HCS 529 Week 4 Defending Evidence-Based Design Choices to Stakeholders Example

Walls or Curtains, Windows or None: Defending Five Evidence-Based Design Choices for a Surgery Center to Surgeons, Nurses and the Finance Committee

[Student Name]

University of Phoenix

HCS/529: Contemporary Health Care Facility Design

Week 4 Assignment

[Instructor Name]

[Date]

The health system, stakeholders, costs and design choices are composites written for a model paper; research findings come from the sources listed.

At the design review meeting for the composite health system's surgery center, the architect presented the renovated layout to 14 stakeholders: four surgeons, two anesthesiologists, the perioperative nurse manager, two staff nurses, the infection preventionist, the facilities director, the chief financial officer, the finance committee chair and a patient representative. The chair's first question set the tone: why should the system spend $310,000 more for walled recovery bays when curtains work in the hospital? This paper defends five design choices with evidence, records the objections and explains the decisions.

Choice One: Walled Bays Instead of Curtains

The design gives each of the 16 preoperative and recovery bays solid side walls and a glass sliding front, rather than curtains between open stretchers.

The Objection and the Evidence

The finance chair objected to the cost, and the nurse manager worried that walls would reduce visibility. The most direct evidence the team found was a before-and-after study of an intensive care unit that moved from multibed rooms to single rooms: compared with a nearby hospital's unit, the adjusted rate of acquiring three resistant organisms combined fell by 54%, and average stay fell by 10% (Teltsch et al., 2011). A broad review also links single rooms to fewer infections, less noise and better privacy for conversations (Ulrich et al., 2008). But this evidence comes from inpatients staying days, not surgical outpatients staying hours, so its size may not transfer.

The Decision

The team kept walled bays for 10 of 16, designated for preoperative preparation and first-stage recovery, where patients undress, discuss their histories and wake from anesthesia, and used curtained bays with glass fronts for the six second-stage recovery spaces. Glass fronts preserve sight lines. The compromise saved $115,000.

Choice Two: Windows in a Windowless Building

The warehouse has no windows. The design cuts eight windows into the south wall to bring daylight into the recovery area and staff lounge.

The Objection and the Evidence

The facilities director noted that new openings in the tilt-up concrete wall require structural reinforcement at about $140,000. The classic study found that patients whose windows faced trees had shorter postoperative stays and took fewer strong pain medicines than matched patients facing a brick wall (Ulrich, 1984), and the later review found broader evidence that daylight and nature views reduce stress and pain (Ulrich et al., 2008). A staff nurse added a point the studies support indirectly: nurses spend entire shifts in the building, and a windowless workplace affects them more than patients who leave in hours.

The Decision

The windows stay, with a landscaped strip outside to give views of plants rather than the parking lot.

Choice Three: Identical Operating Rooms

All four operating rooms are laid out identically, with doors, gas outlets, booms and storage in the same positions, rather than mirror-image pairs sharing plumbing walls.

The Objection and the Evidence

Mirror-image rooms are cheaper because pairs can share utility walls; identical rooms cost about $85,000 more. The review supports standardized layouts as a way to reduce errors and search time but notes limited direct evidence on outcomes (Ulrich et al., 2008). Surgeons and anesthesiologists were strongly in favor, because they move between rooms in a day. When evidence is thin, the people who will work in the room become part of the evidence.

The Decision

The identical rooms stay, and the team will measure turnover time and equipment-search events after opening to test the choice.

Choice Four: Keeping Operating Room Doors Closed

The design places pass-through supply cabinets between the clean core and each operating room, so staff can retrieve supplies without opening the main door during a case.

The Objection and the Evidence

Two surgeons argued that pass-throughs add cost and are rarely used. A study of 48 orthopedic and general surgery procedures found that the number of door openings and surgery length were associated with higher bacterial counts in the operating room outside the laminar airflow zone, while under laminar airflow the number of staff mattered (Perez et al., 2018). Because the center will perform joint replacements, where infection is devastating, the infection preventionist argued strongly for reducing traffic.

The Decision

Pass-throughs stay, and the center will count door openings during a sample of cases each quarter.

Choice Five: Nurse Station Sight Lines

The central nurse station is placed so that every walled bay's glass front is visible from it.

The Objection and the Evidence

The objection was minor; the patient representative asked whether visibility would reduce privacy. The review links visibility of patients to faster response and safety (Ulrich et al., 2008). Curtains inside the glass fronts can be drawn for privacy during examinations.

A Feature the Team Rejected

Not every proposal survived review. A vendor had offered ultraviolet disinfection robots for terminal cleaning of operating rooms at about $95,000 each. The infection preventionist noted that evidence for such devices varies by setting and organism and that the center's case mix, mostly clean orthopedic and eye procedures, differed from the hospital settings where most studies were done. The team chose instead to invest in cleaning staff training and fluorescent marker audits of cleaning quality, and to revisit the devices if infection data suggest a need. Rejecting a feature on the evidence showed stakeholders that the team was not using research only to justify spending.

What the Patient Representative Added

The patient representative, a retired teacher who had knee surgery two years earlier, raised a point no one else had: families wait for hours, often anxious, and the waiting area in the first drawing faced the drop-off lane. The team moved the waiting area to the southeast corner, where two of the new windows face the landscaped strip, and added a small consultation room so surgeons can speak with families privately after a case. Neither change required new research; both came from listening to the people the building serves.

Presenting the Design to Stakeholders

The narrated slide presentation that follows the meeting is organized by audience and decision:

the decision requested and the total cost of design features, $450,000 after compromises

five choices, each with the outcome it targets, the evidence and its strength

what changed after stakeholder input

how outcomes will be measured after opening

a request for approval of the final design

Measuring After Opening

The team will track surgical site infections, turnover times, door openings, patient experience scores on privacy and noise and staff satisfaction, comparing them with the system's hospital outpatient department.

Conclusion

Evidence-based design earned its place in this project only when each feature was tied to an outcome, a study and a cost. The walled bays became a compromise, the windows and identical rooms stayed despite cost and the closed-door design stayed because of the center's joint replacement cases. Stakeholders changed the design, and measurement after opening will test it.

References

Perez, P., Holloway, J., Ehrenfeld, L., Cohen, S., Cunningham, L., Miley, G. B., & Hollenbeck, B. L. (2018). Door openings in the operating room are associated with increased environmental contamination. American Journal of Infection Control, 46(8), 954-956. https://doi.org/10.1016/j.ajic.2018.03.005

Teltsch, D. Y., Hanley, J., Loo, V., Goldberg, P., Gursahaney, A., & Buckeridge, D. L. (2011). Infection acquisition following intensive care unit room privatization. Archives of Internal Medicine, 171(1), 32-38. https://doi.org/10.1001/archinternmed.2010.469

Ulrich, R. S. (1984). View through a window may influence recovery from surgery. Science, 224(4647), 420-421. https://doi.org/10.1126/science.6143402

Ulrich, R. S., Zimring, C., Zhu, X., DuBose, J., Seo, H.-B., Choi, Y.-S., Quan, X., & Joseph, A. (2008). A review of the research literature on evidence-based healthcare design. HERD: Health Environments Research & Design Journal, 1(3), 61-125. https://doi.org/10.1177/193758670800100306