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      Shared decision making in designing new healthcare environments—time to begin improving quality

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          Abstract

          Background

          Successful implementation of new methods and models of healthcare to achieve better patient outcomes and safe, person-centered care is dependent on the physical environment of the healthcare architecture in which the healthcare is provided. Thus, decisions concerning healthcare architecture are critical because it affects people and work processes for many years and requires a long-term financial commitment from society. In this paper, we describe and suggest several strategies (critical factors) to promote shared-decision making when planning and designing new healthcare environments.

          Discussion

          This paper discusses challenges and hindrances observed in the literature and from the authors extensive experiences in the field of planning and designing healthcare environments. An overview is presented of the challenges and new approaches for a process that involves the mutual exchange of knowledge among various stakeholders. Additionally, design approaches that balance the influence of specific and local requirements with general knowledge and evidence that should be encouraged are discussed.

          Summary

          We suggest a shared-decision making and collaborative planning and design process between representatives from healthcare, construction sector and architecture based on evidence and end-users’ perspectives. If carefully and systematically applied, this approach will support and develop a framework for creating high quality healthcare environments.

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          Most cited references61

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          Healing environment: A review of the impact of physical environmental factors on users

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            How physicians can change the future of health care.

            Today's preoccupation with cost shifting and cost reduction undermines physicians and patients. Instead, health care reform must focus on improving health and health care value for patients. We propose a strategy for reform that is market based but physician led. Physician leadership is essential. Improving the value of health care is something only medical teams can do. The right kind of competition--competition to improve results--will drive dramatic improvement. With such positive-sum competition, patients will receive better care, physicians will be rewarded for excellence, and costs will be contained. Physicians can lead this change and return the practice of medicine to its appropriate focus: enabling health and effective care. Three principles should guide this change: (1) the goal is value for patients, (2) medical practice should be organized around medical conditions and care cycles, and (3) results--risk-adjusted outcomes and costs--must be measured. Following these principles, professional satisfaction will increase and current pressures on physicians will decrease. If physicians fail to lead these changes, they will inevitably face ever-increasing administrative control of medicine. Improving health and health care value for patients is the only real solution. Value-based competition on results provides a path for reform that recognizes the role of health professionals at the heart of the system.
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              Therapy by design: evaluating the UK hospital building program.

              A renewed interest in hospital design in the UK, prompted by the Private Finance Initiative, provides an opportunity to consider hospitals as 'therapeutic environments'. Noting that the therapeutic value of hospitals is related to their physical, social and symbolic design, this paper argues that 'expert' knowledges have encouraged the development of hospitals that all-too-rarely provide benign settings for promoting patient recovery and healing. The recent programme of hospital building in the UK, however, has been accompanied by a vigorous debate over what constitutes good hospital design, with four significant ideas emerging: hospitals should be clinically efficient, be integrated within the community, be accessible to consumers and the public, and encourage patient and staff well-being. Suggesting that all four goals demand careful consideration of the real and imagined spatiality of hospital environments, the paper concludes by suggesting ways that health geographers can contribute to debates surrounding PFI hospital design.
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                Author and article information

                Contributors
                mel@du.se
                peter.frost@chalmers.se
                goran.lindahl@chalmers.se
                helle.wijk@fhs.gu.se
                Journal
                BMC Health Serv Res
                BMC Health Serv Res
                BMC Health Services Research
                BioMed Central (London )
                1472-6963
                21 March 2015
                21 March 2015
                2015
                : 15
                : 114
                Affiliations
                [ ]School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
                [ ]Department of Architecture, Chalmers University of Technology, Göteborg, Sweden
                [ ]Department of Civil and Environmental Engineering, Chalmers University of Technology, Göteborg, Sweden
                [ ]Sahlgrenska Academy, Health and Caring Sciences, University of Gothenburg, Göteborg, Sweden
                Article
                782
                10.1186/s12913-015-0782-7
                4373305
                f4b07cea-0b59-45a2-9b0c-798934317d50
                © Elf et al.; licensee BioMed Central. 2015

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 1 April 2014
                : 9 March 2015
                Categories
                Debate
                Custom metadata
                © The Author(s) 2015

                Health & Social care
                design process,healthcare architecture,quality improvements,shared decision-making,person-centered

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