July 25, 2016
Kate Renner, AIA, EDAC, Lean-Six Sigma CE, LEEP AP BD+C, Associate and Shannon Kraus, FAIA, FACHA, LEEP AP, Senior Vice President, Board of Directors

How does your healthcare facility impact your patient outcomes?  Every key design decision is a performance hypothesis with a direct impact on outcomes and the metrics used to measure patient outcomes, including fall rates, infection rates, staff injury reports, satisfaction and HCAHP scores. A well-designed building can improve organizational performance at multiple levels – the human, organizational and environmental scales. The true test of the success of a project design is its functionality after occupancy. To measure this functionality, Post Occupancy Evaluations (POE) were developed as a tool to evaluate buildings in a systematic and rigorous manner, after they have been built and occupied for some time.

One version of a POE, the Functional Performance Evaluation (FPE), includes site audits, user feedback, environmental analysis, spatial analysis and organizational success metrics. The FPE is based on the philosophy of “triangulation” in collecting data. The FPE collects meaningful data using key metrics and multiple measures, before developing conclusions. This tool provides facility owners with insight into ways to improve and optimize operations through facility design, and assists design teams in understanding the consequences of their decisions and engaging in continuous improvement.

The FPE provides insight into a number of performance metrics including patient satisfaction, safety and experience, as well as staff satisfaction and efficiency. A recent review of three facilities completed in the past five years – an academic medical center and two greenfield hospitals – showed above average patient safety ratings, exemplary staff satisfaction and increased staff efficiency. 





HOSPITAL A:  Academic Medical Center Critical Care Hospital (368,000 SF, 232 Beds)

Patient bed floor units were designed and created with patient and staff safety in mind at all times. Clean and soiled equipment and supply and linen rooms are positioned in neighborhoods to reduce the run-and-fetch time. Sub-nurse station locations and placement of support services and supply areas promote more clinical time with patients.

The FPE found that the unit design increased staff efficiency, with an average travel distance to key support areas of less than 60 feet. This has increased staff satisfaction and reduced staff turnover rates by 30 percent. Additionally, the fall rate with injury was reduced by 38 percent, and of that 38 percent, less than five falls can be directly attributed to the building. The falls attributed to the building were caused by the thresholds into the patient toilet room and low toilets, which have been replaced. The nosocomial infection rates were also reduced. The patient satisfaction with overall nursing quality improved by 66 percent and the satisfaction with the promptness in response to calls improved 20 percent.  The patient satisfaction with room accommodations improved 22 percent and the cleanliness scores improved 10 percent.


HOSPITAL B:  Greenfield Community Hospital (185,000 SF, 103 Beds)

The design premise for this facility was to create a hospital unlike any other. One that connects with its environment, both inside and out, to create a place where people can inspire, heal and grow. The design team focused on patient, visitor, and staff experiences. The design embraces light and views toward nature to enhance the experience for the user. The FPE found that the patient experience met and exceeded the design team’s premise to create the ideal healing session. The staff assessment revealed the following staff satisfaction information:

  • 95 percent agree that they are proud of the building that they work in.
  • 96 percent agree that they would recommend working in this building to a friend or family member.
  • 77 percent agree that overall, they are satisfied with the building they work in.

The HCHAP scores revealed that this facility was above the Texas and national average in the following categories that are directly impacted by building design:

  • Patients who reported that their room and bathroom were always clean.
  • Patients who reported that the area around their room was always quiet at night.

The sound study conducted as a part of the FPE found that the sound levels are below the US Environmental Protection Agency’s recommendations in the patient room, both during the day and night.


HOSPITAL C:  Greenfield Community Hospital (375,000 SF, 144 Beds)

The goal for this hospital was to create a patient- and guest-centered facility that would be lean, green and operationally efficient. A key strategy to accomplish this infused hospitality into the design, which allowed the team to transform the traditional paradigm of “patient care” into one of “guest care”— where the human experience is the focus.  

To analyze the impact of the nursing unit design on nurse walking behavior and travel distances, the FPE queried nurses about their paths of travel and sequences in care delivery. The evaluation included asking nurses to identify their patient room assignments and the path and frequency of travel involved in collecting patient medication and clean supplies.  The analysis revealed that dissatisfaction with operational efficiency correlated with long walking distances, due to non-standard stocking of supplies; an operational issue that defeated the design intent.

Based on the FPE data, the research team made recommendations to the hospital’s leadership team and changes were implemented in both the design and operations. The results suggest that the use of evaluations as an applied research tool contributes to improvements in design processes, organizational performance and the industry knowledge-base.



The data gained from our FPEs has allowed us to develop a series of analytical and generative tools that can be used throughout the design process. While POEs are traditionally one-off assessments of built environments, the FPE is a design research tool that can inform the entire process, improve operations post occupancy and become a driver for innovation. This tool can be used to test both new and existing environments to improve operations in existing conditions and influence design of future environments.  For more information, contact Kate or Shannon at 202.682.6289 or skraus@hksinc.com and krenner@hksinc.com

Posted in Health