CVA. Implementa<on of Evidence Based Design Peter Fröst. Building for be.er healthcare TU Del' symposium friday 17th of October

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1 CVA Centrum för Vårdens Arkitektur Centre for Healthcare Architecture Building for be.er healthcare TU Del' symposium friday 17th of October Implementa<on of Evidence Based Design Peter Fröst

2 CVA Centrum för Vårdens Arkitektur Centre for Healthcare Architecture The Center for Healthcare Architecture (CVA) is a na>onal arena for the crea>on, transla>on, exchange and dissemina>on of knowledge about healthcare architecture in Sweden.

3 CVA Centrum för Vårdens Arkitektur Centre for Healthcare Architecture Peter Fröst, PhD, Professor ar>s>c, director. Chris>ne Hammarling, Adjunct professor Roger Ulrich, PhD, Guest professor Inga Malmqvist, PhD, Assistant professor, senior researcher. Marie Strid, PhD, Project leader, Vice dean Göran Lindahl, PhD, Associate Professor, senior researcher Josefina Hinnerson, PhD, Project leader Marie Elf, PhD, PhD, Associate Professor, senior researcher Morgan Andersson, PhD, Guest researcher Sophy Sapan Longe, Coordinator + 10 PhD students

4 Centrum för Vårdens Arkitektur - CVA Healthcare Architecture Interna>onal Master Program Future visions for Healthcare, Housing & Work Two Studios 22,5 crits students annually Started 1998 Healthcare Studio CARE FOR U Jens Axelsson, Maria Hagejärd & Jenny Nyström Examiners Peter Fröst and Inga Malmqvist, Chalmers

5 How do we know what to build? During the 60s, the Swedish Building Research Ins<tute undertook kitchen studies and measured f ex load / oxygen uptake during dish washing and movement paterns for different ac<vi<es.

6 Norms and standards - kitchen Från forskningen utformades en köksstandard. Standarden blev norm och förutsättning för statliga bostadslån samt bygglov.

7 Standard kitchen - func<onal and prac<cal. Based on research. Kitchen design

8 Centrum för Vårdens Arkitektur - CVA

9 Centrum för Vårdens Arkitektur - CVA Norms and standards - Hospitals

10 The kitchen - customer driven, experience, recrea<on, consumer goods, status symbol, dream... Kitchen of the furure

11 Healthcare of the future Rapid development, new therapies, new medical technology, ICT, demography

12 Centrum för Vårdens Arkitektur - CVA Normative Dynamic Integrated planning model Normative Standards Guideline Knowledge development is handled centrally Dynamic Staffparticipation Tailored solutions Knowledge development is handled locally Integrated planning model Dialogues about Space and Activity based on knowledge from research (evidence) and practice

13 Centrum för Vårdens Arkitektur - CVA Evidence- based concept program for healthcare facili>es Na<onal coordina<on of knowledge and research about Healthcare Architecture. Implementa<on of Evidence based design in the na<onal concept programs Coordina>on Innova>on = Dialogue Na>onal network

14 Collabora>on Chalmers and PTS Forum "Evidence- based concept program for healthcare facili<es" Conducted by the Center for Healthcare Architecture at Chalmers on behalf of and funded by the PTS Forum

15 Evidence based concept programs The Good Hospital Ward

16 Centrum för Vårdens Arkitektur - CVA Evidence Base for Healthcare Architecture Research that supports design decisions concerning Hospital Wards By Prof Roger Ulrich in connec<on with the Good Ward In Swedish

17 The process is organised in collabora<ve cross disciplinary and mul< professional workshops with health care planners, staff, researchers, architects and other experts

18 Design of single- pa>ent rooms

19 3D

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21 Design of the func<onal unit

22 Care module with eight rooms

23 High Tech Healthcare Environments for Intensive Care (ICU) and Opera>on (OP) Evidence based concept programs

24 Opera>on

25 Research about OP Environment Distrac>ons - Opera<on requires maximum aten<on and concentra<on from the opera<ng staff during the rela<vely long period of <me. On average, there are about 60 interrup<ons or distrac<ons during surgery. The more severe injured pa<ents, the more interrup<ons. The most common cause distrac<ons during surgery is that the personnel involved in the opera<ng room. (Pereira, 2011), (Primus 2007)

26 Research about OP Environment Ligh>ng - Research shows that ergonomic ligh<ng that can be adapted for all types of interven<ons can help avoid injuries such as for example back pain. A recommenda<on for ligh<ng in the opera<ng room, based on some studies, is to create a more uniform illumina<on. This means that raising the general room ligh<ng and reduce light intensity at the opera<ng lamp/the wound. (Hemphälä et al, 2011), (Douglas, 2010), (Fanning, 2005)

27 Research about OP Environment Hygiene It is the staff and the pa<ent in the opera<ng room which are the main sources of infec<on. With modern opera<ng standards, hygiene, clothing and good ven<la<on system you can achieve high air purity. To achieve good results, human factors and procedures are at least as important as technical solu<ons. (Erichsen 2013, Dharan, 2002, Chow 2005)

28 OP- room

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30 OP- unit

31 OP- unit

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33 ICU Intensive care

34 Research about ICU Family presence Single- pa<ent rooms are important for family support. You can spend a long <me with the pa<ent without disturbing. Moreover, one can be involved in the care and thus feel that it helps the pa<ent. Rela<ves' presence also reduces anxiety for pa<ents and supports recovery. Related par<es' presence also facilitates frequent communica<on between pa<ent and medical staff. (Wahlin, 2009). (Fridh, 2009, Bergbom, 2000).

35 Research about ICU Views to nature affects pa<ents' recovery and may reduce the intake of sleep and pain relieving medicines and hospitaliza<on. It contributes to the posi<ve distrac<on, to reduce stress, promote more posi<ve feelings and support recovery. The possibility of outlooks are also posi<ve for families and personnel. (Kaplan, 2007; Devlin and Arneill, 2003, Whitehouse et al, 2001)

36 Research about ICU Finishing and interior materials Many of the symptoms of ICU- delirium can be caused by improperly designed physical environment around the pa<ent. Examples of interior design that can affect pa<ent experience nega<ve during ICU stay can be - perforated or paterned ceilings, ceiling hoists, ceiling- mounted scales, ligh<ng fixtures, ven<la<on, light from computer screens, etc.. (Bergbom Fridh, Forsberg, Eriksson, 2009).

37 Func>onal space requierments

38 IVU- module A, plan This op<on enables antechamber (and airlock without bed transport).

39 ICU - unit

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41 View from the single- pa<ent room into neighboring room through the sliding glass door

42 View from the monitoring / worksta<on into the pa<ent room

43 View from the ICU bed with the outlook and the ability to family/ rela<ve contact

44 Evidence based concept programs for administra>ve workplaces in healthcare

45 Doctors in Sweden spend 50% of their work >me on administra>on Edvardsson, J, Arnholdt- Olsson, A och Jeppson, B. Mer <d för pa<enten hos läkare i England En jämförande <dsstudie av svenska och engelska läkares arbetsdag. Läkar&dningen. 2014;111:CUWE

46 Research about administra>ve work Noise One of the most prominent problems in open office is noise and lack of privacy. Research have shown that what is most bothering is not the loudest noise but voices, phones and other meaningful informa<on from other colleagues etc Sundstrom, E., Town, J. P., Rice, R. W., Osborn, D. P., & Brill, M. (1994). Office noise, sa<sfac<on, and performance. Environment and Behavior, 26(2),

47 Research about administra>ve work Collabora>on How to place the employees in administra<ve units are very important for how the mee<ngs and interac<on occurs. The probability that two people will communicate as a func<on of the distance between them. Allen, T and Fusfeld, A. Research Laboratory Architecture and the Structuring of Communica<ons. January 1974 #692-74

48 Research about administra>ve work Self- control Ac<vity based offices (Flex offices) together with cell offices is significantly beter than other office types when it comes to health, job sa<sfac<on and sa<sfac<on with the office environment. An explana<on is that it promotes (and is based on) a high degree of self- control, the possibility of choosing workplace and thus the degree of privacy. Bodin Danielsson, C., & Bodin, L. (2008). Office type in rela<on to health, well- being, and job sa<sfac<on among employees. Environment and Behavior, 40(5),

49 Non- pa<ent - integrated workplaces, i.e doctors offices Pa<ent- integrated workplaces Presence in percent on a representa<ve selec<on of administra<ve workplaces in hospitals in Sweden 27 departments, visited three <mes/workday, totally on 1072 occasions. Mean value = 35 %.

50 Concepts We introduce a new approach where also the administra<ve workspaces are designed to be ac<vity- based and needs- driven, just like clinical spaces. We call these ac<vity- based administra<ve workplaces for healthcare. From private offices and mee<ng rooms to a palete of features for different needs

51 Concepts The report surveys indicate that u<liza<on of integrated administra<ve worksta<ons are rela<vely high. In addi<on, the need for more care near workplaces where iden<fied through follow studies. Pa<ent - integrated administra<ve workplaces for direct pa<ent work needs to be developed by adding both more concentrated workplaces as well as new types that supports collabora<on and team work.

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57 Concepts The project's survey indicates that u<liza<on of non- pa<ent integrated workplaces is very low. These premises consists today mainly of cellular offices (mostly private) or shared rooms. The concept therefore propose that administra<ve areas for the indirect care work can be streamlined and made more efficient through a more ac<vity- based design.

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62 htp://pts.lj.se/forskning Thank You!