The HDR CARE Scale, Inpatient Version: A validated survey instrument to measure environmental affordance for nursing tasks in inpatient healthcare settings

Rigorous healthcare design research is critical to inform design decisions that improve human experience. Current limitations in the field include a lack of consistent and valid measures that provide feedback about the role of the built environment in producing desirable outcomes. Research findings about nurses’ efficiency, quality of care, and satisfaction related to inpatient unit designs have been mixed, and there was previously no validated instrument available to quantitatively measure nurses’ ability to work efficiently and effectively in their environment. The objective of this study was to develop, refine, and validate a survey instrument to measure affordance of the care environment to nurse practice, based on various aspects of their work in inpatient units. The HDR Clinical Activities Related to the Environment (CARE) Scale Inpatient Version was developed using item design, refinement, and reliability and validity testing. Psychometric methods from classical test theory and item response theory, along with statistical analyses involving correlations and factor analysis, and thematic summaries of qualitative data were conducted. The four-phase process included (1) an initial pilot study, (2) a content validation survey, (3) cognitive interviews, and (4) a final pilot study. Results from the first three phases of analysis were combined to inform survey scale revisions before the second pilot survey, such as a reduction in the number and rewording of response options, and refinement of scale items. The updated 9-item scale showed excellent internal consistency and improved response distribution and discrimination. The factor analysis revealed a unidimensional measure of nurse practice, as well as potential subscales related to integration, efficiency, and patient care. Within the healthcare design industry, this scale is much needed to generate quantitative and standardized data and will facilitate greater understanding about the aspects of an inpatient healthcare facility that best support nurses’ ability to provide quality patient care.

Interdisciplinary Co-design Framework in Healthcare Design for Older Adult Patients with Chronic Low-back Pain

This study presents three forms of interdisciplinary expertise in the healthcare design context to approach a particular multifaceted problem around the current healthcare for older adult patients with chronic low-back pain (LBP). Using an interdisciplinary co-design framework, first, our design approach performs the role of an initiator to define the problem by exploring the current context of healthcare. Second, it facilitates the experiences of experts and patients to reach the roots of the problem by functioning as a mediator. Third, our approach fulfills the primary role of healthcare design in producing new meanings considering the principles of patient-centeredness. These roles significantly contributed to the design of healthcare innovations. Our framework transformed the distributed disciplinary knowledge developed while tackling the multifaceted problem into new forms of expertise for collaboration in healthcare innovation.

MAPPING A SYSTEMS APPROACH TO EXISTING HEALTHCARE DESIGN, DELIVERY AND IMPROVEMENT METHODS

Design, delivery and improvement processes in healthcare is of great challenge due to increasing pressures on healthcare systems alongside inherent complexities, resulting in limited benefits or unforeseen consequences. A recent Systems Approach framework has aimed at responding to the calls about implementing a more holistic approach. Though being an approach in its own right that can iteratively and systematically structure, guide, and/or facilitate design and improvement projects in healthcare, it can also augment existing approaches that have already place in healthcare designers' and improvement practitioners' agendas. Thus, the objective of this paper is to compare and contrast the questions, activities, and tools of the Systems Approach with processes of other major improvement approaches in healthcare to demonstrate their coverages, overlaps, and extended and new opportunities to pursue in the light of the Systems Approach.

DEEP SCOPE: A Framework for Safe Healthcare Design

Thinking in patient safety has evolved over time from more simplistic accident causation models to more robust frameworks of work system design. Throughout this evolution, less consideration has been given to the role of the built environment in supporting safety. The aim of this paper is to theoretically explore how we think about harm as a systems problem by mitigating the risk of adverse events through proactive healthcare facility design. We review the evolution of thinking in safety as a safety science. Using falls as a case study topic, we use a previously published model (SCOPE: Safety as Complexity of the Organization, People, and Environment) to develop an expanded framework. The resulting theoretical model and matrix, DEEP SCOPE (DEsigning with Ergonomic Principles), provide a way to synthesize design interventions into a systems-based model for healthcare facility design using human factors/ergonomics (HF/E) design principles. The DEEP SCOPE matrix is proposed to highlight the design of safe healthcare facilities as an ergonomic problem of design that fits the environment to the user by understanding built environments that support the “human” factor.

The medicalisation of politics or the politicisation of pedicine: the case of italian struggles to design public healthcare institutions

In the present article, we reflect on some key aspects for the design of pub­lic health systems by retracing the history of the Italian National Health Service, or Servizio Sanitario Nazionale (SSN), from its inception to the present days, analysing how a series of subsequent reforms and counter-reforms impacted its functions and services. Our reflection is based on a collective interview with Fulvio Aurora, Paolo Fierro and Edoardo Turri, three members of Medicina Democratica, which has been and continues to be one of the key organizations in the struggles for keeping health a public value in Italy. While our standpoint on the issue of health is geographically situated, we believe that an analysis of the Italian healthcare sector, with its success­es and its failures, can offer important points of departures for identifying some key characteristics to shape contemporary approaches to healthcare design that can be translocal and cosmopolitan in their application.