Healthcare Design - August 2016 - 62

R RESEARCH | 08.16
Put to the test

A research team shares how a diagnostic tool was created to analyze field research in a
medical/surgical unit, which could then be applied to help design a more functional space
By Camilla Moretti and Upali Nanda
Over the past decade, the nurse's workplace has
generated much interest from healthcare designers
and facility managers alike. This interest, to a large
extent, can be attributed first to the 2004 Institute of
Medicine report "Keeping Patients Safe: Transforming the Work Environment of Nurses." The design of
these spaces, specifically, continues to be critical to a
patient's well-being and safety. Operational efficiency,
staff satisfaction, and-more importantly-medical
errors can be linked to workplace design.
Nurse walking is a key component of the workplace

spatial proximities. The tool can be plugged directly
into building information modeling software, allowing
streamlined integration into the design process.
The diagnostic was conducted in a medical/surgical unit at ProMedica, and HKS received an inaugural
Environmental Design Research Association Certificate
of Research Excellence award for the effort in 2015.

experience that's been discussed at length in the
research literature, too. A 2012 study led by Debajyoti
Pati, professor and Rockwell Endowment Chair at
Texas Tech University, shows that a nurse can walk as
much as six miles during a shift, prompting researchers to examine how much of this walking is of value
and how much time is being wasted in nonessential
travel. While a strong body of research exists on nurse
activity and walking distances, it's evident that there's
a degree of variability between different delivery
models and sites.
Walking distances can't be estimated based on
adjacencies and proximities of key areas alone; it's
imperative to understand the sequence of activities
and the flow of work to adequately assess an optimal
experience. It's also important to put walking in the
context of the overall care model in place to allow a
robust investigation.

gan and is currently developing a new patient tower
at its flagship hospital in Toledo. The project features
a 615,000-square-foot patient tower addition and
120,000 square feet of renovations aimed at improving
the care environment and patient and staff comfort as
well as preparing ProMedica for the future. The 13-story
tower will replace 308 adult inpatient beds, with the
potential for 160 additional beds, and will be guided by
patient-centered care.
ProMedica leadership identified the need to carefully
study conditions in its existing medical/surgical and
intensive care units (designed more than a decade ago)
to inform design decisions in the new tower. There are
two wings with four nurses' stations and 20 rooms in
each, two meds/supply rooms, a nourishment room
(shared by both wings), two soiled-linen rooms, two
equipment rooms, and four linen closets. The staffing
ratio to number of patient rooms is as follows: eight
registered nurses (1:5), four nursing assistants (1:10),
two patient care supervisors (1:20), and two unit clerks
(1:20). A nursing director oversees the unit. Additional
staff members on the unit include physicians, respiratory therapists/occupational therapists, care navigators,
social workers, dietary services staff members, transport staff members, and maintenance staff members.
The area studied was "first to fill," so it was at full occupancy most of the time. Patient assignment was by
block, although this could be changed if the high-acuity
patient percentage increased on a given day. The core
work area on each unit was the central nurses' station,
and off-stage areas weren't visible from the corridors.
All nurses and most nursing assistants used workstations on wheels (WOWs) for computers, with visitors
assigned additional stations for use when needed.
The objective of the diagnostic was to study the
workplace and identify suboptimal environmental
conditions that could be improved in the existing

The project
To achieve this goal, a research team developed a
tool that over a course of 2.5 days does an intensive
analysis of work process, space utilization, and user
experience. The team included representatives from
HKS and two of its internal specialty groups-LINE, its
Laboratory for Intensive Exploration, and the nonprofit
CADRE, the Center for Advanced Design Research
and Evaluation-along with ProMedica Hospital in
Toledo, Ohio.
The methodology includes shadowing, surveys,
interviews, photo essays, collection of light and sound
levels, and spatial analysis to assess proximities (resulting in a heat map of distances) and visibilities. One
of the key deliverables of the diagnostic is translating
the field research information into a parametric tool
that allows designers to assess walking distances
based on a sequence of activities rather than just
62

HCDmagazine.com 08.16

Taking measure
ProMedica is a nonprofit health system that serves
27 counties in northwest Ohio and southeast Michi-

Camilla Moretti

Upali Nanda

http://www.HCDmagazine.com

Healthcare Design - August 2016

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