This article reports a study of the physical design characteristics of a set of adult intensive care units (ICUs), built between 1993 and 2003. These ICUs were recognized as the best-practice examples by the Society of Critical Care Medicine, the American Association of Critical Care Nurses, and the American Institute of Architects. This study is based on a systematic analysis of the materials found on these ICUs in the booklet and videos jointly published by the above organizations in 2005. The study finds that most of these examples of best-practice adult ICUs have the following negative characteristics: (1) they are built as renovation projects with more health and safety hazards during construction; (2) most of them are mixed-service units with more safety and staffing problems; (3) the overall layout and the layout of staff work areas in these ICUs do not have any common design solutions for improved patient and staff outcomes; and (4) in these ICUs, family space is often located outside the unit, and family access to the patient room is restricted, even though family presence at the bedside may be important for improved patient outcomes. Some of these negative characteristics are offset by the following positive characteristics in most ICUs: (1) they have only private patient rooms for improved patient care, safety, privacy, and comfort; (2) most patient beds are freestanding for easy access to patients from all sides; (3) they have handwashing sinks and waste disposal facilities in the patient room for improved safety; and (4) most patient rooms have natural light to help patients with circadian rhythms. The article discusses, in detail, the implications of its findings, and the role of the ICU design community in a very complicated design context.

In this paper we report a study that uses space-syntax theories and techniques to develop a model explaining how spatial layouts, through their effects on movement and visible copresence, may affect face-to-face interaction in offices. Though several previous space-syntax studies have shown that spatial layouts have significant effects on movement and face-to-face interaction in offices, none has investigated the relations among movement, visible copresence, and face-to-face interaction in offices with significantly different layouts. On the basis of statistical analyses of the spatial and behavioral data collected at four moderately large offices, this study shows that spatial layouts have consistent effects on movement, but inconsistent effects on visible copresence and face-to-face interaction; that visible copresence, not movement, is an important predictor of face-to-face interaction; that movement has negligible effects on the relationship between visible copresence and face-to-face interaction; and that functional programs have little or no effect on the culture of face-to-face interaction in these offices. Limitations of the research design for workplace study and implications of the research findings for workplace design and management are discussed.

Spatial configurations of office environments assessed by Space Syntax methodologies are related to employee movement patterns. These methods require analysis of floors plans which are not readily available in large population-based studies or otherwise unavailable. Therefore a self-report instrument to assess spatial configurations of office environments using four scales was developed.

Studies suggest that the physical environment can be important for patient comfort, patient safety, patient privacy, family integration with patient care, and staff working condition in adult intensive care units (ICUs). In the absence of any measuring scales, however, evaluations of the physical environment of ICUs in terms of any of these dimensions have remained vague. For rigorous evaluations of ICU designs from the viewpoint of clinical staff, a self-report instrument with several multiple-item scales was created. These scales were tested in a pilot survey that was administered among a small group of nurse managers and ICU directors at several best practice example sites. Reliability analysis of the survey data showed some scales to be internally consistent. For the other scales, factor analysis revealed multiple components, which were then combined to create additional subscales. Using these scales and subscales, the underlying effects of design on staff perception were studied at the best practice example sites that participated in the pilot survey. The results, limitations, and the future directions of the study are discussed.

OBJECTIVE: To help designers and researchers and other proponents of evidence-based design (EBD) overcome limitations concerning knowledge categorization and acquisition of evidence-based design (EBD). BACKGROUND: The evidence-based design (EBD) approach for healthcare facilities has been widely embraced by both designers and researchers in recent years; however, there are some limitations concerning knowledge categorization and acquisition of EBD. These limitations include an overemphasis on empirical knowledge gained by experimental research, a narrow focus that excludes design knowledge generated outside healthcare and allied fields, and a lack of interest in empirical knowledge gained by qualitative studies. In order to overcome these limitations, the proponents of EBD must acknowledge that design knowledge relevant to healthcare design can be found in disciplines unrelated to healthcare; that design knowledge does not always need empirical validation; and that design knowledge of the semantic kind can be more easily accessed and understood through qualitative studies. CONCLUSIONS: To reassess the foundations of knowledge of EBD with moderated skepticism is necessary because there are philosophical and analytical problems yet to be overcome in delivering on the promises of EBD. To question and reassess the foundations of knowledge base of EBD is not necessarily to deny its value, but rather to stimulate a judicious and balanced appraisal of its limitations so that, in future, we are able to take necessary steps to overcome these limitations.