Fable Hospital 2.0: <i>The Business Case for Building Better Health Care Facilities</i>

Sadler, Blair L.; Berry, Leonard L.; Guenther, Robin; Hamilton, D. Kirk; Hessler, Frederick A; Merritt, Clayton; Parker, Derek

doi:10.1002/j.1552-146x.2011.tb00093.x

Cited by 80 publications

(99 citation statements)

References 41 publications

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“…However, important issues that require further research include concerns about potential additional workload, 4 stress 79 and risks to staff; 30,77,80,81,85 less patient surveillance; 11,37,38 and patients feeling isolated or alienated. 38,68,69 There is limited evidence about the costs and economic outcomes of higher proportions of single room accommodation.…”

Section: Discussionmentioning

confidence: 99%

“…[82][83][84] Acuity-adaptable rooms can cost even more because of the need for more space and equipment, but some cost savings may be made because of a reduced need for patient transfers. 85 Maintenance costs per square metre are likely to be the same, but the greater space requirement for ward areas means that overall maintenance costs may be higher. It is not possible to say whether or not single rooms increase staffing costs because of the scarcity of evidence for impact on staffing levels or skill mix.…”

Section: Introductionmentioning

confidence: 99%

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Evaluating a major innovation in hospital design: workforce implications and impact on patient and staff experiences of all single room hospital accommodation

Maben

Griffiths

Penfold

et al. 2015

Health Services and Delivery Research

177

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BackgroundNew hospital design includes more single room accommodation but there is scant and ambiguous evidence relating to the impact on patient safety and staff and patient experiences.ObjectivesTo explore the impact of the move to a newly built acute hospital with all single rooms on care delivery, working practices, staff and patient experience, safety outcomes and costs.Design(1) Mixed-methods study to inform a pre-/post-‘move’ comparison within a single hospital, (2) quasi-experimental study in two control hospitals and (3) analysis of capital and operational costs associated with single rooms.SettingFour nested case study wards [postnatal, acute admissions unit (AAU), general surgery and older people’s] within a new hospital with all single rooms. Matched wards in two control hospitals formed the comparator group.Data sourcesTwenty-one stakeholder interviews; 250 hours of observation, 24 staff interviews, 32 patient interviews, staff survey (n = 55) and staff pedometer data (n = 56) in the four case study wards; routinely collected data at ward level in the control hospitals (e.g. infection rates) and costs associated with hospital design (e.g. cleaning and staffing) in the new hospital.Results(1) There was no significant change to the proportion of time spent by nursing staff on different activities. Staff perceived improvements (patient comfort and confidentiality), but thought the new accommodation worse for visibility and surveillance, teamwork, monitoring, safeguarding and remaining close to patients. Giving sufficient time and attention to each patient, locating other staff and discussing care with colleagues proved difficult. Two-thirds of patients expressed a clear preference for single rooms, with the benefits of comfort and control outweighing any disadvantages. Some patients experienced care as task-driven and functional, and interaction with other patients was absent, leading to a sense of isolation. Staff walking distances increased significantly after the move. (2) A temporary increase in falls and medication errors within the AAU was likely to be associated with the need to adjust work patterns rather than associated with single rooms, although staff perceived the loss of panoptic surveillance as the key to increases in falls. Because of the fall in infection rates nationally and the low incidence at our study site and comparator hospitals, it is difficult to conclude from our data that it is the ‘single room’ factor that prevents infection. (3) Building an all single room hospital can cost 5% more but the difference is marginal over time. Housekeeping and cleaning costs are higher.ConclusionsThe nature of tasks undertaken by nurses did not change, but staff needed to adapt their working practices significantly and felt ill prepared for the new ways of working, with potentially significant implications for the nature of teamwork in the longer term. Staff preference remained for a mix of single rooms and bays. Patients preferred single rooms. There was no strong evidence that single rooms had any impact on patient safety but housekeeping and cleaning costs are higher. In terms of future work, patient experience and preferences in hospitals with different proportions of single rooms/designs need to be explored with a larger patient sample. The long-term impact of single room working on the nature of teamwork and informal learning and on clinical/care outcomes should also be explored.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Evaluating a major innovation in hospital design: workforce implications and impact on patient and staff experiences of all single room hospital accommodation

Maben

Griffiths

Penfold

et al. 2015

Health Services and Delivery Research

177

View full text Add to dashboard Cite

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“…Another possibility is to use the model to estimate the benefits of treating all patients in private rooms in pediatric hospitals, an emerging trend in new hospital design (Sadler et al 2011). BAPTSM could also be employed to quantify how further reductions in the discharge-ready delay could improve efficiency, i.e., what if all ancillary services could be provided in the evening so that pediatric patients who are medically cleared for discharge during evening rounds could actually be discharged that night?…”

Section: Resultsmentioning

confidence: 99%

The Impact of a Discharge Holding Area on the Throughput of a Pediatric Unit

et al. 2017

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Abstract. Hospital patients often move from one bed to another for both medical and nonmedical reasons. In a highly utilized quaternary inpatient pediatric unit we have studied, bed and nursing resources are stressed not only by frequent movement of patients but also by the unit's patient discharge policy. We present a discrete-event simulation model for examining how the unit's efficiency may be improved by a better discharge policy. In particular, we use the base version of the model to investigate the impact of sending various percentages of discharge-ready patients to a discharge holding area where they can safely wait for a few hours until being picked up by their parent or guardian. Doing so frees up inpatient beds, allowing the unit to serve many more pediatric patients per year. In a revised version of the model we quantify the benefits of helping some patients achieve discharge-ready status a few hours earlier than under current operations. In both cases, our cost analysis shows that the unit could realize hundreds of thousands of dollars more per year in net revenue. This argument can be used to help persuade decision makers, who have otherwise been skeptical of the idea of a discharge holding area.

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“…Performance and investment are linked by Harvard academics to quantify the costs associated with better built assets. This work has demonstrated a clear impact on the business case for higher capital spending, but not necessarily the case for a higher investment in maintenance or the qualitycost consequence of poor building condition (Berry et al 2004;Sadler et al 2011). Only when this evidence gap is addressed will long-term optimum investment decisions across a whole portfolio of assets (that have different age, condition and maintenance requirements) be possible.…”

Section: State-of-the-art Reviewmentioning

confidence: 93%

Critical Infrastructure Risk in NHS England: Predicting the Impact of Building Portfolio Age

Mills

Deka

Price

et al. 2015

International Journal of Strategic Property Management

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ABSTRACT. NHS Trusts in England must adopt appropriate levels of continued investment in routine and backlog maintenance if they are to ensure critical backlog does not accumulate. This paper presents the current state of critical backlog maintenance within the National Health Service (NHS) in England through the statistical analyses of 115 Acute NHS Trusts. It aims to find empirical support for a causal relationship between building portfolio age and year-on-year increases in critical backlog. It makes recommendations for the use of building portfolio age in strategic asset management. The current trend across this sample of NHS Trusts may be typical of the whole NHS built asset portfolio and suggests that most Trusts need to invest between 0.5 and 1.5 per cent of income (depending upon current critical backlog levels and Trust age profile) to simply maintain critical backlog levels. More robust analytics for building age, condition and risk-adjusted backlog maintenance are required.

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Fable Hospital 2.0: The Business Case for Building Better Health Care Facilities

Cited by 80 publications

References 41 publications

Evaluating a major innovation in hospital design: workforce implications and impact on patient and staff experiences of all single room hospital accommodation

Evaluating a major innovation in hospital design: workforce implications and impact on patient and staff experiences of all single room hospital accommodation

The Impact of a Discharge Holding Area on the Throughput of a Pediatric Unit

Critical Infrastructure Risk in NHS England: Predicting the Impact of Building Portfolio Age

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