by Jane Rohde

Introduction

A concurrent theme throughout this year’s Environments for Aging (EFA) held in Savannah, Georgia included ‘what are your lessons learned?’ Even with the most careful and stringent functional and physical space programming process, there are always design and operational adjustments that would be improvements for the next project – with the same or different client. Completion of a post occupancy evaluation is key in raising the bar for better environments designed for aging.

Functional Programming Process

It still surprises me that often providers, as well as designers, do not utilize the opportunity prior to beginning the actual design process to completely vet and understand the proposed care model, the resident desired outcomes, and all the operational flows that are required to deliver a specific care model. As the long-term care world moves away from institutionalized care to person-centered care models, there are all types of operational concerns that need to be addressed for the environment to fully support both the resident and staff needs. The overview of changing from a centralized culture to a decentralized process needs to be fully evaluated; including staff understanding and agreement of the execution of services. As part of a successful person-centered care model, the staff need to fully embrace the concepts in turn supported by the physical environment. The two areas that are the most problematic for change tend to be the decentralization of dining services and the training of universal or shared services staff that are empowered to be self-directed. We have found that facilitating workshops, focus groups, developing resident profiles, and laying out mock-ups to be informative for decision making – allowing changes to occur during the planning and program phase, instead of during the construction and soft opening phases. All changes made during construction are going to cost more and could potentially negatively impact other operational flows and resident outcomes as an unintended consequence. I have received inquiries as to how to gather and use information effectively. We use spreadsheets, icons, and notes for our collection and recording of data. Alberto Salvatore, a healthcare architect, is currently completing a white paper about the functional programming process and the integration on the environment of care. When this is completed, it will be available through the Facility Guidelines Institute’s website. Another initiative is the Functional Program Toolkit, which is being championed by the Environmental Standards Council, a group of volunteers that supports the development of the toolkit as part of the work of The Center for Health Design. The functional programming process is essential in completing a successful project and is required by jurisdictions that have adopted the various Guidelines developed by the Facility Guidelines Institute as licensing code.

Post Occupancy Evaluation

A Post Occupancy Evaluation (POE) is “the process of evaluating buildings in a systematic and rigorous manner after they have been built and occupied for some time.”[1] Once a project is completed and operational, a POE provides information that prevents designed projects from perpetually including design flaws that can negatively impact staff and residents in senior living and other types of healthcare settings. If a Functional Program is detailed and documented, it can provide the framework for the pre-occupancy assumptions and detailed decision-making process; in addition to providing the framework and documentation format for completing a POE. The information gleaned from doing surveys, observations, interviews, and comparisons to the initial project assumptions and owner program requirements (OPR) informs future designs. Front line staff, residents, patients, and families can all provide first hand experiences within the designed environment. Some of the feedback that we have heard includes “need to have point of service storage for all activities and services,” “walking distances are too far – spending less time with patients or residents, and too much time getting to destinations,” and “grab bars located in the wrong places and not supporting safe independent movement by residents/patients.” In senior living, food and the dining experience (or lack of experience) is a major focus for residents. Providing adequate time for them to order, select, dine, and converse are often cut short by staff-driven models. Variety of foods and times for eating are also often discussed during focus groups. One setting made the timing flexible, and found satisfaction to be much higher, no long lines, and adequate space for assistive devices – normalizing the dining experience versus artificially controlling the ‘dinner hour.’

Post Occupancy Evaluation and Sustainability

Post Occupancy Evaluations are very similar to completing commissioning as part of continuous performance improvement for sustainable buildings. Some colleagues refer to the POE as “operationally commissioning” of the physical environment – seeking not only issues with the design of the physical spaces, but also adjustments to operations that can improve quality of life and outcomes for all endusers. In working with the trend toward Health and Wellness in all settings, an intervention is strongest when a physical building element is coupled with an operational policy, procedure, or process.

Conclusion

The phases of architectural and interior design start with the programming and planning needs of a healthcare project – identifying and involving all stakeholders from the beginning, which provides an opportunity for the completion of a much more successful project. Completing the post occupancy evaluation provides a means for both physical space and operational continual improvement, but also provides the ground work for future projects – improving quality of life through a higher quality of design for all generations!

Blog was written for Sunbrella.

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AuthorLauren Erickson