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  • 1.
    Anåker, Anna
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Heylighen, Ann
    KU Leuven, Belgium.
    Nordin, Susanna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Elf, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Design quality in the context of healthcare environments: a scoping review2017In: Health Environments Research & Design Journal, ISSN 1937-5867, E-ISSN 2167-5112, Vol. 10, no 4, p. 136-150Article in journal (Refereed)
    Abstract [en]

    Objective:

    We explored the concept of design quality in relation to healthcare environments. In addition, we present a taxonomy that illustrates the wide range of terms used in connection with design quality in healthcare.

    Background:

    High-quality physical environments can promote health and well-being. Developments in healthcare technology and methodology put high demands on the design quality of care environments, coupled with increasing expectations and demands from patients and staff that care environments be person centered, welcoming, and accessible while also supporting privacy and security. In addition, there are demands that decisions about the design of healthcare architecture be based on the best available information from credible research and the evaluation of existing building projects.

    Method:

    The basic principles of Arksey and O’Malley’s model of scoping review design were used. Data were derived from literature searches in scientific databases. A total of 18 articles and books were found that referred to design quality in a healthcare context.

    Results:

    Design quality of physical healthcare environments involves three different themes: (i) environmental sustainability and ecological values, (ii) social and cultural interactions and values, and (iii) resilience of the engineering and building construction. Design quality was clarified herein with a definition.

    Conclusions:

    Awareness of what is considered design quality in relation to healthcare architecture could help to design healthcare environments based on evidence. To operationalize the concept, its definition must be clear and explicit and able to meet the complex needs of the stakeholders in a healthcare context, including patients, staff, and significant others.

  • 2.
    Anåker, Anna
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska institutet.
    von Koch, Lena
    Karolinska institutet.
    Heylighen, Ann
    Katholieke Universiteit Leuven, Leuven, Belgium.
    Elf, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska institutet; Chalmers.
    "It's lonely": Patients' experiences of the physical environment at a newly built stroke unit2018In: Health Environments Research & Design Journal, ISSN 1937-5867, E-ISSN 2167-5112Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    The aim of this study was to explore patients' experiences of the physical environment at a newly built stroke unit.

    BACKGROUND:

    For a person who survives a stroke, life can change dramatically. The physical environment is essential for patients' health and well-being. To reduce infections, a majority of new healthcare facilities mainly have a single-room design. However, in the context of stroke care, knowledge of how patients experience the physical environment, particularly their experience of a single-room design, is scarce.

    METHOD:

    This study used a qualitative design. Patients ( n = 16) participated in semistructured individual interviews. Data were collected in December 2015 and February 2017 in Sweden; interviews were transcribed verbatim and analyzed using content analysis.

    RESULTS:

    Two main themes were identified: (i) incongruence exists between community and privacy and (ii) connectedness with the outside world provides distraction and a sense of normality. In single rooms, social support was absent and a sense of loneliness was expressed. Patients were positively distracted when they looked at nature or activities that went on outside their windows.

    CONCLUSIONS:

    The physical environment is significant for patients with stroke. This study highlights potential areas for architectural improvements in stroke units, primarily around designing communal areas with meeting places and providing opportunities to participate in the world outside the unit. A future challenge is to design stroke units that support both community and privacy. Exploring patients' experiences could be a starting point when designing new healthcare environments and inform evidence-based design.

  • 3.
    Elf, Marie
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Eldh, Ann Catrine
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Malmqvist, Inga
    Chalmers.
    Öhrn, Kerstin
    Dalarna University, School of Education, Health and Social Studies, Health and Caring Sciences/Oral Health Science.
    von Koch, Lena
    Karolinska institutet.
    Using of group-modeling in pre-design phase of new healthcare environments: stakeholders experiences2016In: Health Environments Research & Design Journal, ISSN 1937-5867, E-ISSN 2167-5112, Vol. 9, no 2, p. 69-81Article in journal (Refereed)
    Abstract [en]

    Background: Current research shows a relationship between healthcare architecture and patient-related outcomes. The planning and designing of new healthcare environments is a complex process; the needs of the various end-users of the environment must be considered, including the patients, the patients’ significant others, and the staff. The aim of this study was to explore the experiences of healthcare professionals participating in group modeling utilizing system dynamics in the pre-design phase of new healthcare environments. We engaged healthcare professionals in a series of workshops using system dynamics to discuss the planning of healthcare environments in the beginning of a construction, and then interviewed them about their experience.

    Methods: An explorative and qualitative design was used to describe participants’ experiences of participating in the group modeling projects. Participants (n=20) were recruited from a larger intervention study using group modeling and system dynamics in planning and designing projects. The interviews were analyzed by qualitative content analysis.

    Results: Two themes were formed, representing the experiences in the group modeling process: ‘Participation in the group modeling generated knowledge and was empowering’ and ‘Participation in the group modeling differed from what was expected and required the dedication of time and skills”.

    Conclusions: The method can support participants in design teams to focus more on their healthcare organization, their care activities and their aims rather than focusing on detailed layout solutions. This clarification is important when decisions about the design are discussed and prepared and will most likely lead to greater readiness for future building process.

  • 4.
    Elf, Marie
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Chalmers Tekniska Högskola; Karolinska institutet.
    Lindahl, Göran
    Chalmers Tekniska Högskola.
    Anåker, Anna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    A study of relationships between content in documents from the health service operational plan and documents from the planning of new healthcare environments2018In: Health Environments Research & Design Journal, ISSN 1937-5867, E-ISSN 2167-5112Article in journal (Refereed)
    Abstract [en]

    Aim: The aim was to investigate the content and quality of the governing documents created in the planning and design phase of new healthcare environments and in the related healthcare strategic and operational plans.

    Background: Quality deficits in buildings can often be traced back to the initial stages in the planning and design phase. Although, large investments have been made to improve the process of planning new healthcare environments and linking the requirements to health service strategies, healthcare organizations rarely relate their strategy goals to the built environment.

    Methods: A retrospective review of documents created in the planning and design stages of new healthcare environments and the operational plans of the target organizations was conducted.

    Results: The organizational operational plans did not contain any statements or information about the built environment or how a building could or should support the organization's goals. Important information was frequently absent from the documents governing the planning and design of buildings. The documents lacked information about what and how to follow-up and what to measure once a construction project had been completed. There were no references to evidence.

    Conclusions: Poor documentation might undermine the quality of the planning and design phase and ultimately the opportunity to create environments that support health outcomes. Therefore, more emphasis must be placed on the importance of documentation but above all to strengthen and clarify the relationship between the healthcare organization strategy to achieve an effective and efficient care process and the intention made in the planning and design process.

  • 5.
    Elf, Marie
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Svedbo Engström, Maria
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Sahlgrenska akademin.
    Wijk, Helle
    Development of the Content and Quality in Briefs Instrument (CQB-I)2012In: Health Environments Research & Design Journal, ISSN 1937-5867, E-ISSN 2167-5112, Vol. 5, no 3, p. 74-88Article in journal (Refereed)
    Abstract [en]

    Objective: The Content and quality of Briefs Instrument (CQB-I) was designed to develop a valid and reliable audit instrument to examine the content and quality of information in documents (briefs) created in the early stages of designing healthcare environments.

    Background: The importance of effective briefing has been emphasised in many research studies during the past two decades. However, there is no developed instrument for auditing the content and quality of the documents, which makes this paper interesting.

    Methods: The study had a methodological and developmental design based on an established methodology for instrument development and validation. The development process consisted of three main phases: item generation and scale construction, assessment of face and content validity, and finally, testing of the reliability. To obtain face and content validity, expert panels reviewed the CQB-I. Content validity was assessed by using the Content Validity Index (I-CVI=item level, S-CVI=scale level). The reliability was tested by test-retest and inter-rater reliability. Results: CQB-I was found to have good content validity (I-CVI =0.78 – 1.0 and S-CVI=0.98). Inter-rater reliability was acceptable (Spearman’s correlation = 0.62) and the stability was considered high for both raters (83% respectively 88%).

    Conclusions: The instrument can be used as a guide for the work process in the design team and contribute to the ongoing development of making the design process more user-oriented with the ultimate goal of healthcare environments designed for a patient-centered care.

  • 6.
    Elf, Marie
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Chalmers tekniska högskola, KI.
    Wijk, Helle
    Sahlgrenska Akademin, Göteborgs Universitet .
    Space planners' perception of an assessment instrument for briefs in the pre-design phase of new healthcare environments2014In: Health Environments Research & Design Journal, ISSN 1937-5867, E-ISSN 2167-5112, Vol. 8, no 1, p. 67-80Article in journal (Refereed)
    Abstract [en]

    Objectives: The main purpose of the study was to investigate the usability of a new developed instrument designed to assess the content and quality in programs for new healthcare environments (CQB-I). We studied the perception of using the instrument on a group of space-planners. The study is part of a larger project designed to assure the quality of early and main stages of the planning of new care environments with a focus on policy documents (programs or briefs), created in the early phases of the planning process. The instrument measures whether there is a clear mission statement for the project based on user needs and care activities that will take place in the new healthcare environment. Furthermore, the instrument measures if there are clear patient-related outcome measures specified and if the information in the documents is person-oriented and knowledge-based.

    Method: The study used a mixed method where the relevance and usability of the instrument was estimated and a focus group interview was conducted.

    Findings: The study showed that CQB-I perceived to be a relevant instrument primarily as a guide for programming, but also for monitoring the produced programs.  Instruments can help to bring research results into planning and contribute to dialogue and collaboration in the early stages by orienting process of user needs, discuss and write down clear performance indicators and related quality assurance process.

     

  • 7.
    Miedena, Elke
    et al.
    Chalmers Tekniska Högskola.
    Lindahl, Göran
    Chalmers Tekniska Högskola.
    Elf, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Chalmers Tekniska Högskola.
    Conceptualizing health promotion in relation to outpatient healthcare building design: a scoping review2019In: Health Environments Research & Design Journal, ISSN 1937-5867, E-ISSN 2167-5112, Vol. 12, no 1, p. 69-86Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: This review explored different conceptualizations of health promotion in the context of, and in relation to, outpatient building design.

    BACKGROUND: Today's healthcare organizations are implementing holistic healthcare approaches such as health promotion, while simultaneously increasing their outpatient services. These health promotion approaches, focused on empowering people to take control of their health, are expected to have implications for the outpatient healthcare building design. Yet there is limited knowledge what these may be. A review of the literature on the current state of the art is thus needed to enable and support dialog on future healthcare building design.

    METHOD: A scoping review of 4,506 papers, collected from four databases and three scientific journals in 2015, resulted in 14 papers relating health promotion to building design and outpatient healthcare. From the subsequent content analysis, multiple common themes and subthemes emerged.

    RESULTS: The review reveals diverse range of health promotion interpretations, three health promotion perspectives (health behavior, health equity, and sense of coherence), associated design approaches, design objectives, health-related outcomes, building features, and solutions.

    CONCLUSIONS: While diverse health promotion perspectives might merely represent variations in focus, these differences become problematic when relating to building design. To support further dialogs on development of health promotion in, and in relation to, the build environment, there is a need to strengthen the health promotion vocabulary. Further research is needed to compare different design approaches and how these can be combined to minimize contradicting implications for building design.

  • 8.
    Nordin, Susanna
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. karolinska institutet.
    McKee, Kevin
    Dalarna University, School of Education, Health and Social Studies, Social Work.
    Wijk, Helle
    Elf, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Exploring environmental variation in residential care facilities for older people2017In: Health Environments Research & Design Journal, ISSN 1937-5867, E-ISSN 2167-5112, Vol. 10, no 2, p. 49-65Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aim of this study was to explore variation in environmental quality in Swedish residential care facilities (RCFs) using the Swedish version of the Sheffield Care Environment Assessment Matrix (S-SCEAM).

    BACKGROUND: Well-designed physical environments can positively impact on health and well-being among older persons with frail health living in RCFs and are essential for supporting person-centered care. However, the evidence base for informing the design of RCFs is weak, partly due to a lack of valid and reliable instruments that could provide important information on the environmental quality.

    METHODS: Twenty RCFs were purposively sampled from several regions, varying in their building design, year of construction, size, and geographic location. The RCFs were assessed using S-SCEAM and the data were analyzed to examine variation in environmental quality between and within facilities.

    RESULTS: There was substantial variation in the quality of the physical environment between and within RCFs, reflected in S-SCEAM scores related to specific facility locations and with regard to domains reflecting residents' needs. In general, private apartments and dining areas had high S-SCEAM scores, while gardens had lower scores. Scores on the safety domain were high in the majority of RCFs, whereas scores for cognitive support and privacy were relatively low.

    CONCLUSIONS: Despite high building standard requirements, the substantial variations regarding environmental quality between and within RCFs indicate the potential for improvements to support the needs of older persons. We conclude that S-SCEAM is a sensitive and unique instrument representing a valuable contribution to evidence-based design that can support person-centered care.

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