The door between the semi-public corridor and the single-occupancy patient room of a newly built University Medical Centre in the Netherlands has been heavily debated during its Evidence Based Design (EBD) and experience-informed design. It was also heavily debated since the wards came into use in 2018. It is well known that, regarding door design, a trade-off has to be made between aspects such as privacy, visibility, and safety. This makes our case study exemplary for the trade-offs to be made in EBD practice. This study traces back to how the design decisions for the door, dating from 2011, were made. Safety, privacy, control, and support for the social and emotional wellbeing of patients, relatives, and staff were the aim, but this is not experienced as such by all concerned. This case study evaluation highlights the tension between EBD principles and everyday practice, where the interplay between ‘bricks, bytes, and behavior’ has to be considered, and every consciously debated design solution might bring new and unforeseen challenges elsewhere. Our practice-based research combines the analysis of documentation on the design decision-making process with evaluation interviews with nurse managers in 2019. Our findings on ‘the (Dutch) patient door debate’ can contribute to awareness of trade-offs to be made in health facility design, complemented with supportive IT systems and efficient and effective staff workflows. It can enhance the understanding of the many aspects that need to come into consideration during design dialogues with experts and end-users.@en

The COVID-19 pandemic placed healthcare design at the heart of the crisis. Hospitals faced challenges such as increasing their ICU capacity and enabling physical-distancing measures to prevent infectious spread. They also needed to co-house suspected COVID patients and nonCOVID patients with different requirements and enforce separate entrances and routes to keep staff and patients safe. It is suspected that even in a fully vaccinated world, other pandemics are waiting in the wings. In a design brief, flexibility is typically mentioned as an important target, and single occupancy inpatient accommodations may be considered as a way to enhance flexibility. To gain insight into and inform future hospital design, this study evaluated what operational coping strategies and design solutions were considered important enablers to increase ICU capacity and support different patient flows, and what design solutions enabled physical distancing. We have collected data from 30 Dutch hospital organizations, including some recently opened hospitals, with 100% single occupancy inpatient accommodation. Using a practice-based approach, in-depth interviewing was combined with document and multimedia analyses to analyze and compare successful operational strategies and design elements that helped provide the flexibility needed in this recent crisis. As we looked at existing facilities and alterations made to allow hospitals to operate in ‘crisis mode’ during the COVID-19 pandemic, we presented emerging design considerations for future healthcare facilities that, preferably, can also be implemented in renovations or refurbishments. We add the perspective of staff as a limiting factor in a hospital’s pandemic preparedness.@en