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

Background: The COVID-19 pandemic placed healthcare design at the heart of the crisis. Hospitals faced challenges such as rapidly increasing their intensive care unit capacity, enabling physical distancing measures, quickly converting to telehealth and telework practices, and above all, keeping patients and staff safe. Improving flexibility in hospital facility design and adaptability of hospital operations to function in “crisis mode” can be seen as ways of future-proofing for pandemics. In a design brief, flexibility is typically mentioned as an important target. Meanwhile, robustness of technical infrastructure is called for, and standardization at unit level with single-occupancy inpatient accommodation may be considered a way to enhance flexibility and adaptability in dealing with a surge in infectious patients. Aim: To future-proof facility design with pandemic preparedness and resilience in mind, this study evaluated what kinds of interventions were taken in Dutch hospital facilities and what perspectives need to be considered when hospitals operate in crisis mode. Methods: We have collected data from facility and estate professionals from 30 Dutch hospitals. Using a practice-based approach, in-depth interviewing helped uncover and compare successful operational strategies and design elements that provided the flexibility needed in the early stages of the recent crisis. Results: As we looked at existing facilities and alterations made to allow hospitals to operate during the COVID-19 pandemic, we discovered that staff availability and adaptability were deemed crucial. Conclusion: We add the perspective of staff as an essential factor to be considered when future-proofing hospital facility desigr crisis mode operation.

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The design of a new hospital is typically used as a catalyst for change, redesign, and the implementation of new work processes to improve health services. Perceived outcomes after relocation may be linked to the success of co-design and stakeholder engagement processes. Especially in striking the right balance between the building (bricks), processes and supporting IT (bytes), and work processes (behavior). Even when stakeholders are engaged in the design, that does not guarantee that their needs will be safeguarded during trade-offs in various phases of decision making. Furthermore, the time window between engagement and project delivery may contribute to a mismatch in perceived outcomes after relocation. This study aims to gain insight into the possible causes of the perceived mismatches as expressed by ward managers some 12 months after relocation. This was some six years after the design of the facility was completed. It will increase our understanding of the complexity of design, construction, and transition processes that have to deal with a gap in time between design and use. We adopt an interpretive case study approach in which in-depth interviewing is combined with an extensive analysis of documents collected over time. We found transformative change requiring an integrative approach to the Bricks and Bytes throughout the whole process of designing, constructing and taking them into use, with stakeholder engagement as a key element. Additionally, we found that health care worker behavior was not considered sufficiently in a predominantly rational design and implementation process focusing on patient centeredness.@en

In hospitals, sinks act as reservoirs for bacterial pathogens. To assess the extent of splashing, fluorescein dye was added to four hospital sinks previously involved in pathogen dispersal to the environment and/or transmission to patients, and one sink that was not. Applying dye to the p-trap or tailpiece did not result in any fluorescent droplets outside of the drain. When applied to the drain, droplets were found in all but one wash basin, and this was more common in the absence of a drain plug. Sink design considerations to install drain plugs, reduce dripping and offset the tap may help to prevent transmission from drains.

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