Objective: This overview is intended to provide the process framework for built environment researchers to use the Delphi method. The article outlines the methodological criteria originally established for the Delphi method, as well as commonly accepted modifications, to advance guidance for evidence-based built environment considerations. Background: Increasingly used in healthcare research, the Delphi method is a process for gaining consensus through controlled feedback from a panel—a group made up of experts or individuals knowledgeable on the subject. The method is often used where there is limited or conflicting evidence, where participants may be geographically dispersed, and where anonymity is desired to control for dominant individuals. The Delphi method consists of panel selection, development of content surveys, and iterative stages of anonymous responses to gain consensus. Panelists receive feedback after each round in the form of a statistical representation of the overall group’s response. The goal of multiple iterations in the Delphi method is to reduce the range of responses and gain expert consensus, which is often seen as more credible than conjecture or individual opinion. Conclusion: With a geographic diversity of healthcare design expertise, and with so many aspects of healthcare design lacking a robust body of supporting empirical research, the Delphi method is well-suited to developing evidence-based design recommendations and considerations for healthcare built environments.

SPRs seem to result in more advantages than disadvantages. However, healthcare is a complex adaptive system, and decisions for 100% SPRs should be reviewed alongside related issues, such as necessary workflow modifications, unit configuration and other room layout decisions, patient populations, staffing models, and inherent trade-offs (e.g., the advantages of privacy compared to disadvantage of isolation).

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Background and Aims Evaluating evidence for the built environment is not easy, and many professionals struggle with the challenge of identifying the best available research. This article outlines the current state of science for evaluating evidence in healthcare design, drawing on previous discussion articles in this journal and introducing a Mixed Methods Appraisal Tool (MMAT), which can be used by professional designers to evaluate research evidence for healthcare design. Two case studies are provided to illustrate the use of the MMAT with an evidence levels algorithm. Critical Appraisal Tools Academic texts often include evaluation tools to assist students in taking a critical stance when reading research papers. For example, Reading Research (Davies & Logan, 2012) contains worksheets that can be used to evaluate systematic reviews, qualitative, quantitative, and mixed methods research. Several HERD articles and editorials have discussed the importance of evaluating the research used in evidence-based design (EBD) (Hamilton, 2011; Marquardt & Motzek,

Abstract:PURPOSE: This systematic mixed studies review (MSR) on hospital falls is aimed to facilitate proactive decision-making for patient safety during the healthcare facility design. BACKGROUND: Falls were identified by CMS as a non-reimbursed hospital acquired condition (HAC) due to volume and cost, and additional financial penalties were introduced with the 2014 US hospital acquired condition (HAC) reduction program. A 2015 alert identifies patient falls as one of the top reported sentinel events reported to the Joint Commission. Variations in fall rates at both the hospital and the unit level is indicative of an ongoing challenge. The built environment can act as a barrier or enhancement to achieving the desired results in safety complexity that includes the organization, people and environment (SCOPE). METHODS: The systematic literature review used MeSH terms and key word alternates for hospital falls with searches in MEDLINE, Web of Science, and CINAHL. The search was limited to English-language papers. RESULTS: Following full text review, 27 papers were included and critically appraised using a dual method mixed methods critical appraisal tool. Themes were coded by broad categories of factors for organization (policy/operations), people (caregivers/staff, patients); and the environment (healthcare facility design). Subcategories were developed to define the physical environment and consider the potential interventions in the context of relative stability. CONCLUSIONS: Conditions of hospital falls were identified and evaluated through the literature review. A theoretical model was developed to propose a human factors framework, while considering the permanence of facility design solutions.https://mc.manuscriptcentral.com/herd This systematic mixed studies review (MSR) on hospital falls is aimed to facilitate proactive decision-making for patient safety during the healthcare facility design. MethodsThe systematic literature review used MeSH terms and key word alternates for hospital falls with searches in MEDLINE, Web of Science, and CINAHL. The search was limited to Englishlanguage papers. ResultsFollowing full text review, 27 papers were included and critically appraised using a dual method mixed methods critical appraisal tool. Themes were coded by broad categories of factors for organization (policy/operations), people (caregivers/staff, patients); and the environment 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 F o r P e e r R e v i e w 2 (healthcare facility design). Subcategories were developed to define the physical environment and consider the potential interventions in the context of relative stability. ConclusionsConditions of hospital falls were identified and evaluated through the literature review. A theoretical model was developed to propose a human factors framework, while considering the permanence of sol...

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Patient safety is often considered in a behavioral context – what can someone do differently to improve outcomes? However, as a complex system of interactions, patient safety is better advanced through a systems thinking lens of human factors and ergonomics (HFE). While HFE is sometimes considered in three domains: physical, cognitive, and organizational, research in the area of the design of the physical environment is often limited to products, equipment and furnishings to accommodate a diverse population of users. With an increased focus on reimbursement related to patient safety as part of healthcare reform, organizations are becoming more aware of their own shortcomings and grappling with solutions to improve performance – typically people and processes. Yet the influence of the built environment, the space in which people work and are cared for, can act as a barrier or enhancement to achieving the desired results – physically, cognitively, and organizationally. Latent conditions of the built environment can contribute to hazards and risk within the system and using Reason’s Swiss Cheese Model can also become an additional layer of defense. A consensus-based safety risk assessment (SRA) design decision tool is being developed to address these built environment latent conditions funded through a three-year grant from the Agency for Healthcare Research and Quality (AHRQ).