In Summary

The built-environment in healthcare defines the patient satisfaction, delivery of care, and operational outcomes. Evidence-Based Design is the process of basing decisions about the built-environment on credible research to achieve the best possible outcomes. EBD findings inform decision making. In a CHD research study, industry standards and best practices related to floorcoverings were explored. Credible product selection is based on evidence, as defined by the stakeholder goal. Evidence and outcomes define the performance attributes of rubber flooring as it relates to creating safer spaces for infection control, safety, and patient-experience.

In this study, also noted above, flooring surfaces were examined using an EBD approach, to define how flooring/floor coverings can contribute to the following performance improvement goals:
    1. Reduce slips, trips, and falls
    2. Reduce patient and staff injuries associated with falls
    3. Reduce noise levels
    4. Reduce staff fatigue
    5. Reduce surface contamination and potential risk of HAIs
    6. Improve indoor air quality (IAQ)
    7. Improve patient and family satisfaction
    8. Represent the best return on investment^xvi

Evidence-based studies have shown that flooring attributes have an actionable impact on the two major HCAHPS questions about quietness and cleanliness: “During your stay, how often was your room and bathroom kept clean?” and “How often was the area around your room quiet at night?” Flooring is also related to improving verbal communication and to pain management by reducing noise. Though RRP is a post-discharge measure, Evidence-Based Design studies have shown the impact of noise levels on the patient and how they can affect higher incidents of readmission.

The healthcare payment and delivery system has shifted from volume-driven to value-based care along with process innovation of care and facility standards are the drivers and framework of healthcare reform. The “new normal” has transformed what key stakeholders demand from flooring products that are a component of and align with an integrated approach to Cost-Quality-Outcomes (CQO). The value attributes of rubber flooring as defined by this course showcase the holistic approach to safety in the healing environment from the floor-up.

With a focus on healthcare outcomes, this course content will support architects and interior designers to address many of the pain points and challenges faced in healthcare. Rubber flooring and its inherent product attributes provide a sound focus on operational optimization, clinical efficiency, and patient/caregiver outcomes with actionable impact on outcomes and reimbursables.

Healthcare systems are streamlining product selection in support of branding, improved maintenance, and to reduce overall costs. The benefits of product standardization are to increase the ability to create safer spaces, and to have an aligned partnership in support of maintaining clinical efficiency and operational optimization.

The resilient flooring industry has many product options to choose from; a true evaluation as it pertains to product selection and de-selection must be undertaken to define product attributes as they relate to the outcomes and drivers discussed in this course for operational optimization, clinical efficiency, patient experience, and safety.

Endnotes

• ⁱNanda, U., Malone, E., and Joseph, A. (2012) wrote Achieving EBD Goals through Flooring Selection & Design. Concord, CA: The Center for Health Design.
• ⁱⁱ(Hamilton K. The four levels of evidence-based practice. Healthcare Design, November 2003:18-26) (Ulrich R. Evidence-based design to enhance patient safety. In The environment for care: An NHS estates symposium. London:The Stationary Office, 2004) (Ulrich R, Zimring C, Joseph A, Quan X, Choudhary R. The role of the physical environment in the hospital of the 21st century: A once-in-alifetime opportunity. Center for Health Design: Concord CA, 2004).
• ⁱⁱⁱhttp://fgiguidelines.org/pdfs/FGI_Update_AcousticCriteria_140929.pdf, http://www.bdcnetwork.com/hospital-constructionrenovation-guidelines-promote-sound-control,http://www.ajicjournal.org/article/SO196-6533(10)00407-41.pdf
• ^ivJoint Subcommittee on Speech Privacy of the Acoustical Society of America, Technical Committees for Architectural Acoustics and Noise; Institute of Noise Control Engineering; and National Council of Acoustical Consultants 2006), Sound Control for Improved Outcomes in Healthcare Settings, Anjali Joseph, Ph.D., Director of Research, The Center for Health Design and Roger Ulrich, Ph.D., Professor, Center for Health Systems and Design, Texas A&M
• ^v(Berglund et. Al. 1999)
• ^vihttp://www.cdc.gov/HAI/surveillance/, http://www.cdc.gov/HAI/pdfs/hai/Scott_CostPaper.pdf
• ^viiBeyer& Belsito (2000), Gerson et al. (1994), and Skoutelis, et al. (1994).
• ^viiiJoseph (2006)
• ^ixhttps://www.healthdesign.org/sites/default/files/ chd_achieving_ebd_goals_through_flooring__design_final.pdf
• ^x(Anderson, Mackel, Stoler, & Mallison, 1982; Harris, Pacheco, & Lindner, 2010; Lankford et al., 2006; Noskin, Bednarz, Suriano, Reiner, & Peterson, 2000)
• ^xihttps://share.kaiserpermanente.org/article/kaiser-permanente-rejects-antimicrobials-for-infection-control/
• ^xii(Joh, Adolph, Campbell & Eppler, 2006).
• ^xiiiContribution of the Designed Environment to Fall Risk in Hospitals
• ^xivSustainable Resilient Flooring Choices for Hospitals: Perceptions and Experiences of Users, Specifiers and Installers December 2010, Healthcare Research Collaborative and Georgia Institute of Technology
• ^xvComparative Analysis of Flooring Materials: Environmental and Economic Performance, Ajla Aksamija, Ph.D., LEED® AP BD+C, CDT
• ^xvihttps://www.healthdesign.org/sites/default/files/ chd_achieving_ebd_goals_through_flooring__design_final.pdf

Sandra Soraci, EDAC, LEED AP, NCIDQ, IIDA As marketing leader, health care solutions, Sandra supports nora systems, Inc.’s healthcare partners by providing flooring solutions through an informed decision-making process in support of operational optimization, clinical efficiency, patient safety, and cost of ownership.

Interface is a world-leading modular flooring company with a fully integrated collection of carpet tiles and resilient flooring. Our modular system helps customers create interior spaces while positively impacting the people who use them and our planet. nora is Interface’s commercial rubber flooring systems and solutions brand. Produced in Germany for more than 65 years, nora premium rubber works to improve operations, efficiencies, health, safety, and wellness with sustainable flooring that eases maintenance, absorbs noise, and provides added comfort underfoot.