The Spatial Layout Effect on the Restorative Quality of the Inpatient Ward Environment
Subject Areas : Health Management Services
Sareh Nikabadi
1
,
Hossein Zabihi
2
,
Azadeh Shahcheraghi
3
1 - Ph.D. Student, Department of Architecture, Science and Research Branch, Islamic Azad University, Tehran, Iran
2 - Associate Professor, Department of Urban Development, Science and Research Branch, Islamic Azad University, Tehran, Iran
3 - Associate Professor, Department of Architecture, Science and Research Branch, Islamic Azad University, Tehran, Iran
Keywords: Evidence-based design, Inpatient room, spatial layout, Length of stay, Data analysis,
Abstract :
Introduction: The study focused on examining the role of the spatial layout of hospital rooms on improving patients' outcomes with an interdisciplinary approach based on data science. Methods: The present research was mixed-method and done through coding in the Python programming environment. The research data included demographic characteristics, patients' history, and environmental characteristics collected through the health information system of the hospital (HIS) and field observation. This was a cross-sectional done in 2019 with a sample volume of 330 patients in the Omid hospital. Data correlation was measured by drawing a Heat map and chi-square test with a significant level of (α <0.05). The data clustering was done using the Cluster map. Results: According to the Chi-squared test results, two environmental characteristics including the number of beds and the view of windows were correlated with the length of hospital stay (LOS). According to the Heat map, the rooms' distance from the nursing station and the ward entrance with the correlation values of 0.69 and 0.76, respectively, compared with the size of the rooms with a correlation value of 0.5 was more correlated to the LOS. The effect of the room length compared to width was greater with 0.52 and 0.48 values, respectively. Either right or left-handedness of the rooms and the beds' distance of the window, did not correlate significantly with LOS. Conclusion: The results confirmed the effect of rooms' spatial layout on patients' recovery. This research was a step in the development of evidence-based design (EBD).
1- Heydari A.S, Bahrami M. A, Eslami S & Keshmiri F. Evaluation of the internal environment of teaching hospitals under the auspices of Yazd University of Medical Sciences based on a six-dimensional Weisboard model. Journal of Healthcare Management Research, 2014; 3(3): 53-62. [In Persian]
2- Nanda U, Pati D, Ghamari H, Bajema R. Lessons from neuroscience: form follows function, emotions follow form. Intelligent Buildings International, 2013; 5(sup1): 61-78. https://doi.org/10.1080/17508975.2013.807767
3- Durmisevic S, Ciftcioglu Ö. Knowledge modeling tool for evidence-based design. HERD: Health Environments Research & Design Journal, 2010; 3(3): 101-23. https://doi.org/10.1177/193758671000300310
4- Zhang Y, Tzortzopoulos P, Kagioglou M. Healing built-environment effects on health outcomes: Environment–occupant–health framework. Building research & information, 2019; 47(6): 747-66. https://doi.org/10.1080/09613218.2017.1411130
5- Lang J, Creating Architectural Theory, The Role of Behavioral Sciences inEnvironmental Design, Fourth Edition with Additions, Translated by Alireza Einifar, Tehran, Tehran University Press; 2002. [In Persian]
6- Tanja‐Dijkstra K, Pieterse ME. The psychological effects of the physical healthcare environment on healthcare personnel. Cochrane database of systematic reviews; 2011. https://doi.org/10.1002/14651858.CD006210.pub3
7- Dijkstra K, Pieterse M, Pruyn A. Physical environmental stimuli that turn healthcare facilities into healing environments through psychologically mediated effects: systematic review. Journal of advanced nursing, 2006; 56(2): 166-81. https://doi.org/10.1111/j.1365-2648.2006.03990.x.
8- Schweitzer M, Gilpin L, Frampton S. Healing spaces: elements of environmental design that make an impact on health. Journal of Alternative & Complementary Medicine, 2004; 10(1): S-71. https://doi.org/10.1089/acm.2004.10.S-71
9- Salonen H, Lahtinen M, Lappalainen S, Nevala N, Knibbs LD, Morawska L, Reijula K. Physical characteristics of the indoor environment that affect health and wellbeing in healthcare facilities: A review. Intelligent Buildings International, 2013; 5(1): 3-25. https://doi.org/10.1080/17508975.2013.764838
10- Harris PB, McBride G, Ross C, Curtis L. A place to heal: environmental sources of satisfaction among hospital patients 1. Journal of Applied Social Psychology, 2002; 32(6): 1276-99. https://doi.org/10.1111/j.1559-1816.2002.tb01436.x
11- Drahota A, Ward D, Mackenzie H, Stores R, Higgins B, Gal D, Dean TP. Sensory environment on health‐related outcomes of hospital patients. Cochrane Database of Systematic Reviews; 2012 (3). https://doi.org/10.1002/14651858.CD005315.pub2.
12- Ulrich RS. Effects of healthcare environmental design on medical outcomes. InDesign and Health: Proceedings of the Second International Conference on Health and Design. Stockholm, Sweden: Svensk Byggtjanst; 2001; 49: 59. yun.ir/14u8s8
13- Andrade C, Lima ML, Fornara F, Bonaiuto M. Users' views of hospital environmental quality: Validation of the perceived hospital environment quality indicators (PHEQIs). Journal of Environmental Psychology, 2012; 32(2): 97-111. https://doi.org/10.1016/j.jenvp.2011.12.001
14- Joseph A, Rashid M. The architecture of safety: hospital design. Current opinion in critical care, 2007; 13(6): 714-9. doi: 10.1097/MCC.0b013e3282f1be6e
15- Alereza Amiri M, Habib F, Shahcheraghi A. Evaluation of Components of Environmental Quality in Hospital, From a Naturalistic Perspective (Case Study of Shariati Hospital, Tehran). Journal of Healthcare Management Research, 2020; 10(34): 21-37. [In Persian]
16- Gao C, Zhang S. The restorative quality of patient ward environment: Tests of six dominant design characteristics. Building and Environment, 2020; 180: 107039. https://doi.org/10.1016/j.buildenv.2020.107039
17- MacAllister L, Zimring C, Ryherd E. Environmental variables that influence patient satisfaction: A review of the literature. HERD: Health Environments Research & Design Journal, 2016; 10(1): 155-69. https://doi.org/10.1177/1937586716660825
18- Greer V, Johnson E, Hsu J. Variables and Outcomes in Patient Room Design: A Study of Design Hypotheses. HERD: Health Environments Research & Design Journal, 2021; 14(2): 219-33. https://doi.org/10.1177/1937586720954952
19- Andrade CC, Devlin AS, Pereira CR, Lima ML. Do the hospital rooms make a difference for patients’ stress? A multilevel analysis of the role of perceived control, positive distraction, and social support. Journal of Environmental Psychology, 2017 1; 53: 63-72. https://doi.org/10.1016/j.jenvp.2017.06.008
20- De Korte EM, Spiekman M, Hoes-van Oeffelen L, van der Zande B, Vissenberg G, Huiskes G, Kuijt-Evers LF. Personal environmental control: Effects of pre-set conditions for heating and lighting on personal settings, task performance and comfort experience. Building and Environment, 2015; 86: 166-76. https://doi.org/10.1016/j.buildenv.2015.01.002
21- Andrade CC, Lima ML, Devlin AS, Hernández B. Is it the place or the people? Disentangling the effects of hospitals’ physical and social environments on well-being. Environment and Behavior, 2016; 48(2): 299-323. http://dx.doi.org/10.1177/0013916514536182.
22- Mohammadesmaeil S, Kianmehr S. Data Mining as an Intangible Model of Information Therapy and Seeking Behaviors in Immune Deficiency Disease Specialists. Journal of Healthcare Management Research, 2021; 11(38): 7-17. [In Persian]
23- Halawa F, Madathil SC, Gittler A, Khasawneh MT. Advancing evidence-based healthcare facility design: a systematic literature review. Health Care Management Science, 2020; 23: 453-80. https://doi.org/10.1007/s10729-020-09506-4
24- Schreuder E, Lebesque L, Bottenheft C. Healing environments: What design factors really matter according to patients? An exploratory analysis. HERD: Health Environments Research & Design Journal, 2016; 10(1): 87-105. https://doi.org/10.1177/1937586716643951
25- Ullán AM, Belver MH, Fernández E, Serrano I, Delgado J, Herrero C. Hospital designs for patients of different ages: Preferences of hospitalized adolescents, nonhospitalized adolescents, parents, and clinical staff. Environment and Behavior, 2012; 44(5): 668-94. https://doi.org/10.1177/0013916511403802.
26- Nikabadi S, Zabihi H, Shahcheraghi A. Evaluating the Effective Factors of Hospital Rooms on Patients’ Recovery Using the Data Mining Method. HERD: Health Environments Research & Design Journal; 2021. https://doi.org/10.1177/19375867211031305
27- Verderber S. Dimensions of person-window transactionsin the hospital environment. Environment & Behavior, 1986; 18(4): 450-66. http://dx.doi.org/10.1177/0013916586184002
28- Sengke MM, Atmodiwirjo P, Yatmo YA, Johanes M. Design consideration for window placement to provide the view within the patient's visual range. Journal of Design and Built Environment, 2020; 20(1): 13-23. https://doi.org/10.22452/jdbe.vol20no1.2
29- MacAllister L, Zimring C, Ryherd E. Exploring the relationships between patient room layout and patient satisfaction. HERD: Health Environments Research & Design Journal, 2019; 12(1): 91-107. https://doi.org/10.1177/1937586718782163.
30- Cai H, Zimring C. Out of Sight, Out of Reach: Correlating spatial metrics of nurse station typology with nurses’ communication and co-awareness in an intensive care unit. In Proceedings of the 8th International Space Syntax Symposium, Santiago, Chile, 2012; 36: 381-391.
31- Choi YS, Lawler E, Boenecke CA, Ponatoski ER, Zimring CM. Developing a multi‐systemic fall prevention model, incorporating the physical environment, the care process and technology: a systematic review. Journal of advanced nursing, 2011; 67(12): 2501-24. https://doi.org/10.1111/j.1365-2648.2011.05672.x
32- Gurascio-Howard L, Malloch K. Centralized and decentralized nurse station design: An examination of caregiver communication, work activities, and technology. HERD: Health Environments Research & Design Journal, 2007; 1(1): 44-57. https://doi.org/10.1177/193758670700100114
33- Nehrke MF, Morganti JB, Willrich R, Hulicka IM. Health status, room size, and activity level: Research in an institutional setting. Environment and Behavior, 1979; 11(4): 451-63. https://doi.org/10.1177/0013916579114002.
34- Huisman ER, Morales E, van Hoof J, Kort HS. Healing environment: A review of the impact of physical environmental factors on users. Building and environment, 2012; 58: 70-80. https://doi.org/10.1016/j.buildenv.2012.06.016
35- Van de Glind I, de Roode S, Goossensen A. Do patients in hospitals benefit from single rooms? A literature reviews. Health Policy, 2007; 84(2-3): 153-61. https://doi.org/10.1016/j.healthpol.2007.06.002
36- Chaudhury H, Mahmood A, Valente M. Advantages and disadvantages of single-versus multiple-occupancy rooms in acute care environments: a review and analysis of the literature. Environment and Behavior, 2005; 37(6): 760-86. https://doi.org/10.1177/0013916504272658
37- Ulrich RS, Zimring C, Zhu X, DuBose J, Seo HB, Choi YS, Quan X, Joseph A. A review of the research literature on evidence-based healthcare design. HERD: Health Environments Research & Design Journal, 2008; 1(3): 61-125. https://doi.org/10.1177/193758670800100306
_||_1- Heydari A.S, Bahrami M. A, Eslami S & Keshmiri F. Evaluation of the internal environment of teaching hospitals under the auspices of Yazd University of Medical Sciences based on a six-dimensional Weisboard model. Journal of Healthcare Management Research, 2014; 3(3): 53-62. [In Persian]
2- Nanda U, Pati D, Ghamari H, Bajema R. Lessons from neuroscience: form follows function, emotions follow form. Intelligent Buildings International, 2013; 5(sup1): 61-78. https://doi.org/10.1080/17508975.2013.807767
3- Durmisevic S, Ciftcioglu Ö. Knowledge modeling tool for evidence-based design. HERD: Health Environments Research & Design Journal, 2010; 3(3): 101-23. https://doi.org/10.1177/193758671000300310
4- Zhang Y, Tzortzopoulos P, Kagioglou M. Healing built-environment effects on health outcomes: Environment–occupant–health framework. Building research & information, 2019; 47(6): 747-66. https://doi.org/10.1080/09613218.2017.1411130
5- Lang J, Creating Architectural Theory, The Role of Behavioral Sciences inEnvironmental Design, Fourth Edition with Additions, Translated by Alireza Einifar, Tehran, Tehran University Press; 2002. [In Persian]
6- Tanja‐Dijkstra K, Pieterse ME. The psychological effects of the physical healthcare environment on healthcare personnel. Cochrane database of systematic reviews; 2011. https://doi.org/10.1002/14651858.CD006210.pub3
7- Dijkstra K, Pieterse M, Pruyn A. Physical environmental stimuli that turn healthcare facilities into healing environments through psychologically mediated effects: systematic review. Journal of advanced nursing, 2006; 56(2): 166-81. https://doi.org/10.1111/j.1365-2648.2006.03990.x.
8- Schweitzer M, Gilpin L, Frampton S. Healing spaces: elements of environmental design that make an impact on health. Journal of Alternative & Complementary Medicine, 2004; 10(1): S-71. https://doi.org/10.1089/acm.2004.10.S-71
9- Salonen H, Lahtinen M, Lappalainen S, Nevala N, Knibbs LD, Morawska L, Reijula K. Physical characteristics of the indoor environment that affect health and wellbeing in healthcare facilities: A review. Intelligent Buildings International, 2013; 5(1): 3-25. https://doi.org/10.1080/17508975.2013.764838
10- Harris PB, McBride G, Ross C, Curtis L. A place to heal: environmental sources of satisfaction among hospital patients 1. Journal of Applied Social Psychology, 2002; 32(6): 1276-99. https://doi.org/10.1111/j.1559-1816.2002.tb01436.x
11- Drahota A, Ward D, Mackenzie H, Stores R, Higgins B, Gal D, Dean TP. Sensory environment on health‐related outcomes of hospital patients. Cochrane Database of Systematic Reviews; 2012 (3). https://doi.org/10.1002/14651858.CD005315.pub2.
12- Ulrich RS. Effects of healthcare environmental design on medical outcomes. InDesign and Health: Proceedings of the Second International Conference on Health and Design. Stockholm, Sweden: Svensk Byggtjanst; 2001; 49: 59. yun.ir/14u8s8
13- Andrade C, Lima ML, Fornara F, Bonaiuto M. Users' views of hospital environmental quality: Validation of the perceived hospital environment quality indicators (PHEQIs). Journal of Environmental Psychology, 2012; 32(2): 97-111. https://doi.org/10.1016/j.jenvp.2011.12.001
14- Joseph A, Rashid M. The architecture of safety: hospital design. Current opinion in critical care, 2007; 13(6): 714-9. doi: 10.1097/MCC.0b013e3282f1be6e
15- Alereza Amiri M, Habib F, Shahcheraghi A. Evaluation of Components of Environmental Quality in Hospital, From a Naturalistic Perspective (Case Study of Shariati Hospital, Tehran). Journal of Healthcare Management Research, 2020; 10(34): 21-37. [In Persian]
16- Gao C, Zhang S. The restorative quality of patient ward environment: Tests of six dominant design characteristics. Building and Environment, 2020; 180: 107039. https://doi.org/10.1016/j.buildenv.2020.107039
17- MacAllister L, Zimring C, Ryherd E. Environmental variables that influence patient satisfaction: A review of the literature. HERD: Health Environments Research & Design Journal, 2016; 10(1): 155-69. https://doi.org/10.1177/1937586716660825
18- Greer V, Johnson E, Hsu J. Variables and Outcomes in Patient Room Design: A Study of Design Hypotheses. HERD: Health Environments Research & Design Journal, 2021; 14(2): 219-33. https://doi.org/10.1177/1937586720954952
19- Andrade CC, Devlin AS, Pereira CR, Lima ML. Do the hospital rooms make a difference for patients’ stress? A multilevel analysis of the role of perceived control, positive distraction, and social support. Journal of Environmental Psychology, 2017 1; 53: 63-72. https://doi.org/10.1016/j.jenvp.2017.06.008
20- De Korte EM, Spiekman M, Hoes-van Oeffelen L, van der Zande B, Vissenberg G, Huiskes G, Kuijt-Evers LF. Personal environmental control: Effects of pre-set conditions for heating and lighting on personal settings, task performance and comfort experience. Building and Environment, 2015; 86: 166-76. https://doi.org/10.1016/j.buildenv.2015.01.002
21- Andrade CC, Lima ML, Devlin AS, Hernández B. Is it the place or the people? Disentangling the effects of hospitals’ physical and social environments on well-being. Environment and Behavior, 2016; 48(2): 299-323. http://dx.doi.org/10.1177/0013916514536182.
22- Mohammadesmaeil S, Kianmehr S. Data Mining as an Intangible Model of Information Therapy and Seeking Behaviors in Immune Deficiency Disease Specialists. Journal of Healthcare Management Research, 2021; 11(38): 7-17. [In Persian]
23- Halawa F, Madathil SC, Gittler A, Khasawneh MT. Advancing evidence-based healthcare facility design: a systematic literature review. Health Care Management Science, 2020; 23: 453-80. https://doi.org/10.1007/s10729-020-09506-4
24- Schreuder E, Lebesque L, Bottenheft C. Healing environments: What design factors really matter according to patients? An exploratory analysis. HERD: Health Environments Research & Design Journal, 2016; 10(1): 87-105. https://doi.org/10.1177/1937586716643951
25- Ullán AM, Belver MH, Fernández E, Serrano I, Delgado J, Herrero C. Hospital designs for patients of different ages: Preferences of hospitalized adolescents, nonhospitalized adolescents, parents, and clinical staff. Environment and Behavior, 2012; 44(5): 668-94. https://doi.org/10.1177/0013916511403802.
26- Nikabadi S, Zabihi H, Shahcheraghi A. Evaluating the Effective Factors of Hospital Rooms on Patients’ Recovery Using the Data Mining Method. HERD: Health Environments Research & Design Journal; 2021. https://doi.org/10.1177/19375867211031305
27- Verderber S. Dimensions of person-window transactionsin the hospital environment. Environment & Behavior, 1986; 18(4): 450-66. http://dx.doi.org/10.1177/0013916586184002
28- Sengke MM, Atmodiwirjo P, Yatmo YA, Johanes M. Design consideration for window placement to provide the view within the patient's visual range. Journal of Design and Built Environment, 2020; 20(1): 13-23. https://doi.org/10.22452/jdbe.vol20no1.2
29- MacAllister L, Zimring C, Ryherd E. Exploring the relationships between patient room layout and patient satisfaction. HERD: Health Environments Research & Design Journal, 2019; 12(1): 91-107. https://doi.org/10.1177/1937586718782163.
30- Cai H, Zimring C. Out of Sight, Out of Reach: Correlating spatial metrics of nurse station typology with nurses’ communication and co-awareness in an intensive care unit. In Proceedings of the 8th International Space Syntax Symposium, Santiago, Chile, 2012; 36: 381-391.
31- Choi YS, Lawler E, Boenecke CA, Ponatoski ER, Zimring CM. Developing a multi‐systemic fall prevention model, incorporating the physical environment, the care process and technology: a systematic review. Journal of advanced nursing, 2011; 67(12): 2501-24. https://doi.org/10.1111/j.1365-2648.2011.05672.x
32- Gurascio-Howard L, Malloch K. Centralized and decentralized nurse station design: An examination of caregiver communication, work activities, and technology. HERD: Health Environments Research & Design Journal, 2007; 1(1): 44-57. https://doi.org/10.1177/193758670700100114
33- Nehrke MF, Morganti JB, Willrich R, Hulicka IM. Health status, room size, and activity level: Research in an institutional setting. Environment and Behavior, 1979; 11(4): 451-63. https://doi.org/10.1177/0013916579114002.
34- Huisman ER, Morales E, van Hoof J, Kort HS. Healing environment: A review of the impact of physical environmental factors on users. Building and environment, 2012; 58: 70-80. https://doi.org/10.1016/j.buildenv.2012.06.016
35- Van de Glind I, de Roode S, Goossensen A. Do patients in hospitals benefit from single rooms? A literature reviews. Health Policy, 2007; 84(2-3): 153-61. https://doi.org/10.1016/j.healthpol.2007.06.002
36- Chaudhury H, Mahmood A, Valente M. Advantages and disadvantages of single-versus multiple-occupancy rooms in acute care environments: a review and analysis of the literature. Environment and Behavior, 2005; 37(6): 760-86. https://doi.org/10.1177/0013916504272658
37- Ulrich RS, Zimring C, Zhu X, DuBose J, Seo HB, Choi YS, Quan X, Joseph A. A review of the research literature on evidence-based healthcare design. HERD: Health Environments Research & Design Journal, 2008; 1(3): 61-125. https://doi.org/10.1177/193758670800100306
