Exploring Post Occupancy Evaluation in Healthcare

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Post Occupancy Evaluation has been mandatory for healthcare projects in Scotland for several years but finding the best way to gather and report the feedback of patients and staff is a developing art in the sector. Building on recent Post Project Evaluation work presented to the Capital Investment Network in summer 2010, NHS Tayside, led by Catherine McFie and James Henderson, has been carrying out a series of trials to establish an effective way to carry out Post Occupancy Evaluation using some of the schemes that they have recently completed.
Post Occupancy Evaluation has been carried out in other construction fields for several years but is still a developing process in healthcare. Whilst there is guidance and standard practice for other building types, the specific nature of healthcare buildings means that a good deal of this guidance is not sufficiently tailored. The high volume questionnaire approach used in other public buildings such as schools was trialled first but it was found to have significant disadvantages. This form of study often has a very low level of participant response unless supported by significant staff time to directly gather data. NHS Tayside found that these problems were compounded by the complexity of healthcare environments and consequently the length and detail of the questionnaires. They also found that results were distorted by current, low level issues that were not necessarily relevant to the subject of the study (eg focussing on issues with the wider hospital when the questionnaire referred to a particular refurbished area). The team also became aware that the language used in the questionnaires frequently created a barrier, as terms such as “external environment” were not necessarily understood by the participants.
It became clear that there was a fundamental need to clearly establish the scope of the POE study in order to get useful results. The early trials were aimed at providing statistical evidence of the new facilities’ improvement in services. It was found that it was difficult to obtain sufficient responses due to the time and participant effort involved in carrying it out, and a lack of comparability between old and new facilities as most patients and many staff had not experienced both. It was also hard to avoid distortion of the results by current low level grumbles such as parking and availability of magazines. Frequently the standardised questionnaires generated responses that whilst statistically helpful, such the number of people who felt that the centre was “welcoming”, the results were not useable to establish how or if improvements had been made. The survey team was hampered as the questionnaire format left little opportunity to capture comments, particularly if these did not refer to a specific question or issue.
After reassessment, the intention of the exercise focussed on providing useful feedback on the usability and experience of the building, and how this supported service delivery and health so that improvements could be made and learning used in different schemes. This change in emphasis required a change in approach, and a move was made away from the statistical questionnaires towards personal interviews. Although this process had to involve fewer subjects, the results and outcomes have been found to be far more helpful and generate directly applicable lessons. It has been very useful to interview some of the staff and repeat patients who had experienced both and old and new facilities.
One of the key strengths of NHS Tayside’s approach has been buy-in to the POE process from all involved. They explained that it is better to know about and mitigate problems and get helpful knowledge for the future. Clearer and more targeted interaction with the patients and staff has enabled better feedback and understanding of the issues and lessons. The involvement and communication between the facilities team and wider health board has demonstrated dedication to assessing and refining the process, aiming to establish key lessons and pass the learning directly into new projects within NHS Tayside. This is expected to be useful at key briefing points in new projects, and potentially become a method of demonstrating project team (including design team and contractor) performance for future projects. It is hoped that as the process is further trialled and developed, these lessons, both in relation to the POE process and facilities design will be disseminated through the Scottish Government Health Directorates, and Capital Investment Networks so as to be more widely useful to other boards and groups from Summer 2011. For more information, please contact James Henderson on 01382 423 101.

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