A team of researchers is working on a new way of designing health care facilities that could profoundly change how commercial buildings are designed.
The team, led by Karen Parent, a professor in the department of physical medicine and rehabilitation at Queen's University, will be examining how staff and patients work and interact in the Carlo Fidani Peel Regional Cancer Centre, a new cancer care centre at the Credit Valley Hospital in Mississauga.
They'll use a cutting-edge research process called evidence-based design, tracing the movements of 30 patients, an undetermined number of doctors and 10 nurses by following, or shadowing, them and recording the data over one or two weeks in February. In-depth interviews and participant surveys will add to the body of knowledge in the $200,000, two-year study.
By using the information collected from the real-world use of a facility, researchers hope to develop "metrics," or standards of measurement, that architects and developers can use when renovating or designing new hospitals or health care facilities.
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Significantly, the process may also challenge one of the most fundamental assumptions that architects use in health care design: That a functional plan developed after in-depth consultation with staff gives an accurate picture of users' actual needs.
The team will interview and shadow participants in the old cancer treatment centre at the Credit Valley Hospital, then repeat the process with the same people once they move into the Carlo Fidani Cancer Centre. The move is expected to take place in May.
The process will be mirrored at Grand River Hospital in Kitchener, Ont., where a control group will undergo the same procedures at the Grand River Regional Cancer Centre as in the Carlo Fidani Cancer Centre.
Architect Tye Farrow of Farrow Partnership Architects Inc. of Toronto designed Credit Valley's new cancer centre and is a partner in the study called Measuring Best Performance and Value for Hospital Infrastructure Support.
He explains the rationale: "What's fascinating is that what people say or the way they do things can often in fact be different from the way they actually do it. Often, staff are unaware on a daily basis how their time actually breaks down. [The study] allows us to have more quantitative hard data."
There is growing research worldwide into the rigorous evidence-based process. If this study confirms the superiority of the process, it could find its way into greater use by developers of all types of commercial buildings, Prof. Parent says.
"In fact, I would argue that it would be negligent not to do so."
Results will be used for design standards to ensure better work flow, productivity, decision making, communication, transaction costs and satisfaction at the cancer centre, said Ron Noble, Credit Valley's vice-president of corporate planning and construction and lead partner in the study. The results will also be widely disseminated for other practitioners.
Following the cancer centre's move, the hospital will be free to make any design changes dictated by the research, and the results will form part of the team's final report in the fall of 2006, Mr. Noble said.
While most of the Carlo Fidani Cancer Centre has been completed, there will be opportunity to make some interior design changes suggested by the study, Mr. Farrow, the architect, said.
How rare is evidence-based design?
It is not a new process in the health care sector, such as nursing and dentistry. And the process of using evidence for design generally is not new, considering that studies have been done for years where workers have been observed in their workplaces in order to develop better design.
However, architect Kirk Hamilton of Watkins Hamilton Ross Architects Inc. in Texas, a proponent of evidence-based design and an acknowledged leader in the research, said the method of using evidence-based design that he advocates requires the study team to develop a focused hypothesis at the beginning of the study and rigorously collect and report data. When researchers have goals that can be measured, they can answer questions such as whether people can be moved through the facility faster or whether any money can be saved.
Because of the rigorous and scientific nature of the process, the results speak for themselves and the process may prove challenging to some architects, given that some may feel a loss of control over their designs, he says.
Prof. Parent said the Credit Valley project is particularly timely in light of a government report that predicts a national nursing shortage in the years to come, indicating a need for good work environments.
It also comes at a time when the Ontario government has included an extra $470-million in last spring's budget for hospitals.
"Now with the focus on reducing waiting times in health care in Canada and increasing patient satisfaction and staff retention, it is a very relevant subject of which we believe we are undertaking the first study of its kind," Mr. Farrow said.
Money for the study comes from the Change Foundation, founded by the Ontario Health Association for the promotion of, support for and improvement of health care. A grant of $100,000 is to be matched by donations in kind.
The foundation supports evidence-based research to the point of providing Prof. Parent with $100,000 for another evidence-based design study, but this time for a study of work spaces.
This project will use the research to redesign an internal office space with the goal of increasing the speed of decision making, increasing communication and becoming more efficient.
Ask the project partners whether they expect the Credit Valley study to challenge the design of the nearly complete regional cancer centre, and Prof. Parent says: "We have to be open to that, but at the moment . . . I believe it's going to be a positive outcome."
"We can only hypothesize; now they're [patients] in the clinic for a full day, but in the new space, hopefully, they'll spend fewer hours at the hospital because we'll be able to process them through more efficiently. That's our hypothesis on our new space design," Mr. Noble said.
Mr. Farrow expects the report will lead to some changes at the cancer centre and maybe on another project.
"We're doing another cancer treatment centre in Trinidad now, and the information will be valuable for that project also."
It's the kind of work that could influence and set the pace for health care design for years to come, Mr. Farrow said.
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