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B41Patient-CenteredHealth Care Design
www.HumanCenteredDesign.org
November 17, 2011Socially Sustainable Design
Build Boston
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The Boston Society of Architects/AIA is a Registered Provider with The
American Institute of Architects Continuing Education Systems. Credit
earned on completion of this program will be reported to CES Records for
AIA members. Certificates of Completion for non-AIA members are
available on request.
This program is registered with the AIA/CES for continuing professional
education. As such, it does not include content that may be deemed or
construed to be an approval or endorsement by the AIA of any material of
construction or any method or manner of handling, using, distributing, ordealing in any material or product. Questions related to specific
materials, methods, and services will be addressed at the conclusion of
this presentation.
Welcome
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This presentation is protected by US and International Copyright laws.
Reproduction, distribution, display and use of the presentation without
written permission of the speaker is prohibited.
Institute for Human Centered Design, 2011
Copyrighted Materials
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Institute for Human Centered Designan international, educational, non-profit organization
dedicated to enhancing the experiences of people of all ages and abilitiesthrough excellence in design.
www.humancentereddesign.org
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Design powerfully and profoundly
influences us and our sense ofconfidence, comfort, and control.
Variation in ability is ordinary, notspecial, and affects most of us for at
least part of our lives.
Design powerfully and profoundly
influences us and our sense of
confidence, comfort, and control.
Variation in ability is ordinary,
not special,
and it affects most of us
for at least part of our lives.
2 core ideas...
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2001 International Classification of
Functioning, Disability and Health
Mainstreamed the experience
of disability and recognized it as
a universal human experience
Equalized mental and physical reasons
for disability
Redefined disability as acontextual phenomenon,
dictated by the intersection of a person
and his/her environment
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DESIGNING FOR HUMAN DIVERSITYJosh Safdie, Director of IHCDstudioInstitute for Human Centered DesignBoston, MA
Urban Design PrinciplesRhode Island School of Design
Department of Architecture10 November 2011
7,000,000,000 DESIGN CRITICS
CANT BE WRONG
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7,000,000,000 DESIGN CRITICS
CANT BE WRONG
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Presenters
Dak Kopec PhD, MS, MCHESAssociate Professor, New School of Architecture and Design, San Diego, CA
Steve Demos RA
Senior Architect, Institute for Human Centered Design, Boston, MA
Bob KayeSenior VP, Planning and Development, MassDevelopment, Boston, MA
Karen Braitmayer FAIAMember, US Access Board
Principal, Studio Pacifica, Ltd., Seattle, WA
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DAK Kopec, Ph.D., MS.Arch., MCHESAssociate Professor
Newschool of Architecture and Design
HEA
LTH,HE
ALTHCA
RE,AND
THEBUILTENVIRO
NMENT
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A FUNCTIONAL SOCIETY IS DEDICATED TO MEETING THE CORE NEED WITH
LITTLE THOUGHT TO COVARIABLES OR COFACTORS.
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Discovery of new ways to produce the
same consequence or obtain the same goal
Early hospital design is representative of
societys early developmental phase
In human development, Piaget calls this the
Sensory Motor Period
d d l d h k d
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Unintended consequences resulted in what Barker termed a
Behavior Setting
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Behavior Settings lead to a prescribed role that Talcott
Parsons called the Sick Role
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To break the chain of events we
must the change the setting.
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AssociationLocation Similarity Sensory Experiences
Perceptual Understanding Sense of Control
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Similarity: Hotels & Resorts
Control: Television,
Window Shade,
Temperature
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Control is the mastery
over ones body and
environment andability to satisfy basic
needs without or with
little compromise.
Belonging is
determined by
environmental
elements that satisfy
individual needs.
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BUT
WE NEED MORE
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Who are the Designers?
Architects Product and Industrial Designer
Management, Operations, Hospital Staff
Who are the Clients?
Patients
Visitors Staff
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Design Choices by Architect
Layout
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Design Choices by Architect
The Circuit: Designed for Hemiplegia
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Design Choices by Architect
Conflict: Corners
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Design Choices by Architect
Failure to Design for Hemiplegia
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Design Choices by Architect
Desk Location
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Design Choices by Architect
Space for Furniture
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Design Choices by Architect
Comfort: Window Sill Height
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Design Choices by Architect
Window Sills as Latent Storage, Display
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Design Choices by Architect
Privacy and Control ---Turf: Toilet Location
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Design Choices by Architect
Privacy and Control --- Turf: Curtain Location
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Design Choices by Product Designer
Role of Products in Recovery Designed to reflect the world out there, i.e., as a tool
for the occupational therapists?
Designed to accommodate change in ability?
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Design Choices by Product Designer
Requiring Aid from Others Telephone
Chairs
Privacy Curtain
Designed for the Patient Call Devices Table Bed adjustments
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Design Choices by Staff, Management
Role of Products in Recovery Designed to accommodate the patients change in ability ?
A modified design to allow patient to do something on theirown, i.e., the patient as patient?
No specialized design, but item is the everyday item usedby those not in the hospital?
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Design Choices by Staff, Management
Gap in Service Counter
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Design Choices by Staff, Management
Unreadable Messages
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Design Choices by Staff, Management
Empty Desk
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Design Choices by Staff, Management
Everything out of sight
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Design Choices by Staff, Management
Telephone Location
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Design Choices by Staff, Management
Privacy and Control: TV Location
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Design Choices by Product Designer
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Guaranteeing Patient- and User-Centered Environments:Planning, Design, Construction & Management
Robert M. Kaye
Session B41November 17, 2011
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Issue
Health care, commercial, and residentialbuildings as delivered and managed mightnot provide accessibility at the standards
to which they were originally designed.
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Common Obstacles to Access
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Cause(s) and Responses
Design and spec for ramp, incl. soilcompaction
V/E of design and spec
Means and methods substitution bycontractor
Field inspection fails to catch improper
material from supplier Red paint stripe on walkway; then,
replacement of three concrete panels
St i B ildi D li
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Steps in Building Delivery:New Construction or Major Additions
1. Planning; Determination of Need
2. Design
3. Construction4. Code Inspection
5. Commissioning
6. Hand-off to the Owner7. Property Management (incl. maintenance
and upkeep)
Responsibilities
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Responsibilities
1. PlanningOwner, Staff (maybe), Planning/
Programming Consultants, A/E Team2. Design - Owner, Staff (maybe), A/E
3. ConstructionConstruction Manager (CM),
A/E, Owners Rep4. Code InspectionPublic Officials, CM, A/E
5. CommissioningConsultants, A/E, PropertyManagement Staff
6. Hand-overCM, A/E, Property Manager
7. Property Management (incl. maintenance andupkeep)Owner, Property Manager, Vendors
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Other Responsible Parties
Sub-consultants
Subcontractors
Suppliers
Vendors
Contract Employees
Contract Facilities Service Providers Many Others, incl. Renovation Architects
C l i C f
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Conclusions: Causes ofCompromised Accessibility
Many responsible parties
Many changes in leadership andresponsibility over the lives of projects and
buildings
Many needs for modifications and manyopportunities for error
No clear set of standards to guidedecisions at each stage of buildingplanning, design, construction and
management
C l i C f
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Conclusions: Causes ofCompromised Accessibility (cont.)
No clear team leader to provide continuityfor achievement of universal access
No clear definition of roles and
responsibilities Renovations might receive less scrutinythan new construction
Effects of repairs and equipment
replacement on universal access oftendepends on individual sensitivity andcommitment
No perceived imperative
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Examples
Rehab Hospital in Tucson, AZ - renovation
TUC, DFW, BOS new construction andrenovation
Luxury apartment complex in metro
Boston area new construction
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Rehab Hospital in Tucson, AZ
Renovation project in 2007 had staff input
Improvements: Bright, clean, cheery, safeenvironment
Access problems (examples):
- access to/from exterior public spaces
- detailing of in-room restroom- use of older hospital beds, other
equipment, etc.
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Cross Slope
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Grading & Trench Drain at Entry
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Tripping Hazard
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TUC, DFW & BOS Airports
Airport-provided, extra-wide wheelchairsdo not fit in HC bathroom stalls in such away as to permit easy transfers.
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Apartment Complex - Metro Boston
Constructed 2006
Owner/Operator/Property Manager is alarge national company
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Site/Civil Design Coordination
Site Design & Construction
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Site Design & ConstructionCoordination
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Existing Grade; Entry Design
Front Entry Design Construction &
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Front Entry Design, Construction, &Maintenance
Front Entry Design Construction &
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Front Entry Design, Construction, &Maintenance
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Existing Grades
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Recommendations
Model the provision of universal access inhealth care facilities, other institutionalbuildings, commercial buildings, and multi-
family residences after existing in-placesystems and procedures for the provision,certification, maintenance and periodic
testing of life safety systems.
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Recommendations (cont.)
Designate the project architect as theresponsible party through commissioning& building hand-over.
Designate state or municipal codeinspection official as the responsible partypost issuance of certificate of occupancy.
Establish regular schedule of inspections/certifications similar to elevatorinspections.
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