Pathogen Considerations 60

2.2.2.4 General Infection Prevention Considerations 61

2.2.3 Design Attributes that Support Infection Prevention 62

2.2.3.1 Reducing Contact Pathogen Exposure 62

2.2.3.2 Reducing Waterborne Pathogen Exposure 64

2.2.3.3 Reducing Airborne Pathogen Exposure 64

2.2.3.4 Examples of Projects that Incorporate IPC-Minded Design 65

2.2.4 Actions for Designers, Researchers, and Health Systems 66

2.2.4.1 Designers 66

2.2.4.2 Researchers 67

2.2.4.3 Healthcare Systems 67

2.2.5 Future Trends 67

2.2.6 Conclusions 68

References 69

2.3 Architecture Can Keep Healthcare Workers Safe: Doffing Area Design to Improve Safety and Workflow in Caring for Patients with Serious Communicable Diseases 73
Zorana Matić , Herminia Machry, Jesse T. Jacob, and Joel Mumma

2.3.1 Introduction 73

2.3.2 The Environmental Context of PPE Doffing Risks 74

2.3.3 Types and Layouts of PPE Doffing Spaces 75

2.3.4 Design Strategies for Safe PPE Doffing 75

2.3.4.1 Location, Size, and Configuration of PPE Doffing Area 79

2.3.4.2 Environmental Cues and Doffing Area Design 82

2.3.4.3 Design of Patient Room Doors, Windows, and Adjacent Areas 82

2.3.4.4 Location and Design of PPE Disposal and PPE Supply 82

2.3.5 Actions for Designers, Researchers, and Health Systems 83

2.3.6 Future Trends 84

2.3.6.1 Human-Centered Design and Focusing on Patient’s Experience During Isolation 84

2.3.6.2 Staff Health and Wellness During a Pandemic 84

2.3.6.3 Integration of Technology to Support Patient Experience and Staff Safety 84

2.3.6.4 Increased Focus on Sustainable Solutions for Use of PPE 85

2.3.7 Conclusions 85

References 86

2.4 Improving Primary Care Teamwork and Communication by Team-Based Clinic Design 91
Lisa Lim, Craig Zimring, and Robert Stroebel

2.4.1 Introduction 91

2.4.2 Physical Space and Teamwork 93

2.4.3 Clinic Design Attributes that Improve Teamwork 93

2.4.3.1 Colocation of Staff Members and Especially Staff Visual Connections Predict Higher Teamwork Perceptions 93

2.4.3.2 Workstation Proximity Predicted More Frequent Observed Communication 95

2.4.3.3 Visual Connections Between Spaces, Team Room and Exam Rooms, Enable Flexible Use of Spaces with Awareness of the Spaces 96

2.4.4 Actions for Designers, Researchers, and Health Systems 97

2.4.5 Future Trends 98

References 99

Section III Improving the Experience of Care for Patients and Staff 103

3.1 Environmental Design to Enhance Well-Being and Experience for Healthcare Workers 105
Lesa N. Lorusso, Sheila J. Bosch, Shabboo Valipoor, Dagmar Rittenbacher, and Tatiana Orozco

3.1.1 Introduction 105

3.1.2 Supporting Staff Well-Being Through Environmental Design – A Review of the Literature 106

3.1.2.1 Resilience 106

3.1.2.2 Safety 110

3.1.2.3 Teamwork 111

3.1.2.4 Autonomy 114

3.1.3 Actions for Designers, Researchers and Health Systems 115

3.1.4 Future Trends 117

3.1.5 Conclusion 117

References 118

3.2 Experience Design for the Immersed Moving Visitor: Introducing “Diachronic Experiences” and Layout as Critical Research and Design Considerations 125
Saif Haq and Chris P. Schieffer

3.2.1 Introduction 125

3.2.2 Experience Design for the Immersed Moving Observer 127

3.2.2.1 Types of Experiences 128

3.2.3 Background Concepts and Theories Regarding Experience of the Moving Observer 129

3.2.3.1 Theories of Experience 129

3.2.3.2 Layout and its Analysis 131

3.2.4 Evidence from Literature 131

3.2.4.1 “Closeness” and Cognition 133

3.2.5 Actions for Designers, Researchers, and Health Systems 133

3.2.6 Future Trends 135

Acknowledgments 135

References 135

3.3 Inpatient Room Design to Meet the Challenge of Patient Expectations 139
Lorissa MacAllister and Bonnie Sakallaris

3.3.1 Introduction – The Multiple Roles and Complexities of the Acute Inpatient Room 139

3.3.2 Background – Influencers of Patient Satisfaction and Experience of Care 141

3.3.3 Review of the Literature – Design Attributes that Improve Patient Satisfaction and Experience of Care 142

3.3.3.1 Unit Configuration 142

3.3.3.2 Room Handedness 142

3.3.3.3 Bathroom Design 143

3.3.3.4 Windows 144

3.3.3.5 Family Zones 144

3.3.4 Actions for Designers, Researchers, and Health Systems 145

3.3.5 Future Trends 147

3.3.6 Conclusion 148

References 148

3.4 A Light Touch: How to Use Light to Improve Patient Experience 153
Jennifer Du Bose and Mohammadhossein Ghasempourabadi

3.4.1 Introduction 153

3.4.2 History of Hospital Lighting Design 154

3.4.3 Health Outcomes and Other Nonvisual Impacts of Light 154

3.4.3.1 Sleep 155

3.4.3.2 Alertness and Cognition 156

3.4.3.3 Mood and Depression 156

3.4.4 Actions for Designers, Researchers, and Health Systems 157

3.4.4.1 Guidelines for the Design Phase 157

3.4.4.2 Guidelines for Everyday Practice 159

3.4.5 Best Practice Example: The University of Kentucky Children’s Hospital 160

3.4.6 Future Trends 161

3.4.6.1 Better Quality Light 162

3.4.6.2 Better Controls 162

3.4.6.3 Better Metrics 162

3.4.7 Conclusion 162

References 163

3.5 Shhhh. I am Trying to Heal: Designing Healthy Soundscapes to Support Patients and Staff 167
Erica Ryherd, Ilene Busch-Vishniac, and Christina Ying Ying Chen

3.5.1 Introduction 167

3.5.2 Unique Challenges of Healthcare Soundscapes 167

3.5.3 Impacts of Healthcare Soundscapes 168

3.5.3.1 Potential Impacts on Patients 168

3.5.3.2 Potential Impacts on Staff 170

3.5.3.3 Overarching Impacts 170

3.5.4 Actions for Designers, Researchers, and Health Systems 171

3.5.5 Future Trends: Positive and Holistic Approaches to Soundscape Design 174

3.5.5.1 Team Collaborations 176

3.5.6 Conclusion 177

References 177

Section IV Care Outside Traditional Hospitals 187

4.1 Using Design to Empower People Facing Cognitive Decline in the Community and Healthcare Facilities 189
Eunhwa Yang, Christina Ying Ying Chen, Craig Zimring, Herminia Machry, Raha Motamed Rastegar, Heather Fellows, Joshua D. Crews, and Maureen Ann McHale Burke

4.1.1 Introduction 189

4.1.2 Background 190

4.1.2.1 Environmental Needs for Aging in Place and Social Activities 190

4.1.2.2 Environmental Needs for Dementia Care 191

4.1.3 CAIP: An Exploratory Agenda to Improve Home for Progressive Cognitive Decline 192

4.1.3.1 CAIP: Research Focus and Framework 192

4.1.3.2 CAIP: Methods and Key Findings 193

4.1.4 A Living Laboratory for the CEP 194

4.1.4.1 Cognitive Empowerment Program 194

4.1.4.2 Purpose, Design Process, and Principles of the Cognitive Empowerment Center 194

4.1.4.3 Design and Current Use of the CEC 196

4.1.5 Experience Room – Case Example from Mayo Clinic 197

4.1.6 Actions for Designers, Researchers, and Health Systems 198

4.1.7 Future Trends 199

4.1.8 Conclusion 199

References 200

4.2 Evidence-Based Innovative Rural Hospital Design 203
Hui Cai, Kent Spreckelmeyer, Brock Slabach, and Mark Burnett

4.2.1 Introduction 203

4.2.2 Background 203

4.2.2.1 Rural-Urban Health Disparities 203

4.2.2.2 Historical Development of CAHs 204

4.2.2.3 Rural Hospital Closures 205

4.2.2.4 Innovative Rural Healthcare Delivery Models and Facility Design 206

4.2.2.5 Strengthen the Community Tie: Provide and Collaborate on the Community Focus that Provides Services Outside The Hospital Setting 206

4.2.2.6 Alternative Emergency and Ambulatory Care-Based Rural Health Delivery Systems 206

4.2.2.7 Focus on Addressing the Root Cause of Community Health Issues in Rural Communities and Providing a Continuum of Care 207

4.2.3 CAH Postoccupancy Research Case Study 207

4.2.3.1 Research Methods 209

4.2.3.2 Standardized Patient Room POE 209

4.2.3.3 Medical Workflow and Departmental Adjacencies 210

4.2.3.4 Financial and Patient Performance 210

4.2.3.5 Rural Hospital Design Prototype: Reviving Main Street 212

4.2.4 Actions for Designers, Researchers, and Health Systems 214

4.2.5 Future Trends 215

4.2.5.1 Community-Based Integrated Care 215

4.2.5.2 Expand Telemedicine and Electronic Medical Records in Rural Communities 215

4.2.5.3 Shift Focus to Outpatient Care and Alternative Models of Care 216

4.2.5.4 Address Root Conditions for Improving Community Health 216

4.2.6 Conclusions 216

References 217

4.3 All In: Clinic Design for Connected Care and Communication 221
Lisa Lim, Marc Matthews, and Jennifer Pecina

4.3.1 Introduction 221

4.3.2 Background 222

4.3.3 Design Considerations for Hybrid Care 223

4.3.3.1 Spaces for Telehealth 223

4.3.3.2 Flexibility of Spaces for Different Modes of Care 224

4.3.3.3 Awareness for Both On- and Off-Site Staff Members 224

4.3.3.4 On-Stage Physical and Virtual Spaces 225

4.3.3.5 Patient Support Areas 226

4.3.4 Actions for Designers, Researchers, and Health Systems 227

4.3.5 Future Trends 228

References 229

Afterword: Call to Action-Transform Healthcare Through Evidence-Based Design 233
Craig Zimring, Robert Stroebel, and Lisa Lim

Index 237