Evidence-Based Design

Architectural Armor: Preventive Biocidal Surfaces

October 23, 2017 / Dochitect / Design for Patient Safety, Evidence-Based Design

Letters to the Editor

Publication: Health Environments Research & Design Journal, Letter to the Editor
Publication Reference: 2017, Vol. 10(5) 162-164
Author: Diana C. Anderson, MD, MArch, Ken Trinder, Kate Mitchell, and Erica Mitchell
View Article

Excerpt: Currently, there are two materials that qualify as preventive biocidal surfaces. Copper and copper alloys are one material. There is now an additional material that suspends cuprous oxide in a polymer, resulting in an equally efficacious substance that can be used both as a slab and as injection-molded shapes. Distinguishing itself from copper alloys, the cuprous oxide in a polymer looks and feels like any other synthetic quartz surface with a smooth, natural stone appearance, without rusting or oxidizing, and fabricates like any other hard surface, with lower cost implication.

For more information, read more about EOS Surfaces here.

Click here to read this Letter to the Editor, in which the evidence of Preventive Biocidal Surfaces is explored.

MedX: Architectural Design for Improved Healthcare Delivery

September 17, 2017 / Dochitect / Evidence-Based Design, The Physician-Architect Model

Presentations

Presentation Title: Architectural Design for Improved Healthcare Delivery
Event: Stanford Medicine X
Presentation Date: Sunday, September 17, 2017
Event Location: Stanford University, Palo Alto, California, USA

How might we re-envision the hospital going forward?

Designers can walk the halls and talk to clinicians, but it can be challenging to learn the intricacies of a profession and its details of practice. Hybrid professionals can provide integrated solutions which cross disciplines in new ways, thus bridging this gap. Encouraging architects to experience medicine from a perspective that is typically hidden and allowing physicians to realize how design can create a context for participation would allow for a deeper understanding of health care delivery. By applying design-thinking to medicine, multidisciplinary approaches for solving current health care challenges can be developed.

Can architectural design impact health care delivery?

A 1984 study changed the way architects design health care spaces. Post-operative patients assigned to a room with a nature view had shorter hospital stays, took fewer analgesics and received fewer negative evaluative comments. This marked the advent of Evidence-Based Design (EBD), now standard practice in health facility design. Architects moved away from design decisions based solely on tradition or opinion, and towards built environments grounded in credible research to achieve the best possible outcomes- analogous to physicians utilizing evidence in making patient care plans. EBD research has demonstrated that design interventions can impact patient outcomes by decreasing iatrogenic infections, medical errors, and length of hospitalization. The business case demonstrates ongoing operating savings when the market share impact of EBD interventions is realized.

What is the model for architects and clinicians to work together towards a common goal of evidence-based practice?

Despite this shift towards evidence-based practice, hospitalization can often result in complications unrelated to the reason for admission, followed by an irreversible decline in functional status and quality of life. Certain aspects of hospital design can contribute to this decline. Although there is no therapeutic value to bed rest, patient rooms have remained focused around the bed. How can we re-envision design to shift the focus to early mobility? Design guidelines set minimum standards for single-patient rooms given evidence for improved privacy, infection control, and quality of care. How can design find a balance between privacy and easy physical and visual accessibilities? Research has demonstrated that certain room layouts are more conducive to clinician interactions and therefore improved teamwork. Should we begin to move away from a one-size-fits-all model for patient room design?

It may be time to disrupt our current thinking and reinvent best practice design trends.

Can we leverage architectural design to solve health care challenges?

Despite the inclusion of clinicians into the design and construction process, there remains disconnect between the initial vision of those who design the hospital and final clinical use of the space.

Conference Presentations

Peek into the Future of Hospitals: Smart Design, Technologies and Our Homes

June 6, 2017 / Dochitect / Evidence-Based Design

Commentaries

Publication: The Medical Futurist Website & Newsletter
Publication Date: June 6, 2017
Authors: Dr. Bertalan Mesko (The Medical Futurist) & Dr. Diana Anderson (The Dochitect)
View article

Excerpt: A simple, round table with a desktop computer and a projector, where the patient and the doctor have their friendly chat. Whenever an examination is necessary, they cross the “blue line” in the room indicating the “boundaries of the clinic” elegantly. It’s definitely not rocket science, but the patient satisfaction index is soaring. What’s the secret?

Click here to read more about The Medical Futurist and The Dochitect ideas on the Future of Hospitals!

Commentaries

Therapeutic Sanatorium Design: Where Hospital Architecture & Medical Practice Converge

February 25, 2017 / Dochitect / Evidence-Based Design, The Physician-Architect Model

Presentations

Organization: Texas A&M Health Science Center
Event: 2nd International History of Medicine Symposium
Location: Bryan, Texas
Date: February 25, 2017

Dochitect delivers the Keynote Address at the 2nd International Symposium on the History of Medicine and Related Disciplines, presenting the historical convergence between Medicine and Architecture.

As Keynote Speaker, Dochitect was introduced by Kirk Hamilton, Fellow & Associate Director of the Center for Health Systems & Design and Professor of Architecture at Texas A&M University.

ABSTRACT

Historical overview
The notion of our health is no longer identified primarily by the absence of illness, but instead has expanded to include a general state of well-being. In medicine, as in architecture, it seems that our ambition for total well-being has become fragmented, due in part to the subspecialisation of medical science, in addition to the rise of complex chronic illness and the need for multiple buildings types for delivering care- from our homes to traditional hospital buildings and now freestanding ambulatory centers.

The sanatorium as therapeutic architecture
The histories of hospital architecture and medical practices have rarely converged. The design of the tuberculosis sanatorium during the early 20^th century illustrates this infrequent intersection; the healthy building emphasizing contact with nature, developed to prevent the spread of contagions by isolating patients and preparing them for a return to normal life. As it preceded the era of antibiotic therapy, the sanatorium model did not necessarily offer any true effective treatment. With the advent of pharmaceutical treatments and critical care technology, hospital design moved into a more industrial period of machine-like centers designed to provide all levels of life-sustaining care. While medical science can often disguise mortality with technology, we are now revisiting the sanatorium model to de-medicalize architecture.

The future of healthy design
How do clinicians and architects find a balance between illness, health, and design? To consider therapeutic design as a possible form of treatment requires participation of both the patient and the caregiver. It may be time to shift our thinking and develop healthcare architecture focused on prevention, rehabilitation, and independent living by taking lessons from the sanatorium model. A future in which design of collective spaces can promote this convergence of care alongside cure should be our goal.

Keynote Presentations

Healthcare Design from a Universal Design Approach

May 5, 2016 / Dochitect / Evidence-Based Design

In The News

Organization: The Centre for Excellence in Universal Design (CEUD)
Event: Presentation on Universal Design in Healthcare
Location: Dublin, Ireland
Date: May 5, 2016

Universal Design is the design and composition of an environment so that it can be accessed, understood and used to the greatest extent possible by all people regardless of their age, size, ability or disability.

During this presentation, Dochitect discusses the application of a Universal Design approach in healthcare environments. The presentation looked at how hospitals and healthcare buildings can be designed from a Universal Design approach in order to:

– Improve care delivery and patient experience
– Prevent clinician burnout
– Integrate caregivers and family needs
– Foster interdisciplinary collaboration for improved care
– Address the changing practice of healthcare
– Apply design-thinking to medicine for enhanced efficiency

Click here to view the presentation slides.

Click here to view the keynote presentation video.

Keynote Presentations

Hearing hoofbeats: time to think zebras?

April 13, 2016 / Dochitect / Evidence-Based Design

Commentaries

Website: The SALUS Global Knowledge Exchange
Date: Published online April 13, 2016
Author: Diana Anderson, MD
View article

In medicine, the old adage goes: “when you hear hoofbeats, think of horses not zebras”.

This nugget of wisdom is attributed to Dr Theodore Woodward, professor at the University of Maryland’s School of Medicine, as he instructed his medical interns during the late 1940s on diagnosing an illness based on the presenting of symptoms.

The logic of Dr Woodward’s advice follows that since horses are common in Maryland while zebras are relatively rare, one could reason confidently that the sound of hoofbeats is more likely to derive form a horse than a zebra. Medically, this translates as doctors analysing symptoms and checking initially for common ailments, not rare conditions. By 1960, the aphorism was widely known in medical circles. Diagnosticians have noted that “zebra-type” diagnoses must nonetheless be held in mind until evidence conclusively rules them out.

But applying this adage to architecture reveals a key question: are we too often considering “horses” for our hospital designs? Can we push the boundaries of design and convert healthcare design from a reactive process to one that is proactive, planning for what is to come? I propose three disruptive design ideas in order to challenge a relatively unchanged healthcare model.

Should the patient bed be the focal point of the room design?
Can corridors become more than an eight-foot wide wayfinding path?
On-stage/off-stage – is separation of flows the answer?

Commentaries

Epidemiology of Hospital System Patient Falls: A Retrospective Analysis

April 8, 2015 / Dochitect / Evidence-Based Design

Peer-Reviewed Publication

Publication: American Journal of Medical Quality
Publication Date: Am J Med Qual. 2015 Apr 8. pii: 1062860615581199.
Authors: Diana C. Anderson, MD, MArch, Thomas S. Postler, PHD, Thuy-Tien Dam, MD

Abstract

Patient falls are the most common type of in-hospital accidents. The objective of this retrospective descriptive study was to describe the locations and characteristics of hospital-related falls. Data on patient characteristics, including locations and fall circumstances, were collected through incident reports and medical records. A total of 1822 falls were documented at a 921-bed, urban academic hospital center over a one-year period; 1767 (97.0%) of the falls occurred in the hospital setting, 55 (3.0%) in ambulatory care. The majority of falls (80.8%) occurred within inpatient units; the remainder within the greater hospital campus. In all, 73.4% of fallers had fall prevention protocols implemented prior to the fall. The youngest age group (≤49 years) had the highest percentage of fallers. This study provides novel insights into variables found to be associated with falling, including location of falls within the hospital campus, efficacy of fall prevention protocols, and age groups.

Additional Press:

Note This research was presented at Medicine Grand Rounds, Department of Internal Medicine Resident Research Day, Columbia University Medical Center, March 26, 2014:

2014 Resident Research Poster_compressed copy

Lectures, Peer-Reviewed Publications

Using evidence based design to produce healthier hospital buildings

September 14, 2013 / Dochitect / Evidence-Based Design

Peer-Reviewed Publications

Publication: British Medical Journal (BMJ) Careers
Publication Date: September 14, 2013
Authors: D. Kirk Hamilton, BArch, MSOD; Diana C. Anderson, MD, MArch
View article

Excerpt: Evidence about how architecture affects staff and patients is increasingly influencing the hospital design. Diana Anderson, a qualified architect and hospital doctor and Kirk Hamilton, an architect now working in academia after 30 years of practice, provide an international perspective on the issues involved.

Diana Anderson describes the personal experiences of poor hospital design:

I am a resident physician, and a large part of my hesitation in pursuing advanced clinical training was because of what I considered an intolerable hospital setting. Staff facilities are frequently without windows or art, and I have found myself desperately anticipating the first ray of sunlight after a long shift. Working in environments with constant noise from ventilator and infusion alarms, floor polishers, telephones, pagers, and staff discussions creates an ongoing battle to work effectively, or to hold private, often life changing discussions with patients.

During my initial time working in hospitals I often wondered whether anyone asked the clinicians about their opinions on the design and function of their work environments, and whether it has been recognised that the characteristics of the physical environment can enhance or hinder productivity, and can reduce the stress associated with our work and the condition of our patients. On my obstetrics rotation as a medical student the call rooms were located several floors above the labour and delivery unit, meaning we often missed deliveries, and so we learnt not to use the suite, and we slept in chairs closer to our patients. On patient units that did not provide space for respite, I found myself retreating to the supply rooms to gain composure during overwhelming moments. As a physician, a licensed architect, and a patient, I believe that many planned spaces are ill suited to their actual use.

Click here to view the full article on evidence-based design and healthier hospital buildings.

Peer-Reviewed Publications

Bridging the Gap: Multidisciplinary Collaboration in Medicine and Architecture

May 1, 2011 / Dochitect / Evidence-Based Design

Peer-Reviewed Publications

Publication: University of Toronto Medical Journal
Publication Reference: 2011;88(3):129-134.
Authors: Elizabeth Viets-Schmitz, AIA; Diana Anderson, MD, MArch.
View article

2011_UTMJ COVER As the world becomes increasingly connected and information is freely shared, a trend toward interdisciplinary collaboration is taking place in both industry and education. This trend is highlighted by recent collaboration between clinicians and architects in both research and design. In the design of healthcare spaces, architects are working with clinicians and researchers to employ an evidence-based approach to making design decisions.

The advent of Evidence-Based Design represents a shift from basing design decisions solely on tradition or opinion to an approach that emphasizes the importance of using credible research to inform design decisions. The research expertise of clinicians is vital to the practice of Evidence-Based Design, which traces its origins to the well-established concepts of Evidence-Based Medicine. In the context of healthcare, Evidence-Based Design focuses on design interventions that help make hospitals safer and more comfortable for patients and staff, that promote healing, and that are fiscally sustainable.

Through case studies and other examples, this paper illustrates how the growing body of credible research regarding the impact of the built environment on people creates unique opportunities for architects and clinicians to work together toward a common goal of evidence-based practice.

Peer-Reviewed Publications

Humanizing the Hospital: Design Lessons from a Finnish Sanatorium

August 10, 2010 / Dochitect / Evidence-Based Design

Peer-Reviewed Publications

Publication: Canadian Medical Association Journal (CMAJ)
Publication Date: First published online Sept 21, 2009. In print August 10, 2010;182(11):E535-E537.
Author: Diana C. Anderson, MD, MArch
View article

As medicine has moved toward evidence-based practice, so too has hospital design, which is increasingly guided by research linking physical environments to health care outcomes through the process of evidence-based design. The Paimio Sanatorium, built in the early 1930s in the southwest portion of Finland and designed by the architect Alvar Aalto, demonstrates an appreciation for good design and the ambition to create healing environments that emulate nature.

Prior to the development of evidence-based design, Alvar Aalto created a healing environment addressing each patient’s psychological and social needs. Just as the starting point in the Paimio Sanatorium design was the individual whose privacy and comfort were of central importance, the current field of evidence-based hospital design emulates this focus of the physical setting as therapeutic.

Peer-Reviewed Publications

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