Spring 2016
In This Issue
Chapter President’s Column – April 2016
NCHE Board Member Working with Student Member on New Telehealth Pilot
NCHE Member Spotlight
Recap from Feb Event: The Future of Healthcare is Now
You Need to Engage Patients You Need a Web and SEO Strategy
Testing Design Through Functional Performance
The Power of Prediction
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Chapter Officers

Leonard Friedman, FACHE

Vice President
April Harris

Laura Munro

Edward M. Daniel

Immediate Past-President
Michelle Comeaux, FACHE





Testing Design Through Functional Performance
By Kate Renner, AIA, EDAC, Lean-Six Sigma CE, LEED AP BD+C, Associate, HKS and Shannon Kraus, FAIA, FACHA, LEED AP, Senior Vice President, Board of Directors, HKS

How does your healthcare facility impact your patient outcomes? Every key design decision is a performance hypothesis with a direct impact on outcomes and the metrics used to measure patient outcomes, including fall rates, infection rates, staff injury reports, satisfaction and HCAHP scores. A well-designed building can improve organizational performance at multiple levels – the human, organizational and environmental scales. The true test of the success of a project design is its functionality after occupancy. To measure this functionality, Post Occupancy Evaluations (POE) were developed as a tool to evaluate buildings in a systematic and rigorous manner, after they have been built and occupied for some time.

One version of a POE, the Functional Performance Evaluation (FPE), includes site audits, user feedback, environmental analysis, spatial analysis and organizational success metrics. The FPE is based on the philosophy of “triangulation” in collecting data. The FPE collects meaningful data using key metrics and multiple measures, before developing conclusions. This tool provides facility owners with insight into ways to improve and optimize operations through facility design, and assists design teams in understanding the consequences of their decisions and engaging in continuous improvement.

The sound study conducted as a part of the FPE found that the sound levels are below the US Environmental Protection Agency’s recommendations in the patient room, both during the day and night.

HOSPITAL C:  Greenfield Community Hospital (375,000 SF, 144 Beds)

The goal for this hospital was to create a patient- and guest-centered facility that would be lean, green and operationally efficient. A key strategy to accomplish this infused hospitality into the design, which allowed the team to transform the traditional paradigm of “patient care” into one of “guest care”— where the human experience is the focus.  

To analyze the impact of the nursing unit design on nurse walking behavior and travel distances, the FPE queried nurses about their paths of travel and sequences in care delivery. The evaluation included asking nurses to identify their patient room assignments and the path and frequency of travel involved in collecting patient medication and clean supplies. The analysis revealed that dissatisfaction with operational efficiency correlated with long walking distances, due to non-standard stocking of supplies; an operational issue that defeated the design intent.

Based on the FPE data, the research team made recommendations to the hospital’s leadership team and changes were implemented in both the design and operations. The results suggest that the use of evaluations as an applied research tool contributes to improvements in design processes, organizational performance and the industry knowledge-base.


The data gained from our FPEs has allowed us to develop a series of analytical and generative tools that can be used throughout the design process. While POEs are traditionally one-off assessments of built environments, the FPE is a design research tool that can inform the entire process, improve operations post occupancy and become a driver for innovation. This tool can be used to test both new and existing environments to improve operations in existing conditions and influence design of future environments.  For more information, contact Kate or Shannon at 202.682.6289 or skraus@hksinc.com and krenner@hksinc.com.

HKS, Inc. is a leading architectural design firm ranked among the top six architectural engineering firms, according to Building Design+Construction magazine. Since its founding in 1939, HKS has completed construction projects totaling more than $77 billion in more than 1,742 cities located in 88 countries. The firm operates from 26 offices worldwide.

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