title: Factors impeding flexible inpatient unit design.
abstract: OBJECTIVE
  To identify and examine factors extraneous to the design decision-making process that could impede the optimization of flexibility on inpatient units.
  
  
  BACKGROUND
  A 2006 empirical study to identify domains of design decisions that affect flexibility on inpatient units found some indication in the context of the acuity-adaptable operational model that factors extraneous to the design process could have negatively influenced the successful implementation of the model. This raised questions regarding extraneous factors that might influence the successful optimization of flexibility.
  
  
  METHODS
  An exploratory, qualitative method was adopted to examine the question. Stakeholders from five recently built acute care inpatient units participated in the study, which involved three types of data collection: (1) verbal protocol data from a gaming session; (2) in-depth semi-structured interviews; and (3) shadowing frontline personnel. Data collection was conducted between June 2009 and November 2010.
  
  
  RESULTS
  The study revealed at least nine factors extraneous to the design process that have the potential to hinder the optimization of flexibility in four domains: (1) systemic; (2) cultural; (3) human; and (4) financial.
  
  
  CONCLUSIONS
  Flexibility is critical to hospital operations in the new healthcare climate, where cost reduction constitutes a vital target. From this perspective, flexibility and efficiency strategies can be influenced by (1) return on investment, (2) communication, (3) culture change, and (4) problem definition. Extraneous factors identified in this study could also affect flexibility in other care settings; therefore, these findings may be viewed from the overall context of hospital design.
authors.affiliation: Corresponding Author: Dr. Debajyoti Pati, (d.pati@ttu.edu), Texas Tech University, Department of Design, 1301 Akron Avenue, Box 41220, Lubbock, TX 79409.
authors.forename: Debajyoti
authors.initials: D
authors.lastname: Pati
authors.forename: Jennie
authors.initials: J
authors.lastname: Evans
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Harvey
authors.forename: Doug
authors.initials: D
authors.lastname: Bazuin
mesh_terms: D003142:Communication; D003625:Data Collection; D003657:Decision Making; D006801:Humans; D007297:Inpatients