We Improve Settings

Neonatal Intensive Care Unit

The Neonatal Intensive Care Unit (NICU) cares for the most vulnerable patient population – preterm babies. As babies survive shortened time in the womb thanks to medical advancements, the focus of their care increasingly shifts to long-term quality of life. Therefore it is necessary to consider the NICU environment in which these babies are born and forced to develop, versus the natural and protective setting in the womb.

This gap between the womb and the NICU environment can have severe and long-term implications for these developing babies. However, little guidance is available to architects, designers and hospital decision makers to determine how to optimize the NICU environment to support the neurodevelopmental needs of preterm infants. This is a crucial time for NICU design, as facilities are increasingly shifting away from traditional open-bay units to single-family room layouts.

As part of the SimTigrate mission, we evaluate and interpret evidence to help organizations make informed decisions. In an ongoing project titled “Developing Methodology for Evaluating Neonatal Intensive Care Unit Design,” we seek to expand internally developed tools for comparing and evaluating design alternatives in adult ICUs for applications in the NICU. This methodology will allow users to determine critical components of designs in order to understand implications of trade-offs. These metrics will continue to be expanded and refined in ongoing and future projects.

Focus on Ambulatory Care

Healthcare in the United States is becoming a divided system where more care is delivery outside of hospitals, and hospital resources are reserved for the seriously ill. To respond to this we have focused on the two extremes settings: ICU (Intensive Care Units) and ambulatory, or outpatient, care.

Outpatient clinics strive to provide more coordinated care through processes such as the Patient Centered Medical Home (PCMH). These clinical models require significant re-engineering of office workflow and re-thinking of clinic design. The PCMH model involves a philosophy of care that is team-based, well-coordinated, and focused on quality long-term outcomes and safety.

SimTigrate has conducted a number of studies looking at the design and delivery of healthcare in outpatient clinics. We learned that open-plan workspaces can increase collaboration and interaction, if workers perceive that communication is a key part of their tasks and if teams have good training in effective communication.

The PCMH team room represents an opportunity to shift the healthcare culture from the individual to the community and tilt the balance toward collaboration and away from the role of the individual provider. Shared, integrated team rooms support the functional and cultural transition to team work. They are intended to allow care teams to work together, share information and coordinate care. At the same time, they need to allow staff to do their heads-down individual work accurately, at high efficiency and without undue interruption.

Examples of our PCMH studies include:

Cherokee Indian Hospital

We evaluated the hospital’s integrated care team room using behavior mapping, interviews and spatial analysis to understand the influence of room layout on communication and collaboration. The hospital sought to build a new facility with patient-centered, relationship-based primary and specialty care through an innovative and integrated team-based approach. Staffers asked SimTigrate to provide design strategies to architects and design metrics to the hospital team to assess the proposed layout of the new facility. (Jan 2014)

Mercy Care

Using internal funding from the College of Architecture’s Research Faculty Development Grant, we worked with Mercy Care’s clinic in downtown Atlanta to develop a design for their new team rooms that would best support their care teams. This was done with behavior mapping in the existing clinic and a simulated exercise in our lab to test outpatient care processes in different space configurations (January 2015)

Academy of Architecture for Health Foundation

Using a grant from AAHF, we did a literature review on how design can affect the behavior of teams, and developed five case studies of PCMH outpatient clinics. (2014) This was done in partnership with Herman Miller. The research involved multiple investigative approaches including, a review of the literature; case studies, interviews, and field observations; behavior mapping and provider shadowing; and a simulation exercise.