Forum -- Hälsofrämjande vårdmiljöer Skånes universitetssjukhus, Malmö. Evidence-based design: Recent developments. Roger S. Ulrich, Ph.D. Center for Healthcare Building Research Department of Architecture Chalmers University of Technology. Design/research questions: .
Forum -- Hälsofrämjande vårdmiljöer Skånes universitetssjukhus, Malmö
Roger S. Ulrich, Ph.D.
Center for Healthcare Building Research
Department of Architecture
Chalmers University of Technology
1.The ‘Beautiful Room Effect’(Maslow and Mintz, 1956)
Implication: An attractive room may produce a more positive emotional state and judgment disposition that generalizes to more favorable perceptions of other persons in the space
2.Service Quality Theory and Research (Parasuraman et al., 1985; Berry and Bendapudi, 2003)
Research findings: Consistent with service quality theory, a growing amount of research has shown that attractive waiting rooms increase patients’ overall satisfaction with care
From: K. M. Leddy (2005)
Press Ganey Associates
Based on data from 1,201,559 patients treated at 4,392 medical practice offices throughout U.S. (January - December, 2004)
Satisfaction with Care Experience by Amount of Time Spent in Waiting Room and Comfort of Clinic Waiting Room
Length of Wait (minutes)
R. Ulrich. Data source: Press Ganey, 2005
Emergency department waiting room where stress, long waits, and low satisfaction are problems
Emergency Department Waiting Room - with garden views to reduce stress, aggression, increase satisfaction
Design: ZGF and Robert Murase
Comments on the report from HTA-centrum (Sahlgrenska) titled:
“Enklerum eller flerbäddsrum på sjukhusavdelning”
Increased infection risk from havingone roommate with a positive culture
Implication: providing single rooms for patients substantially reduces risk of acquiring an infection
STUDY: Converting an intensive care unit to single rooms substantially reduces infection
STUDY: Exposure to hospital roommates as a risk factor for healthcare-associated infection
Examples of studies reporting that single rooms reduce MRSA, VRE, and/or C. difficile
Ben-Abraham, Keller, Szold, Vardi, Weinberg, Barzilay, et al. (2002). Journal of Critical Care.
Berild, D., Smaabrekke, L., Halvorsen, D. S., Lelek, M., Stahlsberg, E. M. & Ringertz, S. H. (2003). Journal of Hospital Infection.
Byers, Anglim, Anneski, Teresa, Gold, & Durbin (2001). Infection Control and Hospital Epidemiology.
Cheng, Tai, Chan, Lau, Chan, et al. (2010). BMC Infectious Diseases.
Gastmeier, Schwab, Geffers & Ruden (2004). Infection Control and Hospital Epidemiology.
Jernigan, Titus, Groschel, Getchell-White, & Farr (1996). American Journal of Epidemiology.
Wigglesworth & Wilcox (2006). Journal of Hospital Infection.
Zhou et al. (2008). Infection Control and Hospital Epidemiology.
(Kaldenburg, 1999; Chaudhury et al., 2003)
Healthcare associated infections
Staff observation of patients
Confidentiality of information
Presence of family
Patient privacy and dignity
Avoid mixed-sex accommodation
End-of-life with dignity
Staff work effectiveness
Reducing room transfers
Adapt to handle high acuity
Managing bed availability
Initial construction costs
Operations and whole life costs
Dr. Charles McLauglan in Hospital Doctor(February 2006)Director of professional standards, Royal College of Anaesthetists
“With single rooms, we need state-of-the-art monitoring equipment because we have not got line-of-sight for the nursing staff.”
‘State-of-the-art monitoring equipment’ in a Canadian hospital built 40 years ago
Toronto General Hospital
Patients with experience with both multi-bed and single rooms
Adults with little or no experience with single rooms
source: NHS Estates & BMRB, 2002
source: Lawson and Phiri, 2003
(after Kaldenburg, 1999-2003)
With roommate Single room
Effects of patient choice on public and private hospital revenues in one UK health region (2005)
Financial Impact of Patient Choice in the Birmingham and Black Country Strategic Health Authority (SHA)
MORI Social Research Institute, 2005
Report prepared for U.K. National Health Services (NHS)
How much have you heard about the patient choice initiative?
A great deal
A fair amount
Just a little
Nothing at all
How much do you think the private sector is better than the NHS in these areas of activity?
source: 1,201 residents,MORI Birmingham SHA study, 2005
Single rooms improve all these outcomes
Flexibility about visiting
(source: Independent Healthcare Forum)
> SEK 600,000,000 at 2005 currency rates
-- Peter Pilsbury, Director of Strategy, Birmingham/Black Country SHA (in HSJ)
156 single rooms
167 single rooms
Everywhere: strong pressures to reduce or control costs but increase quality
Concerning the report from HTA-centrum titled: “Enklerum eler flerbäddsrum på sjukhusavdelning”