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Gentrification or Health-promoting Resource? Long-term Residents' Perceptions and Use of the Atlanta BeltLine

2021-01-27 , Matic, Zorana

Investments in green infrastructure such as multi-use urban greenways are made with the goal to improve the residents' health by creating space for physical activity, recreation, and social interactions, providing opportunities for active transportation, and increasing exposure to nature's healing effects. Despite the host of benefits, regreening initiatives in lower-income neighborhoods can also catalyze 'green' or 'environmental' gentrification. There is growing empirical evidence that gentrification affects the residents' health and well-being, both positively and adversely. The previous scholarship mostly focused on greenway users and has mainly adopted quantitative methods (such as observation and intercept surveys) to measure green infrastructure use, activity patterns, and users' satisfaction. However, the research on the incumbent residents living adjacent to a newly developed greenway is limited. It is still not fully understood whether incumbent residents have a positive perception of newly installed greenways, the extent to which they take advantage of these new resources, and whether the new greenways mostly attract new and habitually active residents. This research seeks to fill this gap by exploring the interrelationships between green infrastructure, green gentrification, and long-term residents' health and healthy behaviors in Atlanta, which that has recently invested into and developed a number of green infrastructure projects. This dissertation has two studies. Capitalizing on free and readily available U.S. census data, the first study proposes a replicable quantitative approach for developing a composite socioeconomic index as a tool for identifying and measuring gentrification. In the second study, this research closely looks at two historically African American neighborhoods in the early stages of gentrification and adjacent to the new BeltLine recreational trail. By interviewing long-term residents, this research seeks to develop a deeper understanding of green gentrification from their vantage point and to examine their responses to new greenway and opportunities for adopting health-promoting behaviors. The quantitative analysis indicated that nearly half of eligible census tracts in Atlanta are gentrifying, while two-thirds will soon be in various stages of gentrification. The census tracts within one-half mile of the BeltLine proposed path are gentrifying at a slightly faster pace. The Atlanta's gentrification patterns echo the previous findings on the proximity of the BeltLine and growing gentrification pressures in the trail-adjacent neighborhoods. Additionally, the results suggest the association between gentrification and residents' better self-rated health. The analysis found a consistent pattern of decreasing rates of residents who report low physical activity and poor self-rated health (both mental and physical) with increasing levels of gentrification. The interviews revealed much more nuanced responses to the trail construction and green gentrification. Most interviewees perceived and used the new trail as a health-promoting resource; while it enabled the habitual exercisers to maintain active lifestyles, it prompted some new trail users to be physically active. However, concerns regarding gentrification and feeling that new amenities cater to the 'gentrifiers' and not the existing community, in some cases acted as barriers to trail usage and regular physical activity. The findings suggest that perceptions of social environment entwine inextricably with perceptions of the physical environment and the extent to which groups or individuals take advantage of health-promoting resources. This study has important implications for future research and design of effective greening infrastructure to increase trail usage among long-term residents, particularly those who are not habitually active.

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From physical layout to spatial experience: Understanding the impact of visual interfaces on teamwork in primary care clinics

2018-07-31 , Lim, Lisa

Teamwork among healthcare providers is critical for the safety and quality of patient care. Multiple national strategies and programs have been developed and recommended for implementation of a team-based approach to primary care, and many healthcare organizations are adopting team-based primary care clinics. However, little is known about how clinic layouts can support the teamwork of staff members in team-based primary clinics. To date, there has been little agreement on how clinic layouts should be designed to support the teamwork experiences of staff members and patients. Thus, different healthcare organizations advocate for unique and significantly different types of team-based clinic layouts. This study looked at four team-based primary care clinics to empirically investigate the relationships between visibility metrics and both patients’ and staff members’ teamwork experience. The results of the study showed that the visual interfaces between staff members and patients, as well as between different groups of staff members, were found to have significant associations with awareness, communication, backstage communication, and overall perception of teamwork. While no specific differences in awareness perceptions were reported between clinics, some negative consequences resulting from the lack of staff’s ability to see the clinic area and other staff members were observed. Staff members had to spend additional time searching for each other and had their patient care process obstructed when they could not see the clinic area or other staff workstations. The visual interface between staff workstations also significantly predicted staff communication patterns. Clinics providing more visual connections between staff workstations reported stronger perceptions of timely and frequent communication, and staff members talked frequently to other staff members whose workstations were visually and physically connected with their own workstations. Furthermore, clinics providing more visual connections between staff workstations reported higher teamwork perception. Surprisingly, more visual connections between patients and staff workstations were associated with lower teamwork perceptions from the patients’ perspective. The visual connections between patients and staff workstations (visual exposure to patients) also negatively affected staff backstage communication patterns. Clinics with higher visual exposure levels reported higher levels of concern for privacy while communicating patient information, and the staff members across all four clinics preferred not to talk about patients at visually exposed areas, even if the locations were inside team areas. The findings of the study support designing team-based primary care clinics to enhance the teamwork experience of both staff members and patients. It is worth noting that this study investigates the teamwork experience of not only staff members but also patients, who are critical entities of teamwork for patient-centered care in primary care clinics. The design implications are expected to be applicable for the teamwork of other settings, especially for strong programs where both inhabitants and visitors exist as main user groups of the spaces.

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Measuring the impacts of hospital nursing floor and patient room layouts on patients’ experience with care in a major teaching hospital

2015-07-30 , MacAllister, Lorissa

While a growing body of literature suggests that the layout of inpatient hospitals impacts a range of outcomes such as noise, falls and mortality, the research has not yet established systematic association between layout and patient experience of care. Experience of care is of growing importance to hospitals with the adoption development of the 1995 Consumer Assessment of Healthcare Providers and Systems program (CAHPS). The CAHPS Hospital Survey tool (known as HCAHPS) has become the leading indicator for quality and as well as other patient satisfaction surveys which publically report the patient experience known as patient self-reported outcome. Previous research has focused on service excellence through staff development, improvement of key service behaviors, and understanding of the influence of patient characteristics. The purpose of this study is to identify associations between spatial variables in the room and unit and patient self-reported outcomes such as Press-Ganey and HCAHPS patient satisfaction scores. This retrospective research study examines 17 units with 81 inpatient room types over 2 to 5 years at a large teaching hospital. This study identifies spatial measures shown through previous research to influence layouts and explores their statistical associations with standard patient satisfaction measures including both HCAHPS and Press-Ganey patient satisfaction surveys. Five primary spatial measures were identified and analyzed: window width, room handedness, head of the bed location, distance to the nurse station, and location of first encounter. Two separate phases of analysis were conducted: a preliminary study of 3,751 respondents in a limited Disease Related Group (DRG) and a general study expanded to 4,615 respondents with a broader range of DRGs. Finding indicate that there are statistically significant relationships between all of the five spatial measures analyzed and specific questions in the surveys pertaining to perceived nursing, physician, individual care and overall room variables. The results emphasize the importance of hospital design on patient satisfaction outcomes of importance to healthcare systems.

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The physical environment and patient safety: an investigation of physical environmental factors associated with patient falls

2011-11-21 , Choi, Young-Seon

Patient falls are the most commonly reported "adverse events" in hospitals, according to studies conducted in the U.S. and elsewhere. The rate of falls is not high (2.3 to 7 falls per 1,000 patient days), but about a third of falls result in injuries or even death, and these preventable events drive up the cost of healthcare and, clearly, are harmful outcomes for the patients involved. This study of a private hospital, Dublin Methodist Hospital, in Dublin, Ohio analyzes data about patient falls and the facility's floor plans and design features and makes direct connections between hospital design and patient falls. This particular hospital, which was relatively recently constructed, offered particular advantages in investigating unit-layout-related environmental factors because of the very uniform configuration of its rooms, which greatly narrowed down the variables under study. This thesis investigated data about patients who had suffered falls as well as patients with similar characteristics (e.g., age, gender, and diagnosis) who did not suffer falls. This case-control study design helps limit differences between patients. Then patient data was correlated to the location of the fall and environmental characteristics of the locations, analyzed in terms of their layout and floor plan. A key part of this analysis was the development of tools to measure the visibility of the patient's head and body to nurses, the relative accessibility of the patient, the distance from the patient's room to the medication area, and the location of the bathroom in patient rooms (many falls apparently occur during travel to and from these areas). From the analysis of all this data there emerged a snapshot of the specific rooms in the hospital being analyzed where there was an elevated risk of a patient falling. While this finding is useful for the administrators of that particular facility, the study also developed a number of generally applicable conclusions. The most striking conclusion was that, for a number of reasons, patients whose heads were not visible from caregivers working from their seats in nurses' stations and/or from corridors had a higher risk of falling, in part because staff were unable to intervene in situations where a fall appeared likely to occur. This was also the case with accessibility; patients less accessible within a unit had a higher risk of falling. The implications for hospital design are clear: design inpatient floors to maximize a visible access to patients (especially their heads) from seats in nurses' stations and corridors.

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The Role of Positive Distraction in the Patient’s Experience in Healthcare Setting: A Literature Review of the Impacts of Representation of Nature, Sound, Visual Art, and Light

2020-12-08 , Dabrowska, Maria Anna

Background One of the key strategies to help patients reduce stress and anxiety in healthcare settings is positive distraction defined as “an environmental feature that elicits positive feelings and holds attention without taxing or stressing the individual, thereby blocking worrisome thoughts” (Ulrich, 1991, p. 102). While several studies found the impact of positive distraction on health-related outcomes, few studies have categorized the distractors and collected the evidence from experiments. Despite the common use in design and broadly accepted assumption that positive distraction brings psychophysiological benefits, there has not been a comprehensive evaluation of research on positive distraction. Methods The present literature review examined 40 peer-reviewed articles from the last 20 years on nature, artwork, music, and light to describe the phenomenon of positive distraction, review the evidence on the impact of interventions on outcomes, and investigate the quality of the research. This paper explored historic background, definitions, and organized the key information from articles into a table. Based on the similarities of themes, I categorized and described the interventions. This paper presents a framework that links the categories to healthcare settings, outcomes, and measures which were used to assess each outcome. Finally, I marked the number of studies in each category that indicated the beneficial influence of interventions for each outcome. The significance of this study lies in collecting and analyzing the studies, describing the crucial aspects that need to be considered when designing positive distractions, and pointing out the directions for future research. Results I organized interventions into the following seven categories: Real and artificial nature, Visual representation of nature, Music and Sound, Light, Illuminated projection, Audiovisual, and Audiovisual with light. The most common interventions were plants placed in a patient room as well as Illuminated projection and Audiovisual interventions with light in diagnostic imaging rooms. Pain and anxiety were the most studied outcomes. While 16 out of 22 studies found a statistically significant improvement in perceived pain, only 10 out of 24 articles found this effect for anxiety. More than 60% of studies that measured the impact of interventions on pain, satisfaction, environmental satisfaction, reduction in restlessness and calm behavior, and perceived attractiveness found statistically significant positive results. Although the positive distraction was initially recognized for its potential to reduce stress, only eight articles investigated stress and distress, but more than half of those studies found a beneficial effect. Interventions in Real and Artificial Nature, and Music and Sound, and Audiovisual with Light showed a beneficial impact on more than six outcomes and emerged as the most promising. Conclusions Despite the 40-years tradition, the field of positive distraction is still in an exploratory phase. This analysis confirmed that there is a positive correlation between positive distraction and outcomes and strong evidence that positive distraction helps reduce perceived pain. Future work should consider the division of the term positive distraction into more precise sub-terms to account for different characteristics of interventions categorized as a positive distraction as well as focus on defining the beneficial features of the distractors, explaining the underlying mechanisms, determining the effect size of interventions, and improving both aesthetics of interventions and the methodological quality of studies.

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Application of the functional scenarios method on alternative settings

2016-05-09 , Bushehri, Yousef

Goals of this study are to set up the frame-work for analyzing residential buildings using the functional scenarios method and to tests the applicability of the method on large scale projects. The metrics for the analysis are based on guidelines for designing spaces that promote healthy aging. In addition, the study was providing an opportunity to developing and refined the method. The result of the analysis determines that the functional scenarios method is applicable to large scale buildings as effectively as smalls scale buildings; design configurations can be extracted from the results of the analysis to inform future designs. The limitations of the analysis are due to the available resources. Opportunities for continued work include 1) developing standard ways of representing the results of the analysis; and 2) developing a systematic approach for extracting design configurations based on the research questions asked.

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An ethnographic study of the role of evidence in problem-solving practices of healthcare facilities design teams

2013-08-12 , Kasali, Altug

Progressive efforts within the healthcare design community have led to a call for architects to use relevant scientific research in design decision making in order to provide facilities that are safe, efficient, and flexible enough to accommodate evolving care processes. Interdisciplinary design project teams comprising architects, interior designers, engineers, and a variety of consultants struggle to find ways to deal with the challenge of incorporating the evidence base into the projects at hand. To date there has been little research into how these interdisciplinary teams operate in the real world and especially how they communicate and attempt to integrate evidence coming from different sources into the architectural design that is delivered. This study presents an investigation of a healthcare design project in situ by using methods of ethnographic inquiry, with the aim of developing an enhanced understanding of actual collaborative healthcare design practices. A major finding is that ‘evidence’, as used in practice is a richly textured notion extending beyond just the scientific research base. The description and analysis of the observed practices is presented around two core chapters involving the design process of 1) the emergency department and 2) the inpatient unit. Each design episode, which depicts the complex socio-cognitive landscape of architectural practice, introduces how evidence, with its various types and representational forms, was generated, represented, evaluated, and translated within the interdisciplinary design team. Strategically utilizing various design media, including layout drawings and mock-ups, the architects represented and negotiated a set of physical design attributes which were supported by differing levels of scientific research findings, anecdotes, successful precedents, in-house experimental findings, and intuition, each having different affordances and constraints in solving design problems over time. Individually, or combined into larger “stories” which were collectively generated, the set of relevant evidence provided a basis for decision making at various scales, ranging from minor details within rooms to broader principles to guide design work over the course of the project. Emphasizing the role of the architects in translation of evidence, the design episodes provide vivid examples of how various forms of evidence shape the design of healthcare environments. The case observed in this research demonstrated that the participants formulated and explained their design ideas in terms of mechanistic arguments where scientific research, best practices, and anecdotal evidence were integrated into segments that formed causal links. These mechanistic models, as repositories of trans-disciplinary knowledge involving design, medicine, epidemiology, nursing, and engineering, expand the scope of traditional understanding of evidence in healthcare design. In facilitating design processes architects are required not only to become knowledgeable about the available evidence on healthcare, but also to use their meta-expertise to interpret, translate (re-present), and produce evidence in order to meaningfully engage in interdisciplinary exchanges. In re-presenting causal models through layouts or mock-ups, architects play a critical role in evidence-based design processes through creating a platform that displays shortcomings of available evidence and shows where evidence needs to be created in situ.

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AGENT-BASED SIMULATION FOR EVALUATING THE IMPACTS OF DESIGN ON NURSES’ SPATIOTEMPORAL EXPERIENCE

2020-01-14 , Hadi, Khatereh

Studying dynamics of care providers’ spatial experience based on their space occupancy and activity patterns allows us to better understand the impacts of design on care providers’ outcomes. During the early stages of design, computer simulation models can be used to evaluate design options for optimizing care providers’ spatiotemporal experience. Current simulation platforms offer advanced capabilities for modeling workflows and activities but have limitations in spatial analytics. This study focuses on developing an agent-based simulation model for evaluating the spatiotemporal experience of care providers based on layout attributes. The proposed model integrates spatial analytic methods into a simulation platform in order to investigate impacts of the layout on care providers’ encounters as an example of spatiotemporal events. Observational data collected from a pediatric cardiac intensive care unit is used to inform the simulation. The model records the care provider agents’ encounters measures defined by unobstructed lines of sight between agents within a defined field of view and distance threshold, including agents’ encounter durations (CCEt) and encounter counts (CCEn). Bivariate analyses of the simulation encounter output and layout attributes show that changes in “compactness” and “betweenness” levels of bedside nurse agents’ locations are associated with changes in CCEt and CCEn measures. These associations are in alignment with records of interactions collected through on-site observations of similar locations and confirm assumptions of the present study. Enhancing simulation platforms through the integration of spatial analysis methods can provide further insights into understanding the impacts of design on building occupants’ spatiotemporal experience.

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Exploring spatial risk: The impact of visibility on ICU mortality

2016-04-20 , Ossmann, Michelle M.

The relationship between inpatient hospital layouts and a myriad of outcomes – noise, falls, patient experience of care, and mortality – continues to fascinate the clinical and architectural communities. Indeed, optimal patient visibility from nursing stations has long been a significant design consideration. Previous research focused on linear distance and frequency of visits between nurse stations and patient rooms, barriers to interaction (doors), and staff distribution in the workspace; the direct association with clinical outcomes was largely measured by proxy or inferred. The purpose of this dissertation study was to systematically investigate the association between visibility and ICU mortality with a three-pronged approach: (1) alternate visibility metrics and a theoretical extension, (2) introduction of a new variable - isovist connectivity, and (3) testing isovist connectivity meaning and significance against ICU patient mortality. Consistent with previous studies, poorly visible and connected rooms were independently associated with higher ICU patient mortality compared to highly visible and connected rooms. Furthermore, the poor rooms were not intuitively apparent while conforming to accepted practice, suggesting the need for robust spatial analysis to determine level of exposure.

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Making “invisible architecture” visible: a comparative study of nursing unit typologies in the United States and China

2012-08-14 , Cai, Hui

China is engaged in the largest healthcare construction program in history, expecting to build more than 2,000 hospitals and a large number of healthcare facilities at all scale over the next few years. This once-in-a-lifetime construction boom provides a valuable opportunity to rethink Chinese hospital design, and especially to consider how to design modern hospitals that are effective and efficient in delivering care, and are responsive to the cultural needs of the Chinese people as well. This dissertation seeks to rigorously define these issues and develop metrics that link design to key healthcare processes. This study uses a range of concepts and analysis tools drawn from cross-culture organizational communications, evidence-based design, space syntax and other research traditions. This thesis develops and refines metrics for four main drivers of nursing unit design: space economy, staff efficiency, natural light and cultural preferences for communication. Communication among Chinese healthcare workers is strongly influenced by cultural preferences for patterns of authority and decision-making reflected in organizational culture and rooted in Confucian principles of hierarchical social structure (Dengji), social network (Guanxi) and face (Mianzi). While the dissertation builds on a longstanding tradition of research focusing on healthcare space economy and staff efficiency, new measures for cultural preferences are proposed and tested. Based on emerging theories of cross-cultural organizational communication by Hofstede and other scholars, and space syntax, this study particularly explores how cultural preferences for face-to-face communication are reflected in the design of Chinese nursing units. Based on the proposed metrics, the dissertation analyzes six pairs of Chinese and US nursing units, matched on layout type. While the Chinese nursing units appear Western, deeper quantitative analysis of their layouts reveals significant national differences in the application of unit typologies in China when compared to those in the U.S. It shows that Chinese hospital design is rooted in cultural preferences such as for positive energy (qi) based on Fengshui theory, and in Confucian principles of hierarchy, social networking and face.

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