effects of a participatory facility design process at a community hospital in British Columbia, The

HD, Feb 2005 by Miller, Aaron, Gamble, Leslie

BACKGROUND

It has been shown that opportunities to create safer workplaces are most cost effective in the earliest phases of design (WorkCover Corporation, 2003; National Occupational Health and Safety Commission, 2001), with substantial increases in costs for renovation once a project has been completed. Therefore, designing a facility using input from end-users and evidence-based design can eliminate many of the problems such as staff injuries, illness, and disease, lower staff productivity, increased length of patient stays, increased patient medication usage, increased building maintenance costs, increased staff turnover, increased workers compensation expenses, and a reduced building life experienced by poorly designed healthcare facilities (National Occupational Health and Safety Commission, 2001 ; Ulrich, 1991).

The design of healthcare facilities and individual workplaces within departments should reflect a closer alignment of work patterns and the physical setting to improve staff workflow and decrease patient wait times (Pierce et al, 1990). The size and shape of workplaces within departments can affect nursing time and efficiency (Herman Miller, 1999). Layouts for healthcare facilities should be individually based on patient admittance patterns, staff and visitor traffic patterns, and the need for support facilities through each department such as team stations, storage, clerical space, administrative and educational requirements, and services unique to the organisation, without a one-size-fits-all approach (Society for Critical Care Management, 1995). A design for an urban hospital environment would therefore not necessarily be effective for a rural hospital in terms of staff and patient needs or cost-effectiveness.

Cranbrook's East Kootenay Regional Hospital (EKRH) in the Interior Health Authority of British Columbia, Canada is currently upgrading and expanding its emergency, ambulatory care, diagnostic imaging, and lobby/reception departments utilising a 'participatory ergonomie process' (PEP). This process, involving both staff and management, occurred from April 2004 - January 2005. Construction for the facility is set to begin in spring 2005 lasting approximately one year.

The objectives of this participatory, evidence-based project are to meet employee and patient requirements for health, safety, comfort and efficiency by utilising a PEP in the redesign of a community hospital. The expertise and active involvement of end users is paramount to achieving success. Specifically, the process aims to ensure that the final design of each department incorporates optimal workplace health and safety conditions, comfort, efficiency of layout (adjacencies, communication, and movement patterns), and work quality requirements for Interior Health Authority employees. Further, the process incorporates comfort and safety requirements for patients seeking treatment at the hospital.

PARTICIPATORY RESEARCH METHODS

This project incorporated participatory ergonomie methods to proactively involve select front-line staff in the design development process. The tools used during the process included: focus group sessions, informal interviews with staff, work flow and task analysis, anthropometric and human factors data, and mock-ups.

FOCUS GROUP SESSIONS

Focus group sessions set the stage for the main interaction between staff, management, and the architects, planners, and economists during the design process. During the schematic design phase of the design process, managers from the emergency department, diagnostic imaging, admitting (lobby and reception), and the site administrator and doctor representative were first able to provide their input into the design drawings and form a rough design of each department in collaboration with the architects and facility planners. During this stage of the design, managers had to physically sign off the drawings to indicate that they were in agreement with the schematic design of the proposed departments. This created 'buy-in' from managers and made them make a decision as to how they wanted their department to be initially shaped. At this meeting, managers selected key individuals to represent the different areas of each department to form a design development team that would shape the design of the departments from the design development stage, through the working drawings up to construction. This team represented end-users who would be working within each department - team members would represent their department at all future focus groups/meetings to discuss any relevant changes. Representatives included: (emergency and ambulatory care department): physicians, nursing, LPN, and unit clerk; (admitting): cashier, security, and auxiliary; (diagnostic imaging): CT scan, ultrasound, nuclear medicine, x-ray, clerical and mammography. Less frequent sessions were also carried out with representatives from all support services impacted by the project including housekeeping, laundry, material management and nutrition services.