Briefing a children’s hospice: bridging the evidence gap and redefining value in contemporary healthcare design

Abstract

Knowledge produced within the field of evidence-based design seeks credible data to support decision-making in the architectural design process. When directed towards the design of healthcare settings, such knowledge can support both the optimisation of patient healing and the improvement of staff performance in ways that correlate positively with patient safety and well-being. Spatial configurations that improve co-worker proximity, visibility, and communication can have a positive influence on staff perceptions of work culture, available support, and workplace safety that, in turn, support the delivery of patient care.1 Spatial proximities also have a direct influence on the types and frequencies of socialisation that will take place within spaces between patients, family members, and staff.2 This can support or hinder the formation of social support networks that can assist patients and family members to cope with stress, and healthcare workers to cope with stress and work-related grief.3 Evidence-based design researchers have also argued that design can be utilised to improve infection control, reduce falls, and minimise errors in medication dispensing.4 A clear disparity exists, however, in the quantity of evidence available to guide the designers of hospital-based palliative care and hospice facilities relative to general hospitals.

Designing Palliative Care Facilities to Better Support Patient and Family Care: A Staff Perspective

“…Where staff perceived the environment to impede the possibility of healing, and particularly where the environment was seen to unnecessarily exacerbate patient and family distress, staff also found this distressing. Other studies have similarly observed that where the ability of staff to deliver an appropriate level of patient care is compromised by external and competing factors, both including and beyond those related to the built environment, this results in feelings of frustration (Bartlett & Clarke, 2012;McLaughlan & Pert, 2020).…”

“…That staff expressed such awareness, and indeed concern, for patient and family well-being suggests that improving the built environment for the benefit of patient and family comfort might also positively impact staff well-being (also see McLaughlan & Pert, 2020). It would be remiss of us, however, to make this observation without also acknowledging that this could compound an existing risk; the needs of palliative care staff could be easily overlooked within architectural briefing processes because staff are likely to prioritize the needs of patients and families above their own.…”

“…This article reports on the perceptions of palliative care staff, specifically their understanding of this relationship between the physical environment and the philosophy of care. How staff perceive the capacity of an inpatient environment to support or obstruct their delivery of care has implications for the quality of care delivered to patients and families, but also to job satisfaction and staff well-being (Curtis & Northcott, 2016; Maben et al, 2015; McLaughlan & Pert, 2020; Novotná et al, 2011; Tyson et al, 2002). Perceptions of a space, or how a building feels , as Martin et al (2019) have observed, are “subtly entangled with the ways that people feel about [that building]…and their understanding of the feelings they have whilst in [that building].” Staff perceptions can provide designers and decision makers with data that speak to functional suitability but also to the emotional experiences contained within these spaces (Edvardsson et al, 2006; Irish Hospital Foundation, 2009; Jencks, 1995).…”

“…Although there is value in translating research from other healthcare settings, doing so carries the risk of effacing the specificities of palliative care needs and transferring this erasure into future palliative care design outcomes. Inspired by Keeney’s (1992) theory of “value-focused thinking,” we asked staff to consider the facility in which they deliver care relative to the philosophy of care (the value system) that guides their work (also refer McLaughlan & Pert, 2020). As McLaughlan et al (2020) have previously posited, highlighting the relationship between spaces and the values that underpin care can make clearer which spaces contribute most to supporting those values, usefully guiding where design attention should be focused.…”

“…As McLaughlan et al (2020) have previously posited, highlighting the relationship between spaces and the values that underpin care can make clearer which spaces contribute most to supporting those values, usefully guiding where design attention should be focused. While recognizing the unique perspective that staff can offer regarding the environments in which they deliver care (Elf et al, 2015; McLaughlan & Kirby, 2021; McLaughlan & Pert, 2020), the data reported here form part of a 3-year study that seeks to complement the knowledge obtained from staff with the views of patients and family members (ongoing COVID-19-related restrictions have delayed these interviews).…”