Celeste Alvaro

Ryerson University

Assessing the impact of healthcare facility design on health outcomes: Implications for strategic investments in design

Billions of dollars are spent annually on the construction and refurbishment of health care facilities. Capital expenditures in Ontario alone are projected to exceed $30 billion dollars over the next five years. As healthcare needs both increase (population aging) and change (from acute to chronic care) we will need facilities that promote health and contribute to models of chronic disease management.

Despite advances in evidence-based design and increased knowledge about the role of the built environment in health, there has been little systematic research and evaluation of how design features influence health outcomes, quality and safety; particularly with people with complex chronic illness (e.g., long-term, multi-morbidity, disease management, rehabilitative care) - some of the highest users of the health care system.

Can strategic investments in the built healthcare environment mitigate adverse events and improve health outcomes?

For instance, over $480 million in unnecessary health expenditures (representing 2.8% of total hospital expenses) can be attributed to preventable adverse events such as infection, falls, and readmission. Can research tools and methods be developed so that ministries of health can reinvest funds typically used for non scientific post occupancy evaluation into evidence-based health and design intervention research that address such issues?

The goal of this research is to create a set of healthcare facility performance metrics and to compare the effect of facility design changes on patient and staff health and organizational performance. The focus is healthcare facilities designed for complex rehabilitation and care. In order to understand what modifications work for what patients, personal characteristics and illness will also be addressed.

The research on design and patient outcomes will examine indicators of quality and safety such as falls, infection, and patient satisfaction, together with indicators of physical and psychosocial health. Methods will include computer-assisted interviews, the ‘go along’ interview method, and hospital database extraction. Staff outcomes related to health and health-related worklife; e.g., sick days, employee turnover, workplace injury, satisfaction) will be measured through staff surveys, focus groups, and hospital database extraction. Differences in how patients and staff use designated areas within the buildings will be captured using naturalistic observation.

This work will contribute to research on evidence-based health care facility design and the development of health facility performance measures that can be used in ministry funded evaluation and future design and health studies.  Integrated knowledge translation ensures that our outcomes and processes can be shared across private and public sectors to inform strategic investments in health care facility design, design for health care management in rehabilitation and chronic disease, and evidence-based post occupancy evaluation.

 






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