Aim The research sheds light on the challenges and limitations of Spanish and Italian hospital design by looking at the gaps between education and practice. Background Hospital design plays an important role in providing high-quality and cost-effective facilities for any healthcare system. Spain and Italy face contemporary challenges (i.e., elderly population, staff retention, and obsolete healthcare facilities) and have similar issues of life expectancy, health expenditure, hospital beds provision, and decentralized tax-financed healthcare systems. Method A cross-sectional, mixed-method study was used. This involved two different data collection strategies and analysis for each area of investigation: (i) education and (ii) practice. For the former, educational programs were reviewed via a web search; for the latter, an online survey of 53 architectural/engineering offices involved in hospital design was conducted. Results Hospital design education is limited to 0/58 in Spanish and 2/60 courses in Italian universities, although each country offers three postgraduate courses. The practitioners’ survey shows that even though their offices have a long history of healthcare design, only 48% in Spain and 60% in Italy have received specific university training. Office staff lack employees with medical backgrounds, which hinders any partnership between health and design fields either for design practice or the education fields. Laws, national regulations, technical guidelines, and previous experience are the most useful information sources, while international scientific publications appear underused by practitioners. Conclusions Italian and Spanish healthcare architecture could be improved by promoting multidisciplinary teams (in practice and education) and improving the education offer by tailoring it to national needs.
The aim of this doctoral thesis is to explore the evaluation of functional and environmental factors in acute-care hospital design that might have an impact on healthcare outcomes.Despite the progress of the evidence-based design process in North-European and North American countries, in Spain it still has not been fully developed. The purpose of this design process is to establish a link between design variables and health-related outcomes. Acutecare hospitals are buildings in constant change to cope with the evolving demands of clinical progress and the social context. Thus, acknowledging the functional and environmental factors that impact on the care process and evaluating them in existing acute-care hospitals becomes of paramount importance.This dissertation follows a mixed-method methodology based on four perspectives: 1) the field, with an ethnographic study during a three-month placement in an acute-care hospital; 2) the theory, with literature analysis; 3) the future, with an ethnographic study of sixteen acute-care hospital visits considered as best practice, and 4) the present, with the evaluation of four acutecare hospitals in Spain.The primary result of this work is the tool CURARQ. The purpose of this tool is, on the one hand to provide a first diagnostic of the functional and environmental quality of the studied unit, and on the other hand to guide in the design decision process of a new development. This tool has been created for seven units in the acute-care hospital and has been tested in four acute-care hospitals in "Comunidad Valenciana". Secondary results include: 1) feedback and scripts from users during the acute-care hospital placement; 2) evaluation through architectural layouts and photographs of the acute-care hospital visits; and 3) evaluation of CURARQ scores of the four evaluated acute-care hospitals.This document provides a current overview of functional and environmental factors in acutecare hospitals, which evidence: 1) the need for refurbishment to promote clinical innovation; 2) the need to update national standards, 3) the usefulness of CURARQ tool to identify priority buildings to intervene, and 4) the usefulness of CURARQ tool to generate synergies between healthcare staff, patients, researchers, and architects to promote the potential of the evidencebased design process in Spain.
La búsqueda de la eficiencia y la calidad es especialmente relevante en la arquitectura sanitaria ya que su diseño tiene una repercusión directa en los resultados clínicos obtenidos. Dentro del hospital, la unidad de neonatología es el lugar donde se atiende a los pacientes más vulnerables al entorno que les rodea. Este estudio evalúa el diseño de dos unidades españolas en relación con las guías de diseño nacionales y las recomendaciones del proceso de diseño basado en evidencias a partir del análisis de sus plantas, fotografías y la herramienta de evaluación post-ocupacional CURARQ-UNeo. Los resultados identifican las posibles actuaciones de mejora para cada unidad. Este tipo de evaluación puede impulsar el avance del proceso de diseño basado en evidencias en España con la finalidad de que las decisiones del proyecto contribuyan a mejorar la calidad de vida de los neonatos, sus familiares y el personal de una unidad de neonatología.
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