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Designing a Healthy Work Environment Architecture-Operations-Technology. Integrating the Process. Learning Objectives. Discover the role of the nurse in healthcare design and determine how nurses can be leaders.

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designing a healthy work environment architecture operations technology

Designing a Healthy Work EnvironmentArchitecture-Operations-Technology

Integrating the Process


Learning Objectives

  • Discoverthe role of the nurse in healthcare design and determine how nurses can be leaders.
  • Learn about evidence based design and list areas of design that have been proven to improve patient outcomes.
  • Learn current design and technology trends and relate those scenarios to their current work environment.
  • Identify nurse leadership initiatives to align the architecture and technology to support processes and work flow.
design focus patient care delivery
Design Focus –Patient Care Delivery

Vanderbilt Nursing



patient care delivery
Patient Care Delivery


  • Open Wards
  • Semi Private Rooms
  • Centralized Nursing
  • 8 hours shifts
  • Rolling Medicine Carts
patient care delivery1
Patient Care Delivery


  • Private Rooms
  • Decentralized Nursing
  • 12 hours shifts
  • Bar Code Medication
  • Patient Entertainment
  • Family Area
designing a healthy work environment
Designing a Healthy WorkEnvironment

Support and optimize the delivery of care models through architecture and technology

nursing roles in healthcare design
Nursing Roles in Healthcare Design
  • Nurses have unique perspectives
    • Patient Safety
    • Family/Care giver needs
    • Physician Interactions
    • Infection Control
    • Working with Teams
    • Work flow and processes
    • Medication Safety
nursing roles in healthcare design1
Nursing Roles in Healthcare Design
  • HIPAA Compliance
  • Communication
  • Organizational Culture
  • Organizational Initiatives
  • Care model/Patient care philosophy
  • Critical thinking skills
  • Outcomes oriented
new nurse competencies needed
New Nurse Competencies Needed
  • Interdisciplinary leadership
  • Communication & relationship building
  • Knowledge of the healthcare environment
  • Business skills
  • Professionalism
  • Transformational leadership

Stichler, JF (2007). Nurse Executive Leadership Competencies for Health Facility Design. JONA, 37(3), 109-112.

leadership roles and responsibilities
Leadership Roles and Responsibilities
  • Nurse Executive
    • Validating that the design supports the strategic vision, mission, values and culture of the organization
    • Stay involved
  • Chief Nursing Officer
    • Ensuring that the design supports the professional practice model
    • Insure project continuity
leadership roles and responsibilities1
Leadership Roles and Responsibilities
  • Director
    • Articulating how the design will affect costs, market share, satisfaction levels
    • Design principles metrics
    • Change management
    • Policies and procedures
    • Training
leadership roles and responsibilities2
Leadership Roles and Responsibilities
  • Manager
    • Determining how the design affects staffing and patient flow
    • Giving staff time to participate
    • Create enthusiasm
    • Team Builder
    • Staffing
leadership roles and responsibilities3
Leadership Roles and Responsibilities
  • Staff Nurse
    • Giving input to the architect team
    • Soliciting creative ideas
    • “Being present”
    • Team Supporter
  • Nurse Project Manager
    • Coordinating the interdisciplinary process of design, giving a voice to all providers and patients
leadership roles and responsibilities4
Leadership Roles and Responsibilities
  • Nurse Project Director
    • Managing millions or billions of dollars; keeping the project on time and within budget
    • Big picture/managing details
  • Nurse Consultant
    • Internal to the organization or external in the architects office
    • Integrating the voice of nursing patient care and design
    • Who’s on the project team?
leadership roles and responsibilities5
Leadership Roles and Responsibilities
  • Nurse Architect/Designer
    • Interfacing the design world with health care
  • Nurse Researcher
  • Nurse Technology Expert on work flow analysis
evidence based design
Evidence based design

Evidence based design is the intentional attempt to base design and construction decisions on “evidence” or “research” to improve outcomes for patients and staff.



Evidence based



It may seem a strange

principle to enunciate as the

very first requirement in a

Hospital that it should do the

sick no harm.

Florence Nightingale, 1859

design research
Design research
  • Group of researchers from Texas A&M and GeorgiaTech combed through several thousand scientific articles.
  • More than 600 research studies were found that establish a link between hospital design and improved outcomes for patients and staff.
  • The studies were assessed on their rigor, quality of research design, sample sizes and degree of control.
Links were identified between hospital design and improved outcomes for patients & staff in the following areas:
  • Patient confidentiality
  • Noise
  • Nature
  • Daylight
  • Positive distraction
  • Social support
  • Improved communication
  • Medication errors
  • Patient falls
  • Infection control
  • Ergonomic design
  • Improved layout for reduced steps
  • Consistency in design

Healthcare Work Environment

(Architectural/Engineering Perspective)

  • Square Footage Requirements
  • Building Codes and Regulations
  • Space Planning
  • Adjacencies
  • Infrastructure

Used by permission: Roger K. Lewis, FAIA, Architect & Planner Columnist, "Shaping the City," The Washington Post, Professor Emeritus, University of Maryland School of Architecture, Planning and Preservation

healthcare work environment clinical perspective
Healthcare Work Environment(Clinical Perspective)
  • Healthcare Setting
  • Work Processes
  • Workforce Demographics
  • Culture and Geographic Location
  • Information Technology

You have to understand how a nurse works in a room in order to design it well

design process vs the nursing process
Nursing ProcessDesign Process vs. the Nursing Process
  • Assessment
  • Planning
  • Intervention
  • Evaluation

Design Process


Schematic Design

Design Development

Contract Documents


inpatient unit influences on design
Inpatient Unit Influences on Design
  • Operational Model
      • Care Delivery Philosophy
  • Patient Population
      • Specialty, Geriatrics, etc.
  • Teaching vs Non-Teaching
  • Staffing
    • Unit Secretary
    • Team
    • Physician Specialty

HKS Architects

inpatient unit influences on design1
Inpatient Unit Influences on Design
  • Processes
      • Supplies
      • Medications
      • Other Services
  • Communication
    • Workflow & Devices
  • Documentation
design trends
Design Trends
  • Charting Alcoves
  • Computerized Charting
  • Meaningful Use
  • Nurse Servers
  • Bar-coding
  • RFID
design trends more systems
Design Trends = More Systems
  • OR Integration
  • Nurse Call
  • DAS
  • Telemetry
  • Network Hardware
  • Physiomonitoring
  • Security
  • Emergency Power
private rooms
Private Rooms
  • Widely accepted as most beneficial.
  • Implemented in almost all hospitals.
  • Semi-private rooms generally occur only for:
    • Elderly patients who feel less

confused with roommate.

    • Veterans who appreciate

camaraderie of roommate.

    • Behavioral/Psychiatric settings
    • Small hospitals with too few resources.

Single-Handed Rooms


  • Concept is accepted by many organizations.
  • Standardization of all patients approached from same side is convenient and helps in responding to codes in room.
  • Some hospitals incorporated angled corner walls to increase view from hallway.

Single-handed rooms


  • Limited evidence of being safer – difficult to judge because every patient is different.
  • Challenge to observe 2 patients at once from communication station outside rooms.
  • Extra cost for not having back to back toilets (no hard numbers for difference).
  • Pushback from nurses that they can’t adapt to mirror-imaged rooms.

Mirror-imaged rooms

nurse servers
Nurse Servers
  • Very convenient and saves time.
  • TJC had issue with contamination from patient to patient – everything in room must be taken out when terminally cleaned.
  • Now TJC accepts if minimum number of towels, linens, and supplies are put in cabinet. Need to make sure it is stocked appropriately and without unnecessary materials.
  • Issues:
  • Who stocks cabinet.
  • Building codes can require the door in the corridor to have a closer, which makes server hard to keep open.
  • Location can be inconvenient and hard to access from corridor and inside patient room.
  • Need to displace personal effects to use bedside table for treatment.
mini pyxis in each room with barcode technology
Mini Pyxis in each room with barcode technology
  • Reduces medication errors by ensuring correct medicine and dosage.
  • Better than barcode medication administration because it is not interrupted by leaving to get medicine once scanned.
  • Provides charge, capture, and inventory management.
  • Operational issue: who stocks machine and how often.
patient lifts
Patient Lifts
  • Infrastructure of steel supports above ceiling being built in.
  • More institutions want lifts in every room. Now only a percentage

of rooms get lifts – typically in bariatric rooms.

  • H-type gantry lift (moves in 4 directions) is preferred over the

single rail lift, which has less flexibility.

  • Some hospitals have lifts into bathrooms.
  • Some hospitals utilize lift teams.
  • Issues:
    • Because lifts are not in every room, nurses often don’t know how to use them.
    • Need education included in lift purchase.
    • Many lifts don’t have the necessary lift ability of 1000 pounds.
bariatric design
Bariatric Design
  • Need more bariatric rooms to allow for increase in heavier patients.
  • Issue of hygiene – make bariatric rooms with wet rooms with drains, hoses, and a hazmat containment pool.
  • Problem with bathroom – need greater

distance from wall for bariatric patients,

but that exceeds

the code for ADA.

consoles for patient controls
Consoles for Patient Controls
  • One console controls TV, lighting, draperies, music, and call system for nurse.
  • Wireless keyboards for internet, communication, controls, and meal selection.
locator systems
Locator Systems
  • Equipment: Keeps track of all equipment in hospital – helps locate and maintain inventory.
  • Patients: Especially helpful in ER – reduces need for security and helps monitor vulnerable and dangerous patients.
  • Staff: Very beneficial for ER and Specialty Services staff. Mostly used with Nurse Calls.
healthcare technology trends
Healthcare Technology Trends


  • Take dietary orders with filter for patient’s specific dietary needs and deliver meal trays.
  • Remote doctor robot has doctor’s face on screen and 2-way communication from remote location. Allows for clinicians to be involved without having to be present.
integrated or suites
Integrated OR Suites
  • Simplifies the many components of the

operating room into one easy-to-use interface.

  • Helps nurses and surgeons make decisions with centralized control of medical devices and information.
                  • Attracts better surgeons and more patients, improves patient outcome and experience, and increases efficiency.
hand washing monitoring
Hand Washing Monitoring
  • Helps ensure compliance and increases frequency of staff washing hands
  • Improves patient safety by reducing spread of infections
operations today s practice environment
Operations: Today’sPracticeEnvironment

Technology ahead of practice transformation

healthcare technology trends1
Healthcare Technology Trends

Smart Beds

  • Alerts staff to changes in patient’s status and movement.
  • Can help reduce emergency reaction time.
  • Some issue with data overload due to info coming from Smart Beds and monitors.
healthcare technology trends2
Healthcare Technology Trends


  • Wireless Phones
  • IV Pumps
  • Telemetry Systems
  • Admitting Systems
  • Bed Exit Systems
  • Smoke Detectors
  • Staff Location, Infant
  • Security & Asset Tracking
  • Ventilators, Pulse Ox, AB Monitors, etc
documentation where how

Design Considerations

  • Philosophy
  • Budget
  • Devices
  • Flexibility

HKS Architects

HKS Architects

wireless communications
Wireless Communications
  • Improves staff to staff communication, patient to nurse communication, efficiency, and

patient satisfaction.

  • Reduces reaction time and overall

noise by eliminating paging.

  • Can also act as a recording device,

nurse call system, and a device alarm.

  • Healthcare applications specifically designed for iPhone being adopted and more being developed.
  • Improves workflow process, reaction time, and efficiency.
  • Technology is widely accepted and easy to use.
ipad uses today in healthcare
iPad Uses Today In Healthcare
  • Physicians Rounds – Physicians use their iPads for EHR, POE, Personalized Team Census (signout), E-Ticket (billing), web-based paging, and their hospital emergency department (ED) dashboard.
  • Education, distraction and preparation - Child life specialists use it to help patients manage stress during their stay. They use the iPad to show patients how physicians prepare for surgery; to play games with patients; and to educate them about their procedures or conditions.
  • X-ray images, EKG results and other patient monitoring programs - Used in inpatient and out patient settings by home health, hospice care workers, nurses, dietitians and pharmacists.
  • Staff documentation – Entering the patients information on a screen that doesn’t require turning your back to the patient.
  • Speech therapy – Speech therapist uses iPad/iPhone app Proloquo2Go with stroke victims and autistic patients to enable patients to speak through the devices to their care team.
planning for the future
Planning for the Future

Mobile Health

  • Wireless
  • DAS
  • Smart Phones
  • Tablets
  • Emergency Power
  • Telehealth

Challenges Foreseen

“The first rule of any technology used in a business is that automation applied to an efficient operation will magnify the efficiency. The second is that automation applied to an inefficient operation will magnify the inefficiency.”

Bill Gates

  • Increases efficiency
  • Reduces administrative work
  • Improves safety for patients and staff
  • Improves workflow processes
  • Better reaction times
  • Improves patient experience
  • Convenience
  • Many are easy to use
  • Improves communication and decision making
  • Difficult to change culture of routine and “old ways,” especially among older staff
  • Learning curve for some technology
  • Requires training
  • Data overload
  • Until staff are sure of devices, need backup – dual info
  • If not widely integrated, less likely to use or remember how to use
  • Not all advances have proven benefits
  • Evidence Based Design is improving the healthcare environment
  • A Nursing Advocate needs to be at the table
  • Technology is ahead of practice transformation
  • Designing for technology must become evidence based to improve healthcare delivery and determine best practices
operations focus
Operations: Focus


Corporate Vision

Clinical Vision

Architecture Vision

IT Vision


NIHD Founding

Board of Directors

healthcare design resources
Healthcare Design Resources
  • Nursing Institute for Healthcare Design ( NIHD)
  • Center for Health Design (CHD)
  • Joint Commission Resources
  • Institute for Healthcare Improvement
  • Agency for Healthcare Research and Quality (AHRQ)
  • Robert Wood Johnson Foundation (RWJF)
healthcare design journals
Healthcare Design Journals
  • Health Environments Research & Design Journal (HERD)
  • Facility Care
  • Healthcare Design
  • Journal of Nursing Administration- Healthcare Design Feature
  • Critical Care Nursing Quarterly – Design Issue
healthcare design conferences
Healthcare Design Conferences
  • Healthcare Design’13
    • November 16-19, 2013
    • Orlando, Florida
    • Nursing Institute for Healthcare Design
    • ASHE PDC 2014
      • March 16-19, 2014
      • Orlando, Florida

Debbie Gregory RN, BSN

Senior Clinical Consultant

SSR Technology Group

Smith, Seckman, Reid, Inc.


The Nursing Institute for Healthcare Design