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 White Papers

​​​ACHA White Papers

High Volume Healthcare as a Livable Environment: Strategies from the ED

Post-Occupancy Evaluation:  Observation on Patient Satisfaction and Staff Operation​s

​By Debbie Phillips, AIA, ACHA and Lou Meilink, AIA, ACHA

Ballinger recently conducted a Post Occupancy Evaluation (POE) of Penn Medicine Chester County Hospital's (PMCCH) new Lasko Tower. Although the primary goal of the study was to gather insights for internal education and future projects, it also offered an opportunity to compare patient satisfaction and operational performance between Lasko Tower (built 2013-14) and an existing unit, the West Building (built - 1962, renovated - 1998). The methodology of the POE included staff and patient surveys, staff interviews, and onsite observation. 

There were several similarities between the two units including private patient rooms and similar acoustical features. However, significant differences at the new Lasko Tower included larger unit size and decentralized care stations between every 2 patient rooms. Because of the similarities between the two units, there was a more direct comparison between HCAHPS scores (noise & cleanliness), and rates of HAIs. The POE analysis reviewed multiple items: 

  • Patient satisfaction with the patient rooms and other family amenities,
  • Staff operations relative to charting and patient care, and
  • Housekeeping operations relative to material selection and ongoing maintenance. 

The study assigned a cost/benefit metric to key design considerations including private rooms, decentralized care stations, intangible amenities, and family amenities. The findings included: 

  • Patients felt that the decentralized nurse stations improved their sense of being cared for - the highest impact for the least cost.
  • Staff felt they had higher productivity on the new unit – even after initial concerns about size and layout of the unit.
  • The highest satisfier for patients in the new unit was the patient room size and bathroom. 

Since the move from West Building to Lasko Tower, the hospital has seen significant improvements in HCAHPS and staff satisfaction. The results from this POE are also being used to help inform the design and furniture/equipment selection of PMCCH's next bed tower.

Read the complet​e paper here.​​​

A Patient Handling and Movement Needs Assessment ToolkitHigh Volume Healthcare as a Livable Environment: Strategies from the ED

​By James Harrell, FAIA, FACHA and Regan Henry, PhD, AIA 

The FGI Guidelines, 2014 edition, stipulates that the governing body of the health care facility provide a Patient Handling and Movement Needs Assessment (PHAMA) to the design team on facility improvement projects. A PHAMA is intended to evaluate the movement and handling of patients in order to assess safety risk - for patients and staff - and identify best practices. This is an integral part of the pre-design functional and space programming process. It should be updated as new information becomes available during throughout project design, construction, and commissioning. PHAMA recommendations and revisions are intended to inform the design about patient handling and movement (PHAM) equipment and associated accessories to be used in specific locations. Such advice includes information about any spatial, structural, utility or design considerations related to installation, use, and servicing of such equipment. 

Many healthcare providers have adopted policies and procedures for safe patient handling and mobility, but it is unclear how many design projects are implemented using a PHAMA. There are a number of states in which the preparation and use of a PHAMA occurs rarely, or not at all. In this White Paper we will elaborate upon the FGI's recommendations by discussing specific factors to be addressed in a PHAMA and draft sample PHAMAs for a variety of spaces and high risk patient populations. It is our aim that this White Paper be used as a tool for hospital administrators and designers as they draft PHAMAs for their respective projects.

Read the complet​e paper here.​


Population-Based Design:  A Wellness Approach for Designing Healthcare EnvironmentsPatient Population graphic.JPG

Author:  Sharon E. Woodworth, AIA, ACHA 

Modern healthcare environments are typically designed with an illness perspective, focusing on spaces that function to support diagnosis and treatment of an aliment rather than a wellness perspective, which identifies environmental factors maximizing wellness for that aliment. Patient-Population Based Design is a framework for understanding the patient's explicit needs related to his or her illness, and in the process, uncovering the hidden potential needs that would improve that particular population's wellbeing. This process begins with a broad understanding of the patient population's clinical diagnosis and clinical presentation, followed by the environmental goals and environmental features that are therapeutic for that illness. 

This paper proposes that the designer must understand more than what supports wellness; the designer must first understand the disease and then translate what wellness would look like for the individual with that particular illness. The objective of Patient-Population Based Design is to create a universal process for designing healthcare settings; having a universal process will increase the likelihood that healthcare environments will be designed to foster health rather than emphasize illness.

Read the complet​e paper here.​


Modeling a Next Continuum to Manage Process and Asset Change

High Volume Healthcare as a Livable Environment: Strategies from the ED

Author:  Donovan K. Smith Jr., AIA, ACHA

Change is an inevitable and iterative process, influenced by a range of factors driving evolution in our environment. These factors involve human decisions, yet are influenced by natural conditions, cultural choices and technological controls as fundamental truths in evidence. In the next continuum, management of functional process and physical assets must recognize integration that drives change. 

Today, the increasing pace of technological advancements and resource limitations are paralleled by awareness of value and a comprehensive perspective on continuous improvement at lower cost in quality of life and care. This white paper expresses a triple-aim perspective on evolving comprehension of transcendent change under technological control, a holistic ability to manage transitional change to provide cultural choices and a life-long learning passion to discover meaning and create sustainable solutions.​ 

Read the complet​e paper here.​


High Volume Healthcare as a Livable Environment: Strategies from the ED

High Volume Healthcare as a Livable Environment: Strategies from the ED

Angela Mazzi, AIA, ACHA, EDAC, GBBN Architects
Jim Harrell, FAIA, FACHA, EDAC, GBBN Architects
Jason Groneck, AIA, GBBN Architects
Stephanie Shroyer, GBBN Architects

High volume Emergency Departments can be chaotic environments that are very stressful for patients, families and staff. There are several challenges that such a department faces: reducing wait times, providing a supportive and efficient work environment for staff, and maintaining a safe and secure environment. This paper recommends evidence-based strategies to improve the patient experience by promoting flow, quality of care, safety and security. From the importance of the first encounter experience, to the habitability of the waiting room and exam room, to ease of wayfinding; being able to reduce the cognitive load for patients and families helps to reduce stress. Staff well-being translates directly to the patient experience, influencing both quality and safety. Maximize staff safety and security is explored through strategies such as decentralization and arraying of spaces to promote flexibility and visualization.

Read the complete paper here.​​​​​


ACHA is seeking white papers for publication. Selected papers will be published on the ACHA website and archived for future access.

Papers may include a variety of topics, but should focus on subjects not commonly covered in the literature. Authors should address one of the following categories:

  • Education: Initiatives in an education-founded specialized field of practice to the Highest Standards
  • Evidence: Integrations of evidence-based strategies and values for safety in a continuum of care
  • Experience: Improvements through experience-balanced patient satisfaction and performance quality
  • Environment: Innovations in planning/design for operational simplicity/positive outcomes and return on investment
  • Economics: Investment metrics build on an economic cycle horizon of sustainable healthcare value

The first author must be an ACHA certificate holder. In keeping with ethical standards of publication, all authors must be involved in the conceptual development, gathering of information/data, writing and final review of the paper.

Initially, abstracts will be submitted and evaluated by a panel of ACHA reviewers. Those abstracts that are identified as lying within the educational objectives of ACHA will be recommended for further development as papers.

​Abstract Format:
The abstract should include the following elements:

  • Title page with author(s) name(s) title(s), affiliation(s), and contact information (address, phone, and email)
  • 300-word abstract/summary (maximum)
  • Five keywords
  • Category (education, evidence, experience, environment or economics)

Please submit in Microsoft Word format to:

Paper Format:
Selected papers should include the following elements:

  • Title page with author(s) name(s), title(s), affiliation(s), and contact information (address, phone and email)
  • Author(s) biography; a 100-word narrative biography should be provided for each author 
  • 300-word abstract/summary (maximum)
  • Five keywords
  • Category (education, evidence, experience, environment or economics)
  • 2,500-word text, including references (maximum)
  • Illustrations: A maximum of 5 illustrations. These illustrations should be provided in separate files. Holder place markers in the text should be indicated by “<insert Figure x about here>”

Please submit selected papers in Microsoft Word format to:​​​


American College of Healthcare Architects
4400 College Blvd Suite 220
Overland Park, KS 66211

Phone: 913-222-8653
Fax: 913-222-8606