NFPA Journal - January/February 2018 - 57

application in the Baystate project,
can shed some light on the benefits of
applying these eight steps to health care
facility renovation and construction.
The Baystate project illustrates the
importance of investing in design strategies that are based on research and
informed stakeholder input, resulting
in improved safety, delivery and experience of care, and return on investment.

1
DEFINE EVIDENCE-BASED GOALS
AND OBJECTIVES

The first step in applying the evidencebased design process is the creation of
an interdisciplinary team to establish
a vision that defines the intentions,
direction, and objectives for the project.
Defining goals based on evidence and
research helps ensure better outcomes
and a better return on investment.
Baystate recognized the importance
of assembling its multi-disciplinary
team early in the process to ensure
input from all stakeholders. Members
of this team represented the hospital's
administration and clinical staffs, as
well as its nutrition and pharmacy
staffs. It included an array of people
involved in the design and construction
of the new addition, including project
managers, engineers, and environmental services specialists. And it included
patients and families-virtually anyone
involved in the delivery and receipt of
care was represented in the design and
evaluation meetings. Critics of this process sometimes complain that it adds
time to a project, but receiving input
from key stakeholders and reviewing
evidence-based goals helps minimize
change orders and ensures that the
final design meets the goals of the
organization.
Key EBD goals were identified to
improve the efficiency of the hospital
and the daily experience for patients,
families, support staff, and caregivers;
improve the design and physical environment of the hospital; and improve
the facility's safety and security, quiet
and privacy, access and wayfinding,
patient rooms, and bathroom design.

For example, EBD goals led to the creation of off-stage and on-stage work
and support areas in the clinical suites.
The "on-stage" corridor was designed
for use by patients, care teams, families, and visitors, while an "off-stage"
corridor linked directly to support
elevators, providing supply carts with
a connection to support rooms while
reducing noise and clutter in the
patient corridor. An especially important goal was to create single-occupancy
patient rooms and efficient unit layouts
to improve satisfaction, care efficiency,
and safety.

2
FIND SOURCES FOR
RELEVANT EVIDENCE

This step usually involves a literature
review to identify relevant research
and to identify gaps in knowledge and
opportunities for future research studies.
Several types of evidence were used
to help inform BMC's design decisions.
A number of research studies and case
studies are cited in the project bibliography, including a well-known study
demonstrating that patients who have
rooms with views of nature request
fewer doses of pain medication, experience fewer complications, and recover
faster than patients with views of brick
walls. Post-occupancy evaluations were
conducted with BMC patients; the 96
patient rooms built in Phase 1 were
designed to be in use for 8-12 months
so that the project and design team
could assess how well the initial patient
room design worked in meeting the
intended goals. Building mock-ups
based on the Phase 1 feedback helped
the team see and experience the design
in 3D so that they could test and experience the actual layout and design.
Sources of evidence also included
surveys and interviews, where patients
and family members who had stayed in
the single-occupancy rooms were asked
to review the room design and to rank
the importance of room features such
as lighting, room temperature, access to
personal and medical technology, staff
visibility, and visitor accommodations.

Additionally, the design team shadowed the clinical team on the inpatient
bed floors for multiple days, targeting
various hours of the day to identify
areas for improvement. Those included
configurations for care team "on-stage"
locations, as well as patient headwalls,
the architectural features in patient
rooms that merge electrical and medical gas functions into single units to
maximize efficiency.

3
CRITICALLY INTERPRET
RELEVANT EVIDENCE

This EBD step involves analysis of
the relevant research to determine if
the evidence is credible and can be
used to inform the project design and
hypotheses.
A decision was made early on in the
planning process to design singlepatient rooms. This decision was supported by industry research indicating
that single-patient rooms improve sleep
and healing and contribute to reduced
infection rates. Post-occupancy survey
results at Baystate confirmed that shifting from double to single rooms had a
positive impact on patients, families,
and staff.

4
CREATE AND INNOVATE
EVIDENCE-BASED DESIGN
CONCEPTS

In this step, the team translates the relevant evidence into design guidelines
and preliminary design concepts.
At Baystate, the evidence-based
design process could lead to unexpected innovations. The ability to
involve the contractor, major trades,
and life safety consultant early in
the planning process and keep them
involved through the project helped
the team at Baystate meet the intended
aesthetic and safety goals and realize
cost savings.
For example, because the project's life
safety consultant, Code Red Consultants,
N F PA . O R G / J O U R N A L * NFPA JOURNAL

| 57

http://WWW.NFPA.ORG/JOURNAL

Table of Contents for the Digital Edition of NFPA Journal - January/February 2018