The continuous learning cycle: A multi-phase post-occupancy evaluation (POE) of nursing units design

Hui Cai Ph.D., Associate Professor, Department of Architecture, Director of Research, Institute of Health and Wellness Design, The University of Kansas
Kent Spreckelmeyer D. Arch, Professor, Department of Architecture, Co-Director, the Institute of Health and Wellness Design, The University of Kansas
Ganesh Sathyan RA, ASHE, Associate Principal, Lawrence Group
Michael Schnaare AIA, NCARB, President, the Lawrence Group

This session will report a collaborative research effort undertaken by a team of investigators from the University of Kansas and the designers at Lawrence Group, and supported by SSM Health System, on evaluations of nursing unit design in St. Joseph West Hospital at Lake St. Louis and St. Mary Hospital at Jefferson City, Missouri. Through a unique, multi-phase, mixed-method approach, this investigation provides an in-depth perspective on how the physical environment of nursing unit design impacts patient safety, staff efficiency, quality of care and patient experience, and organizational performance.

The POE consisted of two phases. During Phase I in 2015, in order to evaluate the effectiveness of a new nursing unit design for the vertical expansion of St. Joseph West Hospital, a POE was conducted at its sister hospital, St. Mary Hospital, where similar design features such as family-centered single patient rooms and decentralized nurse stations have been implemented and used for nine months. Current conditions of West were also collected as a pre-occupancy evaluation. Lessons learned from Phase I were fed forward to the design of St. Joseph West expansion. After the new expansion was completed and occupied, the Phase II POE was conducted in 2018 in both new and existing units in St. Joseph Hospital.

The POE applied the following methods: 1) patient room evaluations using the Center for Healthcare Design (CHD) standardized POE tools; 2) noise measurement; 3) nurses and techs' walking distance; 4) a pre- and post-move analysis of Press Ganey data, fall rates, medical errors, and patients' length of stay. A t-test of the mean score and logistic regression of the "Percent of top-box" for each Press Ganey survey item were conducted in SPSS to determine if a significant change in perception could be observed. The multi-method approach allowed researchers to triangulate data from multiple resources, therefore, obtaining a more comprehensive understanding of effectiveness of facility design.

The results of the Phase I POE demonstrated that patient-care areas in the St. Mary Hospital provide more secure, comfortable, and safe environments for patients, visitors, and staff, compared to the old facility of St. Joseph West (4.48 compared to 2.87). Analysis of Press Ganey score before and after the move to the new facility in St. Mary revealed a significant increase of ratings in all five facility-related questions. The POE also revealed some opportunities for improvement, including the location of nursing alcoves, design of team hub, and location of charting stations in patient rooms etc. With lessons learned from St. Mary incorporated in St. Joseph expansion, the Phase II POE showed that the rating of the patient room further improved (4.48 compared to 4.64). The new design has demonstrated several benefits over the existing units in St. Joseph West in terms of reducing noise, improving patient satisfaction, reducing fall rates and medical errors. The new design also allowed nurses to walk relatively shorter distance (2.77 miles) compared to the results from previous national studies (3.89-4 miles). The POE has demonstrated its value as an important tool for continuous quality improvement in design process.

Learning objectives:

• Share the experience of collaboration among an academic institution, healthcare design firm, and healthcare system;
• Learn the process and results of conducting a multi-method POE to analyze the effectiveness of nursing unit layouts, share the experience of using the CHD POE toolkit to evaluate patient room design and test its validity;
• Discuss the results of Press Ganey analyses before and after moving to a new facility. It replicates Siddiuqui's (2015) study at John Hopkins regarding the impact of environmental interventions on patient satisfaction; and
• Discuss the impacts of innovative design features such as the decentralized nurse station.