Notes on Detailed Elements of Future Planning
| 1. Patient control over environment: | |
| The research indicates that a known patient stressor is their inability to control such things as light levels, pitch and set of window blinds, temperature and ventilation. Any remodelling exercise should seek to give each patient local control of these elements. This will normally be possible by means of remote control handsets, in-room valving, etc. |
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| 2. Noise control: | |
| This is said to be the most important non-clinical criteria governing patient recovery rates. During refurbishment or remodelling every effort must be made to select products and finishes (eg ceiling tiles, flooring, curtains etc which have the highest levels of acoustic absorbency (particularly in corridors)). There is an obvious conflict here with the requirements of infection control measures which generally seek hard floors etc. Noise transfer from the nurses station to the ward should be contained at night by physical barriers such as doors or glazing. |
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| 3. Feeling of warmth and welcome: | |
| This is relatively easy to achieve even in a rigorous grid building like an Oxford Method Ward. There should be a focus on rich colours, textures, enrichment of edges and changes of direction, good use of textiles and materials of quality. It is also vital to consider small details such as seating, handrails etc which make patients and visitors feel that their needs have been catered for. | |
| 4. Low cill heights: | |
| This is of critical importance in that it allows patients and visitors to relax by focussing on vistas beyond the confines of their own rooms. Oxford Method buildings are particularly bad in this respect and seldom have low cill heights where patients may be undressed (for obvious good reasons). It is technically feasible to reduce cill heights although the exercise would be expensive and may result in a need to re-clad large areas of the exterior of the building. |
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| 5. External landscaping: | |
| Self evidently sensible and highly regarded by clinical researchers this is easy to achieve in most ground floor units. | |
| 6. Motorised blinds/curtains: | |
| (See point 1). | |
| 7. Good levels of daylight: | |
| It is not considered feasible to increase the window/wall ratios (save for the lowering of cills described at point 4 - which would not increase the level of daylight within the room). It is however, perfectly feasible to introduce rooflights into bedded areas although clearly this may occasionally be limited by services. |
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| 8. Courtyards with good access: | |
| Courtyards may exist in some Oxford Method Units or they may be created by extension. In any case they must be easily accessible, well landscaped and be equipped with generous seating. |
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| 9. Preference for 4-bedded rooms: | |
| Many Oxford Method Wards already have 4-bed units. Others have six beds and it is sensible to consider removal of two of the beds and their replacement by much needed ancillary accommodation such as assisted shower/toilets (taking care to design the entrance to have good levels of privacy). The reduction in patient numbers may well reflect the increase in bedded accommodation which is a factor of the current vogue for 23-hour surgery and day case work. |
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| 10. Easy access to a sitting room: | |
| The literature cites this as an important method of suppressing anxiety. It is therefore ironic that day spaces are under significant pressure when clinicians seek to increase the number of beds at the expense of other valuable support spaces. The research points to findings that seated accommodation need not be in formal (and often soulless day rooms) but can in many cases be small areas off corridors, eg bay window seats etc. These latter forms of sitting space should be easy to achieve. |
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| 11. Separate consulting room: | |
| Where there are multi-bedded rooms it is essential that there be a comfortable consulting room adjacent, where clinicians can talk openly to patients who are well enough to walk (or be wheeled). This should be possible to achieve in any large scale remodelling exercise. | |
| 12. Large single bed rooms: | |
| The single most widespread recommendation in all literature from all over the world is the adoption of single bed rooms. The benefits are wider ranging and seem to greatly outweigh the disadvantages in nursing efficiency and patient camaraderie. In the UK it is likely that any refurbishment of a state-run Oxford Method Ward will not seek to attempt 100% single room provision. It will instead seek to improve the ratio of single rooms to multi-bedded rooms from time to time. |
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| 13. Large spaces around beds: | |
| This will only be possible if the health economy accepts lower patient numbers in Oxford Method Wards. As discussed at point 9 this may coincide with other trends in healthcare to increase accommodation elsewhere. | |
| 14. Single sex provision: | |
| Self evidently important and clearly better facilitated by the move to single rooms. | |
| 15. Isolation beds: | |
| The recent rise of hospital acquired infections is likely to turn political attention to this issue and may well speed the move to wider spacing of beds and more importantly to provision of single rooms. | |
| 16. Space for confidential discussion: | |
| (see point 11 above) | |
| 17. Reduced staff travel distance: | |
| Where possible staff bases and observation points should be clustered as closely as possible around the beds (without causing noise nuisance). This is more likely to be possible as a result of a large scale remodelling exercise, but should be a target for any redesign of the units. |
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| 18. Space for relative “sleep overs”: | |
| The research literature shows that this is critical to a patients chances of good recovery (particularly children and adults with partners). Fold down beds may be achieved in single rooms but are not likely to be possible in multi-bed wards. |
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| 19. Increased prefabrication: | |
| The literature calls for hospital designers to take account of the need to maximise the chances of utilising prefabricated elements. This will only be possible under the auspices of the largest of remodelling exercises. |
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©2004 Oxford Method Royalties Management Group