Assessing the Feasibility of Measuring Variation in Facility Design Among American Childbirth Facilities

Plough, Avery; Polzin-Rosenberg, Deb; Galvin, Grace; Shao, Amie; Sullivan, Brendan; Henrich, Natalie; Shah, Neel

doi:10.1177/1937586718796641

Cited by 3 publications

(5 citation statements)

References 27 publications

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“…Overall, our findings support existing evidence that the labor and delivery unit environment varies widely across the U.S. and that differences in design may impact care [ 7 , 8 , 36 , 37 ]. Testing different configurations of ORs and even entire labor and delivery units during actual and simulated obstetric emergencies would allow researchers to measure how design may impact performance and care delivery.…”

Section: Discussionsupporting

confidence: 85%

Single-center task analysis and user-centered assessment of physical space impacts on emergency Cesarean delivery

et al. 2021

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Cesarean delivery is the most common surgery performed in the United States, accounting for approximately 32% of all births. Emergency Cesarean deliveries are performed in the event of critical maternal or fetal distress and require effective collaboration and coordination of care by a multidisciplinary team with a high level of technical expertise. It is not well understood how the physical environment of the operating room (OR) impacts performance and how specialties work together in the space. Objective This study aimed to begin to address this gap using validated techniques in human factors to perform a participatory user-centered analysis of physical space during emergency Cesarean. Methods This study employed a mixed-methods design. Focus group interviews and surveys were administered to a convenience sample (n = 34) of multidisciplinary obstetric teams. Data collected from focus group interviews were used to perform a task and equipment analysis. Survey data were coded and mapped by specialty to identify reported areas of congestion and time spent, and to identify themes related to physical space of the OR and labor and delivery unit. Results Task analysis revealed complex interdependencies between specialties. Thirty task groupings requiring over 20 pieces of equipment were identified. Perceived areas of congestion and areas of time spent in the OR varied by clinical specialty. The following categories emerged as main challenges encountered during an emergency Cesarean: 1) size of physical space and equipment, 2) layout and orientation, and 3) patient transport. Conclusion User insights on physical space and workflow processes during emergency Cesarean section at the institution studied revealed challenges related to getting the patients into the OR expediently and having space to perform tasks without crowding or staff injury. By utilizing human factors techniques, other institutions may build upon our findings to improve safety during emergency situations on labor and delivery.

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Section: Discussionsupporting

confidence: 85%

Single-center task analysis and user-centered assessment of physical space impacts on emergency Cesarean delivery

et al. 2021

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“…“Creating spaces for resting,” a prescription cited by six papers, is important for reducing fatigue and therefore improving the quality of care delivered (Plough et al, 2019), for instance, by providing break areas and staff restrooms for professionals to relax and be free from constant work interruptions (Pati et al, 2008).…”

Section: Resultsmentioning

confidence: 99%

“…As such, the design of "multi-purpose furniture, rooms, and equipment" is the most cited prescription (23) related to this group. It can involve, for instance, adaptable beds for different patient needs (Plough et al, 2019).…”

Section: Meta-principle 2: Designing Slackmentioning

confidence: 99%

The Built Environment Influence on Resilient Healthcare: A Systematic Literature Review of Design Knowledge

Ransolin

Saurin

Zani

et al. 2022

HERD

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Objective: The aim of this study was to develop built environment (BE) design knowledge to support resilient healthcare by systematically reviewing the evidence-based design (EBD) literature. Background: Although the EBD literature is vast, it has not made explicit its contribution to resilient healthcare, which is a key component of the highly complex health service. Method: This review followed the steps recommended by the Preferred Reporting Items for Systematic reviews and Meta-Analyses method. After applying the inclusion and exclusion criteria, 43 journal papers were selected. The papers were analyzed in light of five guidelines for coping with complexity, allowing for the development of BE design knowledge that supports resilient healthcare. Results: The design knowledge compiled by the review was structured according to four levels of abstraction: five design-meta principles, corresponding to the five complexity guidelines, seven design principles, 21 design prescriptions, and 58 practical examples. The design knowledge emphasizes the interactions between the BE as physical infrastructure and the functions that it supports. Conclusions: The design knowledge is expected to be useful not only to architects but also to those involved in the functional design of health services as they interact with the BE. Furthermore, our proposal provides a knowledge template that can be continuously updated based on the experience of practitioners and academic research.

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“…Given this potential for unintended consequences of design, facility managers should intentionally consider the current designs of their spaces and how these designs may support or impede their targeted practice patterns and culture. The primary study that generated the data for this analysis revealed substantial variation in childbirth facility design across the United States in ways that appear independent of care provision needs, so there is a clear opportunity for clinicians, managers, and designers to be more intentional about designing childbirth facilities that support the care they aim to provide . Managers should also consider how their processes and culture may affect the ability of design to be an effective tool to improve care processes and outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…In prior work, we reviewed the literature on health care design to identify evidence‐based design elements that may affect the ways care is provided and measured variation in these elements among a sample of childbirth facilities across the United States . In this study, we conducted a secondary analysis to illustrate the mechanisms by which these elements that vary across childbirth facilities in the United States may affect the ways they provide care.…”

Section: Methodsmentioning

confidence: 99%

An Exploratory Study of the Relationship between Facility Design and the Provision of Childbirth Care

Plough¹,

Polzin-Rosenberg²,

Galvin³

et al. 2018

J Midwife Womens Health

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Introduction: Across health care, facility design has been shown to significantly affect quality of care; however, in maternity care, the mechanisms of how facility design affects provision of care are understudied. We aim to identify and illustrate key mechanisms that may explain how facility design helps or hinders clinicians in providing childbirth care. Methods:We reviewed the literature to select design elements for inclusion. Using a modified Delphi consensus process, we engaged an interdisciplinary advisory board to prioritize these elements with regard to potential effect on care provision. The advisory board proposed mechanisms that may explain how the prioritized facility design elements help or hinder care, which the study team organized into themes. We then explored these themes using semistructured interviews with managers at 12 diverse birth centers and hospital-based labor and delivery units from across the United States. Results:The design of childbirth facilities may help or hinder the provision of care through at least 3 distinct mechanisms: 1) flexibility and adaptability of spaces to changes in volume or acuity; 2) physical and cognitive anchoring that can create default workflows or mental models of care; and 3) facilitation of sharing knowledge and workload across clinicians.Discussion: Facility designs may intentionally or unintentionally influence the workflows, expectations, and cultures of childbirth care.

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Assessing the Feasibility of Measuring Variation in Facility Design Among American Childbirth Facilities

Cited by 3 publications

References 27 publications

Single-center task analysis and user-centered assessment of physical space impacts on emergency Cesarean delivery

Single-center task analysis and user-centered assessment of physical space impacts on emergency Cesarean delivery

The Built Environment Influence on Resilient Healthcare: A Systematic Literature Review of Design Knowledge

An Exploratory Study of the Relationship between Facility Design and the Provision of Childbirth Care

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