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The objective of this study is to evaluate the performance of hospital inpatient ward spatial configuration in relation to visibility. Visibility is an important aspect in a hospital inpatient ward, and could support healthcare performance. Visibility is required in an inpatient ward for the purposes of control, surveillance, interaction and commun...
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... this study we evaluate the visibility in an inpatient ward in the design of a new university teaching hospital through isovist visualization and analysis. The ward has an 'H' shaped corridor layout (Figure 1.), consisting of two single corridors of patient bedrooms connected by a middle corridor where the staff areas, including the nurse stations, are located. There are three areas of nurse station. Two stations are located in each corner of the corridors; these are designated to provide control toward the bedrooms along the corridor. The third area of nurse station is located between the other two nurse stations; it has a larger space area and no direct access to bedroom corridors, and is designated as the working area of the nurse. The ward could be accessed by visitors through an elevator hall located at the end of the corridor, which also acts as the entrance to the ward. ...
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... Some of these structures are bewildering to discerning professionals, especially architects, who recognize that the design and configurations of these facilities are not conducive to optimal healthcare delivery services [1]. The spatial morphological configuration can either be defined as the overall shape of the building structure or its interior configuration [2]. The morphological configuration of the design spaces is a man-made object that modifies the natural environment, producing new ambiances. ...
... The morphological design configuration of a hospital building defines the overall shape of the building structure and its internal configuration which can be interpreted as building sizes, shape, densities, spatial forms, frontage patterns, physical connections and arrangement of interior furniture, location, accessibility, and connection to the neighborhood and landscape facilities, among others [9]; [10] and [2] address the spatial configuration of a hospital in-patient ward concerning the degree of visibility as an important aspect of patient care in the ward. The findings of the study had some implications for improving the performance of spatial organization of hospital in-patient wards in terms of visibility. ...
This study analyzed the morphological design features of the hospital physical facilities in Southwest, Nigeria. A lot of research work has evaluated different aspects of hospital design features while only a few of the previous studies included the morphological design characteristics of the physical facilities in their conceptual framework. As a result, hospital facilities are poor at meeting the needs and expectations of users due to the limited studies which have not been clearly understood and adequately carried out within the research circle. This is suggested in this study to provide better solutions to the problem. This study adopted a primary method of data collection which involved the use of 557 structured questionnaires randomly administered to three categories of users. The semi-structured interviews (SSI) were purposely administered to users to support the information obtained through the questionnaires. Through purposive sampling, buildings were restricted to four (4) buildings or departments at the Federal Universities Teaching Hospitals (FUTH) in southwest, Nigeria. Data obtained was analyzed at different levels and morphological design characteristics were assessed to be very adequate while other interior spaces need urgent attention. The study helps hospital policymakers in making appropriate decisions that can improve the healthcare environment in Nigeria.
... Johanes and Atmodiwirjo [36] developed an analytical tool and analyzed the visual acuity from the nursing station and during nurses' walking behavior in the corridor. They found that the layout's spatial arrangement -corridor design and patient room positions -affect the overall visual access from the nursing station in an inpatient ward. ...
A patient fall is one of the adverse events in an inpatient unit of a hospital that can lead to disability and/or mortality. The medical literature suggests that increased visibility of patients by unit nurses is essential to improve patient monitoring and, in turn, reduce falls. However, such research has been descriptive in nature and does not provide an understanding of the characteristics of an optimal inpatient unit layout from a visibility-standpoint. To fill this gap, we adopt an interdisciplinary approach that combines the human field of view with facility layout design approaches. Specifically, we propose a bi-objective optimization model that jointly determines the optimal (i) location of a nurse in a nursing station and (ii) orientation of a patient's bed in a room for a given layout. The two objectives are maximizing the total visibility of all patients across patient rooms and minimizing inequity in visibility among those patients. We consider three different layout types, L-shaped, I-shaped, and Radial; these shapes exhibit the section of an inpatient unit that a nurse oversees. To estimate visibility, we employ the ray casting algorithm to quantify the visible target in a room when viewed by the nurse from the nursing station. The algorithm considers nurses' horizontal visual field and their depth of vision. Owing to the difficulty in solving the bi-objective model, we also propose a Multi-Objective Particle Swarm Optimization (MOPSO) heuristic to find (near) optimal solutions. Our findings suggest that the Radial layout appears to outperform the other two layouts in terms of the visibility-based objectives. We found that with a Radial layout, there can be an improvement of up to 50% in equity measure compared to an I-shaped layout. Similar improvements were observed when compared to the L-shaped layout as well. Further, the position of the patient's bed plays a role in maximizing the visibility of the patient's room. Insights from our work will enable understanding and quantifying the relationship between a physical layout and the corresponding provider-to-patient visibility to reduce adverse events.
... One operational factor that can directly and considerably impacted by physical design is "visibility" (Ahmadpour et al., 2021;Calleja & Forrest, 2011;Gharaveis et al., 2018;Gharaveis et al., 2020a;Gharaveis, Shepley, et al., 2019;Harvey & Pati, 2012;Lim et al., 2020;Lim & Zimring, 2020;Lu & Zimring, 2012;Pati et al., 2014). Visibility, as a design factor, is a combination of various components, such as proximity and the location of walls and partitions, which can be affected by wall arrangements (Gharaveis et al., 2019a;Harvey & Pati, 2012;Johanes & Atmodiwirjo, 2015). ...
... Visibility, a characteristic of a layout, is defined by Trzpuc and Martin (2010), who studied medical-surgical units, as the provision of visual connectivity among different spaces. Johanes and Atmodiwirjo (2015) listed components of visibility on general inpatient units as visibility of the entrance area, visibility to and from nurse stations, and visibility of staff while they are walking on the unit. Prior studies identified visibility as a factor to ensure monitoring patient and staff conditions (Doede et al., 2018;Joseph & Rashid, 2007;Patterson et al., 2017;Zamani, 2019). ...
Unlabelled:
This research explored the relationship between visibility and the level of security risks as perceived by nurses and physicians in emergency departments (EDs). Security in EDs has been reported as a major global concern, and visibility has been identified as a design factor impacting behavior. However, few previous studies have rigorously investigated the role of visibility in reduction of ED security risks with evidence-based design approach. There is a lot of significant questions about how visibility impacts the reduction of security issues in EDs.
Methods:
How visibility may influence ED security was explored via qualitative methods in five EDs using semi-structured one-on-one interviews with 17 clinical staff and 48 hr of field observations. The coding process for both interviews and observational notes followed the principles of naturalistic inquiry.
Results:
The findings suggest security risks can be decreased by improving visibility. Medical staff (registered nurses and physicians) felt more secure in the EDs with higher visibility.
Discussion:
This study provides a framework to identify preferable levels of visibility in EDs and proposes design strategies to minimize security issues. Registered nurses and physicians can improve their team's sense of security by considering visibility throughout their daily practices.
... Some of these structures are bewildering to discerning professionals, especially architects, who recognize that the design and con gurations of these facilities are not conducive to optimal healthcare delivery services (Akinluyi, Fadamiro, Ayoola H. A, Alade M.J, 2020). The spatial morphological con guration can either be de ned as the overall shape of the building structure or its interior con guration (Johanes and Atmodiwirjo, 2015). The morphological con guration of the design spaces is a man-made object modi es the natural environment, producing new ambiances. ...
... The morphological design con guration of hospital building de ned the overall shape of the building structure and its internal con guration which can be interpreted as building sizes, shape, densities, spatial forms, frontage patterns, physical connections and arrangement of interior furniture, location, accessibility, and connection to the neighbourhood and landscape facilities, among others (Huybers, 2013; Akinluyi, Fadamiro Ayoola & Alade, 2021). Johanes and Atmodiwirjo (2015) addresses the spatial con guration of a hospital in-patient ward in relation to the degree of visibility as an important aspect of patient care in the ward. The ndings of the study had some implications for improving the performance of spatial organization of hospital in-patient wards in terms of visibility. ...
This study analyzed the morphological design features of the hospital physical facilities in Southwest, Nigeria. The research work is a reflection of a positive trend that can affect the quality of healthcare facilities design in the years to come. A lot of research work has evaluated different aspects of hospital design features while only few of the previous studies included design characteristics in terms of morphological configuration of the physical facilities in their conceptual framework. As a result, hospital facilities are poor at meeting the needs and expectations of users due to the limited studies on users’ assessment of the morphological design characteristics which have not been clearly understood and adequately carried out within the research circle. This is suggested in this study to provide better solutions to the problem. This study adopted a primary method of data collection which involved the use of 557 structured questionnaires randomly administered to three categories of users and semi-structured interviews ( SSI) purposely administered to users to support the information obtained through the questionnaires . Through purposive sampling, buildings were restricted to four (4) buildings that accommodate 4 main departments which gave birth to other departments such as paediatrics, surgery, medicine, obstetrics and gynaecology at the Federal Universities Teaching Hospitals (FUTH) in southwest, Nigeria built between 1950s and 1970s and managed by the Federal Government of Nigeria. Data obtained was analysed at univariate, bivariate and at multivariate levels. The morphological design characteristics such as the volume in terms of size and proportion, aesthetics, size of the components in most interior spaces are very adequate while other interior spaces need urgent attention. The study helps the hospital policy makers in making appropriate decisions that can improve the healthcare environment in Nigeria.
... However, airborne nosocomial infections in general inpatient wards during the COVID-19 outbreak has been overlooked. A general inpatient ward can be a hub for airborne transmission as it consists of shared cubicles (some of them without closed doors) connected by a central nursing station [1]. Ventilation requirements in general inpatient wards are less stringent than those in special ventilation rooms [2]. ...
... F9 influencing F4: Organizational leadership (F9) influences Hospital Visibility (F4). In hospitals, visibility is necessary for control, surveillance, interaction, and communication among patients and nurses, and it can be controlled by the spatial design of the hospital environment (Johanes & Atmodiwirjo, 2015), which is influenced by assisting the setting of strategic goals for the hospital while successfully supporting of the goals and the effective operations flow of the hospital. F9 influencing F5: Organizational leadership (F9) influences Hospital chain management (F5). ...
This paper aims to 'identify,' 'analyze,' and 'categorize' Agility, Adaptability, and Alignment (Triple-A) readiness factors in healthcare organizations using Total Interpretive Structural Modelling (TISM). This study identified nine triple-A readiness factors for healthcare organizations. The present research looked at the interrelationships between readiness variables for agility, adaptability, and alignment deployment in healthcare organizations. The findings would assist healthcare practitioners in implementing triple-A in hospitals to enhance service quality. TISM and MICMAC analysis is utilized to determine the importance of each of the elements, allowing organizations to prioritize the most important variables first, followed by the rest of the factors. The identified key factors are organizational leadership, flexible service design, advanced technology and innovativeness, strategy fits. This research will aid key stakeholders and academics in better understanding the readiness factors that influence agility, adaptability, and alignment in a healthcare organization. This study proposes the TISM technique for healthcare, which is a novel attempt in the subject of Triple-A in this sector. This research contributes to the Triple-A theory of knowledge, model conceptualizing, and organizational change.
... In particular, this study attempts to analyze the role of the two operations types, the tours and the maps, within a sequence of a wayfinding journey in a hospital building. Some studies in hospital and healthcare facilities have revealed the role of spatial configuration in hospital performance (Johanes & Atmodiwirjo, 2015;Sengke et al., 2020;Yatmo et al., 2018Yatmo et al., , 2021, including issues with wayfinding (Pati et al., 2015;Carpman et al., 2016;Johanes & Yatmo, 2018). This current study demonstrates how the movement of visitors can take place in a particular spatial configuration of a hospital. ...
This
paper addresses the issue of wayfinding and human movement in a complex
building. It focuses on the operations people perform to enable themselves to
move from one place to another during the process of searching for a
destination in a building. The wayfinding operations build upon the concept of tours and maps proposed by de Certeau (1984).
This paper analyses how the tours and
the maps operations were employed and
distributed in a wayfinding journey within a building, with these operations enabling
visitors to reach a certain destination in the building. The tours and maps operations were revealed by looking into the wayfinding
narrative based on observations of participants executing wayfinding tasks. The
results of the study indicate that the length of a wayfinding journey conforms
to the number of operations performed.
Both tours and maps operations had the same role in
regulating the movements in the wayfinding journeys. While the tours operations regulated how people
moved from place to place, the maps operations
supported their movements by giving information from the surrounding
environment. Understanding movement mechanisms by exploring operations in a
wayfinding journey could contribute to the development of digital navigation
systems for indoor wayfinding.
... Accessibility is a factor that tends to affect patients and staff. As discussed in previous literature, good accessibility improves nurses' response time to reaching patient rooms, offers an open design layout for staff to easily access patient rooms, and supports a clear vision for continuous observation to maintain patients' security [3,20,[32][33][34][35]. Accessibility covers entrances and nurses' routes. ...
This paper discusses the potential role of inpatient layout in creating a healing environment for its users, whether there is an existing relationship between inpatient typology and healing environment. The study employs an evidence-based design method adopting a qualitative-quantitative approach as a multiple research methodology. Quantitatively, an EBD questionnaire-ASPECT was distributed to the users to assess the healing environment within specific cases; syntactic maps were used to assess the configuration of inpatient layouts. Qualitatively, a modified EBD-AEDET tool was used as a checklist evaluation. Four different inpatient typologies (H-shape, T-shape, U-shape, L-shape) were chosen to represent four hospitals in Erbil city. Results showed that there is a clear effect of the inpatient typology on the healing environment of patients. Research outputs provide a useful database for healthcare designers in their future designs, especially for inpatient units due to their influential role in creating a healthy and safe healing environment for patients.
... But this ideal is never met due to the initial design consideration of the existing facilities in terms of number of patients per ward, spaces, sizes and availability, organization, location, accessibility, privacy, and proximity among other variables, which could no longer meet up with the current demand for healthcare services. Since this has seriously affected the patients well-being and reduced the staff performances [2][3][4][5] , research is needed to develop policy strategies for renovation and construction of new hospital buildings and environmental facilities to improve the current healthcare situation. ...
... Measures from many researchers in both the developed and developing nations have been identified through the literature to examine the various aspects of healthcare physical facilities addressing design issues and satisfaction from both the patients, caregivers and healthcare professionals' perspectives. For example, the study conducted by [2] focused on the performance of hospital inpatient ward spatial configuration in relation to visibility. The findings show the importance of visibility as experienced by the users in hospital ward; and [8] focused on design such as layout typologies, space connection to another building, shape and arrangement of spaces as factors that determined overall hospital satisfaction. ...
... An interview method of data collection was conducted using different hospital physical facilities such as nurses' stations, the medicine room, emergency ward (both internal, external, and technical conditions) and spatial conditions and workflow practice for each unit was evaluated The finding showed that users of the facilities were satisfied with overall spatial condition and workflow pattern of the facilities and the result highlights the interrelationship between occupational patterns, spatial configuration, and the users. [2] Addresses the spatial configuration of a hospital inpatient ward in relation to the degree of visibility as an important aspect of patient care in the ward. The findings of the study have some implications for improving the performance of spatial organization of hospital inpatient wards in terms of visibility. ...
This study reviewed the theoretical issues relating to morphological and psychological design issues in building hospital design evaluation. The study of morphological configurations design issues in this study, concentrates on the elements of building, shape/form, the structure of the environment, the structural efficiency and the architectural appearance of the hospital building forms. The psychological design issues focused on the essential issues relating to Proximity, Privacy and Wayfindings. Through the literature review of previous models such as Haron, Khan (2012) Operational Efficiency Model, Hamid and Talib Usability Framework, (2012), Zhao, Mourshed & Wright (2009) Model, Alalouch, Aspinall & Smith Model (2016) and Hill & Kitchen (2009). A conceptual framework for physical facilities design evaluation and satisfaction in hospital buildings was developed. The study, however, provides useful information in the development of a design framework that can inform policy on hospital buildings.
... Hence, visibility studies require capturing this information from more than one location as nurses traverse several rooms and change locations during a care episode. To address this deficiency, Johanes and Atmodiwirjo [45] studied visibility from several location points (i.e., station, corridors, elevator, and entrance) as a nurse provides patient care. The authors were able to visualize the extent of visibility using a heat map and quantify the duration a nurse spends in each location for a given layout. ...
... can be used to develop multi-objective problems that consider daylighting. OpƟmizaƟon SimulaƟon Fig. 9 Approach for modeling circulation paths using simulation-optimization & Visibility: Several studies addressed the simulation of layout visibility using agent-based simulation [42,45,79], as discussed in section 3.3.5. All of these studies considered either a fixed layout or a subset of fixed layouts. ...
Healthcare facility design is a complex process that brings together diverse stakeholders and ideally aligns operational, environmental, experiential, clinical, and organizational objectives. The challenges inherent in facility design arise from the dynamic and complex nature of healthcare itself, and the growing accountability to the quadruple aims of enhancing patient experience, improving population health, reducing costs, and improving staff work life. Many healthcare systems and design practitioners are adopting an evidence-based approach to facility design, defined broadly as basing decisions about the built environment on credible and rigorous research and linking facility design to quality outcomes. Studies focused on architectural options and concepts in the evidence-based design literature have largely employed observation, surveys, post-occupancy study, space syntax analysis, or have been retrospective in nature. Fewer studies have explored layout optimization frameworks, healthcare layout modeling, applications of artificial intelligence, and layout robustness. These operations research/operations management approaches are highly valuable methods to inform healthcare facility design process in its earliest stages and measure performance in quantitative terms, yet they are currently underutilized. A primary objective of this paper is to begin to bridge this gap. This systematic review summarizes 65 evidence-based research studies related to facility layout and planning concepts published from 2008 through 2018, and categorizes them by methodology, area of focus, typology, and metrics of interest. The review identifies gaps in the existing literature and proposes solutions to advance evidence-based healthcare facility design. This work is the first of its kind to review the facility design literature across the disciplines of evidence-based healthcare design research, healthcare systems engineering, and operations research/operations management. The review suggests areas for future study that will enhance evidence-based healthcare facility designs through the integration of operations research and management science methods.
