Clarine Joanne van Oel

The door between the semi-public corridor and the single-occupancy patient room of a newly built University Medical Centre in the Netherlands has been heavily debated during its Evidence Based Design (EBD) and experience-informed design. It was also heavily debated since the wards came into use in 2018. It is well known that, regarding door design, a trade-off has to be made between aspects such as privacy, visibility, and safety. This makes our case study exemplary for the trade-offs to be made in EBD practice. This study traces back to how the design decisions for the door, dating from 2011, were made. Safety, privacy, control, and support for the social and emotional wellbeing of patients, relatives, and staff were the aim, but this is not experienced as such by all concerned. This case study evaluation highlights the tension between EBD principles and everyday practice, where the interplay between ‘bricks, bytes, and behavior’ has to be considered, and every consciously debated design solution might bring new and unforeseen challenges elsewhere. Our practice-based research combines the analysis of documentation on the design decision-making process with evaluation interviews with nurse managers in 2019. Our findings on ‘the (Dutch) patient door debate’ can contribute to awareness of trade-offs to be made in health facility design, complemented with supportive IT systems and efficient and effective staff workflows. It can enhance the understanding of the many aspects that need to come into consideration during design dialogues with experts and end-users.

With the need to increase total revenues, airports have begun to use commercial retail. A well-designed airport may provide great service to clients and consumers and increase their satisfaction and in turn their spending behaviours. Since there is suggestive evidence that there might be cultural associations of white, purple or black with different emotional loadings to these colours across cultures, the present study investigated passengers’ preferences for architectural design characteristics of an airport in a new cultural setting. Discrete choice modelling was used to measure the passengers’ preferences for 10 interior design characteristics of the passenger terminal using 3D renderings. Data on 435 passengers were collected at Mehrabad International Airport, which also included passengers’ emotions. Passengers in the terminal hall preferred a curved and transparent ceiling, material in warm colours, cool lighting, with low width and low height, greenery and without any decorations. When compared to other studies, it may well be that passenger preferences for lighting and certain colour schemes reflect geographical or cultural differences. For other interior design characteristics, preferences relating to the shape of the ceiling and the amount of daylight, as well as the presence of greenery, may well be reflections of passengers’ restorative needs.

A significant majority of the literature on natural environments and urban green spaces justifies the preferences that people have for natural environments using four predictors defined by Kaplan’s preference matrix theory, namely coherence, legibility, complexity, and mystery. However, there are no studies implicitly focusing on the visual attributes assigned to each of these four predictors. Thus, the aim of this study was to explore the influence of nine visual attributes derived from the four predictors of Kaplan’s matrix on people’s preferences in the context of urban parks. A discrete choice experiment was used to obtain responses from a sample of 396 students of Golestan University. Students randomly evaluated their preferences towards a set of potential scenarios with urban park images. The results of a random parameter logit analysis showed that all of the attributes of complexity (variety of elements, number of colors, and organization of elements) and one attribute each of coherence (uniformity), mystery (visual access), and legibility (distinctive elements) affect students’ choices for urban parks, while one attribute each of mystery (physical access) and legibility (wayfinding) did not affect the choices. Furthermore, the results indicated a preference for heterogeneity of the attributes. The findings of this study can provide instructions for designing parks.

In 2015 a profound change in the financing of the Dutch health care system was initiated. Pur-pose of the reforms was also to enable elderly to live at home as long as possible. One of the consequences of the 2015 reforms was that care providers closed care homes. It was argued that care providers could use vacant care homes to house independent living elderly of lower and middle income groups seeking a break out from loneliness, and willing to live their live in the vicinity of other elderly without abolishing the independence, thus in a cohousing group for elderly. This mixed methods study aims to gain insight into the conditions that influence the continuity of cohousing groups for elderly. A survey was sent to 114 cohousing groups for elderly, yielding a net response of 52%. The out-comes were then used to select 6 cohousing groups who participated in in-depth interviewing. Informal care is in all interviewed group provided by family caregivers and it was not the co-housing’s responsibility to look after chronically ill members. For elderly, an important motive to live in cohousing was the social connection with others in the group. This also creates a feeling of safety. However, a main reason for cohousing groups in highly urbanized areas appears to be the possibility to bypass the regular waiting list for social housing. The continuity of cohousing groups seems to depend on the regular organization of activities, and therefore membership fees need to be included in the rental agreements.

The design of a new hospital is typically used as a catalyst for change, redesign and implementation of new work processes to improve health services. Perceived outcomes after relocation may be linked to the success of co-design and stakeholder engagement processes. Especially in striking the right balance between the building (Bricks), processes and supporting IT (Bytes) and work processes (Behavior). Even when stakeholders are engaged in the design that is not to say that their needs will be safeguarded during trade-offs in various phases of decision-making. Furthermore, the time window between engagement and project delivery may contribute to a mismatch in perceived outcomes after relocation. This study aims to gain insight into the possible causes for the perceived mismatches as expressed by ward managers some 12 months after relocation. This was altogether some 6 years after the design of the facility was completed. It will increase our understanding of the complexity of design, construction and transition processes that have to deal with a gap in time between design and use. We adopt an interpretive case study approach in which in-depth interviewing has been combined with an extensive analysis of documents collected over time. We found transformative change requiring an integrative approach to the Bricks and Bytes throughout the whole process of designing, constructing and taking into use, with stakeholder engagement as a key element. Additionally we found Health Care Worker Behavior not well enough considered in a predominantly rational design and implementation process focusing on patient centeredness.

Using 3D design models, this study aims to better involve patients in the design of hospitals by investigating what physical environmental characteristics in hospital patient rooms are valued by patients. There is a plea for shared-decision-making and collaborative design processes with representatives from healthcare and the construction sector based on evidence and end users’ perspectives. Existing research is hampered by poor conceptualization of environmental design factors, as these are differently operationalized between medical and technological sciences. Architects communicate through visuals, whereas medical professionals and researchers tend to communicate in words. By using 3D-modeling to research the relationship between health and well-being on the one hand, and the affordances the built environment offers, this knowledge gap can be better addressed. Two hundred four respondents, 60% patients and 40% medical professionals, engaged in discrete choice experiments visualizing a single patient room. A main finding is that patients and medical professionals consistently choose for hospital rooms with the highest amount of daylight access. What this study adds is that the orientation of the windows matters as well. Horizontal windows, allowing for a panoramic view, were twice as much chosen than were vertical windows. Another important finding concerns patients’ preferences for an open door, suggesting patients prefer to stay “connected” to the outside world. This study is important as it shows, empirically, that patients may make different choices if in research the rooms are better conceptualized and thus visualized and if multiple design features are assessed as configuration rather than using a sequential, “one-design-characteristic-after-another” approach.

This study investigates how a no-blame culture affects the effectiveness of project-based design teams across different project delivery methods in the construction industry. Ninety-two team members of 34 project-based design teams assessed the no-blame culture, level of teamwork, and team effectiveness in teams that were procured through different routes. A multilevel analysis shows that the relation between integrated project delivery methods, such as design–build and strategic partnering, and team effectiveness varies across levels of no-blame culture. A mediated regression analysis found that the effect of no-blame culture on team effectiveness is mediated by teamwork. Managers of project-based design teams in the construction industry should, therefore, invest both time and effort in creating a no-blame culture and the level of teamwork in parallel. This will enhance the level of team effectiveness in integrated project delivery methods.