Shared-decision making in designing new healthcare environments : ready to take off for improved quality

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.

Important Parameters in Designing and Presenting Exhibits and Planetarium Programs in Science Centers : A Visitor-Based Framework

This dissertation proposes an initial framework for designing and presenting exhibits in science centers and to recommend methods for improving the educational role of planetariums in science centers.

Brytmånens utformning vid trädfällning - Jämförande studier av böjmotstånd och gångjärnseffekt : Designing felling hinge in tree felling - Comparative studies of bending resistance and hinge effect

Vid trädfällning med motorsåg sparar man en så kallad brytmån som skall fungera som ett gång¬järn när trädet fälls. Om brytmånen går av tidigt finns en risk att trädet faller okontrolle¬rat. De rekommendationer som finns säger att brytmånens bredd skall göras proportionell mot trädets diameter. Genom att teoretiskt och praktiskt undersöka vilka krafter brytmånen utsätts för och vad den håller för har det varit möjligt att dra vissa slutsatser om hur en bra brytmån skall se ut. Ett viktigt resultat är att en bred brytmån (över 30-40 mm) är mycket trög att böja och inte fungerar i det avseendet att den går av redan vid små böjningar. Teoretiska be¬räkningar och praktiska försök visar att en relativt smal brytmån håller för belastningen vid rakt motlut även på stora träd. Som ny rekommendationen föreslås att brytmånens bredd inte bör vara mer än 30 mm. Av försöken kan man också dra slutsatsen att frusen ved är stel och brister tidigt, varför svår¬fällda träd inte bör fällas när veden är fryst.A felling hinge is used when felling trees by help of chain saw. If the hinge breaks early in the fall of the tree there is a great risk that the tree will fall without control. Present recommenda¬tions in Sweden say that the thickness of the felling hinge shall be made in proportion to the stem diameter. By use of theoretical and practical examinations of the forces stressing the felling hinge, and the strength of the wood itself, it has been possible to draw conclusions regarding the correct design of a felling hinge. One important result is that a thick felling hinge (over 30-40 mm) is very hard to bend and does not work well as it looses most of its strength already at a small forward bending angel. Theoretical calculations and practical tests show that a relatively narrow felling hinge will manage very well the forces when felling trees with lean opposite to the felling direction even for large trees. Our new recommendation is that the thickness of the felling hinge in normal Swedish conditions should not exceed 30 mm. Through the studies it can also be seen that frozen, brittle wood breaks at small bending angels. For that reason particularly difficult trees not should be felled when the wood is frozen.

Using system dynamics for collaborative design : a case study

Background  In order to facilitate the collaborative design, system dynamics (SD) with a group modelling approach was used in the early stages of planning a new stroke unit. During six workshops a SD model was created in a multiprofessional group. Aim To explore to which extent and how the use of system dynamics contributed to the collaborative design process. Method A case study was conducted using several data sources. Results SD supported a collaborative design, by facilitating an explicit description of stroke care process, a dialogue and a joint understanding. The construction of the model obliged the group to conceptualise the stroke care and experimentation with the model gave the opportunity to reflect on care. Conclusion SD facilitated the collaborative design process and should be integrated in the early stages of the design process as a quality improvement tool.