Field Research Guide by CADRE

FIELD RESEARCH MANUAL HOW TO COMPLETE FIELD RESEARCH IN

2.5 DAYS

FIELD RESEARCH

2.5 days The Field Research Module is set up as a 2.5-day module or a site visit for one key department or unit.

0 0. 5 1 2

• Online Survey • Photo-Essay

• Site Tour • Intro • Pilot Shadow

• Interviews • Sound readings

• Shadow • Interviews

• Behavior Maps • Sound readings

• Interviews • Debrief • Behavior Maps

Field Research Framework

The complete project involves time on the front end for study design and set up, and on the back end for detailed analysis, synthesis and report.

0 Research Lead does kick-off call

with unit leadership to understand

0. 5

the key components of the unit

hour) and shadows subject 1 and

Behavior Maps (one before and one after

online survey is developed and sent out

the end of each shadow).

Researcher 2 does a series

Researcher 2 does an orientation

existing survey instruments.

2 interviews does a round of the unit to get a behavior map. Sound

Gets a sense of the org chart and

readings are taken during the behavior

interviews and 2 behavior maps.

sample shadowing (30-minute increments) of other subjects.

Collects 4 Behavior Maps between shadow segments. Researcher 1 and

map.

available for interview and shadowing. Researcher 3 (on-site assist – only

Does a tour of the site with the leadership and conducts 2 key interviews.

of interviews, and after every

interview with unit leadership.

confirms all the key subjects who are

Researcher 1 does random

to key subjects, based on this call and

shadowing of Day Nurse (relieved during lunchtime by researcher 2).

2 for 2 hours each. Also gets 4

(who, what, where, how and why). An

Researcher 2 completes

Researcher 1 does a 12-hour

Researcher 1 does photo essay (1

needed for Day 1 – does a 12-hour shadow of the night shift – does 2

behavior maps at the beginning and end of shift).

Researcher 2 do debriefing with unit leadership.

FIELD RESEARCH

OBSERVED DATA

Question 5 Please rate each of the following in terms of importance regarding PROXIMITY TO THE PATIENT ROOM, with 5 being the highest: 2

2 0 0 1 5 0 0 5 2 1 2 5 5 3 1

7 5 0 3 5 1 4 5 7 5 7 7 9 10 7

5 7 7 6 1 3 9 1 10 9 4 5 3 4 9

Very Important (5) 11 12 18 12 4 22 13 3 6 11 12 3 3 4 9

No Opinion

Rating Average

1 1 0 2 1 0 0 0 0 0 0 1 1 1 0

4.00 4.16 4.72 4.17 2.36 4.81 4.35 2.15 3.80 4.15 3.92 2.92 2.76 3.04 4.00

answered question skipped question

Response Count 26 26 25 25 26 26 26 26 25 26 26 25 26 26 26 1

26 3

Med/Surge Inpatient 27,185sf

102

100

26.7

PATIENT

F.7

PATIENT

G.1

ST-01

CORR.

SPATIAL DATA

SEATING

EL-01 8000#

CONF. UP

G.9

PATIENT

CLOSET

TR LOBBY

H.1

N DIR. OFFICE

EQUIP. STOR. PATIENT

CLOSET

PATIENT

I.1 MED/ CLEAN

PATIENT

PATIENT CORR. T

I.3

OFF STAGE

PATIENT

LINEN

CORR.

PATIENT

CORR.

CAREGIVER

PATIENT

874 sq ft

PATIENT

CAREGIVER

843 sq ft

22.8

20.5

SOILED

PATIENT

CORR. NOUR. STOR. CLEAN LINEN

PATIENT

CONSULT.

23.1

23.2

23.5

24.2

BIO MED

24.9

NOUR.

ELEC.

PATIENT

Perception and Behavior: Surveys, Observations, Interviews, Sound Levels, Photos

PATIENT

WAITING

PATIENT LOCKERS

TOAST HOT WELL MW FREEZE COFFEE

LOUNGE T

PORTBL. REF.

HEAT

KITCHEN CLEAN

SINK

D/W KITCHEN SOILED TRAY CART

EL-07

EL-08

TELE.

SINK

LOBBY

HOT BOX

STOR.

ANTE

EL-11

EL-10

EL-09

Parametric Modeling: Walking Distance + Visibility

PYXIS

EL-02

PATIENT LOBBY EL-05

NOUR.

EL-06

EL-03 CHUTES

PATIENT

SOILED

PATIENT

EL-04 ST-02 T

EQ. STOR.

PATIENT

CL. LINEN

NOUR.

PATIENT

886 sq ft

OFF STAGE

CAREGIVER

PATIENT

PATIENT OFF. STAGE

598 sq ft CAREGIVER

PATIENT

MED./ CLEAN

PATIENT

LINEN

PHARM OFFICE

PATIENT

PATIENT SPVR OFFICE

Not at all Important (1) 0 1 0 1 10 0 0 12 0 0 1 4 5 4 0

Answer Options Caregiver documentation outside room Core documentation center Medication Room Nurse server Conference/Education Room Supplies Equipment Room Locker / Break room Nourishment Room (meals) Nourishment Room (Ice/ Snacks) Toilet Waiting Room Service Elevator Patient transfer elevator Soiled utilities Other (please specify)

REPORTED DATA

S.8

PATIENT T

PATIENT

SEATING

PATIENT

T.1

PATIENT T

ST-03

T.8

101

24 2

103

The Data Collected in the Field Research + Parametric Analysis Model consists of existing metrics (performance data currently captured by the unit) and reported data (surveys/interviews), observed data (observations through shadowing and behavior mapping) and spatial data (parametric analysis of the space in terms of key parameters – typically walking distances and visibility).

REPORTED DATA

Reported Data Example:

OBSERVED DATA

SPATIAL DATA

Reported Data comes from surveys that are administered online prior to visiting the site, and from semi-structured on-site interviews that take place with key subjects. Surveys are typically 15-20 questions long and correlate

ONLINE SURVEY

to the questions that are asked in the Functional Performance Evaluation.

Sample Survey Question Med Surg

Sample Survey Responses 5. Please rate each of the following in terms of importance regarding PROXIMITY TO THE PATIENT ROOM, with 5 being the highest: Not at all Important 2

(1) Caregiver documentation

Very No Important Opinion (5)

j k l m n

Question 5

Medication Room

j k l m n

Please rate each of the following in terms of importance regarding PROXIMITY TO THE PATIENT ROOM, with 5 being the highest:

Nurse server

j k l m n

Conference/Education

j k l m n

Supplies

j k l m n

Equipment Room

j k l m n

Locker / Break room

j k l m n

Nourishment Room

j k l m n

Toilet

j k l m n

Waiting Room

j k l m n

Service Elevator

j k l m n

Patient transfer elevator

j k l m n

Soiled utilities

j k l m n

outside room Core documentation center

Room

(meals) Nourishment Room (Ice/ Snacks)

Other (please specify)

Not at all Important (1) 0 1 0 1 10 0 0 12 0 0 1 4 5 4 0

2 0 0 1 5 0 0 5 2 1 2 5 5 3 1

7 5 0 3 5 1 4 5 7 5 7 7 9 10 7

5 7 7 6 1 3 9 1 10 9 4 5 3 4 9

Very Important (5) 11 12 18 12 4 22 13 3 6 11 12 3 3 4 9

No Opinion

Rating Average

1 1 0 2 1 0 0 0 0 0 0 1 1 1 0

4.00 4.16 4.72 4.17 2.36 4.81 4.35 2.15 3.80 4.15 3.92 2.92 2.76 3.04 4.00

answered question skipped question

Response Count 26 26 25 25 26 26 26 26 25 26 26 25 26 26 26 1

26 3

REPORTED DATA

Reported Data Example:

OBSERVED DATA

SPATIAL DATA

Interviews are conducted by the team member with more experience. They are semi-structured, which means that although the interviewee begins with a set of questions and a structured format for walking a subject

INTERVIEW

through their typical day/experience, the interviewer also understands that additional insights are of value and does not strictly contain the interview to these questions. This gives the interviewee some flexibility and makes the content of the interview richer.

Interview Questions • What is your role ? • How long have you worked on this unit? • Walk me through your day and mark on the layout. • What are some of the key tasks you do through the day? • What are the busiest periods for you during the day? • In order of priority how important it is to have support spaces next to patient room? • Tell me a little about your typical work day and the challenges you face on the unit. • How does the space/ design effect these challenges? • For you to do your job well - what are key components in the design of the facility that would help? • Fill out the table in terms of busy times: TIME ACTIVITY Busy Rounds Patient care Call response Medication admin Add task based on response

REPORTED DATA

OBSERVED DATA

SPATIAL DATA

Observed Data Example: PHOTO ESSAY

FIRST TO FILL UNIT (mostly full occupancy) 2 wings 4 nursing stations 20 rooms in each wing 2 meds/supply rooms 1 nourishment room 2 soiled linen 2 equipment (0) Nurse Stations

Observation is a key component of any field research. The first step is to systematically photo-document the entire site. A photo essay is a methodical process of taking pictures where each image is annotated on a to-scale site plan with relevant notes.

REPORTED DATA

OBSERVED DATA

SPATIAL DATA

Observed Data Example: SHADOW DATA

Shadowing is a time-tested observation technique where a researcher follows a key subject through their day/section of the day. This allows a deep understanding of how the subject spends their time â&#x20AC;&#x201C; minute-tominute data is captured on location, activities and behavioral notes. During the shadowing, the researcher also notes any spikes in the sound. It is important to do the shadowing for a meaningful period of time. For example, to understand the workplace it is very important to shadow a nurse for their entire shift. If shadowing is done in 2-hour increments, then the sampling of these hours must be carefully assessed and decided upon.

REPORTED DATA

Observed Data Example: BEHAVIOR MAP

Unlike shadowing (where a researcher follows a certain subject) in a behavior map, the researcher tries to get a series of snapshots of ALL of the people in a particular space and their activities/behaviors. Every two hours the researcher takes a quick walk around the unit. Each person on the unit is marked on the map through a predetermined coded symbol. The activities in which they are involved are annotated next to the symbol. A series of 10-12 behavior maps is needed for a thorough understanding of how the space is utilized differently during the course of a day or night.

OBSERVED DATA

SPATIAL DATA

Med/Surge Inpatient 27,185sf

102

100

26.7

T PATIENT

PATIENT

G.1

REPORTED DATA

PATIENT

F.7

ST-01

CORR.

Spatial Data Example:

8000#

CONF. UP

PATIENT

CLOSET

TR LOBBY

H.1

N DIR. OFFICE

EQUIP. STOR.

SPATIAL DATA

SEATING

EL-01

G.9

OBSERVED DATA

PATIENT

CLOSET

PATIENT

I.1

PARAMETRIC MODELING VISIBILITY ANALYSIS

MED/ CLEAN

PATIENT

PATIENT CORR.

I.3

PATIENT

OFF STAGE

PATIENT

LINEN

CORR.

PATIENT

CORR.

CAREGIVER

874 sq ft

PATIENT

Human behavior and experience must be overlaid on the spatial context.

CAREGIVER

843 sq ft

22.8

20.5

SOILED

PATIENT

Our study methodology utilizes Revit plug-ins that can rapidly analyze key

PATIENT

CORR. NOUR. STOR. CLEAN LINEN

PATIENT

23.1

23.2

23.5

24.2

spatial context to our behavioral data.

BIO MED

24.9

parameters, such as proximity and visibility, on a plan. This provides the

PATIENT

CONSULT.

NOUR.

ELEC.

PATIENT

TOAST HOT WELL MW FREEZE COFFEE

LOUNGE T

PORTBL. REF.

HEAT

KITCHEN CLEAN

SINK

D/W KITCHEN SOILED TRAY CART

EL-07

EL-08

TELE.

SINK

LOBBY

HOT BOX

STOR.

ANTE

EL-11

EL-10

EL-09

PYXIS

EL-02 UP

See PARAMETRIC ANALYSIS GUIDE FOR MORE INFORMATION.

WAITING

PATIENT LOCKERS

PATIENT LOBBY EL-05

NOUR.

EL-06

EL-03 CHUTES

PATIENT

SOILED

PATIENT

EL-04 ST-02 T

PATIENT

EQ. STOR.

PATIENT

CL. LINEN

NOUR.

PATIENT

886 sq ft

OFF STAGE

CAREGIVER

PATIENT

PATIENT OFF. STAGE

598 sq ft CAREGIVER

PATIENT

MED./ CLEAN

PATIENT

LINEN

PHARM OFFICE

PATIENT

PATIENT SPVR OFFICE

S.8

PATIENT T

PATIENT

SEATING

PATIENT

T.1

PATIENT T

ST-03

T.8

101

103

REPORTED DATA

OBSERVED DATA

SPATIAL DATA

It normally takes 2-3 hours to set up the Rhino/Grasshopper model for

Spatial Data Example:

a new floor plan. Once the model is ready, a spreadsheet with all of the distances between each two spaces can be automatically generated in a

Nurse Walking Distances

few minutes. In less than an hour, a heat map can be generated using a

PARAMETRIC MODELING HEAT MAP

pivot table created by the data from the parametric model.

01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40

PATIENT ROOMS

Excessive Excessive Distance Distance

Reasonable Reasonable Distance Distance

Break Room

Conference

Equipment

Ice

Linen

Main Nurse Station

Meds

Nourishment

Soiled Work

WOW Stations

Field Research Framework

[Protocol Development] Interview Observation Guide

[Analysis + Report]

Parametric Analysis

On-Site Data Online Survey

Online Survey Development

[On-Site Observation + Interviews]

2.5 Days on Site Day 0 • •

Online Survey Photo-Essay

Day 0.5 • • • • •

Site Tour Intro Pilot Shadow Interviews Sound readings

Day 1 • • • •

(3+2+12) 8 Interviews 12 Behavior Maps 52 Sound Readings

Day 2 • • •

Interviews Debrief Behavior Maps

APPENDIX STEPS OF RESEARCH IN PRACTICE METRICS THAT MATTER ONLINE SURVEY RESEARCH PROJECT INFOGRAPHIC EXAMPLE

PHASES OF WORK

INTEGRATING RESEARCH IN PRACTICE

RESEARCH “INFORM”

TARGET Create design aims based on key performance goals of the organization

FUNCTIONAL DESIGN

CONCEPT

IMPLEMENTATION DOCUMENTS

EXPLORE/ EXPERIMENT Gather Knowledge; Understand Users; Simulate Scenarios; Test Prototypes. Use Tools That Balance Technology With Empathy

DEFINE Link Design Solution to Performance Hypothesis

Research in Practice Research in practice requires us to inform ourselves about what has been done and tested before, explore and experiment with new ideas and subsequently develop an innovative design solution. It is also about monitoring implementation during construction, and testing outcomes post-occupancy to determine whether the design worked, and learn for the next project. HKS has outlined a simple six-step process, aligned with typical project delivery, to assist our clients and design teams to seize the value of research in practice.

MEASURE Identify key metrics in design and performance and collect baseline data

BELOW: THE RESEARCH CYCLE IS REPEATED THROUGHOUT THE PHASES OF WORK

MONITOR Confirm design is implemented as planned; towards targeted performance goals

Information Gathering

Evaluation TEST Test the success of the design post-occupancy; evaluate if target was achieved RESEARCH “AND CONFIRM”

Simulation

Field Research

THE 6 STEPS OF INTEGRATING RESEARCH INTO PRACTICE

1. TARGET

4. MEASURE

Set a target based on organizational needs and key performance indicators.

Link design metrics to performance metrics. Metrics are actionable data.

2. EXPLORE

5. MONITOR

Find out what you know, and what you don’t. Synthesize what you know. Investigate what you don’t.

Monitor the implementation of design solutions connected to hypothesis.

3. DEFINE

6. TEST

Link design solution to potential outcomes. Design solutions are performance hypothesis. They cannot be tested without metrics.

Test your hypothesis. Did the design “perform” as expected?

We believe that every design decision is a performance hypothesis. In other words, we design to enable better performance and experiences for individuals and organizations. We commit to measuring this performance and holding ourselves accountable. / Setting a target based on the needs of an organization and defined performance indicators is key. We sync our design goals with organizational goals, clearly “identified” in terms of success metrics. Meanwhile we collect design metrics – meaningful information about our designs that is tracked, and tested.

Metrics That Matter AIM // Demonstrate that evidence-informed facility investments contribute to improvements in individual and organizational outcomes, thus enhancing the bottom line.

TRACKING ORGANIZATIONAL GOALS VIA PERFORMANCE METRICS Performance metrics can be linked to: 1. Individuals: Stress, anxiety, fitness, usability, occupancy, satisfaction 2. Environment: Energy savings, air quality 3. Organizations: Utilization rates, efficiency, workflow, time on task, absenteeism, retention, injury, etc.

Getting to the Root of Organizational Goals:

3 Questions to Ask A SAMPLE OF PERFORMANCE AND DESIGN METRICS.

MATTERS TO YOU? 1. WHAT IT BE MEASURED? 2. CAN CAN WE IMPROVE IT THROUGH DESIGN? 3. HOW

Performance Metrics (Occupancy) Satisfaction Metrics

TRACKING DESIGN GOALS VIA DESIGN METRICS Defining the metrics of design is essential. Only when we measure what we do, can we map our designs against operational outcomes and assess if we were successful or not. How do you, as a design team, define success? Is it the gross/net ratio?The project cost per square foot? Is it the ratio of green spaces to built spaces? Is it the ratio of daylight to artificial light? Is it adjacencies? Walking distances? Connectivity? Visibility? Lighting?

/////////////////////////////////////////////////////////// Design Metrics (Planned) Real Estate Metrics

Area/Person; Area/Support Area; Area/Total Area

Spatial Relationship Metrics

Proximity, Connectivity, Visibility

Material Performance Metrics

Thermal Gain, etc.

Flexibility/Change-Readiness Metrics

Under development by HKS

Financial Metrics

Capital Cost

Safety Metrics Efficiency/Productivity Metrics Individual Wellbeing Organizational Wellbeing Environmental Wellbeing

Energy/Building Performance Metrics Usability/Occupancy Metrics Emotional/Physical Health Metrics Environmental Metrics (lighting, sound, etc.) Financial Metrics (operational)

Med Surg

Research & Design Initiative 1. How many years have you worked at [business entity]?

Hello, We would like to ask you a few questions to better understand you, and your work. Your responses will inform the design of the new tower. No personal identifying information will be used when results of these surveys are shared. This survey is not mandatory, and there is no compulsion for you to answer the questions.

j Less than 1 year k l m n j 1 5 years k l m n j 510 years k l m n j 1015 years k l m n

We appreciate your time and thank you for it.

j More than 15 years k l m n

Research Team

2. Which of the following best describes your current occupation? j Leadership/ Management k l m n j Provider (med staff) k l m n j Clinical Staff Bedside nurse k l m n j Nurse manager k l m n j Clinical staff other k l m n j Nonclinical staff k l m n Please describe your role

3. How many patients are you caring for today? (skip if not relevant) 4. Do you expect a discharge / new arrival today? j Yes k l m n j No k l m n j Not Sure k l m n

Page 1

Page 2

Med Surg

Med Surg 6. Please rate each of the following in terms of importance regarding PROXIMITY TO THE CENTRAL DOCUMENTATION CENTER, with

5. Please rate each of the following in terms

5 being the highest:

of importance regarding PROXIMITY TO THE

Not at all

PATIENT ROOM, with 5 being the highest: Not at all Important 2

(1) Caregiver documentation

important

j k l m n

Medication Room

j k l m n

Nurse server

j k l m n

Conference/Education

j k l m n

Supplies

j k l m n

Equipment Room

j k l m n

Locker / Break room

j k l m n

Nourishment Room

j k l m n

Very No Important Opinion (5)

Patient Room

j k l m n

Caregiver

j k l m n

Medication Room

j k l m n

Nurse server

j k l m n

Conference/Education

j k l m n

Supplies

j k l m n

Equipment Room

j k l m n

Locker / Break room

j k l m n

Nourishment Room

j k l m n

Toilet

j k l m n

Waiting Room

j k l m n

Service Elevator

j k l m n

Patient transfer

j k l m n

outside room

center

Room

(meals) Nourishment Room

(meals) Nourishment Room (Ice/

documentation

outside room Core documentation

(1)

Very No Important Opinion (5)

j k l m n

(Ice/ Snacks)

j k l m n

Toilet

j k l m n

Waiting Room

j k l m n

Service Elevator

j k l m n

Patient transfer elevator

j k l m n

Soiled utilities

j k l m n

Snacks)

elevator Soiled utilities Other (please specify)

Other (please specify)

Page 3

Page 4

Med Surg

Med Surg 11. In your opinion, what are the three spaces that you think are absolutely critical for you to have close to your core workstation? 5

7. Please rate each of the following in terms of the Importance of Visibility (having a direct

line of sight) Not at all important

enable a better healthcare experience for you and your patients. What have we forgotten

Important Opinion (5)

(1) Documentation Station to

12. This survey seeks to understand the key issues of travel distances, and visibility, to

Very

j k l m n

Peer Peer

j k l m n

Documentation station to

j k l m n

to ask you? What are some issues you would like to make sure we address in designing the new facility?

Patient Head

5 6

patient room door Unit clerk to entrance

13. Please tell us about some of the key quality indicators you would like to see improvements in, so we can align our design efforts with your goals

Other (please specify)

8. In your opinion, how important are the following in order to monitor your patient (5 being most important and 1 being least)?

14. Please select from the following quality indicators the ones that you think are the most

Not at all important (1) Hearing the patient and the

Very Important (5)

No Opinion

j k l m n

Seeing the patient

j k l m n

Being able to monitor vital

j k l m n

alarms

signs remotely

importance, and can be aided by facilities that are well planned and designed (You can add more options) c HCAHPS d e f g c Error Rates d e f g c Fall Rates d e f g

Other (please specify)

c Infection Rates d e f g

9. What are some key challenges you face, in the delivery of care, which you think could be improved by a better design/ layout of your space?

c Sleep d e f g c Delirium d e f g c Readmission Rates d e f g

c LOS d e f g

10. In your opinion, what are some of the distances you need to travel, as part of patient care, that reduce your efficiency?

Other (please specify as many as you like)

15. In your own words, how would you define "success"? What is YOUR measure of

success in your role?

5 6

Page 5

Page 6

Med Surg 16. On a typical day, please tell us how many trips on average you make to the following locations: Patient Room Break Room Main Nursing Station Documentation Center Meds Clean supplies Linen Service Elevator Equipment room Soiled Utility Nourishment room Conference room Thank you for your participation in this survey. Your opinion is vital to this process and the success of all new initiatives.

Page 7

3 KEY AREAS

A B

Nurse

3,000+

This represents 1,072 feet of wasted walking for Nurse B - walking related just to the 3 key areas

Nurse

1. Medication 2. Nourishment 3. Soiled Work

Nurse

MORE THAN THREE THOUSAND STEPS IN A TYPICAL SHIFT

STEPS ASSOCIATED WITH A TYPICAL MEDICATION EVENT

B Excessive Distance

1,039

Nurse

“Where is the nurse? I’m looking everywhere.” - Doctor

2,230 feet

1,158 feet

200+ MORE THAN TWO HUNDRED STOP/ STARTS IN A TYPICAL SHIFT

Reasonable Distance

1 shift

Nurse

OUND NOTES

“The distance from a patient room to an important area - like nourishment is too far.” - Nurse

World Headquarters 350 N Saint Paul Street, Suite 100 Dallas, Texas 75201 www.hksinc.com Visit us on Twitter, Facebook, YouTube and on our blogs www.HKSSmartHealthcare.com & www.HKSTracePaper.com

HKS VISION STATEMENT “HKS will be a leader in professional design services – bringing value to clients through innovation while being committed to excellence, sustainability, and sound business principles.”

HKS GREEN OBJECTIVE HKS, Inc. is committed to the development and advancement of sustainable design principles, practices, and standards. We encourage sustainable solutions to enhance the social, environmental, and economic performance of our client’s projects and are dedicated to the advancement of these principles within the design and construction industry for the benefit and well-being of the world’s future generations. Sustainable architecture is framed by the larger discussion of sustainability and the pressing economic and political issues of our world. In the broad context, sustainable architecture seeks to minimize the negative environmental impact of buildings by enhancing efficiency and moderation in the use of materials, energy, and development space. HKS will continue to integrate Sustainable Design Concepts in all of our projects and encourage LEED Certification where appropriate.

FOR QUERIES RELATED TO HKS RESEARCH CONTACT UPALI NANDA, PHD, DIRECTOR OF RESEARCH, AT UNANDA@HKSINC.COM