Objective: The purpose of this study was to identify the role of emergency department (ED) design on ED staff satisfaction and performance. Background: High patient volume, surging workloads, and violent behaviors are expected pressures for ED staff. Literature suggests the substantial role of the physical environment in the delivery of care and its role in staff and patient experiences. Nevertheless, limited studies have explored simultaneous interactions between ED physical design elements, attributes (security, wayfinding, visibility, privacy, and efficiency), and staff satisfaction or performance. Method: Interviews, surveys, visibility graph analysis, and agent simulations were employed to understand the connection between ED physical design, attributes, performance, and staff satisfaction. Results: Enhanced security, effective wayfinding, team visibility, noise reduction, adequate privacy, and accessible supplies and equipment were significant predictors of staff satisfaction and performance. Unobstructed views in waiting and triage and controlled entrances were critical for improving security. To improve wayfinding, eye-level signage, reducing surveillance obstacles, and creating direct public routes were recommended. Rectangular units with multiple perpendicularly connected corridors and linear pod arrangements enhanced movement. Including team rooms and enclosed ERs were recommended for privacy improvements. Visibility was critical for team communication and improved by including short-distanced perpendicular corridors and eliminating columns. Enhancing access to supplies or equipment and reducing noise levels improved the perception of staff efficiency. Conclusion: The findings contribute to the general body of knowledge on the impact of ED physical design on attributes that potentially improve staff satisfaction and work performance.

Objective: This review of empirical literature focuses on the design of operating rooms (ORs) by investigating the physical environmental features of ORs associated with patient and staff outcomes. Background: Many ORs built more than 30 years ago remain operational today. However, most are inadequately designed to handle the equipment, processes, and people that a contemporary OR needs to accommodate. However, the evidence base for designing ORs has been sorely lacking, and little guidance exists on how OR design can improve safety and performance outcomes. Method: A literature search was conducted using PubMed and the university’s linked databases. The inclusion criteria included peer-reviewed journal articles that reported some aspect of the physical environment of ORs along with outcomes. The study included empirical studies as well as nonempirical best practice papers. Results: This literature review uncovered 211 articles. The main themes that emerged include OR design-related factors, ventilation, temperature and humidity, acoustical environment, lighting, and materials. Some environmental threats to patient safety in the OR include frequent door openings, clutter, poor air quality, surface contamination, and noise. Further, staff performance and satisfaction were impacted by factors such as the OR layout and equipment and furniture ergonomics. Conclusion: This literature review provides an overview of the research organized into design-focused topic areas to support decision-making by architects and designers. This article highlights gaps in the research and identifies areas where best practice and design assumptions need to be evaluated using rigorous design research.

Outdoor preschools are critical for children’s play and development. Integrating observational and interview methods, this study examined four-to-five-year-old children’s cognitive play experiences in an outdoor preschool with natural, mixed and manufactured zones. The observational results indicated that the natural and mixed zones offered a diverse spectrum of cognitive play, were supportive of different learning styles and expanded their understanding about the world. Children preferred the diverse, challenging and constantly evolving natural settings in these zones. Integrating diverse natural and manufactured settings with loose elements, the mixed zone supported considerable opportunities for functional, exploratory and games with rules play behaviors. The accessible loose materials inspired children’s imagination, social engagement and games. In contrast, the manufactured zone offered the most functional and non-play behaviors, and was perceived as an unexciting, predictable and tedious environment. The findings suggest incorporating natural features and settings in outdoor preschools to support a diverse spectrum of cognitive play.

A number of studies have identified childcare environments as significant resources for children’s development, learning through play, and contact with nature. However, there is a lack of knowledge about how, from a child’s perspective, specific outdoor physical environments in preschools stimulate children’s cognitive play. Emphasizing on the value of listening to children, this study reports the perspectives of 22, 4- to 5-year-olds. The study context was an outdoor preschool with natural, mixed, and manufactured settings. A combination of photo preferences and semi-structured interviews was used to investigate children’s perception of preferred settings and cognitive plays. The results identified that children mainly enjoyed functional and dramatic play. They mostly preferred mixed behavior settings that incorporated ranges of natural and manufactured elements. Compared to other settings, children found mixed settings provided the most opportunities for functional, constructive, dramatic, and game with rules play. The outcomes of this study have implications for the design of outdoor preschools, suggesting a balanced integration of nature with manufactured play features to enhance cognitive play experiences.

This article evaluates the effects of technology integration and design features in clinical exam rooms on examination experiences, communication, and satisfaction. Exam room features can affect the delivery of patient-centered care and enhance the level of communication, which has been shown to directly impact clinical outcomes. Although there has been an increasing body of literature examining design and patient-centered care, little research has evaluated the extent to which information sharing and electronic health record (EHR) interaction are impacted. The research randomly allocated 22 patients, 28 caregivers, and 59 clinicians to simulated clinical encounters in four exam room mock-ups with semi-inclusive, exclusive, and inclusive layouts (128 sessions in 32 scenarios). Video recordings of the simulations were coded for clinician gazing, talking, and EHR-interaction behaviors. Participants also completed surveys and answered open-ended questions after experiencing each scenario (N = 362). Semi-inclusive rooms with a triangular arrangement of consultation table, sharable screens, exam table, and caregiver chair were highly preferred as they supported conversation, gazing, and information sharing. The inclusive layout had higher durations of EHR interactions and enhanced viewing and sharing of EHR information. However, this layout was criticized for the lack of clinician-shared information. The exclusive layouts impeded information sharing, eye contact, and constrained simultaneous data entry and eye contact for clinicians. The distance and orientation between chair, exam table, curtain, and door were important for protecting patient and family comfort and privacy. Characteristics and configurations of design qualities and strategies have a key role on examination experiences, communication, and satisfaction.

Objective: This study aimed to investigate the effect of spatial adjacencies on nurses’ walking patterns and the subsequent impact on staff satisfaction with perceived accessibility and adjacency-related issues. Background: Recognizing the crucial importance of spatial adjacencies in healthcare facilities is essential, as they significantly affect staff morale, fatigue management, operational efficiency, error reduction, and overall patient care excellence, highlighting the need for objective assessments to evaluate the impact of facility layout and space configuration on workflow patterns and staff satisfaction in patient care units. Methods: Integrating on-site observations with survey data, we explored how spatial adjacencies affect staff walking behavior and satisfaction in two med-surgical unit floors. Results: The findings highlighted a significant frequency of movements between nurse stations, patient rooms, and medication areas. Regression analysis identified several contributing factors to staff satisfaction, including the proximity of supplies, team visibility, ease of access across departments, and the location of equipment rooms. Specifically, satisfaction with the proximity of supplies was positively associated with increased provider satisfaction with workflow, quality of care, and workplace. Additionally, valuable feedback from staff revealed concerns regarding break room placement, medication area functionality, and disparities in the availability of supplies. Conclusion: This study highlighted the critical need for carefully planned spatial adjacency strategies to enhance workflow efficiency and raise clinical staff satisfaction within healthcare facilities. The actionable insights gleaned from this research offer valuable direction to architects, healthcare administrators, and design professionals, enabling the creation of environments that positively resonate with healthcare providers and improve healthcare operations.