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A Delphi application in the developing of a pattern language approach to health facilities design guidelines Forbes, Ian 1982

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A  DELPHI  THE  DEVELOPING  PATTERN TO  APPLICATION OF  A  LANGUAGE  HEALTH  IN  APPROACH  FACILITIES  DESIGN  GUIDELINES  by  IAN  FREDERICK  WALDIE  B.ARCH., U n i v e r s i t y Dip.Bus.Admin.,  THE  o f Melbourne,  University  A T H E S I S SUBMITTED  FORBES  o f New  1968  South Wales,  IN PARTIAL FULFILLMENT  R E Q U I R E M E N T S FOR MASTER OF  THE  DEGREE  OF  OF  SCIENCE  in THE  FACULTY  (Department  We  OF  o f Health  accept this to  THE  GRADUATE  STUDIES  Care  Epidemiology)  thesis  the required  UNIVERSITY  OF  Ian Frederick  as conforming standard  B R I T I S H COLUMBIA  January,  (c)  and  1982  Waldie  Forbes,  1982  1972  In p r e s e n t i n g  t h i s t h e s i s i n p a r t i a l f u l f i l m e n t o f the  requirements f o r an advanced degree a t the U n i v e r s i t y o f B r i t i s h Columbia, I agree t h a t the L i b r a r y s h a l l make it  f r e e l y a v a i l a b l e f o r reference  and study.  I further  agree t h a t p e r m i s s i o n f o r e x t e n s i v e copying o f t h i s t h e s i s f o r s c h o l a r l y purposes may be granted by the head o f my department o r by h i s o r her r e p r e s e n t a t i v e s .  It is  understood t h a t copying o r p u b l i c a t i o n o f t h i s t h e s i s f o r f i n a n c i a l gain  s h a l l n o t be allowed without my  written  permission.  Department  of i N ^ O T t A  ^A\g^ £  The U n i v e r s i t y o f B r i t i s h 1956 Main Mall Vancouver, Canada V6T 1Y3 Date  DE-6 (3/81)  Columbia  &?\&'&lA\Gl^>4.y  ii  ABSTRACT  The Health  use  of  Facilities  and  integral  the  structure  while the  Standards  this  part  of  attitudes  and  to  been  Unfortunately  Standards been  have  develop  become  inflexible,  adapt  to  around  method  and past,  ineffective.  planning  changes  a  is  acceptable i n the  to  the  societal  of  planning process.  have  of  become  complexity  indispensable  unable  needs  the  objective  may  the an  i t produces  have  to  the  reduce  has  present  structure  Standards  respond  Design  of  standards  to  which  the  Such  changing  participants  who  them.  our  can  It  is  build  better  Standards.  In lems  the  of  by  purposes the  between  of  an  Pattern  the  are  method  t o assemble  structure "Pattern" for  a  Standards  We  "good"  that  at  Standards  Standards.  these a  good  we  then  observe  to  used  Berkeley,  Standards.  suited and  have  denote  developed we  as  restrictive  Guideline,  which  admirably Guidelines  to  prob-  fundamental  the  established to  a  of  and  Standards  these'new  is  purpose  is similar  requirements  structural  government.  Having  a  societally-responsive  by  the  there  planners  and  alternative  formats  that  used  which  called  examine  positive  and  contexts.  California, satisfy  the  Standards  i s one  we  find  Guidelines  different Standard  and  hospitals  terms  explore  chapter  Standards  difference used  first  will Since  developing we  evolve  a  i i i  This uses  method  the  Medical)  Care 2  then  three  the  The  (Physicians and  including for  the  Nurses)  Alberta.  of  input  feed  back  It  from of  compensatory  Mini-Survey  Study.  evaluate  This  Columbia  and  Chapter three and  of  3  a  the  i t s success Patterns  the  which  flexibility,  and  there  despite  was  of  in assisting  the  that  Patterns  rounds  is  occur.  group  descibes  methodology  that  larger  Delphi  of  This  of  the  of  as  with  Experts British  variations  independent One  Chapter  Medical  Experts  solu-  as  the  one  method  special  Delphi  variables  and  steps  included  potential  partici-  resulting  from  the  sixteen hospitals in  Delphi British  hospitals in Alberta.  questioning  Nursery  Planner  and  Intensive in  parts  such  steps.  l a r g e r group ten  to  various  from  and  Neonatal  Policy  sent  com-  (Planners  problems  a  information.  in  to  of  It  establish  i s described  adds  the  to  and  which  in  builds  pants,  explore  components  anticipates effects  a  to  Technique.  experts  Nurseries  design  is  of  questionnaires  and  Delphi  advantages  methodology  of  the  groups  Newborn  classical  rounds  Columbia  two  interact  in planning Units.  upon  inherent  between who  uses  based  technique's  munication  tions  is  are  details this the  are  Evaluation  of  weaknesses,  a  both  as  of  method  a  series  for  process in  and  In  of the  retaining adjustments  Chapter  anticipated  the  method,  Guidelines.  capability of  out  Delphi  production  series the  carrying  modified  usable  inherent  in  4  shows  unantici-  i v  pated, that  the  helps  future  results create  provide  better,  developments  evaluation  and  environment  changes  an  more u s a b l e  are briefly  change about  John H. M i l sum, P r o f e s s o r Department o f H e a l t h Care and E p i d e m i o l o g y  important  will us.  Standards.  mentioned occur  starting  as  Possible  i n t h e hope the  point  that  planning  V  TABLE  LIST  OF T A B L E S  LIST  OF  v i  ILLUSTRATIONS  ACKNOWLEDGEMENTS CHAPTER  ONE:  viii  .  ix  AN APPROACH OF  1 .0  OF CONTENTS  TO THE PROBLEM  STANDARDS  Introduction  1  1.1  Who  Uses  1 .2  How  Reliable  1.3  How a r e S t a n d a r d s B e i n g i n Canada? T o w a r d a New S t a n d a r d  1 .4 1.5  1.6  1.7  the Standards?  5  are the Standards? Used  The P a t t e r n s Rediscovered  35  The Format  Toward  of  Design  of the  Language  48  a New  52  Method  A METHODOLOGY FOR C R E A T I N G D E S I G N G U I D E L I N E S AND STANDARDS  2.1  An A p p r o p r i a t e  Methodology  2.2  The Groups Structure  Intergroup  2.4  15 29  32  C H A P T E R TWO:  2.3  9  A Change i n t h e R o l e o f Architecture  Pattern 1.8  1  Controlling Variables  and  57 57  61 the Independent  Summary R e m a r k s  71 83  vi  CHAPTER THREE:  CARRYING  OUT  THE  DELPHI  3.1  Round  1:  The Q u e s t i o n n a i r e  3.2  Round  1:  The  3.3  Round  2:  The  Preparation  Response  3.4  Round  2:  The  3.5  Round  3:  Preparing  3.6  Round  3:  The  FOUR:  NOTES AND  84 98  Questionnaire  Preparation  CHAPTER  84  Response the Patterns  Response  C O N C L U S I O N S AND RECOMMENDATIONS  '.  10 8 114 121 163  17 8  REFERENCES  Chapter Chapter Chapter  One Two Four  192 196 198  BIBLIOGRAPHY  199  APPENDIXES Appendix Appendix Appendix  ^ A: B: C:  R o u n d One Q u e s t i o n n a i r e R o u n d Two Q u e s t i o n n a i r e Round T h r e e Q u e s t i o n n a i r e and The P a t t e r n s  20 2 235 333  vii  LIST  OF  TABLES  TABLE 3.0  3.1  Page R o u n d One Q u e s t i o n n a i r e Structure Medical  Experts  92  Self-Rating  Scores  102  3.2  Usability  3.3  Summary o f R a t i n g s f o r Objectives: Newborn Nurseries  126  Summary o f R a t i n g s f o r Objectives: I.C.N.  128  Summary o f R a t i n g s f o r Functions: Newborn N u r s e r i e s  129  Summary o f R a t i n g s f o r Functions: I.C.N  137  Summary o f R a t i n g s f o r Spaces: Newborn N u r s e r i e s and I.C.N  145  Paragraphs Used i n F a m i l y Room  151  Percentage o f Medical Experts A n s w e r i n g i n S e c t i o n One . .  166  Percentage o f Mini-Survey Respondents Answering i n S e c t i o n One  16 8  Percentage o f Medical Experts A n s w e r i n g i n S e c t i o n Two  170  Percentage o f Mini-Survey Respondents Answering i n S e c t i o n Two  172  3.4  3.5  3.6  3.7  3.8  3.9  3.10  3.11  3.12  Rating  Criteria  122  vi i i  3.13  3.14  Percentage of Medical Experts A n s w e r i n g i n S e c t i o n s 3, 4, & Percentage of Respondents S e c t i o n s 3,  Mini-Survey Answering in 4, & 5  5  174  175  ix  A  LIST  OF  ILLUSTRATIONS  Diagram  Page  1.1  An E x a m p l e  1.2  A Pattern Public  of a Pattern  47  Language f o r Spaces  50  2.1  The I n t e g r o u p  2.2  Mode  3.1  D e l p h i I n f o r m a t i o n and O r g a n i z a t i o n Model F a m i l y Room  85 153  Newborn N u r s e r i e s Groupings  1st Stage 158  Newborn N u r s e r i e s Groupings  2nd  3.2 3.3  3.4  Model  70  Activities  77  Stage 159  X  ACKNOWLEDGEMENTS  This  p r o j e c t would  considerable who  became  months did have  time  not a l l agree chosen  and  Ms.  Barbara  assisted  Carter,  the thesis  of  Since  they  the  The  of  we  exceptions Vancouver  Hospital,  early  Morris,  names,  Hospital,  Children's  in  many  their  any o f them.  advise; who  to  the  Moore,  chairman,  editing;  stages,  Calgary, and  Edmonton,  also  and  Ian  committee,  but especially  persevered  to  John  comments  f o r h i s graphics  A l i Hildebrandt  to the limits  Cortland  t o Dr.  f o r h i s perceptive  t o Lou Carbone  and  Dr.  and  and  Holly  o f sanity with  typ-  and c o r r e c t i o n s .  Finally especially support for  go  and Dr. L a r r y  logistics  ing  of  people  spent  participating.  o f S t . Paul's  Michael  thanks  tireless  McDonald  Racine  and  the  o f Vancouver.  MacKenzie  and  Experts  the publication  Ratsoy  Experts,  possible without  o f the twenty-three  time  personally  Special  Milsum  to  been  Planning  not t o mention  Mrs. Bernadet  Planning  and  valuable  are  who  and d e v o t i o n  Medical  of their  n o t have  t o my my  this  seeing  wife  would  partners Pamela have  i t through.  been  a t Thompson without  Berwick  whose  impossible,  a  Pratt  tolerance special  and and  thanks  1  CHAPTER 1:  1.0  AN APPROACH TO THE PROBLEM OF STANDARDS  Introduction  When Health  dealing  with  Facilities  the  Design,  complexities  i t i s reasonable  those  participants  involved  where  possible  to simplify  to  do t h i s  as  so  problems  This  involved  i n Health  role  referents  that  have  isions tives  they  priority.  chosen  and  decision  Therefore  the roles  process  applications.  solutions  from  regardless country  the point  Nurses, of  standardization  of  o f view  project,  of  select  the stable  and  which  issues  decobjecthat  a l l hospital  their  o f Government  i s occurring. building  o f most  are so  the  objectives  because  typical  Architects,  which  the process  performed  People  focus-  participants  the  the results  becomes  many  stereotyped  decide  t o become p r e d i c t a b l e  planning  Physicians,  to  way  issues  about  various  typically  use  will  and n o t d e t a i l s o f t h e  the  have  i n that  easy  The d e c i s i o n - m a k i n g  because  Planning  An  decisions  of variations  which  are likely  the process.  recurrent  occurs  t o assume  t h e d e t a i l s o f a s many  are avoided.  on t h e d i s c u s s i o n  issues.  the  that  occur  i n the decision-making  i s to standardize  possible,  complex ses  seek  which  Hospital province,  preferred Regulators, Planners, or  which  S i m p l i f i c a t i o n through i s usually  successful  2  where  there  is  participants  as  a  high  to  the  degree value  of  presented  f o r decision-making.  each  m u s t be r e p e a t e d l y  issue  Understandably, be  addressed  and  more  that  to  this  constantly  again.  An  munication enabling  evidence  which  this to  indicate  common  objectives,  there  which more  i s a desire  has  issues  need  to  numerous to  It i s clear  has  ensure  that  his-  reduced  time  the  and  time com-  the  improved  resulted  between  the  participants,  objectives  to  no  longer  that  the  Planning  bring  progress  that  communication evidence  process society.  i s  the s i t u a t i o n . standards  are  they  are  t h e p a r t i c i p a n t s , and t h a t  the  consensus,  been  i s now  Facilities  of  become  similar  benefit  has  of issues  standardization  additional  Health  is  of  when  and  to a l l parties.  Now,  tween  such  occurs.  address  concurrent  benefit  Without  the  addressed.  to resolve,  process  among  objectives  participants  standardization  torically  consensus  certain  a s t h e number  these  difficult  more  need  by  of  the  This  a  major  change  factor in  inevitably  role-participants  in  antagonism  o f good having  an  effect  occurring the  Existing  of be-  reducing  results.  changing  themselves.  used  are thereby  priorities starts  is  representative  causing  they  and t h e a c h i e v e m e n t that  not  being  There  There on t h e in  our  priorities Standards  3  have  not  changed  ally  enforced without  disregarded. changes very  medical  influence  ways: devices  care  service;  merely  with  flood  a  Architects  while  to  Planners  use  reflect  create,  not  At  one  just  the  the  and,  through of  the  to a  fiscal  improve  as  of  Standards  as  impact  of  them  changes  resulting in  dealing  of  space;  to  speed  were  in  in  hospital Architects to  the  ensure  space  they  i t s creation.  capable  consistency health  complicate  up  to a s s i s t  obligations of  the  quality  decision-making.  of  "No-  environmen-  quality  aspects  the  standards  Standards,  of  to  in  Standards  the  expediency  Standards  they  the  societal  desirable  quality  Today,  ensure  and  to  participants  the  demanded  totally  adapted  Economy"  t o view  reduce  of  up  to  begun  impact  their  the  time,  decision-making improving  users  speeding  disregard  Standards  to  not  These  view  unilater-  cases  have  the  means  have  to  between  of  a  not  some  economy.  information  resolving  systems,  in  being  environment,  now  than  tools,  and  and  communication quickly  are  "Growth  roles  Hospitals  of  planning  duced.  from  the  rather  simplifying  the  and  and  social  Governments  control  tend  and  fiscally-constrained  changes  or  needs  consensus  s i g n i f i c a n t changes  following  from  new  S p e c i f i c a l l y , Standards  i n the  Growth", tal  t o meet  of of  simplifying application,  facilities  they  decision-making  and  proare  4  afforded because needs  little they  of  In  can  those  this  determine  we  not  who  use  we  Standards.  We  explore  is  part  method  an  with  resource. that  i t will  underlying is  years of  health  of  Standards part  of  and  to  "the  primary these  1 and of  an  of  elements  new  in the  responsive  such  Delphi  to  develop  a method  in  i t in Chapter  2.  Technique,  which  multiple question-  the  information  carry  out  the  study  to  ensure  Standards.  be  the  subject  stated.  are  again  tools  planning of  made  be  planning  i n depth,  use  of  useful  improving clear  that  option. has  that  the  The  in  acceptable  process  to  new  using  Standards  as  It should  of  complex  objective,  develop  the  examine  must  these  principles  3 we  i n health care process  our  experts  to  proceed  have  build  powerful  i s not  we  process  i f they  be  then  on  the  facilities.  are  and  usable  begin  will  the  Standards  of  Chapter  we  Standards  present  inquiring  principle  they  the  variation  produce  important,  examine  Chapter  groups In  Before  of  is a  iterative  naires  d i v e r s e and  concentrate a method  This  the  Once  of  latter  to  problems,  development  the  application  them.  Standards. can  for consistent  respond  chapter  their  responsive place,  opportunity  The  become as  so  Peckham  planning  an  Standards in future  the  quality  rejection use  of  integral suggests,  process".^  a  5  Since and  rejecting  them  made  purposeful.  problem,  i t appears  negative  instruments  will  Unless they of  we  they  will  continue  desperate  facilities.  We  proceed  some  when  Standards?; used  to explore  one  asks  How  reliable  i n Canada?  such  are  These  they?;  aspects  renewed  be  as: and  this  used  Agencies  problems  questions  be  address  to  Funding  i n poorly designed  now  must  collectively  result  apparent  being  i s unacceptable  as  which  which  become  Who  uses  the  How  are  they  a r e examined  sequen-  tially.  1.1  Who Uses t h e S t a n d a r d s ?  Beginning America  Institute  itecture do  with  States.  This  members,  who  from  a l l over  very  few  and  those  out  of  undertook  review  move  in  was  October  (AIA), through  o f space prompted  Standards by  the  the United  S t a t e s o f America  that  a r e i n use  be  on  the Archto  i n the United fact  architects  consistently  could  1980,  a sub-committee^  facility  are being  of  Committee  are health  Standards  date.  report  of Architects  f o r Health,  a comprehensive  a  that  the  and  planners  (USA),  believed  used  a s much  as  i n t h e USA ten years  6  When 1981,3 able  this  some  significant  to say that  which  are  Regulatory 29  the  there  encompasses  these  of  sub-committee  Health  gross  space  that  most  states  had  such  as those  (HEW),  departments. on  from  license  planners  themselves,  using  them.  discovered (HSAj  no  often  I t was  of Health, room  also  Standards  cent  had  Standards.  There  real  concern  the  application  of  Standards.  and  appears  the lack The  State  of AIA  for  however  E d u c a t i o n and  noted  had nominal  about  the  in  special  when m a k i n g  o f t h e HSA's  i n t h e USA  sample  references,  sizes  used  few  Standards  national  cent  detailed  are  I t appeared  published  a r e most  but  61 p e r c e n t o f  established  describe  applications.  'were  In a  that  which  requirements.  which  They  of  and methodologies and  t h e Department  These  provided.  March  Standards  have  some  in  o f a c c u r a t e knowledge  Agencies  Agencies,  back  a body  the committee  projecting  Welfare  by  were  are i n fact  Service  Regulatory  exists  used  Agencies  states,  facts  some new  being  reported  checks  that  24  per-  that  15  per-  a  very  t o be  consistency noted  in  in i t s  report:  "A glaring failure of the regulations w h i c h c a n n o t be d i s m i s s e d i s t h e seeming lack of concern, a t the .State level p a r t i c u l a r l y , over establishing specific g u i d e l i n e s o r methodologies t o serve as a benchmark f o r p r o j e c t i o n . " 4  Clearly  i n question,  where  there  are  no  consistent  7  benchmarks, ners  c a n know w h a t w i l l  While we  i s the concern  no s i m i l a r  believe  planners  Provincial  across data  The  Canada  Provincial  but  introduction  of F e d e r a l l y supported  In  this  because  Standards  always  had  delivery,  have  i s that,  Planning  one  been  exist.  having  being as  a  Standards.  The  ' relatively Federal  used  in  Government,  late  (with  the  make  from  the  use  of USA  each  province  has  for  health  care  planning  effective.  t h e USA,  across  current  the  current  Canada  through  i s not  (certainly  appears  set  The  consistency  Province",  population,)  a  exists.  Insurance), to  not very from  been  the  of  the "Senior  the largest  maintained  and  has  Confederation,  differ  sharing  i n examples  Standards Ontario,  Health  responsibility the  comparable  mid-1960's  we  'similar  authority  However,  informal  as  of  attempted  instance  separate  therefore  extensive. the  do  have  a  building  the  the  a l l hospitals  system  planning  with  have  from  the start  since  plan-  i n Canada,  dealing  whether  health  hospital  agencies  when  planned  (Federal)  especially  review  Standards.  in  t o be  increased  undertaken  agencies,  i s simply  from  with  result  review  responsibility  Beginning  methods  hospitals,  the  central  h o s p i t a l s and to regulators.  has been  Canada,  no  existing  and  question  In  therefore  1950's,  study  can expect  base.  t o how  be a c c e p t a b l e  Government  problems.  as  of the  to  have  Planning Health  8  Facilities  Design  Promotion  Branch  instrumental use  by  have  of  been  guide  by  most  major  with  the  Chi  each  or  involvement a  upon  dependent  upon  regarding  hospital  Unit  have  the  been  Ann  once  This  again  guidelines.  Maternal both  Government,  and  needs  to  the  which and  is  agreement are  this  and  The  assumptions  Provinces  through  not  Michigan.  broad  in  Agencies  space  Prior  be  developed  formulae  Guidelines,5  produced  was  operations  the  to  f o r use  of  certain  for  Government  method  Arbour,  into  about  thought  This  creation  been  usually  Health Planning  operations.  the  Guidelines,^  Federal  from  workloads  and  to  hospitals.  has  and  Federal  Guideline  and  standards  mandatory  latest  Canadian  agreement  complete  modifications  of  Canada,  conditions  The  in  Services  planning  not  to  Program  company  projected  there  adapted  departments  focusses  not  Health  Welfare  are  Province.  translate  is  and  These  Functional  Systems,  method  the  in developing various  modified  is a  in  Health  a l l Provinces.  different  by  Group  making effort,  Special efforts  universally  of  applied  Care the by  Provinces.  Our the same  problem,  planning as  ment across  in  that the the  for of  despite newly  the  USA.  development country.  these  special  introduced There of Even  a  programs,  has  been  common  the  efforts  new  no  group  at  guiding  remains real of  Functional  the  improveStandards Program  9  Guides  have  question  been  of  who  Hospitals,  the  two  have  groups  them  made  Province-specific.  uses  Standards,  P l a n n e r s , and accumulated  in  developing  their  Planning  Regulators  use  when  presented.  committee do  exist  1.2  to  has and  One  are  being  plans,  used  to  concerns  by  are  The  best  look b r i e f l y  to discuss  at  the  i n use.  fact  they  and,  accurately  With  are  reflect  the  particularly hospitals the  funds the  thrust  high  Canadian flowed  to  encourage  Columbia,  current  of  James  on  National the  A.  is first how  The  former  to  assist  Funding  which the  those the  of  or  plans  AIA  Standards  subwhich  reliable?  reliability  development  building after  agenda. Health  provinces  building  the  are  of  the  to discover  they  have  for  social  the  Second  is  Stan-  what  changed  in to  practice.  America the  the  check  problem  historical  secondly,  i n North  were  the  This  there  these groups,  R e l i a b l e are the Standards?  way  the  knowledge  while  How  currently  to  of  unanswered;  dards  of  body  the  answering  Regulators.  Standards  of  remains  i t i s clear  the a  In  of  Hamilton^  With Grants  from  the  hospital prepared  the  programs, World  War,  introduction  Program  in  1948,  Federal  Government  beds.  In  a  report  British on  the  10  needs  of  the  requirement  o f t h e new  assessment  of  providing  Standards  programs,  by  were  by  hospitals.  In  iduals  like  had  book  Early  and  produced  solutions  lines  1954.  for hospital  government thus  elsewhere as  an  The well  This  the  diagrams  supported  economical  resulted  North  which  the  Health  often  guides  were  very  planned  diagrams  smaller  adopted  of  hospitals,  i n North  sizes  Depart-  i n Ontario  of typical  systems  having  Planning  published  approach  hospitals'  i n hospitals  departments  agencies  readily  indivplan-  Standards  that  American  from  hospital  and  planning  The  latest  of  with  was  a  their  or planning of  came  who  early  result  built  include  These  i n the world),  evaluation.  reflected  had  published  i n t h e USA  departments  as  require-  who  the Ministry  i n approach,  fiscally  critical  ogy.  in  well  hospital  the b u i l d i n g  and  as  first  planning  Standards  roles,  examples  hospitals.  less  (and  experts  such  the  a  the early  describing  from  start  being  objectives.  Rosenfield,8 published  i n Canada  some  prescriptive  or  of  o f H e a l t h , E d u c a t i o n arid W e l f a r e  1953  whole  USA  this  facilities,  report,  through  planning  Standards.  in  the  helped  and  statement  i n 1947, o r  central  ment  space  various  expertise  Province,  This  the Hamilton  considerable  ning  the  publications  written  who,  of act.  a definitive  Typified  ments,  hospitals  America  the guidebut  without  and  designs  and  difficulty  technoloperat-  11  ing  with  much  less  modification  consequences  By was in  early  developed. hospital  Two  in  about  place  in  books  planning;  was  space  needs  f o r each  States  and  Regulatory overall  and  i n 1964.  Function  These  aspects of  the  of  (square that  bed  sizing  space, feet)  a  functions  complement)  a  Canada. Agencies  or  bed. of  could i n some  suggested  In  was both  involved,  f o r the purpose  "Souder-Wheeler"  per  numbers  were  area  adopted  cases  of  to  taking  proposed  both the  review  size the  the  very (in space  rooms, number the  role and  useful.  by of  United of  the  approve  f u n d i n g e s t i m a t e s , so  most  own for  meant,  the  in  E.  recommended  determine  by  by  sizes  certain  countries, was  a  This a  was  authors'  they  on  in  publications  the  based  hospital  department,  from  Costs  Souder,^  formula  methodology  areas  Design  J.  The  multiplying This  James  and  recommended  simplistically, the  Needs  hospitals,  area  of  became m i l e s t o n e s  numerous  projections  terms  Space  methodology  provided,  departments.  beds.  unforeseen  and  hospital  simply  with  which  by  Hospital  related  hospitals  of  requiring  appropriate  appeared  published  into  amount  more  Estimating  and  research  created  a  Construction  1963;  Wheeler,1°  talked  their  guidelines  the  1960*s,  Hospital  published Todd  from  or  resulting.  the  General  methods  sophisticated  the  12  For these  guides  review of  approximately proved  given  by  hospitals  lines  in  AIA-CAH 300  between  per  necessary and ed  that  gross  bed,  for  Planning 1972 years  out  of  The  Ministry nized  For have  certain  developed  is  used  sizes.  should as  number  these  Guide-  of  have  much  hospital.  The  50  Standards  many  percent  in  AIA  sq.ft.  programs  which  as  was  discover-  s t i l l  are  to  increase  the  i n s t a n c e s , are  200  1,000  occurred  USA,  the  approximately  than  i n the  as  had  as  from  of  a  hospitals  1 1  t h a t had  these  level  However,  less  Agencies  space  now,  do  have  reflecting  much  needs  better  since  and  1980  where  has  in hospitals,  for  individual  where  marginally  H o s p i t a l Programs,  areas,  enlarged and  only  i s only  overall  been  1979  Unfortunately,  i n most  Health,  larger  sq.ft.  whole  the  1970's  as  ten  date.  It of  just  changes  means  by  early  Columbia,  typically,  to  areas.  problem  Columbia.  and  1979  and  Regulatory  which  British  1964  and  the  Standards  sizes  for  In  area  reflect Space  the  appropriate  increased  of  Support  the  discovered,  1972  spaces  to  into  departmental  Guidelines,  sq.ft.  gross  be  between  sub-committee  these  years  agencies.  built  departmental  700  to  determining  beds  over  ten  other  than  hospitals, new  1981,  formally  teaching specific  for  has  British that  i . e . , above  equipment  justification  in  the  recogthe  700  hospitals. departments  recently  unusual  sizes  been could  13  be  made  by  of  B.C.  hospital  been  planned  It Review must  to  be  amount  to  particular  bed  formula),  the  space.  a  needed  they  should  the to  have  hospitals,  a  bad  when  curtailment Government  of  this  experience have  rooms  and  not  their  that  as  receive  oversize  to  is  combined  area  will  the  other  Standards,  per  se  is  recognized  and prime  of  have  rejected.  pressures  the  per  spaces  relinquish  well  by  i t s method  they  by  to  shown  additional  spaces,  oversizing  be  assigned  at  request  is  wish  acceptability  rejection  i t  they  the  looks  given  space  planners  their  philosophy,  area  that  area  with  prepared  Hospital  can  (using  certain  new  the  that  department  hospital  that  thing  from  Canada  areas  problem  however,  to  the  of  the  planning,  groups  the  departments  acceptable  overall  realized,  interest  no  some  are  of  standard,  decides  they  likely  automatically  The  is  is  new  i t is  hospital  overall  reflect  meet  be  a  number  the  and  that  a l l of  government  If  to  are  i f  there  to  problem.  spaces  for  many  Province  I f , however,  operation  are  each  certain  the  of  in  It  sizes.  remembered  Typically, a  that  inadequate  approval  require  hospital.  planners  Agencies  seek  areas  individual  should  build. to  the  from  It not that  special  clearly purpose  the of  Review.  major  concern  i s one  of  principle.  If  Standards  14  are  to  be  used  hospitals,  and  operation, is  true  the  in  been  or  AIA  to  process, there  a  has  planners  that  in  and  not  When  i t  design  and  build  predict  the  needs  i s not  to  ten  The  of  i s they  reflect assigned  are  by  the  or  from  years  accept  date  not  past  we  their  are  Planning  in  hospital approach years  have  been  eight  ago,  but  years  planning  which  to must  date, are  up  point.  was  because  after  takes  years  Standards  starting  o p e r a t i o n a l concerns  is  completion  Standards.  reliable  Standards  ten  and  It  occurs  which  posed  size  long.  may  to  modern  in  i t still  three  have  recognized  change  even  for  the  Planning  a  delay  design  at  question the  current  ago,  takes  to  of  initial  reliability answer  out  of  bed  hospitals,  occurs  kind  It  hospital  only  have  facilities  possible  years  to  reliable.  f o r more  too  in of  Facilities  by  areas  methods  per  problem  Health  review  five  in  Standard  users,  years  areas  takes  attempts  This  fifteen  it  a  this  acceptable now.  process  of  accepted.  the  the  Canadian  medical  c u r r e n t and  i n c l u d e space  s t i l l  numerous  Once  be  planned  related  differences  the  the  been  to  is  of  their  instances  there  review  recognized. be  some  reflect  study, that  acceptance  must  upgraded  however,  evident  to  Standards  that  systems  determine  consequently  the  eventually  role,  to  related The  they  and  the  unfortunate not  always  therefore  spaces  frequently  do  to  too  small  or  15  inappropriate.  In  highly  radiological  exception.  Groups  planning,12  without  current  complex  to  not  areas  where  tants  feel change  various constant not  policy periods  input  in  highly within  the  Health  with  and  of  policies, who  This  Government  kept  the  user  the  space  in  that their  r a p i d l y changing  It  is  Health  critical  general etc.), use  yet  is  noticeable  in  to  any  hospital  remain  Consul-  periodic-  nursing  that  and  this  Planning  attitude to  has  Laboratory  of  technologies,  (e.g.,  people  i n B.C.  Ministry recognizes  i t i s not  regarded. the  and  interesting,  areas.  policies  systems by  the  Ministry that  noticeable  a  have  i s most  these  other  B.C.  their  groups  appropriately  confident  input  of  "user"  so  and  Radiology  particular  of  is  laboratories  representatives  This  the  supply  with  include  needs  as  M i n i s t r y of  date.  deal  space  certainly  is  to  such  there  The  deal  These  up  inability  ally  to  which  professions. Standards  areas  departments,  significant Advisory  technical  policy,  source  facilities  causes fixed  of  planning for  long  time.  1.3 How a r e S t a n d a r d s B e i n g Used i n Canada?  We  have  observed  that  Standards  existing  in  Canada  16  are  not applied  tihe  USA,  there  Why  then  a r e p l a n n e r s demanding  tently  applied  consistently i s a real  when  across  concern  they  the country  about that  their  this  f o r consistency i s the belief  using New  Existing  Standards  believed  Standards. and  that  Standards  exist?  will  not using  I n t h e p a s t , we  ment,  not only  differ,  It between that  material.  i s critical  that  two d i f f e r e n t  we  that  both  t o ensure  knowledge solution  needs.  that  shared  and t h a t will  by  the Funding  to  check  ed  by t h e s e  when  result.  independently  i n today's  need  with  Standards  a r e n o t t h e same.  a  distinction The  Standards for their  methods and  a r e communication  kind  a g e n c i e s , as a measure  These "Norm",  of their  total  the best  o f Standard  a Planning  tools  increase  t o a problem  and P l a n n i n g A u t h o r i t i e s .  f o r compliance  using  experience w i l l  The o t h e r  Planners  planning environ-  of operational  applied  t h e New  developed  are essential  These  with  and i t i s  have  o f Standards.  i n the comparison  line  adopt  b e g i n making  types  agencies  will  themselves  space  into  o f the groups  P l a n n e r s and h o s p i t a l s  resultant  used  do t h e needs  but the Standards  usefulness the  However,  that  but not used,  seen  the  inherent i n  Standards  R e g u l a t o r s d i d u s e t h e same  resource  them  consis-  about  The f a c t  bring  already available,  agencies  be  are already concerned  o f the ones  demand  reliability.  Standards  reliability  and as i n  i s used  a r e used establish-  acceptable  17  minimum  requirements.  Optimal  G u i d e l i n e , t h e one  Minimal  Standard.  years, are  Standards  is  Guideline  The  and  through  the  need  been  shared  that  Department  do  study have  cases  in  the  Guides. up  exist  USA, ^  t h e terms  Service  themselves  from  come  (HSA)  formula,  Sophisticated  has  like  the that  have  The  when  the  agencies  as  Canadian  required space,  of to the  use  the  t o be a c c e p t a b l e ,  such  and  flaws  i n the  some  to  of  little  construction  chosen  plus  while  been  the  for hospital  Agencies  changes,  do n o t  Planners.  such  who  funding  already proven  SouderWheeler  and a r e making  which  Notably,  from  Affairs,  Planners  Agencies  documents,  to recognize  the introduction  there  1  .have  the e x i s t e n c e o f any  using,  of guide, i t  between  standardization.  of Veterans  requests  the  static  the difference i n  by  up u n t i l  - It i s not surprising  as  ten  Planners  more  begun  used  facilities.  available  last  by  the  Standards  are  Health  the  two f o r m s  have  Provinces,  approve  left  distinctly  Guidelines  regulatory  Standards  i s a  over  o f these  Agencies  i n most  legislation for  the A u t h o r i t i e s  to reinforce  their  present  i s that  recent  i s an  Standard.  the Regulatory  reason  by P l a n n e r s  that  have  to differentiate  AIA  resemble  the  In o r d e r  o f the purposes  important  have  and  used  by  i s clear  evolving  behind.  nature  that  It  used  the Guidelines which  constantly  the  The S t a n d a r d  current  Planners  have  Standards  others  HEW  picked  they  have n o t .  are  18  The  Canadian  earlier close ther  and  the  in  entiation  of  new  (Chi  a  and  basis  ments.  is  Souder-Wheeler  relate that With  to do  not  the  restrictive  have  Canada,  Chicago  to are  of as  Hospital  who  in  create  are  closest  Council  Report  Indiana  Health  are  finding  application  System.  of  Systems in  have  needs  of  beds).  bed-based  often  been  innovations.  the  for  need  current  sophisticated  The  two  most  Guidelines, the  Agency. the  which  program  more  and  old  space  (number  and  the  obvious  services,  for  to  require-  programs and  both  workloads  The  of  as gap.  for  over  bed.  demands  the  designed  space  workload  resources.  Northern now  per  fur-  Program  Guideline  and  to  differ-  departmental  outpatient  USA,  In  methodology  recognition  realization the  a  been  improvement  space  inpatient more  have  be  uses  opportunities  better  which  of  started  Canadian  this  inappropriate  the  new  functional  method's  affect  occurs  sought  resources  the  the  to  and  slowly  situation  Standard/Guideline  significant  formula  move  Standards  a  outpatients,  calculations  Like  supposed  this  Guidelines.  closing  determining  This  and  a  into  have  Methodology)  Governments  is  years  that  toward is  forced  concept,  Systems  for  advantage  ten  idea  step  were  Standards  valid  Standard  Planners as  the  a  deliberate  The  last  between  is  Guidelines a  the  gap  support  Agencies  USA  are  current the  Standards These Health  HSA's  of  1979 the  resources Planning  19  When  we  one  concern  we  do  reach  Planners process  will  that  not  these  a  this  point  in place,  which  While i t  i s essential, Standards  i s reached  where  i s nothing  further  and  evidence  present  there  into  the planning  occur.  knowledge  with  are outdated  have will  built  change  them-  the  to  will  i t  new  ensure  continue  occur.  s t i l l  are  Peckham  ating a  constantly  a major  cepts,  to  put  We  that i f  Agencies  o f knowledge,  of  problem  because  are  when  We  As  the  body  are  Regulating  that  Guidelines  Is i t possible  smoothly?  a  and  Guidelines  body  i s doubt  solve  Standards  t h e same  such  Just  where  enabling  proceed  there  selves.  to  point  to share  clear  that  a  t h e use o f S t a n d a r d s  unaddressed.  thereby  indicates  will  at  remains  Standards,  is  look  cause  points  methods  Tofflerian  of  or  lead  only  to  constant  eventually  problem  Guidelines  (which (which  which  overly  the Design  which  shock".  i n planning  historical  Standards  with  has thrown  "future  used  being  o u t , ^ the constant  years,  traditionally  that  o f concern  and equipment,  i n recent  departure  aware  is  Standards.  impact  appears  rigid  of  new  t o be  con-  acceler-  the planning process i n Standards  now  serve  additions ignoring suggests  either  and  them  that  have as a  changes  to  altogether.  that  do  respond  to  current  do  not),  can  never  the  gap  been point them This  between  knowledge)  and  permanently  be  20  closed. would soon can  Unless  appear open  how  Care  In  produced.  produce  by  of  assisting  based  closed even the  This gave  the  discussing  has  be  a  provide Its  i s then  It  cooperative  use  not  of  The to  of  needs.  the  a  lead  of  It  was  attempt  to  case.  Health Despite  If the  B.C.  were was  spaces  of  the  upon  to  be  process and  Standard  pages  for  based  also  and  rigid to  the  Facilities  'ideal'  covering be  between  hospitals,  Guidelines  i t will  been  an  was  Health  sizes  t i m e . 15  program(ECU)  optimal  M i n i s t r y , the  i t i s not  we  Columbia  for  genuine  the  Ministry ECU  the  two.  will  problem  Units  Institute  to  would  the  between  the  •i t  i t  British  Care  and  facilities.  example  this  Guideline  simplification  that  practical  the  the  upon  states  of  with  This  between  close  does  cooperatively  planners  at  gap  Extended  developed  out  Standards,  appreciate  Columbia  that  flexible  failed.  architects  carried  planners.  has  Architectural  these  communicating  is  was  the  of  the  better  sizing  Guideline  residents research  and  the  as  application  Health's  of  a  To  British  This of  presumed  way  a  develop  soon  the  planning,  Committee  as  Guideline  1974,  Ministry  can  again.  at  Extended  ming,  that  up  look  we  the of  document  of the  which  gap the  a  was guide  and  that  revisions.  anything, opportunity  constant  the  guide  to  complaints  stop by  21  users  and  planners,  government  until  custodial some  new  occurred  of  Delta  1979  when  tunity  to  On  Extended  Care  both  Guideline.  Ministry  The  also  to of  be  a  that  previously  built  the  changes  reduced  the  functional This  the  at  Kamloops  direct  problems  ECU  occasions  supported  by  fixed  therefore  the  four design  percent fees.  government  of We  which  proposed  that  year  and  requested their  of  of  the  must by  units the  built  to  cost see  i s contrary  that may  in  here to  and  Guideline  was  Delta.  The  Guideline,  but  of  the  use  unit  Delta.  In  differences inherent  were  ignored.  on  a  number  Guideline  well  reduced a  a  the  the as  to ECU  at  occurred  idea  oppor-  the  drawings  repeated,  has  in  refused  locational  government  project begin  were  for  again  of  at  the  be  to  changes  the  Health  approach  and  a  unit.  rigid  enforced  by  for  opportunity  first  cost-benefit, which  spaces  translation  plans  required  r e p e t i t i o n of  and  only  include  were  to  cost-saving not  reflected  such  in  exact  guide  incorporate  Ministry  an  recognition  The  Hospital  application  Health  insisted  end,  Unit  the  but  not  could  approach  occasions  anything  considered  new  the  did  changes  Shaughnessy a  formal  programs.  which  These  little that  and  activation  develop  consider  1980,  1975.  the  was  care  buildings  in  the  about  model  necessary  develop  there  for  objectives  save  of is  about  consultants' Standards of  both  by the  2 2  Hospitals used  and  as  a  devices  the  Planners.  point  to  of  in  the  Restriction is  usually  created  by  impact  and  to  guides.  delay  tool.  The  hence also  Where  a  respect  to  that  in  capital  variable  and  cost  opportunities are that  being  for  overly  other  increases  often  as  tools  of  the  this  the  to  be  at  a  desire  in operating has  not  an of (and  It  would  returns  with  reached  therefore  control  growth  costs.^  desire  refuse  independent  diminishing  the  power  is  continued  of  system  the  powerful  health  It  Care  formalizing  least  in  their  Health  are  an  been  the  "run-away"  c a p a b i l i t y to is  It  reduce  to  government's  simplistic.  uncontrolled  fail  substantially  have  already  However,  be  who  point  technology.  to  agencies  appears  has  to  is  variable  mortality  be  restrictions  help  this  considering  the  can  purpose.  the  occurring  project,  which  without that  authorities  objective  uncontrolled)  not  will  that  most  will  remain  consider  costs  and  in  change  appear  is  Standards  government  they  will  regulators  clear  Standards  government.  r e s t r a i n t which  unreasonable technical  by  is  projects  cost-share  of  authorities  It of  and  control  therefore  motivation  to  and  what  buildings.  these  hands  mandatory  of  changes  planning  argued  these  reconciliation,  improve  restriction,  Unless  to  for  control  hopefully costs, already  variables  medical  to  the stop  Government been (such  shown as  23  physician  control  greater  cost  governments in  place  system  impact  must  to  is  flexible  An  cannot  truth  created  not  to  capable  Standards  other  kinds  Standards,  e t c . , which  dards. dards  What that  The  law is  to  of  not  as  the  a  therefore must  the  way  current  put  health  that  the  addressed.  perception  does  which  be  major  yet  That  them  lies  Design  Standards  Safety  Standards.  readily  quantifiable  like  not  of  mean  accommodates  so  Standards  are  clear.  we  a  a l l  Standards,  Design  and  than  with  is this?  a We  Safety  Radiation  updated  the  Level  often  are  Design  Stan-  Guidelines or  Stan-  inflexible?  with  which  stuck  why  i f  resulting  Electrical  far greater extent  so  the  are  but  —  regularly  the  Even  Guidelines,  Guidelines;  Hazard  a  become  change  i t about  makes  answer  be  of  Equipment  by  has  and  Standards,  regulated  in  exist  3  having  needs.  are  between  with  need  costs  planning.  unfortunate  is  have  a n <  are  mechanisms  will  reduce  but  in  Standard  Standards product  to  other It  consistent  role  participants'  that  choices)  System,17  the  costs.  desire  government  have  on  restructuring  Restriction  technology  realize  reduce  authorities  gap  over  the  is  With basis  developmental  very  different  Technical allows  Safety  specific,  background from  Technical  Standards, real  of  limits  the to  24  be  recognized  same  in  variables  application. cause  enough  amount  It  be  down  for  is  will  of  of  measured,  these  examining ious  the  unmeasurable crowding, staff one be  or  state  not  —  functions  not  the  not  i f  to will  a  large  equipment.  precautions matter  which  bad  in  piece  of  a  of  set which  equip-  certain  where  define  through a  result  the  level  same  sorts  identifying  dele-  of  within  describe  The  the a  of  planning,  have  is  emotional too but  causing  the  same same  as  is  can  these  a  that  see  in  therefore causes  levels  of  problem  in  variables concern  to  deleter-  space  enormous  identified  a l l the  We  and  little at  required  problem  that  The  arrangements  space  real  incorrect  space.  what  quantifiable.  e.g.,  what  be  to  amount  continue  Often even  to  always  effects  may  does  events  effects.  only  situation,  as  required  may  stress.  present,  is  trying  or  results of  outcomes  lead  electrical  current  Standards  objects  are  arrest  and  the  application  monitor  given  often  a  occur  negative  outcomes  or  are  r e s u l t s which  Standard  It  because  death.  Technical  of  from  limit  leak,  Standards  incorrect,  the  safe  the  Design  Design  cardiac  leaks  country  cause  as  and  is  from  ungrounded  application.  i n which  arrangement  avoid  a  This  present an  current  always  terious  are  always  example,  causing  limits  application.  arrythmia  every  hospital, ment  are  For  always  can  every  in  seem  to  another  25  situation.  In  effect,  regulate,  in  phous  subjective.  and  What do  not  of  an  people  problems  the  clear  event. who  with  their  measurable  outcomes,  describing  the  controlled table of  event  to  in  Standards  problem,  flexibility purpose  of  It the  into  a  by  is  amor-  that  but  they  desired realized  Standards  then  some  become  scientifically  limit  themselves do  not  This  the  however  relationship must  may  to  describe  event' t h a t  where  what  Since  with  generally the  clear.  of  is  being  be  accep-  relationship  i t  is  is  not  be  done  unaccepconstant. to  very  aspect  requiring  since  solving  problems  solve design  is  the  design.  design.  for Even  s e p a r a t i n g the  Pre-Design  are  been  Standards  state  which  to  not  required.  the  attempt  event,  has  is  between  the  unacceptable of  fact  constant,  only  ignored  building  process  precision  then is  is  is  where  an  generally  outcome  outcome  Design  Design  the  exists  the  of  Standards  They  an  Standards  Design  they  are  events  inflexibility  in Technical Safety  table If  and  this  outcomes.  relationship  way,  outcomes If  in  Standards  Design  develop  preoccupation  what  in  describe specific  the  the  pragmatic  becomes  outcomes by  some  Design  phase,^  a  Design i f we  Process i n which  Standard  wish of  to  Design  problems  to  ignore  achieve  more  of  buildings  are  scientif-  26  ically  analyzed,  subjectively  The  the  functionally  tainly great  the  that  operate  at  level. the  a  They ness"  of  in  some  is  the  only  use the  task  of  those  The  unfortunate  made  aspects  of  effort  is  required  to  the  Wheeler  reality  feel  the  is  both  that  of  space. "Tight-  able or  to  tell  sad.  It  ensure  factual  guides.  In  addition  and to  d i r e c t e d , toward to  that  formulation  of  Guidelines  area can  no  is  easy  per  bed  longer  presently  and  Standards  the this  scientific emphasis,  distilling  i t s simplest  Standards  efforts  Guidelines  the  in  the  to  who  result  the  happy  a  conscious  the  be  but  remember  a  about  space  upon  for Standards  New  them  as  even  cer-  beings  assess  not  in  occur.  being  contained  will  are  must  with  than  spaces  design,  We  "feel" to  of  human  unhappy  create  improve  only  the  well  are  more  These  by  criteria  makes  who  from  sizes  as  they  They  what  results  concentrate  type.  product.  or  how  subjective  instances  level  they  interdependent  comes  for  occupied  happy to  which  an  consideration.  be  be  good  being  data  will  form  and  platforms  will  according  will  number  sub-conscious  People  design  parts  in  relationships.  warrants  spaces  Phase  solution  correct correct  more  the  two  design  fundamental  deal  Design  the  best  providing  the  the  solved,  continuum. just  and  to was be  material  formulation use. of this  The  this way.  an  so  that  Souder-  simplistic  27 J  In recent years process  the major p a r t i c i p a n t s  have come under c o n s i d e r a b l e pressure  accurate. funding  This  has occurred  resources  because,  b e t t e r p r e d i c t i o n s of space,  for  measures  tions,  services. planners  usually  Increasingly, are being  to c l i e n t s  asked  tools,  format  for  numbered  give  used  the planning  by  entries  well  as  a  Standards. used  there  that  multipliers  f o r measuring  implications  o f flow  space  though  (using which  boxes easily  experience  with  needed.  answer to t h i s problem we need  purpose  The s c i e n t i f i c  or  Federal  even  simplified  i s a complex  "social"  seek to be  o f the Canadian  considerable  It would seem that i n recognize  informa-  gets more and more  h o s p i t a l s t a t i s t i c s and planning was s t i l l  to  of  hospital  inexperienced  discovered  alongside  totals),  the  process  had been d e l i b e r a t e l y  summary  and  that the G u i d e l i n e s should  G u i d e l i n e s , they  the  opera-  pre-planning  architects  In the AIA-CAH review  Programming  good  of  to supply more and more  supposedly  layman-user while complex.  productivity  upon  the  i s created  and r e g u l a t o r s t o make b e t t e r d e c i s i o n s .  I t seems incongruous simple  depend  demand  ( t h e r e f o r e of c o s t s ) and  o f the a n t i c i p a t e d  which  to be more  as a l l kinds of  have become l i m i t e d ,  for  tion  i n the design  "scientific" to  aspect and  processes.  the  Guidelines  relates  the  as and  t o the methods  analysis This  aspect  of  systems  i s complex  data  28  which  requires  trained  no  harm  i n reducing  as  long  as  ienced of  the  complex  can  the  material  is  not  to  deal  complexity,  i t is realized  users  It  people  that  be  by  only  implications safely  with  i n the of  that  simplification  can  be  successfully  only  the  of  the  and  desires  simplified. experts To  This  but  some  related  aspects  simplistic  way  existence Needed  of  of  upon  Regardless bi-level  the which  the  It  a  is  with  the  can  be  compiled  by  that  precise  the  to  use.  "number,"  into  the  more  "social-spatial"  i t i s not  which  is a  dealing  built  separation  built  achieved.  spaces  be  but of  Guideline is  that  with  Guidelines  Guidelines  f o r lay persons  can  deals  of  carefully  format  obvious  that  the  this  is  in  be  Guidelines  around.  within  Systems  of  format  requirements other  i t  must  in a  exper-  simplification  aspects  Guideline  people  data  presented  degree,  of  of  used.  scientific  concerns  is  methods,  hands  this  the  aspect  there  shorthand  with  humanist  i t so  format must  first  possible  the  i s used,  the  be  recognized.  level  second  level  to  problem  of  of  Social  Scientific  Systems.  Here, in  present  we  find Design  multi-dimensional, precise  outcomes o f  the  answer  Standards. since  they  events  and  the The  are can  only not  of  Standards concerned respond  to  rigidity are  not  with  the  changing  social  concerns  Although always  the  many  describe  frequently firstly  then  there  can  of  because  when be  a  a  this  is  not  by  Planners  may  not  they  are  users  of  Guidelines  are  and p r o g r a m  implications. basis,  change  change  which  i n one  changes,  between  must  h a s an e f f e c t  upon  aspect  i s  accepted  aspects.  Planners  planning  then  Standards  i n the other  fundamental  represented.  relationship,  the  to the s o c i a l  communication  include  used  event-outcome  the social  that  process  aspect  to the s c i e n t i f i c  so  should  an  changed,  recognize  spaces,  this  Guidelines  responding  secondly, also  as  The  and  Regulator  aspect;  presently  unattainable.  1.4  Toward a New S t a n d a r d  We  have  effective Design  they  that  must  i n order  resemble  G u i d e l i n e s which  ensure  that  planning will  seen  the  and  occur.  Guidelines readily  to  If  they the  responsive  Planners  continuity  regulating  f o r Design  health  Standards  are  will  be f l e x i b l e  new  approaches  in  use.  the  same  because being  This  processes  facilities the  t o be  multi-dimensional  typically  needed  Standards  will of  construction as  they  responsive  will  introduced  respond by  the  30  Planners  who  facility  users.  It do  i s very  not  take  do  the  Standards Design  constantly  evident  this  and  existing will  new  there  Standard  complexities  "distilled"  predictive  usable  Regulators  and of  by  by  the  although the to  elements built  the of  lives  t o check  within  that  merely  form  them new  with  data  quicker This  to into  form  of  who  the  scien-  in  either  results, Standard  presented  consultants  the  Standard.  to deal  data  deal  by  will  their  of  Guidelines  I n t h e same upon  design  i n Design  block  subconscious  sense"  with  recognized  Design  are b u i l t  "common  getting  Standards  is a  sophisticated  building  the  able  Design  and  as a  analyses.  must  fully  spaces.  Sciences the  not  be  from  or  as  must  be  hospitals  then  be  aware  t o the s u b j e c t s under d i s c u s s i o n .  Standard  fundamental occur,  must  used  demands  doubt  i s required  c a n be  hospitals'  the boundaries  The  What  for  detailed  the present  Guidelines  of  form,  with  i s grave  Design  that  dealing  that  assist.  Guideline  The tific  are  express  feelings  of  fundamental  way  thinking  of  objects  people,  world,  so  because,  Standards,  the process.  must  the thought  social  itself,  people  the  is  this  simplest who  the  use  Social  constructed  living  must  For  the  that  this  their  by  daily  foundations  31  of the Design be based of  the S o c i a l  that  upon these o b j e c t s .  Sciences are t y p i c a l l y  i s , constructs  The c o n s t r u c t s  o f a second  of the c o n s t r u c t s made by the a c t o r s  on the s o c i a l scene, whose behaviour the s o c i a l , has to observe  and e x p l a i n  i n accordance  cedural rules o f h i s science. build  level,  our G u i d e l i n e s ,  then  scientist  with  the p r o -  I f we use such a method to  we may  seek  to d i s c o v e r the  ways i n which people "operate" t h e i r world and to d i s c o v e r from  them  from  which  elements  of the b u i l t  people r e c e i v e t h e i r f r u s t r a t i o n s or j o y . can  start  to produce  a new G u i d e l i n e  environment  In t h i s way, we  that  includes  such  a t t i t u d e s t o people and b u i l d i n g .  Before we begin t o look f o r some b e t t e r let  us  return  f o r a moment  to a  Guidelines,  requirement  that the  Standards should be r e s p o n s i v e t o the needs o f a l l p a r t i c ipants  i n the Planning p r o c e s s .  As such,  we have  that Standards can p r o v i d e boundaries r e q u i r e d tors,  they  can  be  made  responsive  seen  by Regula-  to h o s p i t a l  needs  through being m u l t i - d i m e n s i o n a l , but what can they do f o r architecture  and  the  result?  There  attitudes  o f the p u b l i c  changes  has been  a  in  the  fundamental  buildings change  and the p r o f e s s i o n a l s  which must be acknowledged.  that  i n the involved  32  1.5  A Change i n the Role o f A r c h i t e c t u r e  In  the  Vancouver  article  by  Eunice  heading  "A  Thing  modern grey  Raines of  on  Thursday,  appeared  Beauty  architecture.  slickness?"  Sun  Why  ...  on is  May  Page  Five  1981, under  dismayingly  should Vancouver  Beginning with  7,  a quote  suffer  from  John  an the  rare  in  from  the  Ruskin:  " A r c h i t e c t u r e i s t h e a r t o f c r e a t i n g and a d o r n i n g a building so t h a t t h e s i g h t o f i t may contribute to our m e n t a l h e a l t h , power and p l e a s u r e . "  the  article  concern author  went  shared makes  on by  to many  a point  condemn people  that  architects in  our  and  cities  to express today.  a  The  i s important:  " S a d l y , when I l o o k r o u n d V a n c o u v e r I conclude that architects today are failing m i s e r a b l y i n one of their prime purposes: the design of something beautiful. "There is nothing in modern architecture that c o n t r i b u t e s t o my m e n t a l h e a l t h , p o w e r , o r p l e a s u r e . I f I s e e one more b u i l d i n g f i n i s h e d i n g r e y c o n c r e t e , I'll gag. " I am u n s p e a k a b l y d e p r e s s e d b y t h e s i g h t o f t h e b a r e bleakness o f many new houses, apartment buildings, and housing developments that are reminiscent of prison camps, o r P r a i r i e bunkhouses, or granaries, w i t h t h e i r skimpy little metal pipes j u t t i n g out of the roof t o s e r v e as chimneys, their skinny little a l u m i n u m f r a m e s r o u n d windows and d o o r , t h e g a p i n g , o u t s i z e e x p a n s e s o f g l a s s u n r e l i e v e d by a n y l e a d e d o r w o o d - f r a m e d p a n e s , o r s o m e t i m e s no windows a t a l l . "Where are the charming delights of yesterday's architecture: t h e many-paned casement windows, the warmth o f r e d b r i c k chimneys, the f r e n c h d o o r s opening t o f l o w e r e d and l a t t i c e d t e r r a c e s , the dormers,  the  window  you,  you'c o u l d  hours  We  seats  early  1970's,  that which  the  who  people, Blair  and  up  when with  life a  was  book  t o o much  and  be  with  lost  for  since  the  dreams?"  constantly  environments  Thomas  curl  i n hopes  a r e becoming  where,  aware,  f o r some  particularly  time  do n o t c r e a t e  use, view,  we  have  a sense  interact  i n The I n t e r n a t i o n a l  designing  of well  or  Urban  been  live  Crisis  being f o r  with  them.  notes  that:  "Urban man i s t h e l i t m u s p a p e r o f t h i s g r e a t age o f t r a n s i t i o n . . . T h e c o n t i n u o u s assault on h i s s e n s e s p l a y havoc with the mind and emotions...As a r e s u l t , t h e price of living in the city is a , c o n s t a n t s t a t e o f a n x i e t y b o r d e r i n g on panic. There i s a crisis of human i d e n t i t y i n c i t i e s , and t h e i l l n e s s lies s o m e w h e r e down i n t h e u r b a n i z e d s o c i e t y itself, inside i t svalue c o n f l i c t s , i t s e x p l o i t a t i v e s o c i a l i n s t i t u t i o n s and i t s alienated individuals."^  Blair Social  decisions  breakdown in  observes  find  environment breakdown phenomenum,  and of  link,  cities  themselves,  direct  i n our  o f that  o u r modern  a  each  this  society. and  are  other  between There  although  a r e aware  they  link  appears  the people  o f the demise  too  Physical  alienated  and  t o be  a  who  live  i n which  they  from  this  to correct, the s i t u a t i o n .  The  physical/social  but i s the r e s u l t  link  both  i s  not  o f a 200 y e a r p r o c e s s .  a  new  34  Perhaps we  are  society thought matter  this  alienation  subject  to  i n which  the b e l i e f  makes from  the  in  Doctrine  of Materialism  cal  the  sciences  started  way  we  today  view  always We  free  believe  is  process  this  of  the  period  Locke  It from that  world. i s  and  We  see  viewable,  any  knowledge  material  with  until  the  of  the  the  we  matter  do  or  with  empiri-  t o today.  others,  or  scientific  Philosophy  What  not  even  but simply  as  testable,  "personal"  only  industrial  began  as a p h i l o s o p h i c a l concept,  the  ourselves.  This  and has d e v e l o p e d  Descartes,  an  f o r us t o s e p a r a t e  Century  throughout  with  recognize  17th  of  collectively  i n the " p u r i t y " of  o r mind.  revival  because  philosophies  i t necessary  emotion  exists  the  objective  to  manipulable  "emotional"  collected  but  influence.  through  science  acceptable.  The  Modern  Movement  this  philosophy.20  with  creative  build  Born  approach  as  into  architects  s c u l p t u r a l forms,  technology  in architecture  symbols  and  an  age  of  scientific  t o t h e improvement  of  engineers  t h e movement  of  is a new  who  product  materials,  used  created  them  to  monuments  to  I t was  an  progress.  the q u a l i t y  of  of  human  life  i  only  as i t c o u l d  nical this  be g a i n e d  achievements. "technical  nology  itself  We  have  imperative"  but  to  from  see  within  come  to  t h e bounds see  and n o t o n l y life  quality  the  of  fallacy  to distrust as  tech-  separate  of  techfrom  35  it.  Design  beginning ics,  concepts  to  express  responsive  the  the  the  process  Post-Modern  concerns  technology,  Unfortunately, conceptual  of  slow-growth  conservation  existing rests  of  methods  still  with  Movement,^  and  the  econom-  human  for  are  1  needs.  guiding  earlier  this  philoso-  phy.  In  the development  "Post-Modern" ity  of  our  concerns  will  makes  the b u i l t  shall  of now  require  what  that  must  the  we  be  rediscover  structure present  "work"  our  a l l  must  The  space  turn  encompass  we  buildings.  lines  reality  o f G u i d e l i n e s which  of data  socially,  done  for  attention aspects  to  do  respond  the s o c i a l these  new  realGuide-  describing  and  the  to  what  scientific  i t s achievement. a  method  required  of  We  which  will  "good"  Design  set of  values  Guidelines.  1.6  The P a t t e r n s o f Design Rediscovered  The held a  idea  that  by p e o p l e  culture,  ideologies.  about  is The  not  there space  and  belief  f o r these  be  and  that  a  even  common  written  a  down,  central  design  ordinarily  appropriate analyzed  exists  within  part  of  should  rules  a society, modern  they  exist,  for ordering  i s even  more  Design i tis  space  unusual.  or  to The  36  only  development  familiar the  i s by  Centre  and  who  to  provide  He  uses  the  began  and  empirical of  Techniques.  The  this  when  chapter  method some  for  key  people, der's  we  can  concepts  respects  the  features  we  design have  delighted certain which  the  certain  and  repeat  it  is  not  developing aspects  as  of  which  well  of By  to  new as  later  design  adopt  other  a  examining and  Alexan-  Guideline the  in  finding  buildings,  i n a l l good  belief  for were  design.  spatial  the  a  closely  which  important  identified.  "populace"  rules  problem  i t i s appropriate  fundamental  buildings,  examined  Guidelines.  why  required  Ethnographic  our  about  people  Guidelines.  using  the  own  of  approaches  are  at  Berkeley,  elements Design  that  are  1960's.22  address  Alexander  in  Alexander's great  we  see  a l l the  techniques  in  interaction  aware  we  his colleagues  late  scientists  same  of  has  methodology  developing  beliefs  i n the  socially  social  which  Structure  work  work  with and  recording this  responsive,  work  Alexander  this  Alexander's  an  approach  Environmental  observing  space,  this  Christopher  for  California,  In  of  is  that  thousands formed  He  with  calls are  building  designs.  physical  building  of  years  an  them  elements  historically  related He  have  awareness  of  "Patterns"  in  to  each  other  believes that  elements  which  are  37  repeated niques is  i n , say, Gothic  f o r solving  from  recognize that  which  they  a  building.  within  a  those  These  This  "quality"  value  f o r each  "alive".  We  such  events  system,  situations  but  in  to  to  system shared  we  the  place  indivi-  which  i s not  a l l people  design when  we  seek  we  feel  buildings  examine  of  each  by  buildings generate  a n d when  reappearing  the "quality"  f o r good  unconsciously  patterns,  create  These  are interlocked  character  a value  It i s this  keep  they  and  people  Cathedral.  i s central  In t h e s e a r c h  and  from  give  individual,  society.  moments  towns  they  that  "good".  which  because  occur.  personal  different  we  elements,  tech-  proportions  elements,  o f the Gothic  and  some  a r e common) r a t h e r i t  arrangements,  arrangements  buildings  building  dual's  problems  building  are essential  in  most  between  the "Patterns"  different  with  spatial  (although  as s t i m u l a t i n g , p l e a s i n g and  forms  Patterns in  building  special  relationships  Cathedrals  the  and  process,  discover:  "...each building and each town, i s u l t i m a t e l y made o u t o f t h e s e p a t t e r n s i n the space, and o u t o f n o t h i n g else: they a r e t h e atoms and t h e molecules from which a building or a town i s made." 2 3  According modern  to Alexander  buildings  have  the designers  alienated  the people  and b u i l d e r s o f at large  from  38  the  building  were  shared  fifty are  other's peoples, cover  to  core.  planners  the  longer  and  evolve  and  qualities  use  these  out that  which due t o people  unconnected alienated  i s concerned  that  from  that a l l  o f b u i l d i n g s o r towns, he  believes  we  concerned  languages  so  redis-  share  that  each  but  we  buildings  no  continue can  have  which:  The  act of building  of  the  building  involvement  to  formalize  their  Patterns  are  responsive  specialist  way  focus  t o make  made, but are generated, by t h e o r d i n a r y a c t i o n s o f just a s a f l o w e r c a n n o t be only generated from the  i s not the exclusive  f o r a l l who  t h e same  Patterns order  points  are a l l  i s also  "cannot be indirectly, the people, made, but seed."24  In  We  users  He  the languages  intellectually  which  articulate.  He  Alexander  and  languages  lost  movements n e o - p o s i t i v i s m ,  i s impossible.  emotive  have  times.  o f t h e modern  divergent  discourse  and  i n earlier  years so  processes  "live"  that  rather  Alexander  content  aware  that  of  elements their  they  of  the  c a n be  boundaries.  t o use h i s  of  space,  existance,  we  in can  I t i s because the  essence  used  domain  appropriate  has chosen  f o r Guidelines.  "capsules"  an  in a societies'  upon~ e s s e n t i a l  designers  space  but  egocentric  of  socially  as G u i d e l i n e s .  We  39  shall  explore  the  structure  and  philosophy  of  these  Patterns.  In t h e i r b r o a d e s t sense, A l e x a n d e r ' s P a t t e r n s description  of r e l a t i o n s h i p s  which  up  make  a  building  describe  what t h e b u i l d i n g  laws  Patterns  The  or  Patterns  context  and  between  which  can we  be are  spaces,  an  infinite  essential place  and  connect  left  though  a  and  kinds  they  their  of  of  events.  buildings  which  elements. building  Through  will  to  this produce  satisfy  r e l a t i o n s h i p between the e v e n t s which w i l l  i n the  not  relationships  e l e m e n t s c a n be a s s e m b l e d of  do  describe  specific  fabric  a  elements  a r e , t h e y do  both  from  with  structure  variety  even  elements  removed  relationship building  between t h e s p a t i a l  are  the take  building.  " T h i s i s not o n l y t r u e of g e n e r a l p a t t e r n s ; i t i s true of the e n t i r e b u i l d i n g : a l l its d e t a i l s ; t h e shape o f rooms, t h e c h a r a c t e r o f o r n a m e n t s , t h e k i n d o f window p a n e s i t h a s . . . the c o n n e c t i o n of the b u i l d i n g t o the garden and t h e s t r e e t , and t o t h e s p a c e s and t h e p a t h s and t o t h e d e t a i l e d s e a t s , and walls which are around i t . . . " ^ 2  In  seeking  t h e s e P a t t e r n s we  r e m a r k a b l y few P a t t e r n s derived. which  realize that  from which a b u i l d i n g  there  o r a town i s  I t i s t h e power and d e p t h o f t h e s e few  allows  an  infinite  variety  of  are  buildings  Patterns to  be  40  assembled. universe.  A l e x a n d e r l i k e n s t h i s to the atoms of our J u s t as the w o r l d i n a l l  i t s c o m p l e x i t y i s made  up of some 92 e l e m e n t s , so the s m a l l number of these p a t t e r n s which are fundamental t o our w o r l d r e p e a t themselves over and over a g a i n .  Our problem c o n c e r n i n g  d e s i g n stems from the f a c t t h a t j u s t as we can l o o k at the m i l l i o n s of t a n g i b l e t h i n g s i n our w o r l d and i g n o r e the essence o f t h e i r s o u r c e , so we have become concerned w i t h the  outward form of b u i l d i n g s i n our w o r l d and not the  essence t h a t g i v e s them  life.  When i t comes t o u s i n g the P a t t e r n s i n d e s i g n , t h e y d e s c r i b e those a s p e c t s of the environment which must be put i n p l a c e t o have a w e l l - f u n c t i o n i n g s e r i e s of s p a c e s . L i k e the s o c i a l s c i e n t i s t who knows he w i l l not get a u s e f u l answer i f he asks about the r u l e s of s o c i e t y from a member of t h a t s o c i e t y , s i n c e the i n d i v i d u a l ' s frame of r e f e r e n c e i s undetermined and u n q u e s t i o n e d , A l e x a n d e r sees little  v a l u e i n a s s e s s i n g needs.  A s k i n g the c l i e n t does  not ensure t h a t the c l i e n t knows h i s needs from h i s wants and t h e r e i s no way  to determine whether a statement of  need i s t r u e o r f a l s e ; i f , f o r example, one says a p e r s o n needs water we know i t i s a matter of l i f e or d e a t h . he says he needs a museum what does i t mean?  If  To r e s o l v e  t h i s problem, so as t o use an o b s e r v a t i o n a l  methodology,  A l e x a n d e r changes need i n t o i t s o p e r a t i o n a l  alternative,  41 /  Tendency.Since spaces  which  ensure  that  the P a t t e r n i s  satisfy the  social  needs o f  so  fundamental to  concerns,  the  people  how d o e s  who use  making  Alexander  the  space  are  respected?  He people  replaces are  working  trying  in  the  even a f a c t .  we  tested.  view?  which  such  this  try  if  we  to  or  once  more stated,  is  "People  no  way  of  it  is  o p e r a t i o n a l and s a y a  view  from  which  their  can  an h y p o t h e s i s  observation to they  it  whether  fact  Tendency i s  are  we say  or  get  of  what  have  need  statement  as;  ventilation  people  can  usually  environments  environment,  good  view",  statement of  out  of  rule  trying  which  out to  sunshine?;  alter-  get  and  be  more not  can be e v a l u a t e d  a  over  time.  different  to  a  hypothesis,  Since  when  offices  by e m p i r i c a l  more This  we a c t  of  hypothesis,  a period of  Only  meaning  in  description  He p o i n t s a  statement  c a n be t e s t e d  light?;  do.  a  need  have  This  native  with  I f we make t h e  working  offices",  to  offices  interpreting  "People  need  there  is  tendencies resolve  design no two  is  left  having  not  always  a need  are  likely  to  them.  not  without  be  one  tendencies  to to for  come  in  Alexander believes  function modify its  that  redesign.  conflict the  in  must  concept  of in  i n w h i c h needs  a r e met  but  conflict  this  observable  since  is  one  42  and  real.  A Pattern  tendencies flict.  of  In  with  real  real  value  lies  in  actual  events  this  fact  describes  problem  which  This  a  There together  two  describes  creates  the pattern,  IF  Z  (a  spacial  occur  under  illustrate  not a  Guideline require  of  holds  and  problem.  these  aspects  Pattern.  statement  The  a  the  statement  THEN.  The  between  condition  each  an  context.  solve  X occurs,  THEN we  r e l a t i o n s h i p which  under  problem  a  The  does  Pattern  Pattern and  resolved.  and  breaks formula  The the into which  reads:  the conditions  the  scope  the  IF  present  which  cononly  Design  always  in  the  deal  given  formula  The an  a  does.  the  to  relationship  in  will  be  new  t o have  really  parts  parts,  Pattern  occurs  which  t o be  for a  i n order  simple  two  need  fundamental  statement.27  further  To  a  always  is a  has  Problem  the  to  the Patterns  which  a Guideline  and  Pattern  that  by r e c o g n i z i n g  environment  use  exploration  solution  i s what  we  process  Pattern  provides  the  problems  to our  building  in  sense  design  the  application starts  condition Y  (a  needs  X), i n order  problem  always  should  to  to  do be  solve  likely  to  condition X).  this  l e t us use t h e example  of locating  4 3  the  Radiology  location  is  the  facility.  We  conflicting patients  Department.  know  not  that for  the  l o c a t i o n near  an  public  department  in  close  to  tendency  i t  is  Inpatients route  can  be  made  analysis  of  have  a  The  the  have  the  must  do  not  locate  the  We  have  the  this  Pattern  we  more  use  Where a  both  hospital  facility  where  so  use.  that  i t  that  the This  unfamiliar  can  i t  Design  achieved. so  department,  Design  directions. patients  inpatients  the is  the  route  be  results  outpatients  place  the  reached  from  two  access  for  directly  little PROBLEM) an  outpatients  (THEN)  access  has  (THE  and  and  for or  outsimply  inpatients no  will  unconfusing  for  complex  follows:  (IF)  know  route  that  a  facility  problem  and  hand,  and  direct  find  require  other  to  locate  less  escorted  non-public.  On  the  Out-  would  access. to  are  this  tend  us  to  yet  of  to  Outpatients  stretchers  Inpatient  In  they  so  would  requiring  possible  because  we  access  hospital  on  aspects  department.  entry.  clothed  an  and  the  easily,  so  different places.  that  as  partially  common  public  the  Outpatient  exposure,  conflicting  to  f a m i l i a r with location  want  of  access  department's  are  the  Inpatients  the  Inpatients  of  requirements  needs  are  One  public allow access,  is  44  and  i n p a t i e n t s , who  familiar  We no  to decide  judgement,  or  be  or  can  will  one's  be  empirical this  relationship  statement  be  always  produce  fundamental Patterns problem  (viz., the  design  Patterns  form  the  series  allow  design  people  yet and  to  have  spaces,  no  now  will  of  that  then so  that  Pattern  will  numerous or the  guides  for  any  how  the  to  see  Design  be  the  condition,  Guidelines. building,  solution  will  spatial  "capsules"  specific  "conflicting  typical  as  begin  i f the which  this  the  alone  a  correct  these  universal for  designer  collecting  way  stand  of  evolve  of  between  We  together  p r o j e c t , they  project  link  other  conflicts  By  this  activity.  planning  similar  designs. in  the  right  i t i s wrong,  i t is right,  reflective  solution)  a  collected  a  are  "elements"  and  required  good  all  If  is  conflict  is either  any  and  the  If  that  problem  for  solutions that  fact.  evidence  described.  holds  That  described  of  There  upon one's s u b j e c t i v e  values.  action  typical  can  relationship  When  the  is a  someone  impartial relationship.  personal  by  by  a d i s c r e t e access.  a c t i o n based  It  bring to  design  an  escorted  route,  an  on  resolved  wrong.  there  the  have p r o d u c e d  need  will  with  are  is  followed,  unique  tendencies"  or  to  the  between  application.  \  45  We  have  Design  Guidelines  observation relate  to  and  built  First  Level;  Second  for  aspects  generally  applied  the  that  This  Regultors time  tested)  element  They  are  o f how  the we  people  best  upon  operate,  response  design  from  t o be t h e  aspects.  requirements,  Standards,  of the  based  can consider  responsive  scientific  be  forms  can  which  comes  flaws  from  The  i s the further  can  be  the  hypothesis.  Regulators  that  should  can  Standards  be  by  be  this  kept  (further  clearly  they  Agencies, accepted  a  have  evidence  i s  i s wrong  substituted, neither  at  and  will  hypothesis  subjective  other  i n the basic  have  Where  and  can at the  Regulating  Regulators  their  threatened  issues  to  by  a  selectively  They  noticed then  fact,  any  the Planners  be  flaws Where  into  hypothesis  feel  might  these  i t s factual  by  of  applied  see f i t .  Pattern,  made.  Guidelines  t o show  c a n be  of  discussed  validity  reviewed  the  statement checked,  the  that  within  revisions  a new  tested,  Patterns  constantly  presenting  brought  single  the agencies  factually  accepted  be  means  f o r any  Pattern  a  affecting  where  relationships  since  derive This  regulatable  without  Pattern.  should  seeking.  the s o c i a l l y  Pattern  hypothesis  and  are  the e s s e n t i a l  o f the Pattern.  Each  same  we  environment.  Level,  basis  Pattern  ( e m p i r i c a l methodology)  their  by  i n each  party  interpretations,  purely  'scientific'  46  level,  therefore  Believing for  begin In  to  to  his  three  the  region  on  format  tory and  which  the  emperical  problem, tion  over).  cases,  a and  the  and  the  this  is  given  the as  a  of  series  of  is a  the the  shows  an  Pattern help  short  being  problem, supporting  Pattern. solution  and the the There  to  The as  to  problem  follows  positive instruction  an  introduc-  the  Pattern.  a  (see  problem  the  the  to  details.  it will  for  of  presented  Pattern  Pattern  evidence  core  a  of  the  the  of  the  how  we  Patterns.  relating  follows  of  description  statement  before  which  context  summary  other  of  Next,  of  final  is  those  explains  part  this  architecture,  Each  idea  relationships within  succinct  is, always  a  longest  detailed  data of  gives  from  2 8  picture  There  Patterns.  .ideal  construction  a  the  provides  certain  The  is  follows  1.1  with  be  own  to  from  has  capture  which  which  presented.  validity  to  c e r t a i n other  statement  ranging  use  our  Language  concerned  Diagram  in  creating  to  formats  Patterns.  Pattern  example  paragraph  complete  this  each  we  attitude  253  while  those  for  new  some  approach  specific  Pattern  this  presents  example  A  achieved.  Guidelines,  method  books  archetypal the  a  volume  Usually,  easily  Alexander's  second  through  be  Language  Design  examine  same  will  Pattern  in  develop  Alexander in  the  application  section  change  to  the soluwhat  DIAGRAM  47  1.1  Short Passages "...LONG, S T E R I L E CORRIDORS S E T T H E S C E N E F O R E V E R Y T H I N G BAD ABOUT MODERN A R C H I T E C T U R E .  In f a c t , the u g l y long r e p e t i t i v e c o r r i d o r s of the machine age have so f a r i n f e c t e d the word " c o r r i d o r " t h a t i t i s hard t o imagine t h a t a c o r r i d o r c o u l d ever be a p l a c e o f beauty, a moment i n your passage from room t o room, which means as much as a l l the moments you spend i n the rooms themselves.  WOT TWS /  ? U14HT NOT  TOO  U O M £  /  T H E R E F O R E : MAKE EACH S T R E T C H OF CORRIDOR L E S S THAN 50 F E E T ; I N E F F E C T , T H I S MEANS NO MORE THAN 5 OR 6 U N I T S O P E N I N G O F F T H E S I D E OF ANY S I N G L E S T R E T C H OF CORRIDOR. B R E A K LONGER CORRIDORS INTO L E S S - T H A N - 5 0 - F O O T U N I T S BY J O G G I N G THEM, O P E N I N G ONE S I D E TO A COURT, WIDENING THEM INTO L O B B I E S , E T C .  Where a number o f rooms are to share a c i r c u l a t i o n p a t h , i t i s common p r a c t i c e t o s t r i n g them along a s t r a i g h t c o r r i d o r . However, the i n t u i t i o n p e r s i s t s t h a t , from a human p o i n t o f view, long c o r r i d o r s w i t h many rooms o f f them are d y s f u n c t i o n a l : People d i s l i k e them; they r e p r e s e n t bureaucracy and monotony. Let us t r y t o make t h i s i n t u i t i o n more s p e c i f i c . What evidence i s t h e r e t h a t long c o r r i d o r s contribute to human u n e a s i n e s s ?  THIS '  48  is  required  to  solve  diagram  which  of  Pattern.  the  that has  they gone  wording  1.7  the  i s used  to capture  We  find,  are very  clear  into  only  not  i n them  problem.  in  and  analysis a  of  great  detail,  t o an a b s o l u t e  there  the generic  that  the  Finally,  spatial the  form  Patterns,  deal  but  is a  of  effort  i n reducing  the  minimum.  The Format o f the P a t t e r n Language  Let  us  now  language  which  is  that  clear  look  at  the  i s i n essence each  Pattern  development  process  a collection does  of  the  of Patterns.  It  not exist  as  an  isolated  entity.  "Each P a t t e r n can e x i s t i n the world, only t o the extent that i t is supported by other Patterns: the l a r g e r Patterns i n , which i t is embedded, the Patterns o f t h e same size that surround i t , and t h e s m a l l e r P a t t e r n s w h i c h a r e embedded i n i t . " 2  Alexander hierarchy issues  process  o f which  are  (ornament,  uses  larger window  starts  and  connects  one  feels  with them  each  9  the  term  Patterns than panes, a with  Pattern  "size"  dealing  Patterns  other i s  a  with  smaller  of  with  issues.  the  a  details The  Patterns  continuing in  in  (regional)  fundamental  Patterns,  "complete"  measure  Macro  dealing  etc.) or  collection  as  until  network  of  49  Patterns. that  If  need  to  statement) make  then  have  some  linked  be  for  of  the  how  where  ceiling  will  state  created  to  is  the  Patterns  that  are  of  In  describing any  this  these  Design such  Such  must  will  things is  details  required.  be as  be  the  are  rooms  are  inter-related is  It  number  such  should as or  be  the needs  in of  its rooms  and  not  remembered  corridor bench  not  special  described the  a  there  project-specific  heights, spatial  many  This  since  Guideline).  a  how  must  within  Language, as  rooms  which  Spaces"  department.  project  of  aspects  "Public  Guideline  window  aspects  of  some  how  a  framework  d e s c r i p t i o n s of  function, in  the  we  technical  what  be  1.2),  specific  heights,  fundamental  to  meaningful  Diagram  Program.  (as  more  (see  Design  they  need  a  (Patterns  example  particular  universal that  or  the  form  creates  designing  a  to  may  technical details,  planning  Functional and  in  provided,  purpose for  following  department. no  others  Patterns  purposes  considered  obviously  to  Patterns  "whole".  synoptic the  "incomplete"  Patterns  of  the  for  hospital  to  new  ones  In  are  linked  linkage  design.  be  be  existing  The  there  widths,  heights  r e l a t i o n s h i p , the  are  Pattern  50  DIAGRAM 1 . 2 A PATTERN LANGUAGE FOR PUBLIC SPACES  LARGER PATTERNS  C i r c u l a t i o n Realms ( T h e a b i l i t y t o move e a s i l y w i t h o u t b e i n g d i r e c t e d i n an institution)  Short Corridors  Two Entrances for Patients (Separation of In and O u t p a t i e n t s )  (Making c o r r i d o r s enjoyable connections between a r e a s )  No Dead End Corridors (Making through place)  space flow not d i e a t one  Entrance Transition (The need t o p a u s e and change r o l e s from one space t o another)  i SMALLER PATTERNS  A—1  Nl/ Welcoming Place (Warm a s p e c t s o f arrival spaces)  Waiting Landscape  >J^>1/  ( C r e a t i ng a n a s p e c t of a c t iv i t y f o r waiting) People  No Wall Unused (Using the wall f o r thickness of texture and storage)  Light on Two Sides of Every Room (The need t o h a v e l i g h t on more t h a n one s i d e o f a room to improve q u a l i t y o f space  V-  Pools of Light (Use o f l i g h t define social  - -  to space)  Open Areas are a Series of Alcoves (Not h a v i n g l a r g e undifferentiated spaces)  SMALLEST PATTERNS  51 i  When  looking  Patterns  are  Patterns  relating  (issues  Realms  is  relates corridor  that  Short  itself  describes  for  Smaller  planned  at  leads  to  a  only  one  to  to  the  individual  an  another  is  of  can  linked  Corridors  role  thereby while  Two which  be  public  and  issues  a  Entrance  an  outside  in  forming  Welcoming  which  distinctive  from (or  the  must  Pattern,  change  person's  the  for  which  i s within  Larger  need  actual  end.  what  welcome  Smaller  the  the  this  Place,  area  the  so  Patients  Welcoming  to  with  Circulation  and  describes  point  inside  and  to  Larger  spaces  begin  the  department  e.g.,  for  i t s problem  people  Short  see  should  Place  with  describes  Entrances  that  the  between  which  describes  where  aspect  can  note  note  outside outside)  relates  since  we  starting  linkages  continuum  which  "Patient")  We which  a We  role  the  corridors  in  space  "size"  Two  reception  i t .  conclusion  does  Welcoming  Transition  person's  to  with  Pattern  is  to  entry  link  as  the  therefore  in  contexts  Patients  department.  example,  Corridors,  where  Entrances a  to  concerned  to  our  presented  itself  is  at  this a  Place  case  logical forms  arrival.  from  Language Patterns.  these  and  other  completes  the  linkages  the  concepts  way  in  within  52  1.8  Toward a New Method  We  have  between their  Standards  historical  prevailing for  the  we  Pattern  tial  elements  become  rebuilding into  the  change Design  To  those are  basic  basis, those  or  the  use.  which  As  an  needs  alternaapproach,  satisfies  the  essen-  G u i d e l i n e and t h e r e f o r e can What  remains  and e a s i l y c a n be  Only  creating  readily  then  can  i sf o r  we  be  sure  i n the acceptance  important  part  of  or  accepted  resulting  methodology  Standards, aspects  Alexander's  not i n techniques of  of  to the  the  of  Health  Process.  fundamental to  the present  they  meaningful  Guidlines  t o meet  Standard.  that  an  established  t o respond  for quickly  occur  as  Planning  a  Design  Process.  actually  have  same  so  have  socially-responsive  Design  a method  Planning  a  concept,  o f a good  Standards,  Facilities  Design  described  Patterns  will  or  We  failure  Flexibility  an a c c e p t a b l e  to develop  their  attitudes  Language  o f and t h e d i s t i n c t i o n s  Guidelines.  use and  and  have  the problems  and  social  Consistency  tive,  us  explored  social  values  we  a l l share  within  the G u i d e l i n e s .  this of  space  be  It  so  that  recognized  establishing  must  and  the natural  sciencies, can  method  Patterns. of  for  discover  events  must  find  sciences, those and  which i t s  but i n societal  established  Social problems  of  earlier  a  which  from  they  sociology,  to  While  is  concern  of  some  between  the  methods  clearly  enough  this  same  concern In  of to  design, become  Borrowing his  an  approach  called  to  facts  life"  of  able  to  in  human  affairs;  etc., the  social  see  have to  had  to  need, the  social  with  i t  in the  is  about  the  distinction  sciences  are  scientists.30  apply  dev-  sciences  agree  that  social  economics,  world.  this  by  attempt  natural  which  and  many  have  fact  design  It  not is  and  Design  beautifully  scien-  rational  methodologies  we  allowed  the  to  explain  human  aspects  the of  subordinated.  from  approach  are  and  natural  have  developing  Sciences,  to  we  for  Social  scientists  which  abstracted,  process design  of  applied  Guidelines. tific,  social  recognized  objects  the  possible  we  the  of  of  the  objects,  realities  experiences  i t  This  with  cultural  f o r e i g n to  social  deal  Sciences  anthropology,  devices  explain  common-sense  or  to  methodology  observe.  cultural  had  Natural  sciences  particular  order  our  The  to  theoretical  elop  in  personal  wish  always  methodology.  problem  Guidelines.  abstract  have  scientific  as  Design  all  Scientists  the  work  H.  Garfinkel-^  "Ethnomethodolgy"  understanding as  of  they  the  relate  we  can  "common-sense" to  the  built  in  using  develop or  an  "natural  environment.  .54  We  recognize  organized are  at  a rational  a  requires  rational  knowledge  that  we  points  3 2  of  interact  the rules  level.  To  understand  friends,  teachers  i s taught  out  the world  part  is  and  how  the  of  further  notice)  and  i n accordance  derived,  of  nature  is  which  understand  with  accepts  as b e i n g  provided  of  o f the in-group.  how  little  the  of  this  of  as  taught  typical  a system from  one's  In  this  of relevances  until t o be  which  unified  t h a t we  come:  "...to the conclusion that 'rational action' on t h e common-sense level is a l w a y s a c t i o n w i t h i n an u n q u e s t i o n e d and undetected frame o f c o n s t r u c t s o f t y p i calities o f the setting, the motives, the means and ends, the courses of action and personalities involved and taken f o r granted. They a r e , however, not merely taken f o r granted by the actor b u t a l s o supposed as b e i n g taken f o r g r a n t e d by t h e f e l l o w m a n . 1 , 3 3  way  (the r e l a t i v e  c o n s t r u c t s have  notes  The  family,  f o r granted  t h e anonymous  Schutz  by  teachers.  taken  of  experience.  the environment  the world also  very  personal  teachers  to define  aspects  that  i s from  socially  natural  view  members  structure,  common-sense  greater  formed  i n which  structure.  Schutz,  one  the s o c i e t y  within  known  rules  that  one  point  In the  t o d i s c o v e r what  society,  events that  we  selves tancies but  order  o r even  within  their  have from  which  the p r i o r i t i e s society,  i n common  members  i f asked  we  with  the background  which  people  of  must  society could  place  the  must  for  of  upon  "knowledge" remove  but unnoticed"  use not  they  lose We  "seen  of the rules  that  them.  of  they  know  ourexpec-  interpretation,  describe.  Garfinkel  says:  "For these background expectancies to come into view one must either be a stranger t o the ' l i f e as usual' character of everyday scenes, or become e s t r a n g e d from them."34  In we  treating are  saying  the "obvious"  able  to  about  actions  understand  the society  what  and  of people i t is  as  that  t h e r e f o r e what  "strange", people  they  are  believe  it i s .  If relate for  us  society making,  we  focus  t o people to  within  at  causes respect  those  the  an  etc.  to  choosing,  "unique"  people  actions  I f we  treat  we  to display  built  spaces,  of  our  environment  organized  planning,  least  aspects  i n the built  observe  criticizing, or  on  can their and  of  society  i t i s possible  people  operating  arrangement  of  commenting, these  actions  discover values  i t will  as  decision  "strange"  i t is  good be  the  discussing,  what of  which  or  that  bad i n  possible  to  i  56  identify the  those c o n s i s t e n t elements, o r t r u t h s , which  " r u l e s " of good o r bad d e s i g n .  analysis,  we  will  be  able  to  When we have done t h i s  describe  must occur i n the d e s i g n of spaces of  improve of  confidently  that  any  the b u i l d i n g  people's l i v e s who  In  the  next  Guideline  containing  we  and  create  what  to enable a l l members  the s o c i e t y to say t h a t i t i s a good b u i l d i n g .  thus ensure  form  We  such data  therefore  the  can will  quality  use them.  chapter,  we  develop  such  a  method  in  Then i n Chapter 3 i t i s t e s t e d , to e s t a b l i s h i t s  detail.  v a l i d i t y f o r use i n - c r e a t i n g P a t t e r n s as G u i d e l i n e s , which are  usable  method two  available  groups  special way,  f o r Standards.  of  which  people,  We  will  simulates a thus  see  e n a b l i n g the  t e n e t s of the s o c i a l  there i s a  c o n v e r s a t i o n between  f e a t u r e s o f t h e i r world t o be  the  that  details  recorded.  of In  the this  s c i e n t i s t s ' methods can  be  i n c o r p o r a t e d and the r e s u l t s o f t h i s exchange w i l l p r o v i d e the  elements  of  a  socially-founded,  scientifically-vali-  dated, P a t t e r n , whose format i s t h a t o f our new  Standard.  We  a  will  which  can  have  achieved  create  H o s p i t a l Design.  our  effective  purpose  in finding  Guidelines  and  method  Standards  for  57  CHAPTER 2:  2.1  An A p p r o p r i a t e Methodology  In within tics to  A METHODOLOGY FOR CREATING DESIGN GUIDELINES  order  t h e method  develop they  an  This  ing  and o p e r a t i n g  are  the  most  "society" examine Units,  chosen  because  requires  interest this  interests  from  as wide  can ensure  individual  i n order  process  and User  "members"  the  groups  range  of  involvement  a geographic  from  as p o s s i b l e , area  the involvement thereby  both  have  This  of a large  or locational  who  chosen  to Care  and  Non-  subject  also  as d i v e r s e plus,  a  specific  Intensive  as p o s s i b l e .  reducing  Experts  Medical  are involved.  (expertises)  personal  Neonatal  need  collect,  very  We  of  of the l i v -  will  the Patterns,  broad  and  t h e group  i n s t a n c e we who  of  need  i t s elements.  "members"  Experts  We  t o r e c o g n i z e and  between  In t h i s  and  characteris-  use spaces  within  and t h o s e  Nurseries  expert  population  people  f o rour subject area.  a  key  accommodated.  exists  Planning  informed  Newborn  Medical  spaces  which  and produce  be  o f how  "society".  between  interpret  must  the data  f o ruse as G u i d e l i n e s ,  are certain  an i n t e r a c t i v e  soliciting  discourse  those  the order  requires  people  the  there  understanding  s a y about  comprehend  we  used  Patterns  o f any P a t t e r n which  what  of  t o develop  a  group  participation In t h i s  cross  possible differences.  way,  section  biases  of from  usual  When  an  interactive  form  is  a  method  would  formats the  more  The  difficulty  methods people  in to  coming  to  a  Since  time  that  allows  their  own  study, would  Also,  the the  Delphi  appear  to  Before technique, nique the  we  itself. past  Norman  20  a  an  The  Force"  our  a  an  nor  large  required  of  in  "Delphi  communication  to  complete  interactive  the  process,  choice.  particular  understanding  of  application the  Delphi  to  since  its original  use  by  Corporation  of  the  to  would  located  form  a  that  is  participants  required  or  prepared  process  one  repre-  study  funding  than  this  specialties.  time  some  of  geographic  is difficult  at  cause  funded  the  these  with  volunteers  neither  being  of  numbers  Delphi  years  Dalkey  be  logical  describing need  from  more  would  any  would  well  to 2  medical  suggests  Technique,  be  large,  with  since  groups  of  committee  Technique .  different  available,  This  Group  "Task  scheduling of  communication  Technique". between  a  of  inquiry  Brain-Storming^  with  from  time  be  community.  number  requirement  typically  would  a  assembling  variety  with  satisfactory  of  for  major  a  of  from  i t s most  committee  Nominal  together  amount  required.  amounts  a  represent  a  encounter  This  into  required,  structured  requirement  could only occur  agree  and  would  place.  to  select  structured  develop  considerable  in  to  is  Using  "open"  we  one  locations,  be  from  their  sentatives  This  us  "closed"  is  project  committee.  allow  ranging  process  Rand  define Olaf  of  the  Techbecause Helmer  California,  59  it  has evolved  acteristic original mine  use  series  of  form  opinion  a  material, munication often each  called  a  expert  feedback  from  modification round  to  Usually  to  definition that  completely  used,  sound  model,  we  will  a  suggest  selecting  prepared com-  was f o r  and  the  to  receive  group one  so  that  questioning was  reached.  application.  introduction that  only  and Helmer  diverse  for and  special our type  to  the  there the  states  i s not a technique.  has  Delphi  their  broadest  himself  one o f t h e D e l p h i s  with  four  objective  consensus  basis  a  or  experts,  o f development,  i s so  series  of  from  i n the  theoretical  results consistent  of  in this  a  three  by with  to facilitate  anonymously  group  reliable  example  The  occurred,  deter-  experts  the group  members  years  design  most of  the  missiles.  monitors  acted of  by  interspersed  These  i s possible  the technique than  group  Group.  Turoff,  Delphi^,  t h e 20  rather  produce  and  the  char-  to  A-bomb  i n that  and  i s sought  of Delphi  despite  Because  until  used  out to experts  answers  answers  on  a  group.  other  another,  work  of  most  looking  "obtain  t h e members  give  consensus  landmark  sent  assembled  the  Linstone  to  Respondent  to  were  questionnaires  monitoring  between  that  f o r Soviet  [sic]  were  edited,  to  who  feedbacks"3.  questionnaires by  was  opinion  I t s present  similar  targets  intensive  controlled  times  s t i l l  likely  of  directions.  ( i n t h e 1950's)  particular  consensus  a  i s  group  t h e most  That  of  i n many  been 1  widely  t o use as which  will  of guidelines f o r  a  60  facilities  We tion of  to  the  design.  can  begin  ensure  the  broadest  by  using  design  concepts  Linstone  of of  our a  and  Turoff's  Delphi  Delphi.  is  The  defini-  representative definition  is:  " D e l p h i may be c h a r a c t e r i z e d a s a m e t h o d f o r s t r u c t u r i n g a group communication process so that the process is effective in allowing a group o f i n d i v i d u a l s as a whole t o d e a l with a complex problem."5  The  Delphi  arrangement ticular method the  groups for  does  would  allow  trate  on  us  the  as  involved. generate Newborn lines,  involved  our  not  and  of  use  of  so  use what  these  check  As  our  the  any  group  the  par-  structure  already  study  This  basis, will  which  concen-  this is  than  must  the  to  by  in  to  planning  produce a  be  groups  "conversation"  important  concepts results  Delphi  between  a  stated,  interaction rather  results.  will  then  theoretical  conversation"  concepts  then  study.  to  describe  study,  group  the  apply  will  purely  the  method  Nurseries,  a  we  results,  of  "remote  some  this  have  value  Our  in  out  value  a  could  so  precise  measurable  seen  described  interaction,  carrying  Delphi  the  for  as  larger,  guidesurvey  group.  '  In  upon ly the  the  structuring of  two  basic  elements.  define  the  membership  r o l e s each  will  play  the  First, of  we  can  i t i s important  each  i n the  study  participating  process.  concentrate to  clear-  group  Secondly,  we  and can  61  structure control ables  the  f o r the negative  which  could  the  former  the  processes  tion  we  about  2.2  Delphi  o f any  be  processes,  groups  c a n draw  upon  and  so  as  independent  foreseen.  dynamics  upon  the  In  to  vari-  resolving  t h e knowledge  i n the l a t t e r  published  literature,  to guide  our actions.  of  situa-  particularly  The Groups and Intergroup S t r u c t u r e ,  accordance  described ing  the  a  who  with  they  hospital  graphical medical  reference  Nursery  i n that are  i n planning. t o both as  Even  the  illustrate, Computer  as  Newborn  Newborn  on  on  for collecti s to  'society'  knows.  recurring  issues  what  people  need  so  focussing  the results  produced  We  approach  Design,  the theory  available  Search  and  possible,  when  such  material  between  what  science  o u r method  of  operating  problems  Library,  chapter,  know  this  planning,  To  social  i n the environment  know.  published  mous.  to  the  elements  a r e exposed  practical  what  best  person  conflict  to deal  people  the  seeking  causing use  on  what  are  with  i n the previous  data  'know*  of  effects  we  of group  c a n draw  between  reasonably  situation,  In  We  interaction  ways  involvement and  that a  a s many  we  may  single  Nurseries,  for a  is  enor-  Biblio-  the University  o f B.C.  35  articles,  only  Nurseries  and P l a n n i n g .  of  extent  at  with  of  know  area  the  the subject  of asking  of  a  Biocross  In the  62  Ross  Laboratories  60 r e f e r e n c e s through of  book  are cited.  published  expertise  numbers  on  Newborn While  material  available,  of people  the  i t  i n excess  5  i t i s clear that  on  involved  Planning* ,  i s  subject,  not  so  i n the area  a  of  there i s ,  vast  clear  amount  that  of Nurseries  the i s as  large.  Since Nursery  Design  population Staff use  and  will the  a  volved  be  confined  relatively  that  from  the  data  increase  will  be  fully  reasonable  aware to  saved  the  of the  to  avoiding  of  also  The as a  fields relevant  t o be  part  choice  of of  consequence  research.  they  of  that  the  issues  and  will  available.  extensive  find-  can  the  assume  deal  of  who  of experts i n -  to the operational  great  this  public  We  likely  will  of  Nursing  Nursing  observed.  material a  the  and  aware  those  reasonable  that  of  Medical  population  as  Staff,  a sample  to the l i t e r a t u r e ,  assume by  being  and  the p r o b a b i l i t y  fully  also  informed  of  number  i n the results  i s  problems  research,  Medical  from  the  but  the  i s excellent.  not only  i t  not contributors  be  from  sample  confidence  Further, experts  a  small  to  this  to  sample  population as  of  collected  (as experts)  people  exposed  facilities;  the people  limited  these  can  subjects  i n Nurseries  factors  be  are  representative  recognize  if  population  h o s p i t a l nursery  ing  are  the  It time  literature  certainly is  also  and  cost  reviews  and  63  relying ground is  instead  upon  knowledge  of  high  likely  that to  still  be  current  relevant  there  is  similar  examined strong  by  for  sized  the  described  upon  need  to  their  The  by  experts  However,  cross  back-  probability  the  correct.  in  the  he  of  are  we  must  reference  both  analysis outcome  by  outcome  is  occurence approach  to  of  that  these  event  is useful  of  the  the  and  f o r our  set  of  problem,  by  the The  i s the  use  of  probability  of  an  the  fact  exists  for  that  which  probability  probability  the  most  opinion.  given  final  small  is  experts  process  are  of  the  the joint  probabilities.  but  a  research.  Mini-Survey  probabilities The  as  social  is  makes  (defined in  Mini-Survey)  from  which  Mini-Survey  determine  the  circumstances  paper  the  particular  experts.  the  a  estimates  prior  derived  in  people)  and  this  of  of  the  out the  of  set  20  expert  a  specified  referencing  Mini-Surveys  to  points  basis  (the  of  15  theoretical Bayesian  cross  use  modifying  synthesis  provided  of  Finsterbusch?  from  paper  useful  set  Kurt  case  samples  a  draw  literature.  and  a  to  opinions.  A  event  experts  concerns  both  assume  expert  In  any  the  cannot  be  This  followed  exactly.  We  know  functioning  of  we a  have unit  a  great  which  many  could  be  issues  related  addressed.  to  The  the  probi  ability to  the  is  high  planning  that will  the be  key  issues  addressed  by  which expert  are  fundamental  users.  It  is  64  very  likely  exactly  that  those  facilites  what  issues  would  check  a  form  of Mini-Survey  Survey  of  by  the expert  a  Theorem  through  mathematical  basis  in  o f events a direct  a  will  opinions  larger  i f the  sense  occurs  from  outcome  the for  be  of  a l l  We  need  ensure  through  some  In the of  the  case Mini-  then  modified  the joint  combination. the numeric  in forecasting,  here.  will  to  experts, the  mathematical  i s v a l u a b l e where  i s used  then  population.  account  a  experts  I t remains  divergence  probability  ity  raised.  of  by t h e s e  any p o p u l a t i o n o f u s e r s  Finsterbusch,  shows  Bayesian  which  have  that  described  i s produced  This  probabil-  b u t n o t o f much  t o use t h i s  idea  use  differ-  ently.  Required of  spatial  not  causing  larger able  hypothesis  has been  t o modify  experts  The  of  value;  experts' build  should  results in  develop  a  and t h i s  c a n be  However,  issues  response of  to  corrective  the group  round  be  a  We  from  by  the  interaction.  be  the  Mini-  check  a t t h e end o f t h e i f required.  a  diver-  Mathematics will  or  by  would  developed  input  i t s principle.  we  is  cause  checked  there  the Bayesian  a Mini-Survey  identified  t h e wrong  further  and t h e  for i t s resolu-  issue  should  effect  by  an  findings,  in  only  likely  population.  having  full  most  identification  o f i t s cause  or i f i t i s , that  expert  by  i s their  i s that  identified  themselves  Survey.  and  the s o l u t i o n  conflict,  only  experts  the recognition  (Mini-Survey)  gence,  not  of  The n u l l  solution  our  conflict,  clarification tion.  from  is the  study  Now  we  6 5  The and  first  Nurses  must  whom  recognize  medical make  group we  due  these  professions.  points  of  because  to  can  be  just  a  results.  The balance  and  this  Consumers  and  experts  knowledge  of  be  of  from  the  concerns  be  which  course  of  a  the the  Medical, who  have  function  others Delphi  their  in  can  comment  events.  view,  will  of  Nursing best  technical  of  H o w e v e r , we  for  Admin-  technique.  upon,  and  experts;  and  group  a  affect  arrange  groups  the  in  planning  of  which  each  one  attitude  this  perceptions  through  aspect  responsibility.  to  and  own  practical  Administrators  other  a l l  priorities  s t r u c t u r e must  two  within  their  one's  difference  come  not  normally  negative  one's  variable  ones  addressed  them  the  just  process,  partisan points  group  operational  will  of  and  Designers. are  of  the  their  the  which  with  degree  We  would  attitudes held  a  normally  d i f f e r e n c e s between  this  normal  in  as  Experts.  check,  always  area  Physicians  involving  biases  bring  the  Nurses  this  by  cross of  the  User  differences in  seen  comes  istrative  and  be  accept  design  to not  specific  of  the  will  or  advocates  must  are  d e c i s i o n making  reflect  will  we  any  is  People  so,  the  stereotypical  Physicians,  as  of  balancing  This  with  process  Medical  presumed  planning  hospital.  the  can  clearly  between  called  Like  view.  associates This  the  possible  i t may  exposure  involved  s o l u t i o n s developed  for  occur  participants  have  regardless  provision to  have  that  users,  we  a  There problem  expressing during  the  recognize  66  that  this  medical which ers  communication  group  they  have  sense,  shares  often  problems  of  attitudes concerns  because  similar  technical  comprehension  i n common  which  tend  emotional the  or  meaningful  a  do n o t have concerns  i s only  consumers  be  to  of  shared,  users  b u t t h e two g r o u p s  basis  f o rdiscussion  may  or  consumers.  reflect  response  priorities  may  with  to be  a  a  more  created  least  by  commonMany  policies,  users.  known,  do n o t n e c e s s a r i l y  sufficient  Consum-  situation.  the Technical at  each  These  by  have  Medical a  common  t o make a p r o d u c t i v e  joint  effort.  It cal"  i s necessary,  detail  material. Technical  be  developed  This  or  detail  Consumers  Users  be  must  Mini-Survey  analysis  as  lies of  To  given  "techni-  the  Design  "emotive"  i n which  the  and Consumer ( o r  the material for this,  the  input  from  material  allow in  the basic  with  the  addi-  technical  Delphi-Surveys  and  a  checking  as  part  of  the  the  the Delphi-Surveys.  group  comprises i n two  planning  t o s o l v e them;  enablers  Delphi  supplement  expert  Development  expertise  ways  be  a  basic  created  after  Another line  produce  reactions.  will  separately  requires  experts  non-technical) tions  t h e r e f o r e , that  which  the Planning  areas.  problems  second  i n the process  i s essential  First  i s their  including  i s their by  Experts  skill  which  a  to  Guide-  whose  real  skill  in  vocabulary  of  as s y n t h e s i s e r s ,  problems  are  recog-  67 I nized,  the  tions to  common  elements  produced.  react  to  Like  the  technical  Medical  technical  questionnaire  a  critical  Delphi  of  Experts*  part  process  the  area  cal  e x p e r t i s e which  peripheral ners  are  as  of  past  the  Consumers,  e x p e r t i s e and  answering  are  identified  rounds. being  just  they  must  to  take  problems. to  Consumers.  the  Both  critical  to  solu-  allowed not  a part of  Designer  identification of  be  t h e r e f o r e must  However,  able  is central  additionally  acceptable  q u e s t i o n n a i r e s as  resolution  with  and  this of  particular  have  process, Consumers  obtaining  a  the  Experts  problems  They  be  into  techni-  rather and  than  Desig-  balance  of  attitudes.  In Group  the  acts  process. tribute enable part  as  questions  to  process.  the  Delphi  the  Designers  Monitoring  i s to  be  designed and  Group  would  act  as  using  the  input  the  the  study,  as  this a  as  m a t e r i a l , then  Experts  for reaction  results  i t is essential  that  experts  process Rather  between than  facilitators, (Planning  (technical)  return this  material to  further  do  They take  Experts.  but  the  redis-  rounds.  Medical  and  of  not  objective of  Monitoring  m a t e r i a l and  communication  Medical  the  managers  interactive  In  the  develop  the  the  group  from  objective  produce  acting  another  Technique,  collect  between  experts  the  Delphi  independent,  Their role  the  in  traditional  development.  they  Experts)  Experts the  the  to  Medical  68  In experts Each  broad  interacting  group  modify  uses  their  needing  to  supported needs  outline  by  v i a  point  with  of  Linstone  two  while  in  This  a  process.  the  and  issues  approach  discussion  i s  of  for heterogenistic logic  societial  of  to develop  bringing  focus.  says  groups  interactive  of the other  into  who  have  remote  world  complex  we  view  addressed  i n our present  dealing  a  the e x p e r t i s e  own be  then,  the when  problems:  "If the technique (Delphi) i s viewed as a two-way communication system rather than a device to produce consensus i t fits this evolving culture admirably."8  Although Planning group  Experts  of  very  ilitate  this,  of a  act  as  an  simple  they  rather  than  their  single  planner's  committee.  The  instance  discussion  times.  divergences. of  view  as  would  approach  any  as  opposed  as to  to  spec-  Planning  convergent  are  be  representing  secondly,  They  fac-  i n order  representing  their  s t i l l  firstly,  (neither  for  are  To  committee  because  nor  o f one  must  i s required  and  selected  and t h e  group  s t r u c t u r e o f the group  expertise  point  each  group  at different  location) are  of  combined  facilitators  (Technical)  Experts,  roles  Group  the r e s p o n s i b i l i t y  functions  This  this  unstructured  geographic  the Monitoring  actual  small in  of  become  internal  objective  Medical ific  the  different  acceptable  Monitors,  now  maintained.  perform  is  have  people,  separately  that  the roles  ideas  represent  to  a  a  diverse  69  group o f p l a n n e r s . prepare  They w i l l  i n t e r p r e t m a t e r i a l from, and  m a t e r i a l f o r , the Medical  t h i s they w i l l  Experts  and when d o i n g  draw upon t h e i r knowledge o f the 'world o f  p l a n n e r s ' t o summarize i s s u e s and a r t i c u l a t e p l a n n i n g c o n s t r a i n t s or planning contexts.  They can f i l l  o r add d e t a i l s and o p i n i o n s o f t h e i r own.  They w i l l  to work as a c o h e s i v e group i n both o f these  The  final  aspect  t o be examined  in details, need  roles.  i n the d e s i g n o f  the groups and group s t r u c t u r e s i s t h e m a t t e r o f p r o v i d i n g for to  the M i n i - S u r v e y ,  ( o r l a r g e r group i n c l u d i n g consumers)  produce r e a c t i o n s t o t h e work developed  acting experts.  T h i s survey would o c c u r a f t e r a s e r i e s o f  P l a n n i n g P a t t e r n s had been developed. the  by t h e i n t e r -  At t h e same time as  T e c h n i c a l Users would be commenting on what had been  p r o d u c e d , t h e l a r g e r group would a l s o be r e a c t i n g t o what had  been produced.  collected,  When the responses o f both groups a r e  the Planning  corrections  i n response  Experts  can make  any  t o t h e M i n i Survey's  t i o n o f any b i a s e s o r o v e r l o o k e d  areas.  necessary  identifica-  An e v a l u a t i o n o f  the d i f f e r e n c e s between the a c c e p t a b i l i t y o f the work o f the  experts,  as r e p r e s e n t i v e o f t h e p o p u l a t i o n  and t h e  r e s u l t s o f t h e w i d e r group s u r v e y o f t h e p o p u l a t i o n , w i l l i n d i c a t e how r e p r e s e n t a t i v e t h e e x p e r t s r e a l l y a r e . will  enable  us t o a s s e s s  This  the a b i l i t y  t o g e n e r a l i z e the  method f o r o t h e r a p p l i c a t i o n s and w i l l  be a p a r t o f t h e  c o n c l u d i n g e v a l u t i o n i n Chapter 4.  70  From the  flow  the  of  following  material  clear.  I t should  always  the central  of  material  continuity  as  between  be  noted  point  well  as  of graphics,  2.1  Diagram the  that  the  Delphi  i t sediting. and  and This  style.  DIAGRAM 2.1 THE INTERGROUP MODEL  M ON nas. qz.cu?a>  PLANNING,  groups  the Monitoring  for receiving  lettering  structure  for  becomes Group  is  distributing, i s to  ensure  71  2.3  C o n t r o l l i n g the Independent V a r i a b l e s  Having involved  and  proceed,  a  i.  the  roles  relationship of  because  There  variables as  the number  considered, study.  described  is  could  already  within  the  which  Independent  these  of  the  allows  the  Variables  affect  provision  structure  four  as  the  for  groups  Delphi  must  now  be  of  the  results  dealing  described  with  and  to  some  these  are  follows:  Population ing who  Biases  -  these  representatives can  describe  trative  concerns.  selected  from  locations  as  Alberta.  who  from  the  These  each  have  even  population  and  and  Adminis-  from  British  as  are many  Columbia  and  further  rep-  for  Consumers  greater  select-  participants  allows  including an  Nursing  discipline in  by  relevant  expert  Mini-Survey  by  eliminated  Medical,  possible  The  resentation users  the  are  and  Technical  geographical  distri-  bution.  i i .  Misunderstandings these  are  process, each  reduced allowing  If  Experts  not  do  Medical  the  Omissions  through  in  the  thereby Patterns  reflect  Experts,  to  be  ideas  final  by  as  round  -  interactive fed  soliciting produced  the  the  Communication  Experts  a l l responses  individual  comments.  the  or  the  back  further Planning  understood of  to  the  by  ques-  72  tionnaires experts  i i i .  will  to correct  Negative  scribed  situation;  idiotic  and  be  the  contact,  up  an  thereby  There identified. interactive structure.  known  causing in  may loss  using  committee and  a l l  the  a  to  be  face.  These  Delphi,  which  Experts  not  out  face  structure  in a  abandon  turn of  be  or  and t h e f e a r  responses  does  (or  to  to  without  since  until  contradicting  publicly;  which  face  to are  face dealt  are working which  i s not  attract  these  influences.  are other Some  independent  will  exchanges The  of  The P l a n n i n g  multi-disciplined,  is  one  to  position  perceived  taken  particularly  small-group  a  by  face  unwillingness  communication  anonymously.  negative  majority  idea  eliminated  facilitates  take  persons  p o s i t i o n once  bringing  in a  to  in a  the  are de-  domination  while to  Upon  generally  as:  9  the d i f f i c u l t y  ideas  f o r the  Dynamics  influences  the  position;  (status)  '  of  are in);  higher  with  Group  unwillingness  direction  will  of  these  opportunity  misunderstanding.  i n the group  presenting  of  -  an  i n the l i t e r a t u r e  personality  facts  this  Influences,  Communication  the  provide  first  affect  v a r i a b l e s which  c a n be  the questionnaires  i n the  a n d some w i l l of  these  affect  variables  the  inter-group  relates  to the  73  capability openness two  f o r maintaining  of structure.  expert  groups  inter-change This  would  reorder  the agenda  objectives.  participants  should  as  may  the  i t continues.  feel  committee  the  need  the meeting's  provide  or  by t h e  repriorized,  face-to-face  so as t o obtain  The D e l p h i  be  of a  flexibility  exchanged  t o "mature"  be a p a r t  the  of  periodically  has the a b i l i t y  where  degree  If the material  can  normally  structure  a  to  original  t h e same  opportun-  ity.  The  literature  contains  many  problem  i n survey  research  (of which  clearly  one), of  rigidity  or  direction  once  Finsterbusch culties, particular where,  new  line  each  down  previous in  It Dynamic enquiry.  i s  concerns  i s a  series  which  into  questions  results.  Mini-Survey  may  suits  to  It i s possible  and  to  change  report  d i f f i -  might  arise,  not  be  or  leading  cannot  be  four  groups  to utilize  which  to the  carried out  of the enquiry.  similarity the  any-  and between  responsive i s then  a  changed.  of Mini-Surveys  the dynamics  approach  method i s  may  c a n be  the  has  the  taken.  The s u r v e y  see  ability  to  been  interviewers  population  easy  of  the questionnaires  the next  form  the Delphi  action  questioning  example  survey's  serial  that  of  a large  survey  of  research  but normally  Finsterbusch's break  course  notes  l u  or  a  lack  references  steps  between in a  the various  this Delphi  rounds o f  74  the  Delphi  ing  too late  ruin  the process  that  there  the effectiveness  that  this  Group  will  that  t o make  material  tion  of  identified  have  intervene,  questions,  will  aspect  or  round  i n preparing  with  to  arises  further  the  These  feedback  either  the  are  being  Technical  case,  possibilities  questions,  issues find  Group  make  f o r the  next  the  of thing  that  might  prepared  finalized, have  i t i s possible Turoff^  answers  i s needed  Experts  can  can  to  finally  being  unsatis-  They  material  development  the Patterns  after  In  Patterns  certain  the inten-  Planning  Typical o f the kind  a l l the  prior  the  of  I f they  the  their  make  could  Monitoring/Planning  that  context.  preparing  discovered  Patterns. rounds.  and  resolutions,  when  i s when  experts  the  i s consistent  asked,  a planning  received.  be  occurs,  discover-  which  To  as p a r t i c i p a n t s i n the D e l p h i .  corrections  occur  compromises  the process.  received  questions  problem  already  of  and a v o i d  a t t h e end o f each  being  the  factory  a r e some  flexibility ensure,  dynamic  warns  to  i t  by  the  a  new  seen  the  or  add  could  more occur  when:  "a r e s p o n d e n t f e e l s t h e s h o c k r e s u l t i n g from a r e a l i z a t i o n that the other side also feels i t h a s some v a l i d p o i n t s t o b e m a d e . Theref o r e , i t i s only a t t h e t h i r d round t h a t t h i s type o f respondent begins t o put a great deal of careful e f f o r t i n t o t h e p o i n t s h e i s maki n g . . .".  so  that  more  resolution.  questioning  rounds  will  be  needed  t o have  a  75  With is ity  a  this  flexible  we  are dealing  A  group  with  Policy  with  when  Design  the following  another that  issues  Policy  developing  had  Delphi,  s t r u c t u r e , to ensure  for dealing  Units  particular  there  since  we  make  Guidelines  aspect is  needed capabil-  i t i s quite Design for  clear  Standards.  Cardiac  Care  comments:  "Unit planners are faced with the r e s p o n s i bility of defining hierarchy of goals, supportive o f , and consistent with long-range hospital goals and o v e r a l l community health care needs. Their policies for unit operation must in turn be consistent with the objectives of the unit. Policies become t a n g i b l e only through specific operations of the u n i t , i n v o l v i n g a coordinated s e t o f a c t ivities and s u b - a c t i v i t i e s . The designer's responsibility i s to develop a clear unders t a n d i n g o f each l e v e l in this hierarchy in order to perceive clearly the operational order which ultimately will find expression in the p h y s i c a l design."^ 2  Since ly our  a t what design  tional  consensus  issues of  seeks  opinion not  them.  as  interested  so  l e t us that  attributes.  deal  with  to  a r e no  groups with  views  a  of  on  supports  advocates.  i n having  While  generate  experts, An  expert  expert  can  brief-  can  ensure  the  topics  and  experts,  with case  a  view  that  a l l views contribute  but a p o l i c y group  tradi-  heterogeneous  topic the  look  of  a  instead  a policy, an  we  technical  homogeneous  opposing  t o t h e outcome  policy  entails  Turoff13  there  informed  to  among  Delphi  resolving  those  is  tends  the strongest  policy  Delphi  has the necessary  Policy  group to  a  are dealing with  a Policy  Delphi  seeks the  we  make  in are an  maker  h i s dec-  76  ision  for  options own  and  He  requires  supporting  them  evidence  to  to  develop  allow  him  to  a l l  the  make  his  decision.  It with a  him.  a  can  broad  Policy  will  be  group  to  Delphi  groups  involved,  we  looking  order  to  is  to  this  the  resulting  impact  problems.  The  likely  to  consensus. of  no-consensus and  must  the  modes  negative  to  require than  develop  must this  we  have  study  to  a  i n which  We new  we  options  simple  do  go  is  not  have The  operate.  the  our  case,  have  been  describe  suggest  both pure  the  unresolved  which  a  the  of  to  in  in  identification  process  operate  approach. must  a  and  in  from  conflict  which  However,  must  on  with  among  In  consensus.  a  date"  decisions  objective  dysfunction)  Patterns  Guides  issues.  produced  (or  modes.  the  to  consistent  consensus  a l l possible  Patterns  the  The  at  explore  not  resolve  is  planning  arrive  ensure  approach  Planning  in planning.  more  What  our  experts,  seeking  to  does  produce  way  are  not but  problems,  elements  We  policies  Policy  presented;  diverse  minimize  good  are  therefore, that  of  Delphi.  help  optimize  seen  the  does  which  most  require requires  consensus Policy  diagram  below  and  Delphi shows  77  DIAGRAM 2.2 MODE ACTIVITIES  Achieving  from tions  that  general  format  can  Experts  providing  choose, This  done  or  and  questions  that  and  required  two  make  are  indica-  i s not  to allow  round  of the to  Secondly,  the  of questioning, by  either  i n the feedback  o r by any o t h e r  between  the  answers  corrections  (indicating  being  First,  (the content  the appropriate  and " s c a n n i n g "  Design  potentially  ways.  no-consensus.  has occurred)  t o ensure  Delphi  i f there  c a n be d e s i g n e d  results  additional  questioning  in  a t t h e end o f each  the  consensus  t o another  the questionnaire  i n consensus  analyze  where  of  be  a  to another  o f consensus  themselves)  either  Planning  can  requires  o n e mode  direction  This  questions  from  the degree  achieved.  be  flexibility  o f moving  one whole  Consensus Required  No-Consensus Required  Consensus Required  capable  Identify the b e s t way t o \ solve the / conf1icts.  Identify what t h o s e conflicts are.  Recognize there e x i s t s a number o f areas of c o n f l i c t between f u n c t i o n and space.  mode  method  has  rounds  they  occurred.  will  ensure  flexibility.  Another ed  i s t h e impact  Planning any  independent  Group.  biases  of  any  v a r i a b l e which i n t e r v e n t i o n by  In a t r a d i t i o n a l  by one o r o t h e r  Delphi,  o f the groups  must the  be  Monitoring/  should who  address-  there  be  are actually  78  shaping it  the  would  action  be  detected  required  biased  we  have  bias are  or  exists. an  aspect  The  issues,  whole have the  been, last  Expert  this  that  could  insist  The  yet  evaluate negative  they  than  that  incorrect  would  no  longer  a  potential  areas;  both  the  into  Planners  too  narrow  believe  not  these  In be  may  this  a  to  be  instance,  produced  that  both  Mini-Survey  opportunity deducted, In  missed,  the  fact,  i f  the  the  be  by  the  Medical  implications.  and  impact  from  great  many Group  prepared.  possibility  accepted the  a  to  suggest  Monitoring  e v a l u a t i v e round  is  prior  to  a  should  which  or  of  more  in  the  in-  set  occurs  because  be  affect  this  as  be  planning  effect  where  minimized.  may  to  since  added  bias  are  two  the this  yet  given  second  in  on  In  groups  They  the  "perspective".  might  another  pass  therefore  others.  round  be  the  expected  one  versa,  could be  be  and  and  comment.  of  and  Users),  Group  out  material.  mistakenly  identified  the  one  process  Patterns  produced be  is  the  are  will  were  Patterns  bias  vice  Groups  areas  and  of  or  bias  the  Planners'  evaluative  Patterns  allow  of  the  this  further  could  planning  series  point  Biases  direct  to  to  Users/Planning  Monitoring  disinterested  because  relevant  to  modify  first  advertently  the  solicit  chosen  i f necessary,  independent  be  to  (Medical  by  would  material  design and  questionnaires  that  Medical  Experts In  this  u l t i m a t e l y taken  care  Experts  could case, of  the  not the  through  79  the  structure  Planners each ed  are  Pattern to  be  the Pattern  itself.  involved  i n this  i s always  presented  tested  certainly tical  of  be  and  Although  evaluation  by  other  since intend-  evaluated,  Planners  other  process,  a s an h y p o t h e s i s ,  continuously  evaluated  no  i t  i n future  will prac-  application.  A bility  final  that  much  independent  i n the general  attention  issues with  or  might  a broader  perspectives  to  structure  large  changes,  of a  too  they  be  occur  the  address be  issues  a variety  i t i s  Some w i l l  will  might  to develop  Design,  too  futuristic  putting  In order  "hierarchy".  the p o s s i -  the p r o j e c t ,  concern  of  so t h a t  some  from  long-range  much  the Delphi  issues,  of  to  instead  the questions  levels scale  paid  that  within  comes  progress  perspective.  of  various  be  conversely  incremental  into  variable  necessary issues  at  "Macro"  or  "Micro"  or  detailed  model  for  question  issues.  In building planning are  selecting we  approach  clearly  which  chose  to  follow  so value  mental.ist" 1^ planning choices  tive  of the p o l i c y  to  be  achieved).  neither  ends  that  best  "Rationalistic"  (which  policies  to achieve  policy  t o t h e outcome)  between  We  the  and means  the  approach  successive value  appropriate  ( i nwhich  defined  h a s t h e most  an  based  itself  rather  believe  that  than a  i s t h e one  nor the  allows  them  "Incre-  the making  upon  the  of  rela-  the o b j e c t i v e s  more  appropriate  80  model  i s one  major  issues,  vant  turn an  to  This  model  decision-making  of  Rational  to  "scan"  ignores "scan"  the  context reduce  by  a l l  identifies  of the  identify  the  detailed  without  the  length  with  the  rele-  risk  some  "Mixed-Scanning"  developed  by  major  an  the the  overview.  shortcomings  of  which  approach  1  "third" It  5  overview  of  has  elements  which  attempts  likely each  approach  to  occur  but  one.  Once  this  Incrementalist  policy  dec-  policies  This of  the  issues  evaluation  but  as  Etzioni.  using  issues,  occurs, the  at  The  Amitai  the  detailed  ision-making  dealing  been  Planning for  done  to  model.  has  to  context  be  unimportant.  appropriate  opportunity  this  must  issues or  be  the  within This  missing  out  allows  and  factors.  either  is  which  Etzioni  both  are  limited  believes  alternative  to  helps  systems.  the to He  states:  "... i n c r e m e n t a l ism reduces the unrealistic aspects of rationalism by limiting the details required in fundamental decisions, and c o n t e x t u a t i n g [sic] rationalism helps to overcome the c o n s e r v a t i v e s l a n t o f incrementalism by exploring longer-run alternat i v e s ." 16  The  actual  mixed-scanning  questionnaire  approach  by  using  design the  will  follow  following  this  formula-  tion:  Prior the  to  formulating  Planning  Experts  the will  first review  set the  of  questions  current  plan-  81  ning  literature  the  issues  planning istic  for  which  have  previous  approach,  identified  i s s u e s or been  raised  facilities. a  and  context  set  the  of  by  From  draw  upon  clients  this  subject  questionnaires  and  in  Rational-  topics  will  developed  be  around  them.  i i .  The  questions  will  require  the  first  nature the  them  are  since  general  directions affect by  asked  the  The  which  options comments of  the  could their chosen  be  policy  that  so  policy of  why  Planners, impact This  in  within  important or  will  is a  major  issues  will  provide  the  Medical  which  will  the  values  Incrementalist  little  simply  i t was  Experts allow  relative  "scan" in  the  An  in be  chosen.  to  make  exploration in  unfortunate  this  policy  setting  approach  demonstration  therefore,  .can  consider,  trends.  options.  very  values  knowledge  ask  is  answers;  futuristic  broad  of  of  Group  style.  experts'  This  or  the  Expert  kinds  to  question  choices  various  developing  by  Experts  then  is  have  planning  and  policy.  set  of  two  long-run,  in current  kind  and  Technical  develop  will  Technical  second  the  objective  context  Rationalistic  i i i .  to  open,  changes  the  of  outcome  i s given  instance,  accepted  to  without  of the a  82  In  the  second  Experts  would  results  from  directions, ing  that  the any  first  everyone value  are  the  that  find  of  the  choice  process, a l l  choosing  be  policy to  Planning  explor-  which  need  in this  choices  new  round  from  the  a l lparticipants  and  by  ("rate")  others.  In  i s  a  Incrementalist express  between  the  f o r any  spots  evaluation  the  of  worth  to assess  made  participants  in  look  might  chance  second-round in  to  trouble  f e d back a  the  It i s also  the  choices  words,  values  round,  choices.  i s given  of  which  to  questions,  "Rationalist-Scan"  issues  results  round  a  first  or  policy  the  of  take  i n depth,  further  round  other  policy-  vein,  their  each  the  by  personal  other's  policy  the planning  experts  choices.  In  the third  must the  develop Design  policy will  and  Guidelines. which  These  when  to  The  accept,  reject  (within the Design  earlier  stage,  use  time, of  broader  which  are  in  circulated  choice  offered  same  Patterns  f u r t h e r d e c i s i o n s t o be made  acceptability. decision  round,  the Planning  documents  allow  final  here or  "scan"  the Mini-Survey population.  themselves  f o r comment, as t o  their a  the  policy  P a t t e r n s ) , and as  i n the  i s being  evaluation If  as  constitutes  modify  i s Incrementalist  a final  serve  this  in style.  At the  conducted  by t h e  i n going  to the  "scan"  reveals  any  83  further  trouble  choose  to  explore  spots,  continue,  further  the  planning  through  policies  experts  additional and  can  rounds,  ultimately  to  achieve  resulution.  2.4  Summary Remarks  Our  Delphi  tion  between  ning  Experts)  group in  detailed  and  the  all  been  of  the  specific  on  without  this  Delphi  objectives tool  to  in  In  in  process  people  outlined  can  the  new  within ensure  open  (the  Plan-  the  other  of  for  The  including  the  the  the  questions,  groups,  maximum causing  exchange  negative can  happenvarious  their  minimal  cost  and  more  out  prove  time.  according to  be  responsive  have  flexibil-  from  carried  use  operate.  travel  i t will and  Design,  without  to  what  they  format  to  with be  here,  group  conversa-  significant  which  This  proceed  One  as  Delphi  product.  for developing  lines  the  openness)  the  as  world  considered  requiring  so  describes  representation  (structure  "open"  interpreting  exchange,  carefully  locations  and  of  an  experts.  and  Experts)  elements  essentially  of  learning  the  influences  is  groups  about  structuring  ing  two  (Medical  planning  ity  Design  an  to  If the  excellent  Design  Guide-  hospitals.  the  results  next of  chapter  carrying  we out  describe this  in detail  Delphi.  the  process  84  CHAPTER 3:  3.1  Round 1;  Before it  was  the  developing  general  THE  DELPHI  The Q u e s t i o n n a i r e P r e p a r a t i o n  required  achieved  CARRYING OUT  that  the  direction  i n two  the  round  Planners  of  ways;  first  the  first,  the  prepare  whole by  of  Delphi  material  study.  This  developing  a  Study  to  guide  guide  diagram  was  of  the  secondly,  by  i  conceptual  framework  examining which the in  relevant  could  study  that  of  survey by  would  related  to they  The tial tion  flow of  diagram straints  might  diagram of the  to  which  required  t h a t was Although  thus well  this as  3.1), imposed  diagram  to  round  the  liter-  to  ensure  as  them  the  Medical  upon  subjects  other  the  needed  through  i t  is  a  i t  illustrates the  represents  i t s important  issues  them.  describe  upon  of  first  of  so  topics  purpose  the  efforts  to  of  The  administrative or  also  be  to  their  was  would  p r o j e c t , as  familiar  important  illustration  list  purpose  Planners  were  project.  a  visually  feel  information  (see  develop  The  the  focus not  study;  reference.  rounds.  issues  and  to  describe  inform  able  whole  subject  to  to  planning  participants; the  was  be  a  other  developing  Experts  which  as  was  the  the  literature  used  diagram  context  ature  be  for  to  very  comple-  simplistic the  actions the  building  essen-  of  limits  steps.  conthe to  85  DIAGRAM DELPHI  INFORMATION  AND  3.1 ORGANIZATION  MODEL  86  The diagram and  first is  the  aspect  the  Matrix  Activities  ning  with  that  we  levels  intended  or,  those  matters  over  a  period  are  the  Short  Term  current  of  items  of  these  which  may  built  it  recognized  round are  be (the  always  concern.  kept  that  each  flow  of  This  helps  of  row  information to  Concerns.  develop  i s not  build and  context  In  3 when  isolated (shown detail,  a building  this block  a l l the  way,  and  as  we  that  arrows  is a  the  "Micro"  each  "questioning  next  round.  each  level  of  become synthe-  recognize downward round).  "Macro" level  and  bottom),  are  to  within  with  f o r the  the  ideas  with  each  Space  Issues),  starting the  at  there  with  during  need  the  diagram  specific  Term  addition,  finishing In  Long  the with  deal  called  i n the  the  is  Finally  developed  of  Objectives  which  shown numbered  be  Issues,  associated  are  'rows'  to  strata  Functions.  these  clear  extending  as  Next  ideas  (e.g.,  Round  Patterns.  Objectives  ning  during  are  the  strata  the  Term  to  Issues  are  i t  implications  called  Begin-  concerns  Long  problems  Planning  that  within  These  into  are  to  levels  columns which  discontinuous sized  three  is  diagram.  relate  round.  of  the  (issues)  makes  referred  environment;  These  diagram strata  are  on  Concern  i n each  have  the  Space  Planning. can  in  recognized of  strata  These  these  are  the  different  which  practices;  out  the  of  item  Issues  strata  carried  time.  be  Levels  concern,  first  top  third  be  three  The  can  showing  to of  explored.  and  which  of  round"  level Planwill  87  The or  the  next  aspect  Activities  There  are  naire  and' e a c h  the  be  the  these  Evaluate; their  of  The  issues the  indicated  by  are  "columns"  into  Patterns  To  be  more  specific,  present  functions  space  the  menting  on  develop  i n more  final Round will  each  round 2, be  and  explore the first  depth,  created  and  modify  or  diagram.  a  question-  the  that  is  must Why  shown  as  problems  final  final  as  i s Why;  topic  The  in  shown  issues  real  stage  is  theme  are  and  round, "rows"  round,  from  this  in  would and  the  draft  distributed Round  exemplify the  3  issues.  for would  Patterns  be  then  most  to  as and  fact  solicit  Objectives,  p r e s e n t e d by  selected  the  was  the  planning  ideas some  round  were  This  summarize  from  received  the  a l l horizontal  first  issues  others'  then  ments  these  what  round.  would  final  into  the  of  during  the  rounds,  themselves.  understanding  would  The  brings  general  round  are  solutions?  together  on  first  i s E x p l o r e , the  the  diagram,  The  What  I f ; If  these  the  columns  corresponding to  important? is  questioning  developing a certain  i s What? second  vertical the  with  the  information.  theme  causes,  the  these, each  theme  discussed?  examine  form  concerned  progressing  are  which  three of  Discover;  i s to  The  the  done  the  second  respondents through  having  specific  a  com-  respondents issues.  The  important  issues  from  Patterns  (Guidelines)  evaluation. be  used  themselves.  to  The  com-  amplify,  88  Although overall  there  methodology,  the  importance  set  some  This  question  spectrum  ledge  of  limits  discussion  from  by of  the of  From  now  i t would  the scope  possible  Planner's  of  was  the Planning  develop  still  developed  areas.  personal  be  in  experience,  literature,  necessary  an  open  especially  forum  analyzed  concerns  from  to  themselves.  The g r o u p These  of the  a feel for  the questions  Experts.  topic  conflicts.  simplification  the experts  context,  on  recent  a visual  to help  structure  known p l a n n i n g list  was  drawn  their  where  know-  there  This d i s c u s s i o n produced  a  a  were short  o f key Categories:  (i)  Parents  (ii)  Staff  (iii)  Equipment  this  (i)  short  and  and  Babies  Babies and  Category  Supplies  list,  Major  Category;  Parents  and  Issues:  Access  by  Education Care The  by  Issues  were  Babies  parents of  parents  parents  whole  family  concept  developed:  89  (ii)  Category:  S t a f f and Babies  Issues:  Infection P a t i e n t Mix Care of Babies Patterns of S t a f f i n g S t a f f Education Stress Administrative routines  ( i i i ) Category:  Issues:  Equipment and S u p p l i e s  Supply methods Access t o other  facilities  Space needs f o r access to equipment Environmental  issues  Mechanical s e r v i c e  supplies  Washing and c l e a n i n g  A g r e a t many other i s s u e s were d i s c u s s e d , f o r example, concern this  with which  i s s u e was then  task of r e l a t i n g  types of incubators might rejected  as being beyond  to space or planning needs.  be used, but the s p e c i f i c The c r i t e r i o n  used i n d e c i d i n g t o r e j e c t was:  Does the type of i n c u b a t o r  affect  spaces?  the planning of nursery  answer was no, because  In t h i s  case the  p r o v i s i o n must be made f o r a l l types  90  of  incubators.  ations haps,  would  already  height  conditioned might  be  I t could  of  be  be  described  service  spaces. presumed  assumed  outlets  In t h i s to  as or  way  include  that a  sub-issue  as  only  incubator  an  aspect  "whole"  sub-issues,  vari-  of  per-  of  a i r -  issues would  which  be  ad-  dressed.  Once and  the  lished, were be  the context issues  to  the style  of  be  covered  and  formulated.  How  2.  How  much  To when answer  resolve  were  time  was  the  answered  i n the  to  would  be  most too  would  t o answer  that  large  ques-  range  of  upon?  be  the  way  in  when  a  the  respondents' which  some  the  guidance  underquestions was n o t  question?  the problem  i t came  themselves  "structuring"  needed  i n mind  would  be  estab-  considered:  h a d t o be t o u c h e d  of  identified were  how  standing  given  round  In d e c i d i n g  clear  should  this  the questions  bearing  issues  in  was  of  much  tion;  1 questions  content  i n v o l v e d , two f a c t o r s  1.  Round  the Monitor  Space  Planning  dependent  upon  Group  decided  questions, the  a  that good  respondents'  91  planning would  experience  therefore  subjects  that  directly  to  open  require  dealt  with  the medical  open  the  questions.  most  structured  Objectives world  and  The  Space  Planning  questions.  and  Functions  would  could  therefore  be  of  The relate a  more  style.  The would the  to risk  questions  relate  questions  from  the  Table  3.0  then  sorted  to the appropriate and  original as  were  would  match  matrix.  follows:  so  degree the  The  that of  Category  Issues  structure required  appropriate question  and  Level  format  of  is  in  Concern  shown  in  92  TABLE 3.0 ROUND ONE  Level  of  Concern  QUESTIONNAIRE  Category  STRUCTURE  Issue  OBJECTIVES  any ideas suggested by respondent  any ideas suggested by respondent  FUNCTIONAL  Parents  . . .  Staff  . . . .  PLANNING  . .  Staff  . .  Equipment  . . . .  Type  Completely open  Access Education Family  Infection P a t i e n t Mix Care Issues Patterns of Care . Education . Stress . Administration  Equipment  Question  Semi-open (Answer t o a specific issue topic, any ideas.)  Supply Methods Cleaning  Infection Patterns of Care . Administrative Routines  Access to Space f o r Environment Mechanical Services  Closed (Most questions to i n v o l v e selection from given options.)  93  Within were  each  designed  In  the  to  examine  might was  from  the  a  can  since  there  be  important  kinds  be  future.  the  anticipate well  allowance  information. were  care.  in  as  of  questions  p e r s p e c t i v e , any  considered  predicted,  the  questions  issues  process  must  rows)  current patterns of  whether  be  (the  different  longer-range  to  design  which  concern  O b j e c t i v e s , the  affect  still  of  solicit  row,  related  that  to  first  later  would  level  for  This  It  those  both  idea  that  concern  important  those  as  designed  is  today  important  future  changes  which  cannot,  within  the  spaces  planned.  To leave ful, two  allow  answers the  open  first  parts.  This  some  context to  receive  section  First,  we  q u e s t i o n would  to  of  cause  the  that  would  naturally  would  then  allow  respondents  would  onto  happen,  years. which  Ten real  the  years  events  tive  fictitious  five  year  flows, their  to  activities  was  fall  could  budget most and  ideas  might  definition  focus  The  as  periods  hospitals demands.  a  for  doing  most  still  be  use-  broken  into  Nurseries. bound-  subject. concept  part over  It of  asked the  than  all,  next  10 in  specula-  i s only  Provincial  planning  a  what  time, p e r i o d  rather  after  yet  think of  their  being  years,  of  the  area,  anticipated  Ten  to  second  definition  be  that  around  to  chosen  events.  fiscal which  this  and  respondent  second.part.  within  maintained  q u e s t i o n n a i r e was  for a  aries  nursery  any  the  asked  be  must  two cash  relate  94  The the  use o f the two p a r t q u e s t i o n  Monitor  Group t o c r o s s  reference  format a l s o the ideas  allowed  given i n  p a r t 2 o f the q u e s t i o n t o the s p e c i f i c aspects of p a r t 1 so t h a t any anomalies o c c u r r i n g examined.  In a l l stages  Newborn N u r s e r i e s separated  i n order  in later  rounds c o u l d  be r e -  o f the p r o j e c t the q u e s t i o n s f o r  and f o r I n t e n s i v e  Care  Nurseries  were  t o a l l o w respondents the o p p o r t u n i t y t o  answer c o n c e r i n g o n l y one s u b j e c t , i f they had no exposure to  the o t h e r  s u b j e c t , without  invalidating  the q u e s t i o n -  naire .  The  second  essentially  level  required  of  open  concern; answers,  Functional i n which  respondents  wrote down what they f e l t a p p r o p r i a t e , but i n t h i s they  Aspects,  instance  were g i v e n some l i m i t s t o the s u b j e c t area upon which  they c o u l d r e p l y . vide  policy  Important was t h e f a c t t h a t answers p r o -  criteria,  rather  than  operational  criteria.  The  answer r e q u i r e d would be a statement o f an o b j e c t i v e  and  the purpose o f the a c t i o n r e q u i r e d t o d e a l achieve i t .  We  d i d not need  infection concern  control  was w i t h  an answer  which  said  e.g. "Given  that  here  staff  must wash."  Our  i s needed the e a r l i e r  i n f e c t i o n c o n t r o l and why.  issue;  what  It is a difficult  areas  require  task t o com-  municate what a p o l i c y i s t o l a y p e o p l e , e s p e c i a l l y when an exact ners.  definition We  decided  i s not always c l e a r even t o p o l i c y to resolve  this  plan-  by g i v i n g examples o f  what p o l i c y meant i n each c o n t e x t , u s u a l l y i n the preamble  95  to  the  question.  In  addition  receive be  policy  addressed  which aged  to  ing.  answer.  Even  though  try the  There  were  causing  final to  question a  given  the  as a  encountered  required range.  opportunity  style.  In  disagree?,  some the  to  aspects  to  a  that  we  encour-  subconsciously  respon-  also  would  they  each  to  order  of  stated  that  in  five  third  not  must  solicit  most  page  feel  do  nursery  Architectural in  selected  would  in  in  overanswer-  section ideas  and with-  question.  In  this  last  to  comment,  instances question  of  a  question in  some  preferred  where would  questions  ask  for  an  the  Plan-  problems format  was  response  option  than  were  a question  devel-  to  instances,  section, other the  was  major  comments In  Aspects,  that  the  The  and  selection  diagram)  situations  planning.  the  Planning  the  encompass  opinions  the  one  Planning  nursery  in  of  of  in  work.  of  solicit  limit  and  topics  Space  felt  made  felt  sufficient  series  in  to  statements  be  a  work w h i c h  section;  Experts  designed  of  answers,  i t was  brief  excessive  around  ning  be  ten  to  space  i t was  amount  felt  (referred  to  the  set  a  by  was  we  left  The  oped  criteria, and  would  whelmed  out  restricting  f u r t h e r pages,  dents  this  to  of  asked,  the from  providing a  closed  agree?  explanation  or i f  96  " d i s a g r e e " was sary.  t i c k e d ; however, none was  neces-  The q u e s t i o n s on C r i t e r i a f o r I l l u m i n a t i o n and  phone  Systems  Questionnaire context was  needed  (see  3.4.3  questions  i n Appendix A.)  would  in this  encouraging  were l e f t  result.  s e c t i o n and  this  was  priately  had  most  input  to present  informed  situations  and  by  real  examples  q u i c k l y grasp  plest  method was  the  the  ideas were  to be  a way  of  what was  to present  which  would  say they agreed  allow  basis for this current,  and  give  so  that  The  (both  respondents  within  check  A specified  each  sim-  positive  to  choice.  a  range Where  could g i v e a d d i t i o n a l comments.  s e t of q u e s t i o n s was published  developed  g u i d e l i n e s , which  probably be used i n a nursery p l a n n i n g p r o c e s s . numbers were g i v e n  appro-  respondents  them.  the plans  given  The  with r e s p e c t to the  or d i s a g r e e d .  Agreement" was  needed, the respondents  Experts.  diagrams of p l a n s , and  negative)  some  Planning  r e q u i r e d of  and  "Degrees of  s e c t i o n o f the q u e s t i o n -  presented,  q u e s t i o n make comments about  using  I  Group f e l t no mis-  situations  the  The  Round  open, because  felt  comment, p a r t i c u l a r l y  could  c h o i c e and  Tele-  comments.  required  questions  of  Some u n s t r u c t u r e d  The development of t h i s f i n a l naire  3.4.4  and  so s p e c i f i c that the Monitor  understanding  of  absolutely  by  would  S i z e s and  (as i n most g u i d e l i n e s ) without  reason  97  or  explanation.  Ranges  and  types of  for  selection, usually  Provincial  In  v i e w by  two  the  tise,  the  use  to  confident  of  was  to  this  this for  This  expertise  he/she  was  used  to  themselves  check this by  Federal  and  the  for  any  occur,  The  identify of  to  they  list the  their  their  get  an  quesof  of  expertise.  about  their  areas  probability  of  of  i n t e r e s t , as  i n d i c a t i o n of  policy  the  section  normal p o i n t  own  felt  of  the  first  categories  of  of  and  The their  experrating  providing  an  topic.  the  them.  felt  a  section  nominated  they  offered  were r e q u i r e d  analysis.  how  from  sections  information  designed  according  person  either  of  was  answer on  The  numbers  f i x t u r e s were  main  perception  selecting  accurate  Should  three  respondents  to  themselves  the  to  to t h e i r  as  by  and  t a k e n f r o m commonly used  background  section  opinion  temperatures,  plumbing  s e l e c t i n g from a l i s t  applied  second  and  sections  for  required  room  standards.  tionnaire,  it  electrical  addition  experts,  of  was  to  expertise simply  to  have.  would  the  how  which  we  had  matching  of  the  the  addition,  pattern  suggest  respondents' d i s c i p l i n e  appropriate  to  have, w i t h In  consistent it  category  required  purported to  check  or  of  expertise  i t would  be  disagreements.  biases  influenced  area  expertise.  of  98  3.2  Round 1;  The  could  at  The be  Response  questionnaire  graduates nurse.  The  the  was  pre-tested  U n i v e r s i t y of  p r e - t e s t was  B.C.  by and  done i n about t h r e e hours and  (of what was  one  t o c o n f i r m t h a t the  required).  The  nursing  practising  questionnaire  t h a t t h e r e were  m i s u n d e r s t a n d i n g s e i t h e r i n the q u e s t i o n s scope  three  asked o r  in  no the  r e s u l t s of the p r e - t e s t  showed t h a t two approaches might be taken by respondents t o the  questionnaire.  First,  a respondent c o u l d  go  through  the q u e s t i o n s f a i r l y q u i c k l y making minimum comments i n the open q u e s t i o n s  and  e s s e n t i a l l y checking  the s e l e c t i o n most  c l o s e l y r e p r e s e n t i n g t h e i r i d e a s i n the more d e t a i l e d f i n a l section.  Secondly, a  i n d e p t h answers and  respondent c o u l d  take a g r e a t d e a l o f  go  through g i v i n g  time.  The p r e - t e s t a l s o showed t h a t the f i n a l major  flaw.  Some of  the  s e c t i o n had  U n i v e r s i t y nurses supposed  a  that  the request-for-comment spaces i n the A r c h i t e c t u r a l S e c t i o n required  of  them an  This was  over and  e v a l u a t i o n of  the  above the q u e s t i o n  would cause an enormous and  diagrams  a l r e a d y asked.  that  no  evaluation  This  unnecessary time i n c r e a s e ,  a note a t the b e g i n n i n g o f the s e c t i o n was clear  provided.  was  so  added t o make i t  required.  In  addition,  because o f t h e i r more academic o r i e n t a t i o n , the p r e - t e s t e r s experienced  a  problem  with  some d e f i n i t i o n s  being  used.  99  To a v o i d t h i s , minor rewording and more preamble were added in t h i s area. issues  of  Much more emphasis seemed t o be  family  or  parent  involvement  hence  needed these  on  were  included.  A f t e r the p r e - t e s t c o r r e c t i o n s were made the r e s u l t s were s e n t t o the 20 e x p e r t s s e l e c t e d f o r Round 1. results  came i n from  the  respondents  the  When the  following  back-  ground d a t a was o b t a i n e d :  (i)  The Mode f o r c o m p l e t i o n time was  three hours,  and  the  Distribution  was  from  Mean f i v e two  hours.  hours  The  t o ten h o u r s .  This  was  c o n s i s t e n t w i t h the r e s u l t s expected from the  (ii)  pre-test  result.  Most  the  of  experts  classified  themselves  a c c o r d i n g t o our a n t i c i p a t e d c a t e g o r i e s .  An  e x c e p t i o n o c c u r r e d w i t h two p h y s i c i a n e x p e r t s (who  were  their their  medical  Two  who  as  academics) , who  specialty  academic  physician listed  listed  was  h i m s e l f as  (Neonatology)  specialty.  One  chose over other  i n the P e d i a t r i c c a t e g o r y a Neonatology  specialist.  nurses who were l i s t e d as r e p r e s e n t i n g an  administrative  point  of  view,  chose  100  obstetrics  and  others  obstetrics  chose  names  exchanged  than of  were make  minor  Group  felt  Physicians  and  important having  adjusted  to  of  were  on  to  the  listed  the  that  the  Nurses  team  on  the  people  responding  Rather the  the  not  as  their  basis  Monitor-  sub-categories  were  warrant  so  lists.  miscalculations,  additional  list  who  administration,  additions  these  ing  The  two  under  sufficiently  delay  caused  by  included.  Experts  was:  Physicians Academic Pediatrics Neonatologists  2 3 5  (leaving  specialty  unchanged)  Nurses 4 6  Administration Obstetrics Total Of  these,  (iii)  20 17  Two  responses  nurses  withdrew  drew  did  but, from  due  answering.  returned.  changed  and  answered withdrew  were  to  not  due the  employment respond. to  study.  other  time One  positions, One  nurse  commitments,  physician  commitments,  with-  without  101  Since at  we  85%  had  and  i t  One  not  to  one  obstetrical  ticipated familiar  had  was  round. add  most  still  ticipants, next  a  80%  of  decided  nurse  the  with  the  With  respect  with  different as  to  to  original  the  the  who  response  proceed to  was  pre-test  high  the  exception  participants  in  themselves  unusually  had and  par-  to  the  decision  inclusion already  of  par-  therefore  was  study.  their issues  follows:  confidence the (See  in  dealing  respondents Table  3.1)  rated  102  TABLE MEDICAL  ISSUE  EXPERTS  CATEGORY  3.1  SELF-RATING  SCORES  Percentage of Physicians Rating t h e i r A n s w e r s by the percentage P r o b a b i l i t y o f an A c c u r a t e Answer  Percentage of Nurses Rating t h e i r A n s w e r s by the percentage P r o b a b i l i t y of A c c u r a t e Answer  >80%  >50%  <50%  >80%  >50%  <50%  A.  National or Provincial Policies  80%  10%  10%  30%  30%  40%  B.  L e g a l and Outcomes  50%  30%  20%  40%  50%  10%  C.  Intra-departmental functions within a hospital  90%  10%  90%  10%  -  Inter-departmental . functions within a hospital  80%  20%  80%  20%  -  10%  20%  80%  20%  -  10%  90%  10%  -  70%  10%  20%  70%  30%  -  70%  30%  -  80%  20%  -  D.  Ethical  E.  Staff Organization Issues  70%  F.  Staff Training Issues  90%  G.  Patient Issues  70%  H.  Environmental Safety  90%  J.  Equipment  80%  K.  Unit tion  80%  Family  Administra-  Some c o n c l u s i o n s c a n b e d r a w n (a)  30%  10%  20% 20%  from  the  results:  N u r s e s do n o t f e e l c o n f i d e n t w i t h "Macro" i s s u e s such as N a t i o n a l P o l i c y a n d do n o t f e e l i n f o r m e d a b o u t l e g a l a n d ethical issues.  103  (b)  Physicians issues  (c)  Both  feel  but f e e l  with  individuals  were  less  aspects  others.  duties  on  the  are  not  Physician not  unsure not  confident  noticeable  i n this  tended  to  issues.  Round been  1,  was  section  focus  on  issues  clear  that  achieved  from  certain with  who  are not  administrative family  very  physicians  were  organizational  reasons  of  with  Levels  they  the  on  in  Confidence  and  physicians  than  i n the  Functions  "Macro"  Objectives  and  not  on  expected.  the Monitors  to  given  of  rather  provided  as had been  objectives  nurses  issues  issues  non-involvement.  the answers  both  who a r e  feel  comparing  that  issues.  hospitals  same  staff  certain certain  administration  comments  respect  of  in  in  nurses  with  These  "Micro"  cases  additional  long-range  It  when  section  In most  section  area.  confident  although  i n larger  unit  National  issues.  confident  familiar  about  legal  issues  because  f o r t h e same  Objectives  given  in  in this  probably  I t was  unit  with  feel  Notably,  specialists  involved  with  nurses  other  involved  the  and  most  than  dealing  inadequate  physicians  dealing  (v)  confident  "scan"  o f the r e s u l t s o f  of the methodology  the purity  of  the  had n o t  Levels  of  104  Concern. some  I t had n o t been  instances  the  possible to maintain  same  data  was  given  particularly,  the Functional  Issues  Architectural  Aspects,  the experts  short-form  answers  consistency, year  time  Long  Range  argued changes made. they  this  In f a c t  could  required  as  could  the  feedback  It  Planning  material  was  felt  personnel  ten  Experts  under  that  the  i n the c l i n i c a l  they  n o t be  documented  affecting changes  reduction, useful  describing  of this  f o r the next  support sector  the  which better  planning a  trend  Intervention  Objectives  health  be  that  (as provided  results  meaningful  o f the view  i t sextraction  a n d 1.4)  these  as  the ten  were  are  years.  their  effect  cited  e.g., noise  in  With  would  to this  who  the regrouping  1.3  there  span,  which  on  It could  are already  those  s e c t i o n s , and  B, S e c t i o n s  time  again  with  level.  felt  interpreted  within  deal  i n support  etc. — be  through  appropriate  —  appeared  section.  statements  i s s u e s which  to occur  occur  design)  Appendix  that  by  experts  and i n  sections;  enlarged  to  Objectives  were  two  d i d not develop  the longer  control,  and  failed  they  b u t no  with  which  earlier  to the contrary,  ought  objectives  more  the  Some e x c e p t i o n s  environmental  Delphi  in  of short-term  felt  that  in fact  indicated  d i d not deal  system.  the  experts  i n ten years,  details  they  and  Issues  that  of  a l l the  span  where  in  these  within  material  was the into  f o r expansion Section  (see  round.  t h e o l d adage are short  term  105  thinkers alists, This in  and n o t l o n g who  indicates  by  so would  instead  terns.  force  some g e n e r a l  about  infection patient issues  control,  ratios  were  and n u r s e s ,  were  was  and  by t h e Pat-  this  group to  nurses.  questions with  i n Sections  equal  frequency  identified  space.  1 and  needs f o r  better staff Although  by  to  the types  of  t h e same p r o p o r t i o n s f o r  more p h y s i c i a n s , e s p e c i a l l y greater  need  those f o r space  areas.  experience  i n an a r e a ,  and were  i n community  tendency  that to  2 i n preparing  involvement,  n o t i c e a b l e t h a t where  administration  item  to generalize this  groups  i n about  users have  longer  substituted  as n e o n a t o l o g i s t s , i d e n t i f i e d  the nursery  people  family  and a d d i t i o n a l  identified  physicians working  s u b j e c t s mentioned  medical  benefit  c o n c l u s i o n s about  t o t h e "open"  Both  explore  f o r marginal  but i t i s unwise  and n u r s e s .  from  itself.  I t was d e c i d e d  p o p u l a t i o n s o f p h y s i c i a n s and  physicians  recent  to further  aspects  increment-  An o p t i o n w o u l d  f o r u s e a t t h e end o f Round Drawing  were  It  little  thinking.  round  are  as i t presents  fordetail.  another  Answers g i v e n  the  can expect  stage  "probing"  be o f i n t e r e s t  other  in  problem  "participatory"  planners  2,  each  planners  possible at this  objectives  may  with  t h i n k e r s v i z . they  terms o f " a n t i c i p a t o r y "  been  do  deal  term  was  people  because  not c l i n i c a l l y  hospitals  to avoid  were  answering  may  n o t have had  o f involvement  in  i n v o l v e d , o r where  talking  about  some o p e n  I.C.N.s,  questions  and  106  to  check  but  the  with  no  noticeable with  comment.  in  a  tistical data  to  This  the  serious  qualifying a  who  ments  were  nized  expert  in a  of  explanatory  by  very  required.  round  where  was  done  the  issue,  also necessary  this  B,  one  is a  the  when 3,  a to by  staterecog-  qualifying  through  Section  given  these  This  statistics  Appendix  sta-  statistical an  where  area.  bias  to present  f o r t h e comments  pertinent  with  (See  but  This  with  I t was  were  particularly,  feed-back  particularly  one  information  comments  ability  sections,  biases  Section.  diagreed  to account  only  some  results;  our  or  i n some  that  providing  agreed  disagreed;  made  weighting  next  who  "weighting"  respondents  with  When  m e c h a n i s m was  introduce  meant  statistical  problem  those  option  Architectural  percentages.  about  minimum"  compiling  respect  created  the  "acceptable  or  adding  of  presented  in  Architectural  Aspects.).  Good can in  be  seen  the  tes. been  In  the  as  in  done  by  respect of  the  to Isolation  case,  medical  the  size  American  f o r weighting  space  Sections  larger  need  current  Neonatal  B,  this  i n planning  double  this  of  latter  involved  Appendix Since  with  rejection  working much  examples  their  Intensive space  staff  own  Care  3.1.6  proposal  was  Institute  of  Units,  and  our  and  for bassinet-  who  units,  in  comments  in Nurseries  guidelines  offered  3.1.5,  Rooms  of  had and  recently a l l those  insisted questions  3.1.7,  as  (See  Comments.).  consistent with Architects,  on  in  research 1980,  as  107  described valid.  i n Chapter  In t h e next  to allow  We  from  considerable and  particularly problem, during by  the groups,  It  i s also  backgrounds, opposed each  this  group  saw  would  occur.  Round  2 was  all  expressed variances  for their people  with  and n u r s e s ,  i t could  opposing  only  arguments  a l l the questionnaires  of  most  1  degree this  concern  were  needs.  1  that  physicians'  separate  isolation  i n Appendix  To  resolve  t o change  B,  this  position  o f arguments further  given  comments.  similar  specialist  were d i a m e t r i c a l l y be hoped that  a  that  once  compromise  had been  deal  analyzed,  priority  were  very  o f consensus  similar clearly  The  well  types  of  of  understood  was e x p e c t e d Medical  satis-  amount  of useful planning  occurred.  about  generally  of the limited  sections  and a g r e a t  and  in  Round  the exception  A high  round  and  both  to  prepared.  respondents  first  the  provided,  supplied.  that  physicians  When  With  ideas  presented  issue  given  obvious  i n Round  2 feedback  a n d t h e two s e t s  noting  results  factory. term  were  both  on  The  round,  to  i t was  on space  Comments. was  felt  situation  within  i n Round  3.1.3,  we  received  respect  opportunity  worth  this  occurred  with  Section  the next  made  t h e comments  c a n be s e e n  further  document,  f o r f u r t h e r comments  groups,  This  this  we  polarization  nurses'  rooms.  of  round  respondents,  noted  1  data from  Expert issues  corresponded  long by was this  groups and  the  to  the  108  individuals'  professional  effect  of  geographic  levels  of  care,  differed often  on  differed  comparable  3.3  between  between i n urban  they  felt  people  appeared people and  in  rural  important.  in  the  same  t o be  similar settings  Ideas  city,  no  more  than  in  inter-provincially.  o b j e c t i v e s o f Round  Feedback  the  further  (ii)  There  The Q u e s t i o n n a i r e P r e p a r a t i o n  primary  (i)  those  which  situations  Round 2; The  differences  although  issues  category.  responses  comment,  and  any  disagreements  had  with  Ask  for additional  data  2 were t o :  given  i n Round  highlight  particularly  the respondents  given  i n Round  data  1 for  might  have  1.  to resolve  polarized  issues.  (iii)  Rate  the data  establish in  the  given  what  Patterns  i n Round  information and  This  last  objective  able  to  whole  identifiable  would  just  decide  which  what was  1 responses,  to  must  be  included  could  be  omitted.  critical  issues  to  actually  p a t t e r n s , and which  contribute to a pattern.  being made issues  109  The P r e p a r a t i o n o f the m a t e r i a l f o r f u r t h e r q u e s t i o n i n g and f o r feedback, was done s e c t i o n by s e c t i o n , then reviewed as a whole.  T h i s review was  to determine whether there were  o v e r l a p s and whether adjustments were r e q u i r e d t o make Round 2 viable.  T h i s was  work to check  c o n s i s t e n t with the need  whether a c o r r e c t i v e  to "scan" the  i n t e r v e n t i o n was  needed  by the Planning E x p e r t s .  It been  became obvious  collected  respondents,  and  then  that  that  each  i f e v e r y t h i n g was  section  d u r i n g the next round. answers l o o k i n g  an enormous amount of data had  for similar  responses.  take hours  The f i r s t t a s k was  The  back  to  to answer  t o go through a l l  statements which  e x a c t l y as s t a t e d , or reworded vidual's  would  fed  could be taken  t o combine a number o f  M o n i t o r i n g group  was  indi-  required  to  c o n s i d e r c a r e f u l l y where two statements were a c t u a l l y s a y i n g the  same t h i n g .  I t was  often  necessary to l e t statements  remain as they were i n case a m i s i n t e r p r e t a t i o n had o c c u r r e d or  an  intent  had  not  been  understood  by  the Planners  that  would be understood by Medical E x p e r t s .  The reduce  Monitors' the volume.  i n t e r v e n e t o reword  role  to  analyze  the  material  Then i t was  required  that  the Planners  and  proved d i f f i c u l t because  was  reduce m a t e r i a l . there was  than might have been d e s i r a b l e .  to  In p r a c t i c e  this  a tendency t o reduce  less  110  The  Monitors  useful also  gained  further  as F u n c t i o n a l where  any  reduction  Issues  from  duplication  by e x t r a c t i n g  the Objectives  occurred  as  a  what  was  Section  and  result  of  this  move.  Section The  data  on  consensus  was  Definition Intensive this  1,  from  Definitions collected  could Care  round  to  be  The  part)  included  Functional Planners on  into  made  accept  to deal  now  a  split  had  with  so that  of  so  Nurseries  and  were  simply  that  from  the statements could  1  asked  (the  Section  rated  in with  second 2,  reassembled be  one  one f o r  d e f i n i t i o n s but  Section  responses  Objectives,  parts.  statement  these  part  two  considerable  single  reject  into  received  Respondents  or  with  was  f o r Newborn  Objectives  Issues,  1,  which  Nurseries.  comments. was  Round  the  by t h e  like  those  Functions.  Three These  rating  aspects  were  asked  of  the  respondents.  were:  Importance;  how  Desirability; doing  what  was  Feasibil ity; implement  this  important  how  was  desirable  suggested?, how idea?  what  had  been  be  the  would  said? results  of  and  practical  would  i t  to  be  to  Ill  It  was  obvious  disagreement, but  have  i n that  undesirable  practical on  outcomes  scales  issues  Importance,  rated low.  In  each  rating  through  rating  tions  was  5,  given  to enable  the  value  of  line  by  and  a  they  i n some  things.  Any  resulted  questionnaire, experts, items.  with  given  1  space  and  aspect).  and were  must  deal  with  statements thought  be to  on  a  were to  the  way  positive  by  scale.  This  putting  a  rating  separately, almost  by  similar  or  each  f a c s i m i l e ) on a  respondents  o f two  of  consis-  enable item  of  Defini-  allow  exist  they  (a  t o ensure  saying  validated  f o r which  i t , to  each  on  t h e meaning  formatted  to  of  high  set of  each  thereby  alongside  highly  At the beginning  (or a composited  done  would  point  1,  t o comprehend  i n the i n c l u s i o n  according  aspect  from  be  Choices  which  in  Issue  still  scored  rating  was  variances  i t would  choice.  offered  be  Important  those  This  cases  though  could  among  rating  i n Round  comment.  though  which  f o r each  an  Questionnaire,  The q u e s t i o n s  given  that  was  i n the  be  our f i r s t  (a n e g a t i v e  the point  itself,  perceive  Scale  aspects  s o l u t i o n s which  upon  the respondents  results.  statement  a  Section  was  tent  be  depend  they  the  could  for consideration would  three  even  Those  would  reason  aspect)  these  something  t o implement.  a l l three  other  that  the items  rejected  scored  the  to even  similar Monitors i n the by  the  separate  112  The were  headings  used  as  material ings.  used  collected  way,  Nurseries,  2.11  to  2.0  1,  Round  1,  2.20  further 2.  Round  2.1  these  comments  put  these  Care  in a  1  a l l the  covered  Intensive  were  and  under  2.10  to  covered  part  This  was  extra  prepared  t o o b t a i n a more d e t a i l e d  that  take  the  the  i n each  area  of  Planning  Experts  that  i f a  compared  with  conflicts  which  the p o l i c i e s  require  general  headings  Support  Activities)  Nurseries, felt  most  trate  those  head-  Newborn  Nurseries.  from  respon-  section  input  for  on d e s c r i b i n g  consider. aspects of  were  felt  would  numbered  both  Each areas  were  This Round  part 2.  which  list  of  they of  Section  This  were  was  be  of  new two  Staff  Intensive  Care  respondents to  most  activity 2  under  and  asked  of  achieved,  describe  was  felt  could  t o be  the i n d i v i d u a l  which  activities  understanding  and  in  neces-  I t was  Activities  respondent  a  o f the  identified.  Newborn  with  given  considered  needed  be  2  Section  important  to  Centred  activities  was  detailed  felt  they  (Patient  within  the n u r s e r i e s .  respondents  important.  in addition  should  staff  i n the environment  would  go  description  place  activities  input  to  set of questions  sary  and  grouped  i n Round  2  Round  some a d d i t i o n a l  so  issues  (See Appendix B . ) .  A  by  the  in  was  Sections  2 had r e c e i v e d  in  headings  i n Round  this  Section  categorize  sub-section  In  dents  to  concenfamiliar  topics  t o be  the  they new  113  In style  of  result  c o u l d be e a s i l y  comments  been  develop  from  clearly  the  earlier  not conveying  1.  these answers  of  the p r o p o r t i o n a l i t e m i z e d and  where  statistics.  were the  used  to  statistics  of conviction  certain  an a n s w e r .  data  and  aspects  In t h i s  i t s closed analysis  comments  the sense  by a s e c t i o n w h i c h  architectural  Round  As f e e d b a c k ,  to qualify  statistical  followed  statistical  t o t h e q u e s t i o n s were  i n d i v i d u a l s had i n g i v i n g  The  with  t h e M o n i t o r Group about the  outlined  "weights"  Aspects,  and  done.  of responses  given  has  were  Architectural  q u e s t i o n i n g , coding  percentages  As  3,  Section  comments  by t h e M o n i t o r s  i n c l u d e d a l l t h e comments supplied  i n s t a n c e comments  by  the  were  about  respondents  included  was  in  virtually  i  unaltered  and  the  respondents  were  w h e t h e r a l l o r some o f t h e comments tunity any  t o add f u r t h e r  issue  raised  comments  during  the  o r d e r t o e x p l o r e more d e e p l y  required  were v a l i d .  or develop previous  some  to  questions  were  needed  to  The  oppor-  a discussion  round  was  about  given  in  issues.  T h r o u g h o u t t h e comment segment o f S e c t i o n 3 , tional  indicate  highlight  or  where a d d i develop  an  i d e a , t h e P l a n n i n g E x p e r t s s i m p l y i n s e r t e d q u e s t i o n s as t h e y felt  necessary.  through their  The  i d e a was  t h i s s e c t i o n as a c o n t i n u u m ,  i d e a s and e x p a n d i n g  earlier  f o r the respondents  rounds.  reacting  t o move  and d e v e l o p i n g  on t h o s e o f o t h e r p a r t i c i p a n t s i n  114  3.4  Round 2:  This of  questionnaire  the previous  would to  The Response  n o t be  Group  had  volunteers,  the  document  was  was  itself.  questionnaire which  recognized failure to  be  agreed This  emphasis  had we  t o do  proved  t o be  The  first,  fear  realized  would  be  and  p u t on  required as  this  was  considered  could  be  of  feel  this,  the  overi n both  page  t o handle  B.).  A  might  do  those  at  prior  the  i t was the  had done, o r  a l l , would t o sending  unnecessary.  made  the  sections  While  they  of  suggestion  questionnaires  what  problem  Monitor-  size  to  how  on  g e t incomplete  response  to a group of  familiarity.  to return  pre-test  the f i r s t  the questionnaire  adjustments  to  that,  concentrate  greatest  a  the  the  To o f f s e t  was  the  and  might  soon  be  how  reduction  o f time  to  respondents  to  i n parts  amount  concern  concern  t h e document  In r e v i e w i n g  that  was  felt  as  unwilling  document,  reaction  integration  the l i k e l y  the major  reaction  to get respondents  the  i t was  Appendix  that  worse.  succinct  (See I n t r o d u c t i o n  they  far  such  of responding.  itself,  included  with  There  accompanying  o f work  a  considering  possible  by t h e t a s k  letter  as  When  t h e immediate  the  volume  and  2 questionnaire,  questionnaire  whelmed  round,  useful.  t h e Round  ing  represented  during  be out  I t was  the  round.  required.  that  there  was  t o complete  the requested  a  problem  with  the questionnaire,  deadline  passed  and  the began only  115  five  responses  that  some  depth. of  days  Section  2  rather  checking  ing  needed  Group not  to  lists  of  telephone i t was  address  noticed  being  that  that  of  were  of  The  activi-  needed.  the  in  segment  satisfactorily.  activities,  t h e r e were  issues  input  descriptions  some  indicated  a l l the  t h e new  answered  with  clear  responding  On  non-responding  problems  i n the  follow-  areas:  (i)  In S e c t i o n s different  1 and 2 r a t i n g  factors  combinations  (ii)  The  "new  nal  material, task  Respondents perception  segment  which  thousands time  through  seemed  item  with of  2,  possible  required  and p r o v i d e  to evaluating to  three  consuming.  in Section  in addition  f o r most  ( i i i ) Regardless  very  to think  material,  each  produced  a n d was  input"  respondents  '  Those  not understood  than  by  participants  was  had  received.  were  The M o n i t o r  respondents ties  were  be  an  origi-  previous  overwhelming  people.  of  the  had of  the  Introduction  been task As  and  letter,  overwhelmed  by  and  o f f doing  the  questionnaire.  time  all  motivation to continue.  had went  put by,  they  their  lost  116  Since for  this  eventuality  reassess first  priorities  task  answer  of  an  was  2,  2,  the Monitoring  reduce  could  exploration new  Group  radically  be d r o p p e d  ideas.  intent  and  could  be  given  they  would  do  ed.  These  options  This  the  i n order  was  was  new  of varying  2.  which  with  the  Respondents  of  t h e amount  Round  and n o t one  consistent  Round  to  input f o r  making  ideas  to The  required  altogether,  of  t o reduce  problem.  The  still  allowance  required  time  presented  the purpose  the choice  h a d made  the a t t r i t i o n  of previously  original  (i)  the study  i n v a l i d a t i n g the study.  part  developing  of  and c o r r e c t  to  without  Section 2  the methodology  the  o f time  ratings requir-  were:  To c o n t i n u e  t o do  a l l the ratings  on  a l l  ques-  tions.  (ii)  To' do made to  (iii)  each  a  the  the Planning upon  bility  and  o f these  and  having  of  issues  of  issues  the sorting  Experts, own  ratings  the s o r t i n g assessment  of  Desira-  Feasibility.  Importance  on t h o s e  rating  respondents  options  leave  their  To do a l l r a t i n g s  allowing  Importance  selection,  based  on  By  only  items  which  and n o t on  the choice  t h e answers  high  selecting  from  others.  of  received  were  would  still  make  117  possible whole  what  was  issues  essential;  and  identifying  sub-issues  t h e most  required  to  important  develop  the  patterns.  A  final  experts,  of  groups  Delphi  Michael  Yesley  that  been  a  time staff  before,  would long  be  expertise.  needs felt were  of that  70%  of  than  some  wish  D.C.  to  them  of  the  the study, i f 14  who  sample  answers of  would  80% r e s p o n s e  o f the o r i g i n a l  20  few  during were  both have  from  was  had  previously the  year  Study clear  during  a  of  the Washington  from  that i t round  a  as  similar  D.C.  study  noted.  the  ask  could  Mr.  Yesley  i t was  were  experts  Mr.  Delphi  and  some  from  Commission  had n o t responded  to  changing  and  of  original get  sought  members  changes,  and  was  discussions  done  effects  of  large  new  the To  California.  a  were  of  continue.  Congressional  add  substitutes was  to  Corporation  out  the a t t r i t i o n  members  information  In t h e s e  This  with  acceptability  a  carried  representative  acceptable more  or  participants  inform  not  t h e Rand  no d e t r i m e n t a l  The to  with member  the  to deal  i n Los Angeles,  acceptable  as  and  now  studies,  who  Washington,  how  should  the problems  during  at  was  particularly  respondent idea  concern  reduction  them be  to  received,  been, a c h i e v e d . t h e 17 who  telephoned, i n the  continue.  physicians  participants.  were  time  I t was  provided  and This  answered  they  nurses, would Round  an be a  1 and  118  The first  telephone  five  continue orship said  and gone  he w o u l d  seven  of  t o t h e U.S.A.  continue  t h e same  to  continue.  A  i n some  cases  the  On  and t h i s  t h e numbers  t o make  in  that  i n addition  original  one p h y s i c i a n had l e f t  bringing  required  and  indicated  respondents,  and t h a t  exchange was  survey  up  hospital  t h e 14  nursery  letter  of course to  was  as one  One  of  his  meant  and once  sent  additional  13.  group  his Alberta  request,  to the would direct-  replacement  a  compatible  additional  again  a  nurse  head  nurse  the retirees  agreed  e x p l a i n i n g t h e "new"  method  q u e s t i o n n a i r e s , were  distribu-  ted.  An  unfortunate  Physicians the  Planning  Intensive workload. was  and  final came  one  this  that  by  would  strengthen changes  back  had  fairly  were  the  parts  due  to  o f t h e team i t  Patterns  the r e s u l t s again.  the a d d i t i o n a l  by  i n planning  to continue  the actual  aspects  Academic  considered  experienced  to evaluate  made  of  physicians,  certain  planning  quickly.  one  not prepared  the time  been  that  t h e most  weakened  be a b l e  the  was  the other  t o be  Units,  While  they  of  Experts  Care  expected  prepared 3  and  problem  nine  had  been  i n Round  Once  these  responses  119  The  final  list  of Expert  Academic Pediataric Neonatologists  1 1 4  Respondents  was:  Physicians  Nurses Administration Obstetrics  3 5  14  Total  Once  a l l the  "scanned"  the  answers  results.  I t was  response,  the data  (six)  chose  scores  five  more  data  would  than  had  the  possibility  of biases  evaluation  in  respondents. the  need  serious  In  for a  as  Monitors of  the highest many  other  ratings.  them)  anticipated  in  The  here  a  is  the  result  further  of  Experts  this  round  of  and  evaluation questions,  the deal  satisfactorily  in  by  three  great  to technical inexperience  3  the  meant  due  design,  of  high  with  and  This  to provide  Delphi  level  respondents  sections  concern  these  r a t i n g s on  offered  a l l  required  been  Round  The  3  Importance  Patterns.  countered  plus  the  impact  A great  doing  be  the  by e n s u r i n g  (Option  only  available  assessed  incomplete.  only  doing  Experts  been  that  was  completing  has  and  respondents  respondents Planning  clear  were  t o use t h e Importance  Importance first  responses  with  the  but  this  through Mini might but  the  Survey indicate not  more  effects.  examining  the  ratings  returned,  i t was  noticeable  120  that  positions  had  not  In  comparing  the  of  consensus  (through  ments  and  primary  better  .divided, though  eg  arguments  made b y  expected,  cessfully with  could  now  prepare  the  The  the  second  comments  from  effects  of  consistent  the their  knowledge  Medical  had  Medical  with  other  the  been  and  Experts,  more  control, were  of  a  Policy  appeared  as  seeing  the  positions  had  was  suc-  were  now  pro-  The  this  Planners  information  then  explore  final  these  in providing  positive  and  This  also  to  i l l u -  negative  the  the  was  different  consistent  "world"  good  information  across  to  round.  them  generally provided the  initially  allowing  given  etc.  Delphi  Experts  the  was  of  as:  shift  suggestions.  "workings"  such  a  useful  comthat  after  i n the  the seen  even  and  very  i t  upon,  degree  be  i t  using  Experts  could  options.  problems  comments  categories,  of  by  experience,  peoples'  material  policy  with  1.  Round  high  Rooms,  Planning  role  the  other  professional published  to  round  from  strate  a  their  solutions with  the  a  experts  divided  that  was  infection  the  Although  "polarized"  perform  solutions  which  indicated and  agreed  Isolation  others.  operating  vided  upon  from  scores) i t  better  remained  this  there  1,  firmly  need, f o r  experts  which  Round  access;  issues  the  most  still  substantially  Importance  from  family  with  upon  high  statistics  Similarly,  been  issues  i s s u e s were  space;  changed  planners  with with  of nurseries.  121  3«5  Round 3 ;  As were It  soon  would  the  have  form  the  to  this  analyzed  and  First, items only  (ii)  as  the  Patterns with  with  Then,  assign  ing  the  to  into be  preparation  event  for  since  i t was  used  to  Round  series  to  task  the  in a  the  their  prepare  of  in  a  to  be  Experts.  major  data  2  Expert  proved  Planning  2  began.  collected  questionnaires  Sections  ratings  those  a  presented  would  Round  Patterns  assembled  of  Importance  naire,  the  to  role  was  in  quite  follows:  "Scan" with  responses  material  This  method  the  preparing  and  expected,  forward,  (i)  The  consuming  The  of  a l l the  groups.  was  study.  straight  of  circulated  time  Patterns  half  task  Patterns. and  most  than  that  be  Mini-Survey  However the  more  determined  individual  and  as  received,  was  book  Preparing the  scores  to  2  1  for  a l l scales,  No.  each  criteria  and  Rating  of  Usability  1  identify  been  or  filled  a l l i f in,  1;  answers  Rating of  had  to  from  of  from  Table  3.2.  the 1  to  question4  accord-  122  TABLE 3.2 USABILITY  CRITERIA  Description  Rating 1 (Most  RATING  . Important)  More t h a n 20% o f r e s p o n d e n t s g a v e a No. 1 s c o r e o n a l l three scales.  . W h e r e >75% o f r e s p o n d e n t s g a v e No. 1 o n t h e I m p o r t a n c e S c a l e o r No. 1 p l u s No. 2 t o t a l e d >75% o n I m p o r t a n c e . . Where a M e d i c a l E x p e r t , r e c ognized i n t h i s area, has additional supporting comments. . Where t h e P l a n n i n g E x p e r t s f e l t t h a t t h e i t e m was i m p o r tant f o r a P a t t e r n even i f the medical users d i d n o t . 2 (2nd O r d e r o f Importance)  . W h e r e >50% o f No. 1 r a t i n g s o r c o m b i n a t i o n s o f No. 1 a n d No. 2 r a t i n g s w e r e g i v e n o n the Importance S c a l e . . Where a s p e c i a l i s t ' s comments lead the Planning Experts to c o n s i d e r the item's inclusion in a Pattern f o r supporting an issue. . Where t h e P l a n n i n g E x p e r t s f e l t i t s h o u l d form a s u b issue of a Pattern.  3 (Unimportant; not use i n P a t t e r n )  for  . W h e r e a h i g h l y r a t e d i t e m was c o n s i d e r e d by P l a n n i n g E x p e r t s t o p e r t a i n more t o management t h a n t o s p a c e o r planning issues. . Where a n i t e m s c o r e d l o w o n Importance and a l l s c a l e s .  4 (Rejected)  *  . Where M e d i c a l E x p e r t s r a t e the i s s u e v e r y low e s p e c i a l l y on t h e D e s i r a b i l i t y o r Feasibility Scales.  123  (iii)  Where 1  comments  rated  answers,  validity the  (iv)  and  to  be  be  adjusted  answers  form  would  be  which  was  whole  there  was  Pattern,  but  use  following  in  Round  selected  those  Rating  and  respondent  3  answers  examined  for  which  would  Rating  of  No.  1  would  so  be  that  Good  Planners  a whole  might  review.  groupings  the  cause  respondents  this  Rated  they  judgment  to  determine  issue  and  which  topic.  could  Planners or  draw  be  data  upon  identified to  would  "explaining"  but  complete  the  supplement  lesser rated  qualifiers  from issues  within  the  produced.  from  therefore  be  by  of  insufficient  charts  issues  by  topics  the  No.  sub-issues.  aspect  sources  Pattern  result  new  with  Usability  subject  a  Where  other  a  The  required  really  issues  given  related  an  associated  would  Usability  by  could  was  used  any  "weighted".  assembled  The  for  as  were  these  ratings  The  (v)  given  summarize  Round which  2.  For  had  a l l three  results  which  illustration  f i n i s h e d with  typically  with  the  more scales  a  No.  than  1 30  rated  were  we  have  Usability percent  No.  1.  of In  124  many in  cases  User  lution dary  the  Planners  comments of  a  issues  are  shown  in  these  to  i n many  problem  as  Highly  indicated  that  unchanged  1.3.11.  4  As by  Round  most an  important  example  respondent  not  we in  were  a  plan-  No.  2  within  as  issue  issues  often  primary the  Round  issues  Pattern.  the  comments  issues by  and  1  the  voting  certain  present  in  rated  are  a  the  further  infeasible  that  Then  solve  developed  summaries  the  They  problem.  supported  rejected  Seconalthough  ways.  could  a  reso-  action  the  following  and  presented  2:  Where l e n g t h o f s t a y i s r e d u c e d , s m a l l e r nurseries adjacent to the Mothers' Room ( o r s h a r e d b e t w e e n two r o o m s ) c a n be provided f o r those mothers/babies where the s t a y i s l o n g e r .  this  case,  or  5  a l l three  implement  these  the  charts,  Secondary  incorporated  in  in  represented  not  that  presented  Pattern.  policy  3.  occasions  a  In  on  was  No.  but  i t was  made in  were  shown  really  instance,  statements  several  happen.  an  a  Important  On  statement,  such  a  summary  planning  issue  cons  useful  in various  issue  the  and  in  managerial  to  statements  not  used  improved  In  additional  not  a  cases  downgraded  Users.  3,  i f an  presented,  Finally, rated  were  just  guidelines.  these  did  issues  or  because  and  not  decide  problem  provided  was  included  used  be  which  be  often  would  data  pros  could  secondary  these  that  the  problem  these  ning  so  examined  such  an  75  percent  idea  of  scales  and  would  be  respondents the  rated  comments  dangerous.  the  said One  issue  that  to  physician  cited  an  built  and  vise  example due  to  properly,  was  an  had  to  in the  given  The  before  f o l l o w i n g manner.  ing  to  the  section  what  was  stated.  for  the  full  assigned is  to  listed  listed  percentages  to  lower  next  the  column  or  briefly  remained  column  are  a major  i n f l u e n c e on  their  used  best be  useful  basis their  fundamental  do  not  in  to  Round  a  2  the  noted for  requirement  of  the  this  most  in  this  had an  made  section.  It  why  was  Rating  often  important  methodology  The  to whether  a l l sections  reasons  due  comments  respondents in  2  Architectural  These  d e c i s i o n as  1,  chart.  Included the  are  i t is  Usability  from  was  100%  why  the  Rating  rating  this  from  Rating  Ratings  by  B,  criteria  shown on  comments  This  basic  total  given  Appendix  Importance  because  the  is  Usability  changed.  Planners'  evaluating  ratings.  the  questionnaire.  comments  to  in  accord-  Usability  final  comments  Pattern,  that  was  exhibited  summary  refer  with  not  reasons or  a  responded  being  i t  consideration  are  initial  The  they  space-related  should  chose  5)  references  from  and  the  who  unchanged  the  by  super-  Since  i s numbered  should  The  unit.  3.7,  item 2,  those  lists  Section  was  of  the  or  was  idea.  i n accordance  Where  (4  scores  either  item  reader  access  careful  to  each  evaluation.  respectively.  from  3.3  Round  followed  from  3  in  (The  resulting  or  First,  installation  control  the  Tables  used  similar  planning,  rejecting  item  next,  by  to  descriptions.)  this  a  stolen  for  charts,  the  of  were  issue  summary  where  inability  babies  important be  Denver  formed  a  respondents in its  that  a  ability  TABLE SUMMARY BRIEF DESCRIPTION AND I T E M NO.  OF RATINGS  INITIAL USABILITY RATING  3.3  FOR O B J E C T I V E S :  % RESPONDING FINAL U S A B I L - BY IMPORTANCE RATING ITY RATING 2 1 3  NEWBORN  NURSERIES  REASON FOR USABILITY RATING  USED IN PATTERN  % NO. 1 SCORES ON A L L SCALES  80%  10%  10%  .Importance Ratings  .Birth Home  1  25%  50%  25%  .Importance Ratings .Planners Comments  .Size of Well Babies' Room  <20%  1  1  60%  20%  20%  .Importance Ratings . P l a n n e r s and Users comments  .Size of Well Babies' Room  30%  B a b i e s t o spend time with parents  1  1  50%  50%  .All three scales high .High Importance  .Size of Well Babies' Room .Family Room  40%  Parents attitude to learning experience  1  1  50%  25%  .Importance Ratings . P l a n n e r s and Users comments support  .Family Room  Orienta-  1  1  1.3.1  Family tion  1.3.3  D e s i g n e r s must provide flexibility  2  1.3.4  Design i s t o a l l o w mothers' choices  1.3.5  1.3.7  25%  30%  .  30%  TABLE 3.3 - Continued SUMMARY OF RATINGS FOR OBJECTIVES: BRIEF DESCRIPTION AND I T E M NO.  INITIAL USABILITY RATING  % RESPONDING FINAL U S A B I L - BY IMPORTANCE RATING ITY RATING 2 3 1  1.3.8  Size related to Infection Control  1  1  100%  1.3.9  Application of systems approach to Design  1  3  60%  20%  20%  NEWBORN NURSERIES REASON FOR USABILITY RATING  USED IN PATTERN  % NO. 1 SCORES ON A L L SCALES  .Importance Ratings .Users Comments  .Size of Well & Sick Babies' Room  50%  .Important issue but Planners could not relate to building issues  .Not  30%  used  TABLE 3 . 4 SUMMARY OF RATINGS FOR OBJECTIVES: BRIEF DESCRIPTION AND I T E M NO.  INITIAL USABILITY RATING  FINAL USABILITY RATING  1  % RESPONDING BY IMPORTANCE RATING  I.C.N.  2  3  80%  20%  .Importance Ratings  .The Sickest Babies' Room  .Importance Ratings .Planners Comments  .Adults in the Nursery Room  .High a l l t h r e e Scales .Major P l a n n i n g Issues  .The Sickest Babies Room  .High Importances high .Users comments mostly supported .Planners felt t o be g o o d  .Family Room  <30%  <30%  The s i z e o f t h e Unit in relation to S t a f f stress  1  1.4.3  Recognition of t h e number o f s t a f f needed  •2  '1  75%  25%  1.4.4  Attention to r e s e a r c h i n the a r e a o f I.C.N.  1  1  80%  10%  1.4.7 (a)  Need f o r improved Family only Educ. facilities  1  1  25%  75%  1.4.8  P o s i t i v e need t o defuse physical environment  2  1  30%  40%  30%  .Planners felt important aspect for space  .Family Room  25%  50%  25%  .High  .Adults  space f o r to grieve  1  1  NO. 1 SCORES ON A L L SCALES  1 1.4.1  1.4.10. Need parents  %  USED IN PATTERN  REASON FOR USABILITY RATING  10%  scores  Importance  on  30%  <30%  40%  1  the Nursery  in  <30%  T A B L E 3.5 SUMMARY BRIEF DESCRIPTION AND I T E M NO.  SIZE  OF RATINGS  INITIAL USABILITY RATING  FOR F U N C T I O N S :  FINAL USABILITY RATING  NEWBORN  % RESPONDING BY IMPORTANCE RATING 1  2  3  20%  NURSERIES  %  REASON FOR USABILITY RATING  USED I N PATTERN  .Used by P l a n ners as a subissue  .Size o f Well Babies' Room  <30%  .High R a t i n g on Importance . U s e r s comments very supportive  .Size o f Well Babies' Room  <30%  NO. 1 SCORES ON A L L SCALES  2.1  UNIT  AND MIX  2.1.1  Size as a funct i o n o f nurse ratio  1  2  30%  50%  2.1.3  Nursery s t a f f must be c o v e r e d during meals  1  1  50%  50%  2.1.8  16 I n f a n t s a r e Maximum i n G r o u p  2  2  40%  20%  20%  .Used a s a d i s cussion point  .Size o f Well Babies' Room  <30%  2.2  PATTERNS  2.2.1  Mothers need choice of location  1  1  50%  30%  20%  .High rating .Users and Planners felt c r i t i c a l issue  .Size o f Well Babies' Room .Adults in the Nursery  30%  OF  CARE  TABLE 3 . 5 - Continued SUMMARY OF RATINGS FOR FUNCTIONS: BRIEF DESCRIPTION AND I T E M NO.  INITIAL USABILITY RATING  NEWBORN NURSERIES  FINAL % RESPONDING U S A B I L - BY IMPORTANCE ITY RATING RATING 1 2 3  REASON FOR USABILITY RATING  USED IN PATTERN  % NO. 1 SCORES ON A L L SCALES  <30%  2.2.3  With rooming-in n u r s e r y becomes temporary hold  1  1  60%  30%  10%  .High Importance Rating . U s e r s comments positive  .Size of Well Babies' Room  2.2.4  Parents encouraged by i n v o l v e ment i n u n i t function  1  1  70%  20%  10%  .High R a t i n g . U s e r comments positive . P l a n n e r s used  .Family Room  30%  2.2.5  Flexibility of attitudes to help parents relax  80%  20%  .High R a t i n g s on Importance .Some b a d U s e r comments b u t P l a n n e r s used  .Family Room  <30%  2.3  INFECTION ISSUES  2.3.1  Need f o r s i n k s in walking distance  1  1  90%  10%  -  .High R a t i n g s .User and P l a n ners f e l t major issue  .Size Patterns .Infection Barriers  40%  2.3.2  A d e q u a t e gown & wash a t a c c e s s  1  1  80%  10%  10%  .Major i s s u e f o r planning space  .Adults i n Nursery .Infection Barriers  50%  1  1  TABLE 3 . 5 - Continued SUMMARY OP RATINGS FOR FUNCTIONS: BRIEF DESCRIPTION AND I T E M NO.  2.3  INFECTION  2.3.3  Controlled issue  2.3.5 (b)  INITIAL USABILITY RATING  FINAL USABILITY . RATING  % RESPONDING BY IMPORTANCE RATING 1  2  3  10%  REASON FOR USABILITY RATING  USED IN PATTERN  % NO. 1 SCORES ON A L L SCALES  ISSUES 1  1  80%  10%  Parents/Siblings a n d known Infection  1  1  90%  10%  2.3.7  Separation of D i r t y and C l e a n Supplies  1  1  80%  10%  2.3.9  Enough f l o o r space/patient to reduce cross infection  1  1  90%  10%  2  1  40%  40%  2.3.10  NEWBORN NURSERIES  access  No i s o l a t i o n room - s e t a s i d e s p a c e i n open  10%  .Major i s s u e .High score  .Adults i n Nursery .Infection Barriers  40%  .High Importance Ratings .Major P l a n n i n g issue  .Visitors Place .Family Room  40%  .High Importance Ratings .Favourable Comments  .Adults i n Nursery .All size Patterns  30%  .High Importance . A l l t h e size Ratings related .User & P l a n n e r , Patterns comments good 20%  .Major d i s a g r e e ment .Planners used in discussion  . Isolation Barriers i n I.C.N.  30%  <30%  TABLE 3.5 - Continued SUMMARY OF RATINGS FOR FUNCTIONS: BRIEF DESCRIPTION AND I T E M NO.  2.3 2.3.11  INITIAL USABILITY RATING  NEWBORN NURSERIES  % RESPONDING FINAL BY IMPORTANCE USABILRATING ITY RATING 3 2 1  REASON FOR USABILITY RATING  USED I N PATTERN  % NO. 1 SCORES ON A L L SCALES  INFECTION,ISSUES Need f o r a separate i s o l a t i o n area  2  1  35%  35%  10%  .Major c o n t r o very .Used i n d i s c u s s i o n due t o U s e r comments  .Isolation Barriers i n I.C.N.  1  80%  10%  10%  .High s c o r e s on all scales . U s e r comments  .Size of Well Babies Room  <30%  2.4  STAFFING ISSUES  2.4.1  A qualified nurse with Nursery at all times occupied  1  2.4.3  Concept o f Mother/Baby/ N u r s e team  1  1  60%  20%  10%  .High Importance score . A c c e p t a n c e by Expert Users  .Family Room  <30%  2.4.4  Staff ratios of I.R.N./L.P.N, t o 4 mothers plus babies  1  1  80%  10%  10%  .High Importance . U s e r comments indicate value  .Size of Well Babies' Room  <30%  2.4.5  Combined N u r s e / Infant ratio of 2 p e r 10-12  2  1  50%  25%  25%  .Good s c o r e .Used by P l a n ers in discussion  .Size of Well Babies' Room  <30%  40%  1  TABLE 3 . 5 - Continued SUMMARY OF RATINGS FOR FUNCTIONS: BRIEF DESCRIPTION AND I T E M NO.  NEWBORN NURSERIES  % RESPONDING INITIAL . FINAL U S A B I L - BY IMPORTANCE USABILITY RATING ITY RATING RATING 2 3 1  %  REASON FOR USABILITY RATING  USED IN PATTERN  .Very h i g h s c o r e by a l l u s e r s .Basic p h i l o sophy used  .Family Room . A l l ICU Patterns  .Based on u s e r acceptance of controlled access policy  .Family Room .Adults i n the Nursery  <30%  NO. 1 SCORES ON A L L SCALES  2.5  PARENT  ACCESS  2.5.1  V i t a l f o r parents t o have a c c e s s  1  1  90%  10%  2.5.3  Various hospital policies related to degree o f parent access  1  1  50%  50%  2.5.5  Mothers encouraged i n t o t h e Nursery  1  1  70%  20%  10%  .High scores .MD's c r i t i c i s m based on routines .Good acceptance  .Family Room .Adults i n the Nursery  50%  2.5.6  F a c i l i t y needed near s t a f f f o r mother/baby interaction  1  1  70%  10%  20%  .High s c o r e , .Fundamental t o F a m i l y Room issue f o r Planners  .Family Room  40%  2.5.8  Mother involved in routines with child  1  1  100%  .High score .Users good comments  .Family Room  40%  -  50%  TABLE 3.5 - Continued SUMMARY OF RATINGS FOR FUNCTIONS: INITIAL USABILITY RATING  BRIEF DESCRIPTION AND I T E M NO.  2.5  PARENT  2.5.9  Area f o r a l l family visiting  2.6  TRAINING  2.6.1  Demonstration Room n e e d e d  2.6.2  Hospital stay an e d u c a t i o n opportunity  2.8  STAFF  2.8.1  2.8.7  NEWBORN NURSERIES  % RESPONDING FINAL U S A B I L - BY IMPORTANCE RATING ITY RATING 2 3 1  REASON FOR USABILITY RATING  USED'IN PATTERN  % NO. 1 SCORES ON A L L SCALES  ACCESS  -  <30%  .High score .Basic concept of V i s i t o r s Room  .Visitors Room  30%  .High s c o r e .User & P l a n n e r comments  .Family Room  40%  80%  20%  .High score .Basic issues for education  .Family Room  40%  1  20%  40%  .Upgraded due t o comment that s t r e s s i s due t o consumer demands  .Staff Retreat  1  100%  .High s c o r e on all scales  .All size related problems  1  1  90%  10%  1  1  70%  1  1  S t r e s s i s minimal in t h i s area  2  Ability to contact right person i n emergency  1  ISSUES  as  ISSUES 10%  <30%  40%  TABLE 3.5 - Continued SUMMARY OF RATINGS FOR FUNCTIONS: BRIEF DESCRIPTION AND I T E M NO.  INITIAL USABILITY RATING  NEWBORN NURSERIES  % RESPONDING FINAL U S A B I L - BY IMPORTANCE ITY RATING RATING 2 1 3  REASON FOR USABILITY - RATING  2.8  STAFF  2.8.8  Cheerful colours t o be u s e d  1  1  60%  40%  2.8.9  Need f o r s t a f f p r i v a c y and c o u n s e l l i n g area  1  1  80%  20%  2.9  SUPPLY  2.9.1  Mobile infant with supplies  2  1  35%  35%  .15%  2.9.2  No s u p p l i e s shared—each bassinette isolated  1  1  50%  30%  ' 20% .High score .Planners felt good concept  2.9.5  Storage o f clean and dirty separate  1  1  100%  USED IN PATTERN  % NO. 1 SCORES ON A L L SCALES  ISSUES  -  .High scores .Planners & Users b a s i c need f o r t h i s in planning  .Warm colours  .High scores .Basis of Staff Retreat  .Staff Retreat  .Planners felt good concept  .All area Patterns .Adults i n Nursery  50%  METHODS  .Basic concept in a l l areas  <30%  .Size of Sick Babies' Room  30%  .Isolation Barriers  60%  TABLE 3 . 5 - Continued SUMMARY OF RATINGS FOR FUNCTIONS: B R I E F DESCRIPTION AND IT-EM NO.  INITIAL USABILITY RATING  NEWBORN NURSERIES  FINAL % RESPONDING U S A B I L - BY IMPORTANCE ITY RATING RATING 2 1 3  REASON FOR USABILITY RATING  USED I N PATTERN  % NO. 1 SCORES ON A L L SCALES  2.9  SUPPLY  2.9.6  Capacity to get dirty supplies out without entry to unit  1  1  90%  10%  —  .High s c o r e s .Planners felt good concept  .Adults in Nursery  40%  2.9.11  Storage f o r commonly used e q u i p m e n t and a c c e s s f o r X-Ray and L a b .  1  1  60%  30%  10%  .High s c o r e .Good supply issue concept  .All size related Patterns  30%  1  1  80%  20%  —  .High score .Comments generally favour  .All size Patterns  40%  2.10  VISUAL  2.10.8  METHODS  SUPERVISION  Infants should be v i s i b l e a t a l l times from nursing centre  TABLE 3.6 SUMMARY OF RATINGS FOR FUNCTIONS: BRIEF DESCRIPTION AND I T E M NO.  2.11  PATIENT  2.11.1  2.12  2.12.3  2.13  % RESPONDING FINAL U S A B I L - BY IMPORTANCE ITY RATING RATING 2 3 1 -  %  REASON FOR USABILITY RATING  USED IN PATTERN  . C o n f i r m e d by literature  .Size of the Sicker Babies Room  30%  NO. 1 SCORES ON A L L SCALES  MIX  One a n d o n e h a l f spaces per 1,000 d e l i v e r i e s or 3 per high referral  PATTERN  INITIAL USABILITY RATING  I.C.N.  OF  1  1  60%  20%  20%  1  CARE  Encouragement of parent p a r t i c i p a tion through a c c e s s t o ICN and staff  1  1  80%  20%  -  . H i g h s c o r e s on all scales .Major f a c t o r i n p l a n n i n g and philosophy  .Adults i n Nursery  30%  1  1  20%  60%  20%  .Major i s s u e not resolved but argument weighe d t o w a r d no isolation  . Infection Barriers i n ICN  <30%  INFECTION ISSUES  2.13.1  No i s o l a t i o n a r e a n e e d e d due to incubators and a i r s y s t e m s  TABLE 3.6 - Continued SUMMARY OF RATINGS FOR FUNCTIONS: BRIEF DESCRIPTION AND I T E M NO.  2.13  INITIAL USABILITY RATING  % RESPONDING FINAL U S A B I L - BY IMPORTANCE ITY RATING RATING 1 2 3  I.C.N. REASON FOR USABILITY RATING  USED IN PATTERN  % NO. 1 SCORES ON A L L SCALES  INFECTION ISSUES  2.13.2  Provision of discrete isolat i o n room necessary  2  1  10%  15%  20%  . T i e d as an issue with 2.13.1 t h e r e f o r e mode 1 r a t i n g as a sub-issue .Basically r e j e c t e d by most U s e r s  .Infection Barriers i n ICN  <30%  2.13.3  Space around i n fant to create g e o g r a p h i c and pyschological barriers  1  1  60%  30%  10%  .Basic issue i n size patterns and infection control  .Size of Sickest Babies Room .Infection Barriers i n ICN  30%  Space t o p r o v i d e clearing of s u r f a c e s and enclosures  1  .High s c o r e s .Comments o f l o w scores descript i v e so P l a n ers used .Basic space & control issue  .Size of Sickest Babies' Room .Infection Barriers i n ICN .Adults i n Nursery  40%  2.13.4  1  70%  10%  20%  1  TABLE 3.6 - Continued SUMMARY OF RATINGS FOR FUNCTIONS: INITIAL USABILITY RATING  BRIEF DESCRIPTION AND I T E M NO.  ..... 2.13  ^ .., , ,  .......  I.C.N.  % RESPONDING FINAL U S A B I L - BY IMPORTANCE RATING ITY RATING 2 1 3  REASON FOR USABILITY RATING  USED IN PATTERN  % NO. 1 SCORES ON A L L SCALES  .  INFECTION ISSUES  2.13.5  Need f o r l a r g e scrub unit at . Nursery.entrance  2  1  55%  15%  15%  .Ratings margina l but major planning issueso r e q u i r e d an upgrade  .Adults i n Nursery  30%  2.13.6  Need f o r gowning and s c r u b b i n g a t entrance.  1  1  70%  20%  10%  .Same i s s u e s a s 2.13.5 b u t higher scores .Some MD users doubt need f o r gowning  .Adult i n Nursery .Family Room  40%  2.13.7  N e e d f o r many scrub facilities in Nursery out of t r a f f i c i n close proximity  1  1  80%  20%  .Very important issue with large consensus .Used as m a j o r space issue  .All size. Patterns .Adults i n Nursery  '60%  1  1  80%  20%  .High s c o r e s .Critical basic issue effecting space .High degree of consensus  .All size Patterns .Infection Barriers i n I.C.N. .Adults i n Nursery  60%  2.13.8  A i r handling systems used avoid cross infection  to  TABLE 3.6 - Continued SUMMARY OF RATINGS FOR FUNCTIONS: BRIEF DESCRIPTION AND I T E M NO.  2.13  % RESPONDING FINAL U S A B I L - BY IMPORTANCE ITY RATING RATING 1 2 3  REASON FOR USABILITY RATING  USED IN PATTERN  % NO. 1 SCORES ON A L L SCALES  INFECTION ISSUES  2.13.9  2.15  INITIAL USABILITY RATING  I.C.N.  T h e r e s h o u l d be non-shared s u p p l i e s a t each bassinette  PARENT  1  1 .  80%  20%  -  10%  .High s c o r e s .Critical basic issue effecting space .High degree of consensus  .All size Patterns .Infection Barriers .Adults i n Nursery  60%  .High s c o r e s .Basic parent issue  .Infection Barriers .Adults i n Nursery  50%  ACCESS  2.15.1  V i s i t i n g to c h i l d s h o u l d be • u n l i m i t e d except for staff routine needs  1  1  80%  10%  2.15.2  S p a c e t o be provided for family access for bonding  1  1  80%  20%  .High s c o r e s .Some U s e r s h a d d o u b t s on f e a sibility in I.C.N. . P l a n n e r s used in p r i n c i p l e  .Family Room .Adults in Nursery  30%  2.15.3  Encouragement for sibling involvement  1  1  80%  20%  .High .Good  .Family Room  30%  scores Sub-issue  TABLE 3.6 - Continued SUMMARY OF RATINGS FOR FUNCTIONS: BRIEF DESCRIPTION AND I T E M NO.  2.15  PARENT  INITIAL USABILITY RATING  % RESPONDING FINAL U S A B I L - BY IMPORTANCE RATING ITY RATING 2 3 1  (b)  REASON FOR USABILITY RATING  USED IN PATTERN  % NO. 1 SCORES ON A L L SCALES  ACCESS  2.15.4 (a)  I.C.N.  P a r e n t s t o be i n formed i n d e t a i l Parents taught infection techniques  OF  1  1  90%  -  .Good i s s u e s a s sub-issues in Pattern .Some M D s n o t b e e n on t o o much information . A l l a g r e e d on learning techniques  .Adults in Nursery  40%  10%  .High score • M a j o r i s s u e as use p r e f e r e n c e  .Locating the I.C.N.  40%  10%  .High s c o r e s .Some u s e r s d i s agreed with which s e r v i c e s were needed .Fundamental issue  .Locating the I.C.N.  30%  10%  1  2.17  LOCATION  ICN  2.17.1  Locate firstly n e a r l a b o u r and delivery  1  1  70%  2.17.2  Easy a c c e s s f o r Diagnostic services  1  1  90%  20%  TABLE 3.6 - Continued SUMMARY OF RATINGS FOR FUNCTIONS: BRIEF DESCRIPTION AND I T E M NO.  2.18  STAFF  2.18.1  2.18.3  2.18.5  2.19  FINAL USABILITY RATING  % RESPONDING BY IMPORTANCE RATING 1  2  3  90%  10%  -  1  USED IN PATTERN  % NO. 1 SCORES ON A L L SCALES  .Major consensus .Basic issue f o r size Patterns  .Size of Sickest Babies Room  30%  10%  .High agreement .Some f e l t i t m i g h t be h a r d to achieve . P l a n n e r s made solution recommendations  .Staff Retreat  30%  10%  10%  .High s c o r e . B a s i c need a g r e e d by a l l  .Adults in Nursery  40%  50%  -  .High s c o r e .Consensus of u s e r s meant basic planning requirement  1  Private space f o r s t a f f away from noise of machines  1  1  8 0 % • 10%  1  1  80%  1  1  50%  Space  REASON FOR USABILITY RATING  STRESS  Primary help i n space i n the Nursery  SUPPLY  2.19.1  &  INITIAL USABILITY RATING  I.C.N.  adjacent  1  METHODS  Supplies to ICN f r o m c e n t r a l stores not another unit  s  <30%  TABLE 3.6 - Continued SUMMARY OF RATINGS FOR FUNCTIONS: BRIEF DESCRIPTION AND I T E M NO.  2.19  SUPPLY  2.19.2  2.19.4  2.20  INITIAL USABILITY RATING  % RESPONDING FINAL U S A B I L - BY IMPORTANCE RATING ITY RATING 2 3 1  I.C.N. REASON FOR USABILITY RATING  USED I N PATTERN  % NO. 1 SCORES ON A L L SCALES  METHODS 70%  1  Two s o u r c e s o f supply i n Unit: C e n t r a l w i t h 24 hour supply, remainder at incubator  1  Dirty storage physically separate removed without unit entry  1  1  .  20%  80%  20%  10%  .High s c o r e s .Fundamental issue f o r supply planning  .Size of Sickest Babies Room  40%  .High score .Fundamental infection issue  .Adults i n Nursery  50%  .High score . B a s i c space planning issue  .Size of Sickest Babies' Room  30%  .High score .Basic space planning issue  .Size of Sickest Babies' Room  40%  1  VISUAL SUPERVISION /LOCATION  2.20.1  B a b i e s s h o u l d be l o c a t e d so that adjacent nurse can s u p e r v i s e i n breaks  1  1  . 80%  20%  -  2.20.2  Due t o h i g h staff ratio, supervision at bedside not station  1  1  80%  10%  10%  TABLE 3.6 - Continued SUMMARY OF RATINGS FOR FUNCTIONS: BRIEF DESCRIPTION AND I T E M NO.  2.20  VISUAL  2.20.3  INITIAL USABILITY RATING  F I N A L ' % RESPONDING U S A B I L - BY IMPORTANCE RATING ITY RATING 2 3 1  I.C.N. REASON FOR USABILITY RATING  USED IN PATTERN  % NO. 1 SCORES ON A L L SCALES  SUPERVISION  Need f o r c e n t r a l communication base as a s t a t i o n  1  1  60%  40%  -  .High score .Good p l a n n i n g issue  .Adults i n Nursery  <30%  TABLE 3.7 SUMMARY OF RATINGS FOR SPACES: BRIEF DESCRIPTION AND I T E M NO.  INITIAL USABILITY RATING  VALID FINAL U S A B I L - COMPOITY NENT RATING  NEWBORN NURSERIES AND I.C.U.S REASON FOR USABILITY RATING  PARTLY VALID COMPONENT  USED IN PATTERN  i  3.1  NEWBORN  NURSERIES  3.1.1  S t a f f i n g and Workflow Diagram I  2  2  25%  75%  .High degree o f consensus .Good comment s  . B i r t h Home .Size of Well Babies' Unit  3.1.3  I s o l a t i o n Rooms and American Academy o f Pediatrics  1  1  75%  25%  .Very v a l u a b l e comments a b o u t the i s s u e used as b a s i s o f Infection Pattern  .Infection Barriers in I.C.N.  3.1.5  S p a c i n g f o r Term or Minimal Care Nurseries  1  1  50%  50%  . D i s c u s s i o n on comments rejected - p r e s e n t standards . B a s i c i s s u e s on s i z e s used  .Size of Well Babies' Room  S p e c i a l Care Unit Intermediate Care Sizes  1  1  25%  75%  .Excellent comments were b a s i s f o r many issues i n the Patterns  .All size Patterns .Heights of Service Outlets .Adults i n the Nursery  ,3.1.6  Ul  TABLE 3.7 - Continued SUMMARY OF RATINGS FOR SPACES: BRIEF DESCRIPTION AND I T E M NO.  3.1  NEWBORN  INITIAL USABILITY RATING  FINAL VALID U S A B I L - COMPOITY NENT RATING  NEWBORN NURSERIES AND I.C.U.S PARTLY VALID COMPONENT  REASON FOR USABILITY RATING  USED I N PATTERN  NURSERIES  3.1.7  Maximal Care Space s u g g e s t i o n s  1  1  No Vote Needed  No Vote Needed  . U s e r comments rejecting current s t a n d a r d s were used i n space Patterns  .Size of Sickest B a b i e s ' Room .Adults i n the Nursery  3.1.8  Where t h e requirements of the American A c a d e m y c a n ' t be met  1  1  No Vote Needed  No Vote Needed  .Excellent comments u s e d .Basis of Infection Barriers Patterns  .Infection Barriers in I.C.N.  3.2  NEONATAL  I.C.U.  3.2.2  An I.C.N. operating in i t s own e n v i r o n m e n t  1  1  40%  60%  .Further discussions clarified locational issues  .Locating the Intensive Care Nursery  3.2.3  S p a c i n g around Bassinettes/ Incubators  1  1  60%  40%  .Basis o f space issues - user comments u s e f u l  .Size of Sickest B a b i e s ' Room  TABLE 3.7 - Continued SUMMARY OF RATINGS FOR SPACES: BRIEF DESCRIPTION AND I T E M NO.  INITIAL USABILITY RATING  VALID FINAL U S A B I L - COMPONENT ITY RATING  3.3  MECHANICAL CONSIDERATIONS  3.3.1  Heating, V e n t i l a t i n g and _A i r Conditioning  1  1  No Vote  3.3.2  Plumbing related t o numbers o f sinks  1  1  100%  3.3.3  Gas O u t l e t numbers  1  1  75%  & 3.3.4  Heights Outlets  o f Gas  NEWBORN NURSERIES AND I.C.U.S PARTLY VALID COMPONENT  No Vote  25%  REASON FOR USABILITY RATING  USED I N PATTERN  .Comments u s e d i n service consensus .Basic of related Patterns  .All size . Patterns .Heights of Service Outlets .Babies i n the Sun  . B a s i c i s s u e used in a l l size Patterns .Fundamental t o space needs  .All size Patterns .Heights o f Service Outlets .Adults i n the Nursery  .Basic to a l l size Patterns .Used i n c l u s t e r module patterns .Fundamental t o Heights of outlets pattern  .All size Patterns .Height of Service Outlets .Adults i n the Nursery  TABLE 3.7 - Continued SUMMARY OF RATINGS FOR SPACES: BRIEF DESCRIPTION AND I T E M NO.  INITIAL USABILITY RATING  VALID FINAL U S A B I L - COMPOITY NENT RATING  3.4  ELECTRICAL CONSIDERATIONS  3.4.2  Heights of Electrical Outlets  1  1  —  3.4.3  Performance Requirements f o r Illumination  1  1  60%  NEWBORN NURSERIES AND I.C.U.S PARTLY VALID COMPONENT  100%  40%  REASON FOR USABILITY RATING  USED IN PATTERN  . D i s c u s s i o n and comments u s e d as b a s i s o f Heights Pattern  .Heights of Service Outlets  .All disagreements were on the b a s i s o f maintaining 100-120 f t . candles .Used a s a s u b issue  .Babies i n the Sun •Warm c o l o u r s  149  to  cause  hold  the  when  respondents  making  successful  in  the  (and  choice  comments  their  that the  displayed  to  "display"  policy  the  choices.  This  while  the  ratings  degree  of  conviction  a  great  deal  of  shows  the  values  that  proved  themselves in that  they to  be  indicated  choice)  the  about  the  "knowledge"  choice.  The  second  Patterns  in  column less) ing  was  format  the  those  no  issue  scores  primary  inclusion of  column  the  a  1  30  mechanism  data  A  for  instead  an  of  one  or  more  Finally,  the  last  percent  (more  ratings, since  Pattern.  summarized but  used.  No.  sorting in  ratings,  was  title  receiving  a l l respondents'  a  issue's  were  which  lists from  last  for  change  this  scor-  determining was  or  made  an  to  Category  3,  since  indication  of  validity  the  there of  comments.  Once location  a l l for  assembled. given  by  actual style. at  the This  the  This  the  assembled  data Pattern  been  was  assembling  and  style  was  usability  identified, required  Experts  format  of  used  in  the  the  building  the  Pattern early  and  Patterns  taking  and  the  rated  a  were  o f ..an  item  theme.  followed  Patterns  the  The a  set  developed  California.  following to  had  Medical  wording  Berkeley,  In  the  show  example,  the  type  a of  typical  Pattern  information  used  has in  been its  150  creation.  I t must  influence  from  "extend"  the  entirely  the  required  to  Table  phrases  resolve  3.8  which  correspond  on  items  3.3  detailed to  3.7.  Diagram, from  to  the  the  ment .  (  the  that  is a considerable  have  solution  full a  on  been  the  used  first  understanding  item  set  of  The indicate  to  numbers those  which  most  descriptions item  paragraphs  responses  table,  there  of  to  page what  is is  problems.  q u e s t i o n n a i r e and  fully  the  the  Experts'  the  shows  that  comments  and  Planning  2  Tables  realized  numerous  Round  The  be  numbers  outlined  these in  items  the  numbers  taken in  be  outlined  their  seen  3.2. in  paragraphs  bracketed  influenced  brackets  i n Diagram can  from  against develop-  151  TABLE 3 . 8 PARAGRAPHS USED IN FAMILY ROOM 1.3.7 [1]  1.4.7 [2]  1.4.8 [3]  2.2.4 [4]  2.2.5 [5]  2.3.5 [6]  Need t o develop an attitude in patients so as t o c o n s i d e r the time i n the h o s p i t a l as a time of l e a r n i n g (more s a t i s f a c t o r y and complete parent education).  2.4.3  There must be improved f a c i l i t i e s f o r education and p r e p a r a t i o n of the f a m i l y p r i o r to d i s charge - parent education programs.  2.5.1  [7]  [8]  2.5.3 [9]  There must be a p o s i t i v e attempt to defuse the i n t e n s i t y o f the p h y s i c a l e n v i r o n ment as the i n f a n t moves nearer to d i s charge . In order to encourage parent involvement t h i s can be accomp l i s h e d through group p a r t i c i p a t i o n and t e a c h i n g so the nursery and post-partum ward f u n c t i o n s as a uni t . F l e x i b i l i t y of s t a f f ing and a t t i t u d e s so t h a t mother and f a ther can r e l a x and enjoy the event of the new baby. Parents and/or s i b l i n g s with symptoms of an i n f e c t i o n should not enter nursery.  2.5.5 [10] 2.5i6 [11]  The concept of a mother/baby/nurse team i s used whereby one nurse looks a f t e r the total care of a mother and baby including her education. It is vital for parents t o have access to newborns to f a c i l itate the bonding process. Hospital policy varies as f o l l o w s : - some h o s p i t a l s do not a l l o w parents t o enter the nursery - o t h e r s encourage mothers to demand and encourage them to relate closely to nursery s t a f f i n the nursery but prevent mothers from e n t e r ing nursery - o t h e r s a l l o w mothers f r e e access to nursery - others allow controlled access to nursery. Mothers should be allowed and encouraged i n t o the nursery. F a c i l i t y i s needed f o r mothers who choose to stay i n the nursery near s u p e r v i s i o n and support to enable observation of parent/baby interaction, plus teaching needed.  2.5.8 [12]  2.6.1 [13]  2.6.2 [14]  2.13.6 [15]  2.15.2 [16]  Where p o s s i b l e , t h e m o t h e r s h o u l d be i n v o l v e d i n normal nursing routines of her infant. Demonstration/confere n c e room i s needed f o r t r a i n i n g and e d u cating nurses, pare n t s and m e d i c a l staff. The h o s p i t a l s t a y i s a teaching opportunit y and p e r s o n n e l s h o u l d be d e s i g n a t e d to a s s i s t parents. T h e r e must be gowning f a c i l i t i e s a t the entrance f o r s t a f f and p a r e n t s . Even t h o u g h t h e r e i s no i n d i c a t i o n t h a t gowning decreases infect i o n i tr e i n f o r c e s other techniques. The p o l i c y o f t h e unit should actively encourage involvement by p a r e n t s t o f a c i l itate parent/infant b o n d i n g and p h y s i c a l s p a c e s h o u l d be p r o vided f o r private access to the c h i l d for breast feeding, education, e t c .  2.15.3 Where t h e r e a r e s i b lings involved, [17] encouragement should be g i v e n b y s t a f f t o i n v o l v e t h e "whole family' although p h y s i c a l a c c e s s may n o t be p o s s i b l e .  2.  Family Room ...continued  Family  Room  JUST AS A FAMILY ROOH AT HOME IS A PLACE WHERE THE FAMILY ARE TOGETHER DOING ACTIVITIES OF INTEREST AND LEARNING SO DOES THE HOSPITAL NEED A FAMILY SPACE.  1 1+  S i n c e a m o t h e r and h e r c h i l d are r e q u i r e d to s t a y in h o s p i t a l f o r some d a y s , an o p p o r t u n i t y e x i s t s t o use t h e v i s i t as a l e a r n i n g exper ience.  THEREFORE: IN ORDER TO ALLOW MOTHERS OR BOTH PARENTS THE CHOICE OF UTILIZING THE HOSPITAL STAY TO LEARN CHILD OR FAMILY CARE, A SPACE MUST BE PROVIDED IN CLOSE PROXIMITY TO THE STAFF ACTIVITY IN THE NURSERY WHICH HAS:  II  13  3 7 14-  OPPORTUNITY TO BE IN DIRECT CONTACT WITH STAFF WHO ARE WORKING IN THE NURSERY TO ASK ADVICE OR ASSISTANCE WITHOUT HAVING TO DISTURB ROUTINE NURSERY CARE. PROVISION TO WORK IN A CLEAN ENVIRONMENT BY MAKING IT A PHYSICALLY SEPARATE SPACE AND YET STILL HAVING ACCESS TO STAFF BY ENSURING NORMAL BARRIER TECHNIQUES (E.G., HAND WASHING). AN EASY TRAFFIC FLOW FOR MOTHERS AT ANY TIME FROM THE NON PUBLIC POSTPARTUM AREAS. THE ABILITY TO BE FLEXIBLE AND DIVIDABLE THROUGH SCREENING AND BY ARRANGING FURNITURE TO ALLOW MOTHERS TO HAVE HELP WITH BREAST FEEDING AS WELL AS ALLOWING OTHERS TO HAVE GROUP EVENTS. 5.  AN ATMOSPHERE OF EXCHANGE.  FRIENDLY  lo 1+  7 HI  12  We know that the involvement o f s t a f f i s important to ensure the education process o c c u r s . | With the general l i m i t s on the number of s t a f f a v a i l a b l e t h i s learning experience must occur where the presence of s t a f f i s r e q u i r e d most of the time. If t h i s access does not occur there w i l l be i n s u f f i c i e n t s t a f f t o provide t o t a l mother and c h i l d care i n c l u d i n g education. Nursing s t a f f and medical s t a f f t r a d i t i o n a l l y find t h e i r mother and c h i l d care time concentrated in two a r e a s ; a t the bedside and l n the nursery.[ Since the i n f o r m a t i o n a mother r e c e i v e s at the bedside i s u s u a l l y personal, individually p r o v i d e d (one to one) and can be r e a d i l y given with any h o s p i t a l stay, i t i s more important t o deal with the less available opportunity. T h i s i s t o exchange i n f o r m a t i o n and draw upon l i m i t e d s t a f f resources while i n the nursery areas; an o p p o r t u n i t y that should be maximized.j Regardless of whether mothers Room-In or not, a f a c i l i t y must be provided f o r mothers t o stay near s u p e r v i s i o n . Here they get support t o achieve t h e i r parent/baby i n t e r a c t i o n or l e a r n from the nurses p r i m a r i l y occupied in the nursery. Numerous babies have low r e s i s t a n c e to i n f e c t i o n , so i n f e c t i o n becomes a s p e c i a l problem when c o n s i d e r i n g mothers having access to the n u r s e r y . | Because ot the need t o be with the n u r s i n g s t a f f ,  s p e c i a l p r o v i s i o n should be through a t r a n s i t i o n space 3 e i t h e r w i t h i n the normal 15 nursery or j u s t o u t s i d e the n u r s e r y . | I t could be argued that a mother 's p h y s i c a l c o n d i t i o n i s known by s t a f f t h e r e f o r e po s i b l e r i s k of 10 i n f e c t i o n can be minimized. However, access to the baby, in the presence of other babies with s u p e r v i s i o n by 3 s t a f f w i l l a l s o want to be 8 a v a i l a b l e t o the f a t h e r (or s u p p o r t i n g r e l a t i v e ) whose 17 i n f e c t i o n r i s k i s unknown. P r o v i s i o n must be made f o r hand washing or gowning or other b a r r i e r techniques f o r these known " o t h e r s " to e n t e r t h i s zone. I t should occur with ease and not intimidation. T h i s space becomes a meeting space. A space to share learning experiences. A p l a c e f o r m u l t i - p a r a mothers to share ideas with f i r s t time mothers.1 An o p p o r t u n i t y f o r group demonstrations by '3 the s t a f f , o f c h i l d c a r e |4techniques with mothers j£ having a c c e s s to t h e i r b a b i e s to p a r t i c i p a t e . ! I t becomes the p a r e n t s f a m i l y room where £ there can be an exchange of i n f o r m a t i o n and enjoyment. '( CONTEXT T h i s space i s not the same as Mothers Exchange. T h i s i s a work area t h a t has a c c e s s f o r other members of the f a m i l y . It i s f o r i n d i v i d u a l f a m i l i e s to be t o g e t h e r not a group of mothers. Mothers Exchange i s part of the bedroom, p r i v a c y zone, Family Room i s p a r t of the a c t i v i t y zone.  Ln CO  154  The written of  Patterns  have  t o evoke  an a p p r o p r i a t e  the heading.  "every  expressive  man's"  response  idea  of  the  subject  title  on f i r s t  Place,  Infection  such  Babies'  Sun, o r a more p r e c i s e t i t l e  Visitors'  Each  I t e i t h e r suggested a whimsical,  Exchange, The S i z e o f the Well the  titles.  reading emotive,  as;  Mother's  Room, and Babies i n  such a s ; The B i r t h  Barriers  was  in  Intensive  Home, Care  N u r s e r i e s and Heights o f Service O u t l e t s , which were i n t e n d ed to evoke more pragmatic a t t i t u d e .  The  title  evoker, s i n c e written tern. only  i s intended  the  i s necessary  so t h a t  having  need be used  People could  P a t t e r n -and could  build  than  a  thought It i s  an image of what i s i n c l u d e d i n the P a t -  the t o p i c i t s e l f  Language.  more  i t i s a l s o a d e f i n i t i o n o f the t o p i c .  t o provide This  to be  easily begin  read  the P a t t e r n ,  i n c r e a t i n g the P a t t e r n  remember what i s implied i n using  i t to create  upon the ideas and, more i m p o r t a n t l y ,  ideas encompassed by the P a t t e r n .  linkages,  t o evaluate the  To t e s t t h i s concept, one  has  o n l y t o t h i n k o f s i m i l a r t o p i c s which evoke images t h a t  can  be developed  as P a t t e r n s  F l o o r F i n i s h e s and Texture  Immediately which  provides  under  eg Continuous Benchwork, Soft  on W a l l s .  the t i t l e  a context  i s a succinct  f o r the data  statement  following.  It i s  155  often  written  resolved  as a statement  within  Barriers  the pattern  i n Intensive  "Designing  Spaces  Fundamental." in  expounding  t o Help  In t h i s  the Pattern  infection.  Care  o f t h e dilemma  some  Infection  Nurseries  statement  c a s e , we c o u l d  truth  e.g. i n the Pattern  "Mothers  Need  Removed f r o m H o s p i t a l expect that  to find  Once tion  space  i s written  specific cases,  needed  starting  statement  detailed  description  provides  to deal  with  Exchange  and Share  of we  the find  Experiences y o u would  and how t o e n s u r e  the s o l u -  on t h e f r o n t page.  The s o l u -  statement,  t o be c a r r i e d  with  within  i t , without reading  requireROOM  SPACE FOR ....".  The  PROVIDE  a  summary  o f the  o f the Pattern  The r e s u l t when  i t becomes p o s s i b l e  a l l  A  cases,  t h e body  It i s , i n  oriented  "THEREFORE:  i s , i n many  d e s c r i b i n g the  out.  action  WHEN PROVIDING  more r a t i o n a l e .  i s that  i s the basis  i s provided,  of positive,  o r "THEREFORE:  t o s e t a c o n t e x t by  belief  statement  positive  usually  solution  page  a  a collection  ments "  steps  t o reduce  In t h i s P a t t e r n ,  for this  i s placed  as  t o be i n f o r m e d  i s provided.  the contextual  t o the problem  tion  Routines."  Infection i s  spaces  Mothers'  to Socialize  the reason  appropriate  that  a  of  expect  statements a r e w r i t t e n  Space  have  can design  Pattern,  a  we  the Reduction  fundamental  would be  e.g. i n the Pattern  a s t o how we  Other  that  to grasp  reading  the f i r s t  the issue  deeper w i t h i n  which  and how  the Pattern.  156  To tion  complete  is  being  picture  used  resents  the  Typically are  stated.  to  where  being  both  the  ments,  some  methods  tried  more  to  keep  sible.  of,  support ular  the  This  groupings lists  detailed  e.g. and  the  areas.  Pattern  common.  The  was  valid another  that to  The the  causes  approach  of  the  This some  are  to  to  the  one been  in  As  often  state-  references  the  within  spaces  activities  and  not  Pattern  larger  If,  are  more  for  postopic the  numerous  this  partic-  adults  in  related  to  This  It might  into  We  covered  have  babies.  exist.  prob-  where  for, describing  the  for  solution.  which  grouping  taken.  social  pages  of  Nursery,  to  where  factual  the  three  some  i s that  spaces  about  or  that  adults  spaces  some d e s c r i p t i o n s o f  used  this  of  used.  literature  two  the  are  rep-  described.  photograph.  consists of  information  thread of  which  a  f r o n t page, more d e t a i l e d  also  concept  this had  is a  of  either  being  used  illustration  and  in  key  common  break  of  explanations  f u n c t i o n a l needs  essence  there  impossible  Adults  diagram  and  is  essence  of  diagram  Patterns  became  simple  illustra-  the  form  relationship  i s placed.  There  the  an  zoning  space  rationale  describes in  a  Pattern,  relationships or  involved  statements. and  or  the  a  remaining  material  lems  of  the  is  mood  spatial  are  Pattern  these  the  of  which  This  described,  possible  On  set  essence  relationships  the  f r o n t page  i s appropriately placed,  what  as  the  is  have  Patterns  example,  we  the been i f had  157  focussed would  on  have  related and  Materials caused  to Clean  Pharmacy  Patterns  In  the  principle,  creation  Supply,  Activities  f o r these  the  Distribution  deal  Holding  which  would  sense, with  within  a  problem  must  broken  down  cases,  this  holds  for this  aspect  cases,  Patterns  describe  done.  can simply  a  larger  been  when  or  Once developed Pattern  the  with  progressively terns.  special  Language  separate  of  toward  Simplistically  include than  this  i s shown  and a  reso-  In  other which  cases  needs  the  t o be  one  might  initially  Patterns  Patterns  the p a r t i c u l a r  In  within  had t o be d e v e l o p e d . issue  a  Pat-  purists.  nursery-oriented  the larger  that  time.  In t h e s e  a p p l i c a t i o n to the Nursery  itself  indi-  environment  something  "atoms"  by P a t t e r n  exist  the  a n d why to  each  described.  in  physics  suggest  degree  be  the  the smallest  conflicts  to  possible  prudent  for direct  starting  what  like  I t would  issues  collection  thought  issues Clerical  created  Pattern  to this  needs  state  It i s therefore  tern,  by  have  r e s o l u t i o n but are not problematic.  Pattern  have  the  design.  true  lution  need  topic  and Washing,  t h e "atom"  problem  most  separate  Dirt  visible  be  of  thread, i t  topics.  "purest" must  a s t h e common  or  had  design,  This  been the  was  done  and l i n k i n g  them  specific  i n Diagram  issue 3.3.  Pat-  158  DIAGRAM  1ST S T A G E  NEWBORN N U R S E R I E S  1)  Large  VISITORS'  Specific STAFF RETREAT  3)  Very  were  sal" in  T H E S I Z E OF OF T H E S I C K B A B I E S ' ROOM  Issues H E I G H T OF S E R V I C E OUTLETS  general  t o complete  added.  This  that  print.  grouping,  the ideas  rearrangement  taken  from  other  within  the additional  so therefore  bold  MOTHERS' EXCHANGE  T H E S I Z E OF T H E WELL BABIES' ROOM  ADULTS IN THE NURSERY  this  Note  HOME  Issues  BABIES IN T H E SUN  needed  BIRTH  FAMILY ROOM  Specific  To  GROUPINGS  Issues THE  2)  3.3  Patterns  each  i s shown  Patterns,  Alexander's  that  general  were  grouping  i n D i a g r a m 3.4.  which  are  Patterns,  "Univer-  a r e shown  159  DIAGRAM 3.4 NEWBORN NURSERIES 2ND STAGE GROUPINGS  1)  Large  Issues  RECEPTION NODES  FRIENDLY INFORMATION  ENTRANCE TRANSITION VISITORS' PLACE  2)  Specific  THE BIRTH FAMILY ROOM  MOTHERS' EXCHANGE  Issues  WARM COLORS  SHORT PASSAGES  NO WALLS UNUSED STAFF  HOME  POOLS OF LIGHT  ADULTS I N THE NURSERY  RETREAT  T H E S I Z E OF T H E WELL B A B I E S ' ROOM  T H E S I Z E OF T H E S I C K B A B I E S ' ROOM  3)  Very  Specific  Issues  LIGHT ON TWO SIDES OF EVERY ROOM WORKSPACE ENCLOSURE  H E I G H T OF SERVICE OUTLETS  WINDOWS OVERLOOKING LIFE  ADJUSTABLE LIGHT QUALITY WINDOW HEIGHT IN MEETING ROOMS  FILES AT HAND BABIES  I N T H E SUN  160  The to  final  each  Pattern  arrows  where  Pattern  such  determination  THE  SIZE  the  WELL  of  factor  TRANSITION  hospital  and then  because ing to  find  linking a rather  clear  was  a  leads Issue  a to  like  the issues o f OF T H E  simple  deal  f o r them  process  a  so that  The l o g i c  this  the  en-  kind of  i n t h i s way.  of  tasks  was r e q u i r e d .  Hav-  diagram  the least  used  there  needed  number o f  i n Appendix  assumes  then  in  before  series  the actual  technique  appropriate,  to link  ad-  ahead o f  received  with  became  (See Diagram  logic.  are truly  times  sorting  arriving  NODES  are first  Patterns  sorting  several  the recognition  way t o t h e n u r s e r y  connections,  crossed.  planning  nections  their  complex  was  RECEPTION  people  of the Patterns  be r e a s s e m b l e d  This  we p l a c e d  These  the logical  arrow-lines  Similarly,  linkage  a n d p r o v i s i o n w a s made  made  with  concept  o f t h e way p e o p l e  because  the nursery.  The  hierarchy of  starting  whose  and which  s e q u e n t i a l l y t o THE S I Z E  affecting  Thus,  ENTRANCE  process  lines  i n a Specific  ROOM.  progression  the spaces.  tering  and s i z e  lead  This  order  HOME  by  identified  Pattern.  descending  o f space  ROOM  attached  to link  ROOM a n d s o o n .  the natural  dress  other  i n a  was t a k e n  t h e arrow  a s THE BIRTH  BABIES'  Another  were  of  OF T H E W E L L B A B I E S '  BABIES'  of steps,  they  which  be  the  SICK  that  the direction  could  Issue  or series  so  influenced  influence Larger  step,  C,  p.386.)  to establish  that i s an  a  i f the conappropriate  /  161  position number  for of  complex  specific  study.  ing in  This built  the  and  specifically  linkages  within  we  were  statement  of  the  between  their  clarity,  cated  basic  be  are  used  to  least  That  more  The  there  a l l  fundamental  Since  residential  changed  so  the  use  of  this  elements  a  a  the  in  are  universal for  provide  Ques-  supplement  appropriate  that  true.  Round  modified.  is  the  is also  Third to  most  adoption  context context  buildconcept  or  com-  in  some  could  be  hospitals.  the  not  strong  the  possible  this  to  belief  which  were  Language  enough  Pattern  to  that  convey  adjoining  themselves. and  If  the  intent  Patterns  a  line  clearly,  was  distinction  another  Pattern  diagram a  provided should  to  be  improve  is also indicated.  Questionnaire  deliberately  needed  been  in  the  used  approach.  about  one  for  that  this.  interactions  Patterns  the  so  achieve  more  their  they  found  to  chart,  considered  from  had  Patterns  made  The  was  Language  Patterns  Where  the  Patterns  that  examples  existing  of  the  document  environment  Pattern  mercial  have  the  arises  on  cross  will  Patterns  types  more  some  Nursery  existing  i  will  assembling  tionnaire,  our  Pattern  lines  diagrams  In  in  each  format  for  simplified.  Firstly,  e v a l u a t i o n was  required  the  Third  because and,  only  secondly,  Round  was  uncomplito  avoid  162  the  problems  Round  were  chiefly  Patterns,  versal  group.  one  Universal our  changing  a  that  In  need the feel  to  the we  and  so  Did  had  were  the  in  on.  The  itself: the  improving?  Was  title In  appropriate.  or  each  q u e s t i o n s f o r any We  the  the  part  the  the  whole the  Non-Modified  f o r the  each  The  testing  versus people  not would  section,  Pattern.  first  content  of  dealt  lettering space  with  form  of  style was  comments  a l l questions  the or  left a  problem  format first  the at  the  be  of  page  diagrams end  respondent should  was  Pattern:  the  the  a The  part  the  I s s u e s ? Was  summary  additional felt  after  a l l the  case,  the  whether  parts.  second  of  altered.  put  q u e s t i o n s about  Uni-  f o r both  changing  unsure  our  Conse-  for  allow  allowed of  end  nursery-related  was  i t cover  used  and  two  the  diagram.  Patterns also  of  a l l those  at  to  impact  section,  Did  locate  sections  P a t t e r n s s h o u l d be  format  ask  to  Language  split  q u e s t i o n n a i r e form  Pattern  clear?  two  since  first  i t correct?  clear?  had  about  reused  questionnaire designed  Pattern  This  Pattern  the  standard  the  encountered  evaluation  Berkeley)  Universal  Pattern.  concerns  the  q u e s t i o n n a i r e s was  finally  Modified  from  the  of  with  decided  (taken  set  This  slightly  Was  requirements  concerned  i t was  following  quently,  feel  so  Patterns  document  of  e x c e s s i v e time  2.  We New  with  of  might of  the  163  closed, safe was  select-from-an-option  because quite  ences.  in  t h e i n t e n t o f what  clear  with  question  the  Content  was  only  once,  occurred,  partic-  assessing was  what  provided  preamble  a c t as  the  the  Experts,  volumes to  were  Hospitals  of  each  the purpose  f o rthe Pattern rather  which  than  only  introduction  assembled, in British  included  at the start  d e s c r i p t i o n o f , the use o f the Pattern  Once  t o be  of  o f the Patterns.  i n front  preamble,  ought  explained  Format  was p l a c e d  could  i n t h e answer  no m i s u n d e r s t a n d i n g  i t came t o t h e q u e s t i o n s  the  required  considered  prefer-  This  Thus,  was  respondent  preamble  questionnaire  stated  and  a  This  simple  and t h e intended  diagrams.  the  that  section.  When  needed  respondents  a.Pattern,  the  a n d we  To e n s u r e  ularly  type.  copies Columbia  Language, behind  needed  the  to  be  t o , as well  as  Language were  itself.  sent  and  out to  i n Alberta,  t o consumers.  3.6  Round 3:  The  intent of this  Mini-Survey group  of  include earlier  The Response  of  final  the h o s p i t a l s  respondents. a l l those  rounds.  This  had  been  contact  telephone  a  The  who  retirement by  round  had  was  larger  Expert  and more  Group  participated  occurred  once  resolved.  In  was  t o combine  made  was but  expanded retired  cases,  to reintroduce  the  diversified  the reason many  with  them  to from  for their no and  prior seek  164  their good  renewed  participation.  accompanying  naire  would  The divided  be  i t was  of explanation  with  felt the  that  a  question-  sufficient.  Expert as  letter  Instead  groups  receiving  the  questionnaires  were  follows:  SENT  OUT  RETURNED  Physicians: Neonatolog i s t s Pediatrics Academic Infection Specialty  4 3 2  _JL  2 2 1 _1  Total  10  6  Obstetrics Administrative  6 _4  3 _3  Total  10  6  20  12  Nurses:  Total  Thus, Group.  Experts:  the response  rate  The M i n i - S u r v e y  was  60  of hospitals  percent was a s  SENT B.C.  Hospitals  Alberta  Hospitals  Consumers Total  Here  the response  rate  was  74  OUT  f o r the follows:  RETURNED  16  12  10  6  4  4  30  22  percent.  Expert  165  When  a l l  accounted for  the  have the  for, new  been  the  results  Pattern  with  have  Nurses  consumers lowing  Having  ed.  the  and  3.9  agreed  that  certain  tions  to  was  noticeable  issues  into  unrelated cal  of a  the  issues  what  had  Care Other  the  broader  Nurseries comments  lacking article.  that  Language  two  and  groups  of  Physicians  hospitals  summarized  in  i t becomes  clear  Patterns  of  and  the  the  to  earlier.  fol-  aspects which  of  he  Experts  in  Infection felt who  comments,  were felt or  revisResponagreed  made  had  which  suggesextents.  focussed the  of was  the  in  "dangerously  i n one  case,  who  critical  Visitors'  technical  c r i t i -  Experts  very  Barriers  the  otherwise  w e r e much more  One  access  and  brought  Experts  be  groups  differing  Patterns and  to  Mini-Survey  satisfactory  the  public  need  Both  although  once  said  and  Infectious Diseases  s u p p l i e d good  two  includes  are  the  not  together,  from  these  questions,  categories;  which  statements  been  implications  Pattern  presented.  problem,  in  the  to  or  statistics 2  Experts  was  were  positive  specialist  also  what  the  of  Medical  Patterns  solve  The  Section  statistics,  aspects  with  in  returned  and  response  results  the  both  been  3.14  compiled  Generally,  dents  The  1  from  Mini-Survey  to  which  The  had  compiled.  Section  recorded  together.  Tables:  Patterns  been  and  were  separately  Universal Patterns.  and  is  questionnaires  compiled  questions  It  the  Place  and  Intensive naive".  details a  of  were  supporting  166  TABLE  3.9  PERCENTAGE OF MEDICAL EXPERTS ANSWERING IN SECTION ONE  1.1  FACTS IN THE PATTERN  1.2 SCOPE OF THE PATTERN  1.3  WHAT IS DESCRIBED MAKES CLEAR  1.4 IMPORTANCE FOR PLANNING  c  >o  PATTERNS  <J  01  Ol  sso  i.  s_ o  CJ  u  c  1—1 >, <o  +J  c  1—I ><  o cu sso u  c  CU  o  o  ui  E  OO  3  CU  >  •+Jrso a.  Ci. oo  O  c  o  c_>  ai  S-  ai > o  > o  +J  c  cu  •r• — r M<34u  Sa.  cu  +J  <u  a. E o  o c  io  cu >-  +J  o cu  zz  0) — i J= o  +-> o o s-  1—  •1—  4->  ta _o  -a  o  c  o  E  m  +J  +J  h- 2: o  >  +J  <_>  1— oo  Cl-  o z  cu >-  CU CJ  -C  h-  o z  C O CU  >-  o  CJ  to 01  Ul  CO cu  to  <a o  ca  c_>  cu E  oo  *—*  c  0  25  25  50  0  50  50  Visitors Place  0  0  50  50  0  50  25  Mothers Exchange  0  0  13  75  12  75  25  Family Room Room  0  0  25  50  25  50  25  25  75 25  75  25  The S i z e of Well Babies Room  0  0  5  75  20  50  25  25  75 25  75  The S i z e of Sick Babies Room  0  0  10  75  15  50  50  0  75 25  75  L o c a t i n g the I n t e n s i ve Care Nursery  0  0  12  75  13  75  25  0  0  100  75  25  25  100  75  0  100  100  100  100  75 25  z  1—1  oo  The Babies Home  <  O o z  o  75  25  25 100  75  0  100  75  25  0  75 25  60  40  0  25  75 25  75  25  0  25  75 25  75  25  0  75  25  0  100  0 25  167  TABLE 3.9  —Continued  PERCENTAGE OF MEDICAL EXPERTS ANSWERING IN SECTION ONE  1.1  FACTS IN THE PATTERN  1.2 SCOPE OF THE PATTERN  1.3  WHAT IS DESCRIBED MAKES CLEAR •  >>  PATTERNS  <j 01 St-  o o c  Cu i. i-  o  >1 <o  +J  +J  o  h-  CU >  •»-> o o c »—t >>  l-H  r—  to  o  C O 3  (J Ol s-  so u c  CU E o co  o > +J  So Q.  c  o  CO to >  -o  Ol s_  >  o  4->  Ol  CU  Ol  o  "a.  SZ  •r•r-  CO  25  0  75  0  25  0 100  0  100  0  0  OO  Q-  o  cu  OO  J= I—  cu  J=  CO  o  1— CO  to Ol to ro  CO  o E  tn 01  o  to  z:  >-  cu  o  75 25  75  25  >-  Infection Barriers i n ICU  0  50  The S i c k e s t Babies Room  0  0  Babies i n the Sun  0  0  25  25  50  75  25  0  75 25  75  Heights of Service Outlets  0  0  25  50  25  75  25  0  75 25  Adults i n t h e Nursery  0  0  10  75  15  75  25  0  Staff Retreat  0  0  25  50  25  75  25  0  2  — io  O CU c c  E  o  o s_  CL 3  •r— +J  •i— •M  CU  •>-> O O Sh - Q-  c o  rz  E CU  i — r— ro -Q  1.4 IMPORTANCE FOR PLANNING  to Ol >-  o  z  ai  to <a CO Ol E o oo  +J <t +J  o  cz  z  75  25  0  0  00  0  0  25  75 25  70  30  60  40  70 30  70  30  0  75 25  75  25  75 25  70  30  0  50 50  50  50  75 25  50  50  0  100  0 100  75 25  t—1  to  0 100  '  0  168  TABLE 3.10 PERCENTAGE OF MINI-SURVEY  J  PATTERNS  FAC1 "S to 1 THE PAT! 'ERN  1.2 SCOPE OF THE PATTERN  1=  >>  t—ro + > o  1—  > •4> -  O QJ SSo u c  iS_ o <_> c  — t1 >) +> t/» O  1.3 WHAT IS DESCRIBED MAKES CLEAR  1.4 IMPORTANCE FOR PLANNING  >\  > 0) + u QJ  +J  o s_ so o  RESPONDENTS ANSWERING IN SECTION ONE  rj  > • — r+ > i. o  CL > OL o 3 s_  OJ  e  o oo  u c o o tn  OO  a-  E ai -a ai s. <u > o o "ai  ra -O  +J  rr <v •i— u  oo  a> -t-> aj  ••-> o o s. I— Q-  c o  o +j  T>  o OJ  —r  n a; ^: o l — oo  c <u c JC o  to a>  >-  o z  o  t/1  < c  VI  CD  >-  ai  o z  >-  o z  to  <a o  ro  r— <_)  CL  E O u c  t/i ai  in ai  o oo c  l-H  +> -  «t 4J  O Z  The Babies Home  0  0 50  50  0  50  30  20  85 15  80  20  85 15  70  30  0  Visitors Place  0  0  30  70  0  20  60  20  75 25  70  30  70 30  85  15  0  Mothers Exchange  0  0  25  50  25  40  60  0  85 15  85  15  85 15  75  Family Room  0  0  20  60  20  50  50  0  85 15  85  15  75 25  50  50  0  The S i z e o f Well Babies Room  0  0  20  60  20  80  20  0  85 15  75  25  85 15  70  30  0  The S i z e of Sick Babies Room  0  0  0  70  30  60  40  0  85 15  85  15  85 15  75  25  0  L o c a t i n g the Intensi ve Care Nursery  0  0 20  40  40  60  40  0  75 25  75  25  75 25  75  25  0  0  25  169  TABLE 3.10 —  Continued  PERCENTAGE OF MINI-SURVEY RESPONDENTS ANSWERING IN SECTION ONE  1 .1  PATTERNS  FACT S IN THE PATTERN  u  ss_ o o  *—1 £Z  >) ca  +-> o  l—  1.3  WHAT IS DESCRIBED MAKES CLEAR  >>  *J CD  1.2 SCOPE OF THE PATTERN  +J CJ CU  s_ so  u cz  »—< >>  +J CO  o  : E  c  Ol  > o 01  Sso o e  »—» cu  E  o co  ZJ  cu  >  o  c o  CJ  so CL  cari co  CO  Ol  O)  i.  Ol  > o  CJ  >  o  JQ-  •>-( • — r O • <fr-<*rz Ol  ZJ CO  Ol  +J  Ol  ca .o +-> o o sh- C L  • — r — r O  Ol  •o  o • r+J  CT  E  co  +J  1.4 IMPORTANCE FOR PLANNING  o  Ol  +J  01  -£Z  h-  3  O  CU J=  I—  CO  CO  o  CO  !=  CJ  ca  CO  ca CJ  Ol  CJ  Ol >-  o z  cu >-  z  E  CO  CJ  Ol >-  Ei »—  Ol  Ol  — r — »4  Q-  o  CO  c  o  CO  CO  o  E  +J  o  <.  rz  O z  CO  Infection Barriers i n ICU  0  0  0  70  30  75  25  0  75 25  75  25  75 25  75  25  0  The S i c k e s t Babies Room  0  0  0  70  30  65  35  0  60 40  75  25  75 25  75  25  0  Babies i n the Sun  0  0  25  75  0  55  30  15  85 15  75  25  75 25  85  15  0  Heights of Service Outlets  0  0  0  80  20  70  30  0  85 15  85  15  85 15  85  15  0  Adults i n the Nursery  0  0  0  80  20  50  50  0  85 15  85  15  85 15  70  30  0  Staff Retreat  0  0  0  80  20  65  35  0  85 15  85  15  85 15  70  30  0  170  TABLE 3 - 1 1 PERCENTAGE OF MEDICAL  2.1  IN TENT OF THE FORMAT  E X P E R T S ANSWERING  IMPROVEMENTS NEEDED  2.2  Yes / No  Yes / No  Yes Yes Yes / / / No No No  IN SECTION TWO  STYLE IS  2.3 2.4  Yes / No JZ D  3  PATTERNS  O  a .C  t-  IO  Ol  o > >  ro  CJ  c  ,— (_>  Ol  in  o o  •r—  TJ  ra +->  S-  01 TJ  c  =J  The Babies Home  25  75  Visitors Place  1—  -t->  o z  cu '>•  c  sm cu c  tA 3  1C  o o  ai +-> +J cu  _j  at •»->  H-  3  +J  in  E  IO J-  cr io  •r— O  cu cr ID  3  ac  IO _J  cr  £ O  _1  o o  h-  +J  %-  (J  tA  o  Z3  C  to o o  •M  io  JC  IO  r—  1—  E D_ o c u. - i -  ai  LU  IO  IO U  IO  IO  f- C T a> c:  c JC <J  cu o o  h1—  c  •o c  c  3 O  o  IO 4J  JC  S-  1—  <_)  TJ  +J  o o  cu c  ZD  CJ  cu  o z  o  1—  cu oo o o  <  0  25/ 0 75  50/ 0/ 0/ 50 100 100  25/ 75  100/ 0  0  50  0 25  25  50  50 . 0  50/ 0 50  50/ 50/ 0/ 0/ 50 50 100 100  60/ 40  0  50  0 25  25  Mothers Exchange  75  25  0  25/ 0/ 25/ 0/ 0 75 100 75. 100  25/ 75  100/ 0  0  50  0  Family Room .  50  25  0 25  25/ 75  25/ 25/ 25/ 75 75 75  25/ 75  75/ 25  0  25  0 25  50  The Size of Well Babies Room  50 25  0 25  0/ 100  25/ 25/ 25/ 75 75 75  25/ 75  75/ 25  0  50  0 25  25  The Size of Sick Babies Room  50 25  30/ 0 70  30/ 30/ 30/ 70 70 70  50/ 50  100/ 0  0  70  0  0 30  Locating the Intensi ve Care Nursery  50  0/ 25/ 25/ 100 0 100 75 75 /o  25/ 75  75/ 25  25  25  25  0 25  50  25  0  0 50  171  TABLE 3.11 —  Continued  PERCENTAGE OF MEDICAL EXPERTS ANSWERING IN SECTION TWO  2.1  IN TENT OF THE FORMAT  2.2  Yes / No  IMPROVEMENTS NEEDED  Yes / No  Yes Yes Yes / / / No No No  2.3 2.4  STYLE  Yes / No  IS  JC  cn ZJ  PATTERNS  01  r—  JZI  s_  ea Ol CJ  >  ra  s_  o  4->  o  ra  to s-  Ol T3 rz ZD  o  r+J  o  c  Ol  Ol  ' s-  (0 01  T3 CZ  o  cr cz  ZJ  CU  cn c IA  ZJ  4-  cz  o  CJ  -t-> +-> Ol  _J  Ol r— +-> (—  Infection Barriers i n ICU  25  50  25  0  0/ 100  The S i c k e s t Babies Room  50  50  0  0  0/ 100  Babies in the Sun  30  70  0  0  Heights of Service Outlets  33  34  33  Adults in the Nursery  70  30  Staff Retreat  50  50  4- cn  CO  E  ra icn  <a •f— o  Ol cn ra ZJ  cn cz  ItJ _J  cn c  o  _J  o o  1—  +J  i.  o  J= CO  o o  (—  ai rz to zzt rz rz -t-> CO  ra i — E a.  o  •r—  C  o  Ol 1—  o o  !o  ra TZt C ra  +-> to Sai  LU  >e CJ  t~  cz  o  r~  r—  CJ  01  +J  r—  -a cz  O Z  ZZt  cu  cr  J= CJ  cz U. i -  o  ra ZJ  O  o o  1—  CO  T3 o o CD  <L  25/ 25/ 25/ 75 75 75  25/ 75  25/ 75  25  0  0  25  50  50/ 25/ 25/ 50 75 75  25/ 75  100/ 0  0  25  0  0  75  30/ 70  30/ 25/ 25/ 70 75 75  25/ 75  75/ 25  0  30  0  0  70  0  25/ 75  30/ 25/ 25/ 70 75 75  25/ 75  75/ 25  0  50  0  0  50  0  0  25/ 75  30/ 25/ 25/ 70 75 75  25/ 75  75/ 25  0  30  0  0  70  0  0  30/ 70  50/ 25/ 50/ 50 75 50  -  80/ 20  0  50  0  0  50  172  TABLE 3.12 PERCENTAGE OF MINI-SURVEY RESPONDENTS ANSWERING IN SECTION TWO  2.2  IS  Not Too Clear  Confusing  Format Useful in Planning  Too Technical  Understandable  Not Technical Enough  Too Colloquial  A Good Style  Yes Yes Yes / / / No No No  STYLE  Understandable  Yes / No  2.3 2.4  Very Clear  Yes / No  IMPROVEMENTS NEEDED  w  INTENT OF THE FORMAT  o-^r?  2.1  The Babies Home  20  60  0  20  25/ 75  25/ 30/ 30/ 75 70 70  25/ 75  85/ 15  20  20  0  0  60  Visitors Place  30  50  20  0  20/ 80  20/ 30/ 25/ 80 70 75  20/ 80  75/ 25  15  15  0  0  70  Mothers Exchange  50  25  25  0  20/ 80  30/ 20/ 40/ 70 80 60  20/ 80  75/ 25  25  0  0  0  75  Family Room  30  50  20  0  25/ 75  25/ 25/ 20/ 75 75 80  25/ 75  85/ 15  15  0  0  15  70  The S i z e o f Well Babies Room  20  60  0  20  25/ 75  20/ 30/ 50/ 80 70 50  20/ 80  85/ 15  0  65  0  0 .35  The S i z e of Sick Babies Room  35  65  0  0  25/ 75  20/ 25/ 40/ 80 75 60  25/ 75  85/ 15  0  70  0  0  30  L o c a t i n g the Intensive Care Nursery  75  25  0  0  20/ 80  30/ 40/ 40/ 70 60 60  30/ 70  75/ 25  50  0  0  50  PATTERNS  cn  cu  c •r—  s<U  + + > -J Ol  _l cu  +J I—  CO  E  ta u  cn  Ol  O) IO =J  cn  • — r _cj O IO  <a  cn c  o  _l  o o t—  +-> t-  o  JZ CO  o o  \—  0  173  TABLE 3.12 — Continued PERCENTAGE OF MINI-SURVEY RESPONDENTS ANSWERING IN SECTION TWO  2.1  INTENT OF THE FORMAT  2.2  Yes / No PATTERNS  ai  t-  <o OJ  (_> £>  t— J3 IO  •a  c  ra  •4->  to s_ cu  T3  IMPROVEMENTS NEEDED  Yes / No  CO  r—  O o o t— *->  o  CO  c to 3 4C o o 1—  +J +J Ol _ l Ol  4->  •M OO Ol E  •o icn IO  a  co IO 3 Ol c .  IO _ l  cn c o  -J  o o  4J S-  o to o o 1— J=  3 4 - cn O l cz to T =3 cz cz •!-> IO lO i—  E°-  IS  JZ  cn 3  Ol  »>  01  STYLE  Yes / No  Ol  c  sia ai  Yes Yes Yes / / / No No No  2.3 2.4  lO  o cz JZ  u  Ol 1—  o o (—  JZI CO  •a  O CZ Ul r— IO  CJ  IO  •rC J=  to s-  OJ  cz  +->  a  Ol  l—  C =>  +J o z  TD  10  •r~  3 o  a  CU r—  to  o CJ o o  •o o o CD <  >  zz>  Infection Barriers i n ICU  70  30  0  0  20/ 80  20/ 20/ 30/ 80 80 70  20/ 80  75/ 25  0  40  20  0  40  The S i c k e s t Babies Room  60  40  0  0  20/ 80  20/ 35/ 35/ 80 65 65  20/ 80  80/ 20  0  25  25  0  50  Babies i n the Sun  70  30  0  0  35/ 65  35/ 35/ 40/ 65 65 60  35/ 65  85/ 15  0  40  0  0  60  Heights of Service Outlets  50  30  20  0  35/ 65  35/ 35/ 60/ 65 65 40  30/ 70  85/ 15  20  20  0  0  60  A d u l t s in the Nursery  50  50  0  0  35/ 65  35/ 35/ 65/ 65 65 35  30/ 70  85/ 15  25  0  0  0  75  Staff Retreat  65  35  0  0  30/ 70  35/ 30/ 60/ 65 70 40  30/ 70  75/ 25  25  0  0  0  75  c  i —  1—  o  LL.  c 1 -  1—  174  TABLE PERCENTAGE  OF MEDICAL  3.1 SUFFICIENT PATTERNS TO DESCRIBE LANGUAGE  PATTERNS  YES  NO  EXPERTS  ANSWERING  YES  -  100  -  Language NICU  100  -  100  -  Uni v e r s a l Patterns Modified  SECTIONS  3,  4,  5.1 ARE MODIFICATIONS OBVIOUS  &  5.  5.2 SHOUL D THEY BE FURTH ER MOD IF IED  NO  100  Uni v e r s a l Patterns  IN  4.1 3.2 ARE LINKAGES USE OF PATTERNS OF LANGUAGE ACCEPTCLEAR? ABLE  Language of Newborn N u r s e r i es of  3.13  50  50  YES  20%  NO  NO  YES  80%  20% 80%  175  TABLE PERCENTAGE  OF MINI-SURVEY 3.1 SUFFICIENT PATTERNS TO DESCRIBE LANGUAGE  PATTERNS  RESPONDENTS  NO  YES  NO  Language of Newborn Nurseries  75  25  72  28  Language NICU  70  30  72  28  Uni v e r s a l Patterns Un1versal Patterns Modified  ANSWERING  3.2 4.1 ARE LINKAGES USE OF OF LANGUAGE PATTERNS CLEAR? ACCEPTABLE  YES  of  3.14  60  40  IN  SECTIONS  3,  4,  &  5.  5.1 5.2 ARE MODIF- SHOULD ICATIONS THEY BE OBVIOUS FURTHER MODIFIED  YES  NO  40  60  YES  • 40  NO  60  176  The since  result  i t was  that  were  f i l l  the gap  nesses  was  the  groups  the  a  except  did  not  feel  the  and  with  prior  noticeable exposure in  any  material.  This  was  very  pleasing  useful  feedback  devise.  other  With  respect  of  the  3  and  respect first  to  four  Babies  i n the  slightly  more  Locating  most  the  the  upon  the  on to  respondents,  Pattern  presentation to  larger  situation.  commenting  or  communication  with  that to  indicated  Tables  the  have  i t was  before,  the  with  group  constrained  derive  on  of  i t i s the reverse  o f the  response  Mini-Survey  style  to  of  shown  weak-  i t was  work  This  occurs  Nursery  the  to  a corrective  the  of  Scope  lettering  able  seen  concerns  Experts,  required  the concerns  similarity  of  results  Further,  involved.  f o r answers  2  have  representative  the  the  their  To  pleasing.  fully  been  were  therefore  not  successful  Round  distribution  the  than  and  had  been  and  similar  the  between  distribution  a l lcases, of  most  who  that  Content  Care  regardless  was  had  of  most  planners  the Experts,  had  fact  reservations  In  who  that  proved  the Patterns.  not a divergence  similar  A  Intensive  "naive"  Reinforcing  Factual  Patterns. Sun  by  Experts  i s the  have  the  respondents,  population.  4,  and  possible,  the Experts  that  evaluation  i n completing  made  there  this  t e c h n i c a l ^aspects  lacking  Mini-Survey and  the  identified  process clear  of  the  this  format,  aspect  Planners  the  Concept,  of who  Patterns aspect  the were  as of  a the  177  Patterns,  the  fortable  working  therefore  were  not  mine sary. be  style  final  The  any  from  the  less  technical  were  not  the  of  since: the  this  the  there  and  is  Criticism Patterns,  of  was  which  because  the  type  they  more  tech-  felt  of  respondents  the  criticism  comprehended  suggesting  had  that  of  "mode"  s u c c e s s f u l l y completed.  of  flaw  they  are  the  would  to  deter-  be  neces-  showed  sufficient was was  was  Delphi  was  material  been  there  the  3  there  no  and  Group  rounds  Round  Patterns;  results  been  the  com-  this  respondents  Monitoring  of  consensus  the  two  were  and  enough  This  Patterns  the  Mini-Survey  of  and  enough.  the  received;  requirement  clear  Mini-Survey  that  "Expert-Opinion" on  Format  Guidelines.  idea of  people  as  i n language,  "scan"  revise  the  Pattern  further questioning  final  to  of  indicated  tools.  task  unnecessary  received tion  the  communication  whether  them  technical  of  i n t e n t and  The  of  i n which  supportive  good  to  was  the  felt  colloquial"  Patterns  language  the  four  respondents  "too  nical  is  with  received  within  supportive  noticeable Expert  answers  a  evident  Rounds  study.  comments  clear  clear  The  this  indicain  evidence which  was  project  the of a had  178  CHAPTER 4;  If are  CONCLUSIONS AND RECOMMENDATIONS  the arguments  adequate  purpose  and  put forward  t h e method  successful,  they  i n the i n i t i a l  described  point  to  chapters  i n achieving a  new  their  direction  in  j  addressing important ing  the  social  f o r our purpose  of a process  rather  stration  i s  adjusting  our societal  ities  of  timely that  our  Western  there  nique  with them  know  about  important  (in a their  "tool"  its  usefulness  the  pursuit  can  do  success  like  something  about  i s  which many  qual-  particularly which  from  emphasizes others,  shows a  hetero-  has  amply  of the Delphi  Tech-  logic.  the Delphi  t o be o u r means o f  of the population,  social  science  world,  we  exist.  i n gathering  of better  demon-  a transition  of the s u i t a b i l i t y  does  the beginnThis  discussion  through  t o one  Delphi,  a segment  from  This  i s going  emerging  selecting  we  It i s  attitudes to the sociological  period  an example  for this  In ting  Our  design.  demonstrated  i s increasing  society  of  i t sc o n c l u s i o n .  that  buildings.  uniformity-seeking geneity. 1  t o have  than  evidence  because  provided  responsibility  Design  context)  have We  expressly  further i n a form  Guidelines  to learn we  demonstrated  have  knowlege  what  communica-  should  that  an  demonstrated valuable i n  forbuilding.  179  We to  began,  build  a  required of  the  and  to  of  further  to  clarify  are  the  Guidelines use  in  the  tion  to  assess  the  would  Delphi  systematic  as  by  basic  assessing  having  to  In,this  to  needs three  well  what  he  pitfall  calls he  of of  by and  the  notes:  on  have  Design  to  Delphi  method Eight  Delphi  their  the  comple-  format,  go  for eval-  applica-  been  can  This  met  and  world  and  problem  of  assessed  Pitfalls  will to  the  We  of  permit  assess  example.  addresses world.  be  Basic  opportunity a  the  applications.  our  an  now  our  of  environmental  acceptable  criteria  method  this  of  world.  events  Language  shall  they  opportunity  upon  of  Linstone.2  as  our  describe  represent  We  these  i t s value  how  Pattern  further  published  people  experts leads  with  for  a  that  set  weaknesses  for  evaluation  application  in  a  that  an  -  aspects  that  certain  spatial  required  whether  its validity  comparison  by  within  was  Nurseries  a way  provide  method  method  Newborn  when  a  important  i n such  occur  application  and  the  "use"  method  for  That  operate  Standards.  strengths  three  the  we  exist  establish  The in  Delphi  who  to  which  Finally  criteria  of  Units,  affected  "adaptable"  uate  that  problems  relationships. of  people  required  required  world  tion  a description the  is  with  Standard.  I n t e n s i v e Care  what  We  One,  responsive  solicit  "world"  described  Chapter  more  Neonatal  that  in  We  Linstone Illusory  our begin  problem  have finds  a  of  chosen this  Expertise.  180 \  "... [In Delphi], reliance i s almost invariably p l a c e d on p a n e l s o f e x p e r t s o r s p e c i a l i s t s the specialist i s not necessarily the best forecaster. He f o c u s e s o n a s u b s y s t e m and f r e q u e n t l y t a k e s no a c count o f the l a r g e r system. "... A panel consisting o f e x p e r t s on t h e v a r i o u s body subsystems (e.g., circulation, respiration, r e p r o d u c t i o n ) , d o e s n o t c o n s t i t u t e e x p e r t i s e o n human b e h a v i o u r and group dynamics."3  The  concern  all  the  first  c e n t r e s on the a b i l i t y  ideas  needed  concern  diverse  group  the  expert  the  inquiry  two  reasons:  (i)  of  our  to  ensure  opinions showed  In  same  topic.  with  a  This  application  representation,  so  was  we  then  Mini-Survey.  Delphi  types  the  main  In  the  of  perspectives  they  The  the  chose  we  a  checked  results  a l l the  discipline,  were  of  Medical  presented  Although  their  pro-  often  diverse  and  the solutions  d i d cover  similar  were  at  times  areas  and a l l  the  results  issues.  Mini-Survey compared  opinions, comments  inquiry,  o f concern.  o p i n i o n about  opposite,  were  the  regardless  fessional  (ii)  Delphi  main  Experts,  their  cover  to represent  t h e r e p r e s e n t a t i o n t o be s u c c e s s f u l f o r  the  the  to  of experts  the were  3.9 t o 3.14  inquiry  with  the  statistical remarkably  i n Chapter  when  Medical profiles  similar.  3.)  experts of  their  (See T a b l e s  T h i s means  that the  181  method  provided  material and  and check  as  a  provided  This format  means  of  this to  of  be  production  Mini-Survey  i t s content  was  made  by  of  the  the  This  as  technical  be  cannot  a way  to  helped  of us  inter-  Experts, the  the  solicit  that  is essential  thus  context to the  Planning be  tested  production  would  as a check  well  ed.  data  the operations  problems,  involvement  as  well  rounds  Planning  as t o whether  some  may  that  iterations  successful  the Planners.  there  sure  structuring  i n such  This  t o be u s e d  any  to  the  of  that  in  Delphi  interpretation  ensured  be  the actual  The  i s concern  Experts'  experts,  could  the  of suc-  of the Patterns.  of  there  Planning  of  important  solutions.  Regardless  the  the v a l i d i t y we  and  was  descriptions  Patterns,  collect  a "conversation"  and t h e i r  cessful  to  successful  "world".  could  providing  opportunity  important.  were  what  through  pretations  events  was  we  particular  work  result  the questions  descriptions  an  issues  be  the  due t o  detected.  The mis-  strong  reactions of  Mini-Survey  respondents,  were  problems now  any b i a s e s  of the possible  The  some  of  corrected,  which  but should  went be  however  undetectavoided  in  future.  A further  possible  variation  corrections  of  that  might,  results,  is  in future, the  provide  involvement  of  182  various  planners  employment that  the  the  planning  only  this  were  surveys,  prove  measure  useful  to  making  by  regulators  as  in  proven.  check  their  ensure  the  same  when  the  in  their  I t should  i s not  Patterns  effec-  for  incorrect  practical  applica-  the b u i l t  variation  environment.  f o r new  obvious,  If  Standards,  survey  people;  these later  extra  acceptance  as  One.  of  planning  finally of  The  take,  surveys  Finsterbush  Medical  the  of the  might  Experts  and  Planners  and  aspects  not  the  government  applicability time  length  the v a l i d i t y would  It  survey  additional  considering  might  of  survey  assessment  testing-in-the-field  by  Mini-  series  then  and  single  i s by a  i n Chapter  corrections  but  the  described  cited  i n Standards.  of  checks,  corrections;  for their  are  achieving  would  operating  of certainty  first  Medical  material  by  with  those  Mini-Surveys  Architects  tion  government  particularly  the  additional  to  make  tions  of  interesting  hospitals;  the  "checked"  are not clearly  and u l t i m a t e l y  similar  detected  This  interpreters  remains  for achieving  Dynamic  were  and  satisfactory.  Another Survey  as  screening  the only  i s not  itself.  i f the Mini-Survey  hypotheses  i n planning  practice  Experts,  role  that  tion  it  Medical  scientist"  realized  tive,  private  Experts  of the Planners  "social be  Planning  as  skills  both  i n the Mini-Survey  the  manner  from  prove  Standards.  of  implicaof  time  of confirmavaluable  in  183  The ology,  second  was  problems,  and  the  the  agreement  Group/Planning  on  be  capable  no-consensus,  flexibility execution  While describe some  a  how  factors  are:  the  too  of  a  the  avoid  preconceptions.  produce method less at  a  of  is  and  being  of  is  of  pitfall.  too  of  in  consensus  degree  to  is  issue  This  leads  us  is  available  correctly,  to  but  the  These  responses;  by and  a  balance  interests  of  expedi-  in  able  to  to  trying  aspects, most  these  we  to had  significant successfully  believe  desired  examine  to are  responses  the  us  of  achieve  these  were  there  controlled.  expert's  of  we  an  which  Execution.  unstructured,  that  interactive  achieve  Sloppy  the  failures,  Let  Monitoring  enthusiastic  each  producing  the  designed,  This  be  occur,  as  the  executed  time  In  some  Patterns.  capable  this  time.  and  remember  the  upon  of  satisfying  and  literature  structuring,  results,  to  to  picture  to  Delphi,  modes,  always  level  tious  factor  the  trying 'consciously  much  some s u c c e s s e s  be  of  method-  would  key  flexible  that  of  clear  The  warns o f  cannot  controlling  problem  between  can  which  maintaining  experts;  deal  i n our  problem  available.  Linstone  Delphi  a  depended  great  the  a  ability  create  changing  truly  i n which  provide  the  meant  and  was  in  to  of  critical  solution.  lay  This  to  i n which  the  Group  process.  would or  event  requirements  Delphi  considered  i t s capability  the  these  aspect  result  that  the  regard-  concerns  one  184  Selection Turoff,^ tions  projects  This  only  volunteer.  In  complicated As  by a  urban  centres  would  come  input  a  participants  implication  three-fold;  ficial;  the  which  of  multi-disci-  what  from  well  was  will  further  representa-  physicians  they  in  anticipated  This some  have  able  who  urban  peers".  may  time  research  experts  and  with  antagonism  o r those  own  calibre  gained  was  experts. evidence  were  because  their  of  meant the  affected  biases  o f changes  o f development  we most  their  tended  informed  by  experts concern  occurred  they  that  not  super-  discounthave•for  information  were  because  i n Delphis  be  were n o t  t o be  experts  who  could would  a l l the issues  or; three,  are of  having  Patterns  of the disregard  peers,  diluted  the  examined  the s p e c i a l l y  actually These  on  and e i t h e r  that  input of  this  the level  depth  two, t h a t  their  of  one, that  in sufficient  examined  ed  type  specialist  "country  of  f o r funded  limitation  some  sugges-  to the process.  The  be  their  are  and  s u f f e r e d by being  to get rural  not pleased  level  We  this  consequence  from  experienced important  trying  There  available  case  Linstone  i n recognition of  i n this  those  our  were  paid  project.  from  by  acceptable  happens  related  cited  result.  be  i s normally  health  tion.  must  but rarely  select  i s  t o a good  honoraria  involved.  to  Experts  as c r i t i c a l  that  plinary  of  not  true  there  where  is  false  185  data ed  was  is  introduced.4  by  concern  the  stated  tion  would  and  which  area  of  is  will  take  Mini-Survey  is  whole cal, be  to our  both  assured  could  be  that  first  positive  the  control felt  respondents three  alternative  time. said rounds was  of  this  adequately  round,  which  was  However, they  could  which to  correct-  there the  resort  is  also  Mini-Survey  for  As  a  practical  This  look  we  "poor" applica-  appears  again  validity.  to  be  an  3)  had  allow  were  and  was  method  application  this  received  good  was  a  not  maintain sent  to  greater  the  we  major  of  the  issues.  returned the  to  Patterns.  controversial  returning  c r i t i -  that  capability  in  been  and  time  p r e - t e s t e d , was  the  expressions,  evident  the  pop-  from  sufficiently  respondents'  explore  Dynamic  In  produced  reduced  the  Expert  negative  effort  them  to  Medical  comments  (Round  that  to  to  the  confident  predicted  the  that  of  we  last  time.  be  compensation.  alternative  lack  interaction The  an  no  and  of  i t through  be  round  Maintaining weakness  one  for Pattern  their  would  method.  select  evaluative in  adequate  some  may  opinion  this  expertise  test  i n the  and test  is  to  option  of  for  there  weakness  ulation  allow  way  Unfortunately,  level  that  Another  it  the  earlier,  Pattern  only  Mini-Survey.  whether  respondents  The  in  the  submissions schedule  them. time  Our or  for only  suffer  186  attrition  of  failed  ensure  ed  to  the  completion  The  failure  under  participants. good  was of  viewed  time  development this  could  was  done  problem  had  interaction for  the  presentation  little The  room  design  recting  of  a  the  check  freely the  result, normal  be  restricted insert  area  As would  this  instance,  than  the  method  was  a  extra  round,  consequence,  require  completing  successful.  the  the  did  means  allow  for  cor-  "adventure".  misinterpret, round is  in  such  primary to  the  Patterns  was  felt  just more us  the one.  i t  more  rounds  of  for  a  the  to  more  concern,  within  than  had  that  formal  a l l  he  which  select  exploration  we  While  opportunities.  studies  so  the  was  more  exploration  once  there  three  but  that  group,  of  do  M l  other  subject  then  substantial  Experts  next  become  issue  the  application  area,  an  and,  did  the  the  that  exploratory  time-frame. topic  of  passed.  comments  unforeseen  Planner  opportunities  subject  one  a  seem-  group,  much  findings  in  the  for  a  time  one  but  Where  better  by  allowed  not  where  Planner  explore  time  feedback.  methodology  i f  himself.  exploratory may  to  the  issues by  i t  impossible.  in  and  as  from  additional  evident  feedback  deviations  As only  of  be  extra  because  that  benefited  for  of  2,  urgent  meant  to  Medical  allowing  Round  less  have  ask  made  between  interpretation  as  proved to  been  in  control  could  reassessment, be  results  Even  and same  whole In  important that  the  187  The  final  relates Again,  to  the  despite  careful  Also,  we  people  order  one  participants'  is  to  draws  most  whole  likely  process  preconception with  our  that in  does  only  time  as  to  actual  produced.  We  were  needed.  much  much  meaningful  by  to  how  how  and t h e  i s required  of material  material  material  was  results.  only  experience  yet  our  can  results  not suffer  resulting  due  to  The  improve  show  greatly  influenced  of the issues.  Delphi  Chapter  structure  Two,  we  "correct" increased  the Delphi structure.  from  while  poor  the this  which  execution causes  the Planning bias  because  Experts'  becomes o f  o u r method  the  concern  encourages  the interactions.  discussed  would  application,  by  This  during  the Mini-Survey the  effects  to overstructuring  be  process-intervention  In  and  rounds.  gained.  Unsatisfactory are  much  versus  i s that  of the product  being  how  produce  judgement  between  turn-around-times  to  execution  i n the literature  judgement  respond  in  conclusion  poor  Delphi  activity,  volume  f a r greater  can  quality  learn  of  material  for this  we  showed  required  of  a l l the warnings  t h e enormous  that  the subject  handling  could  with  found  on  preparations  experience deal  issue  intervention  correct  that  between  when rounds  I t was  also  any b i a s e s . we  were  i t was  and We  found,  required  usually  necessary  assumed  to  to  done  by  make  up  188  lost  time  and  details. for  This  ensuring  sure  "lost"  that  proved  the  i f a l l these some o f  polarized  by  Medical,  Delphi  the  been  for  conducted  use  of  have  Delphi  Delphi  then  typical  problems  produce  the  is  may  and  a  tool  out  for  a  them.  so  and  only is  by are  are  not  had  not or  resolved  the  where  the  an  errors of  poorly is  operators. no  to  good Our  funding,  the  have  with  amateurs.  expert?  adhere  We  to  the  to  suit  our  encountering  a l l  the  "excuses  exist", We  the  past  excuse  there  structure  our  authors  really  number  useful to  of  been  enthusiastic  product.  strength  we  where  of  Delphi, no  mechanism  unresolved  common  possible  e v e n t u a l l y overcome  avoid  the  typical  modify  which  intended the  i t  "we  experienced  pitfalls to  have  Delphi  be  that  than  left  in  Experts.  of  demonstrated and  but  f i l l  factors  significant  part-time  even  carry  were  could  of  a  more  that  principles,  needs,  in  time  i s not  demonstrated  process,  because  Most  This  are  successful  execution  Experts  evolution  Delphi who  the  literature  of  very  Planners  is constantly decried  Delphis."^  the  of  pitfall.  plenty  a  Planning,  demonstrated  volunteers Surely  than  the  this  amply  funding,  Medical  Technique in  be  having  i s s u e s which  Execution  stage  exists  the  by  negative  the  rather  Sloppy of  to  completion  occurred,  by  experts  have  method usual  and  was  still further  to  expect  problems -rather  189  It  i s  Patterns in  which,  users  note  their  itself,  during  entered  into  we  results  have  Guidelines  We  impossible  earliest  would  Since  a process,  worth  say  conclude  that  c a n be be  this  successful  Pattern  they  than  that  we  truly  While a  the  successful t h e same  Delphi?  responsive  other  that  might  interactive-  o u t from  would  but be  here  the successful  evolv-  methods  any  carried  have  Design  are both  successful,  activity  some o p t i o n s  a  o f the  could  itself  what  to  conclude  rather  borrowing  the  to  the  and  Pattern  produced  socially  Technique  probably  we  exploring  In that  process  definition  Delphi. of  have  without  of  and t h e D e l p h i  communication locations  achieved  terms  on t h e  that  t o ask the question:  concept  would  aspect  t h e method  the  Expert  commenting  of  encouraging  both  felt  own  of the "conversation".  that  need  the  i t i s  work.  participants,  We  that  in their I t was  set  succeeded  solutions  systems.  about  a  t h e method,  had d e s c r i b e d value  the s p i r i t  been  produced  and  the evaluation.  still  Since  within  s t y l e o r any o t h e r  indicates  product  method  events  h a d no q u a l m s  lettering  ing,  own  the  format,  evidence  tested  problems,  that  Mini-Survey,  our  themselves  displaying  to  that  when  describing  Medical by  clear  remote  from a  the  form  of  the beginning  end t o one, i t  i s  f o r the future.  concept elements  from of  the our  Patterns, method  are  we  find  i n the  190  relationships  which  conversation. management pants, just  It  also  process  namely  the  Planning  easily  move  possible  settings  of  of  British  conferencing  form.7  Knowledge  the  possibly  of  the  Such  limitless. encountered'in  Another  so  that  them  a  method  possibility  be  tested.  much  this  of  the  West  faster  i s to  the  we  could  into  the  interactions  and  Delphi  readily  and  will are  soon  be  virtually problems  overcome.  method  Pattern  enrich do  rural  real-time  systems  hypothesis will  is  and  the  developed  This  which  extend  a  execution  be  It  place  applications  a p p l i c a t i o n of  available  paper-  interactive  in  answers,  time-related  than  is  education  one-way  of  might  and  the  using  individual  previously  validity  as  the  of  urban  out  link,  a p p l i c a t i o n might  the  Languages"  If,  of  our  evaluate  can  with  actual  "Pattern"  in  a  partici-  restriction  carry  satellite  AV/TV  the  subject  This  groups  interactive  Many  the  in  of  e l e c t r o n i c methods.  and  province,  Mini-Surveys  possible.  to  of  of  the  into  Network  extension  hospitals  one  assemble  via  simulation  involvement  from  Columbia  Delphi,  the  Group.6  away  to  a  The  by  communications  already  here  allows  the  and-pencil  with  together  of  as  rounds  hold  described Guidelines  stated the  within "Pattern  otherwise.  has  shown,  accurately  we  have  produces  191  usable  and  powerful ties  socially  instrument  design.  participants occur of  only  such  mandatory  i n Health  purposeful  decision  would a  interaction of,  making  which  the  method  we  have  described  Until  such  a  realization  exist  have  design.  that  little to  f o r such  value act  possess  of health  change  indicate  for  having  that  help  result  that  i t i s  respect  does and  occur,  in their  against  in  Standards  the can  and t h e  formulation.  Standards present  innovative  more  f o r , and  involved  in their  to  The  a communication process will  the  begin  better,  time  a  faciliby  will  process.  ensures  At  we  realization  complexities  aspects.  the basis  continue  a  surely  means  become  will  is  e v a l u a t i n g t h e whole  develop  understanding  now  Planning  evaluation to  Guidelines,  f o r t h e improvement  Required  after  an  responsive  and  as  they  application responsive  192  CHAPTER NOTES AND  ONE  REFERENCES  1.  A r t h u r H. P e c k h a m , Planning Process," (May 1975), p. 52.  J r . , "The Use o f S t a n d a r d s i n t h e H o s p i t a l A d m i n i s t r a t i o n i n Canada,  2.  This sub-committee was mandated,- to examine the problem of Standards. This f i r s t report contains a l i s t o f a l l Planning Agencies i n the United States and the Standards they use. The report also contains 42 Bibliographic References of a v a i l a b l e Guidelines. A P r e l i m i n a r y R e p o r t by the Sub-Committee on Programming and Design, James Diaz, Chairman. Mexico City: American I n s t i t u t e of A r c h i t e c t s , October 1980.  3.  James D i a z and B i l l Porter, Standards for Projecting Community H o s p i t a l s . " Paper ly Meeting of the American Committee on Architecture D.C., March 1981.  4.  I b i d . , p.  5.  Health and Welfare C a n a d a , Recommended Maternity and Newborn Care, Ottawa: Canada, 1975.  6.  Health and Welfare Canada, Guidelines for Minimum S t a n d a r d s i n t h e P l a n n i n g , O r g a n i z a t i o n and Operations of S p e c i a l Care Units in Hospitals, Report of the Working Party on Special Care Units in Hospitals, 1976.  7.  J a m e s A. H a m i l t o n a n d A s s o c i a t e s , A H o s p i t a l P l a n a P r o f e s s i o n a l Education/Programme o f the P r o v i n c e B r i t i s h Columbia, Canada, Minneopolis, 1949.  8.  Isadore Rosenfield, Hospitals; Integrated York: Reinhold P u b l i s h i n g Corp., 1947.  9.  James J . S o u d e r , E s t i m a t i n g S p a c e N e e d s and General Hospital Construction. Chicago: Hospital Association, 1963.  10.  E. Todd W h e e l e r , H o s p i t a l D e s i g n and York: M c G r a w - H i l l Book Co., 1964.  11.  Diaz and Standards,",  " C o n s i d e r a t i o n s About New Space Requirements for presented a t the QuarterInstitute of Architects, for Health, Washington,  5.  Porter, p. 7.  "Considerations  Standards for Information  Design,  and of  New  Costs in' American  Function.  About  New  New  \  193  CHAPTER ONE —  continued  12.  In t h e mid 1950's the M i n i s t r y of Health i n B.C. appointed a Laboratory A d v i s o r y C o u n c i l and a Radiological Advisory Council with representation from g r o u p s a n d a s s o c i a t i o n s whose p r o f e s s i o n a l s t a f f s u s e d such facilities. While they were o r i g i n a l l y establ i s h e d t o a d v i s e the Deputy M i n i s t e r i n charge o f h o s p i t a l s about r e g i o n a l d i s t r i b u t i o n o f s e r v i c e s (i.e., Pathologists and R a d i o l o g i s t s i n r u r a l areas) they e s t a b l i s h e d s t a n d a r d s and reviewed spaces f o r p l a n n i n g approvals. I n t h e 25 y e a r s o f t h e i r e x i s t e n c e , t h e a b i l i t y t o g i v e f i r s t c l a s s a d v i c e has dwindled due t o r e p r e s e n t a t i o n by a s s o c i a t i o n , n o t e x p e r t i s e . In June o f 1 9 8 1 , t h e L a b o r a t o r y A d v i s o r y C o u n c i l was r e p l a c e d by the Laboratory S t r a t e g i c P l a n n i n g Group which c a n draw upon e x p e r t s b u t a p p e a r s t o be r e l y i n g upon t h e C h i S y s t e m s M e t h o d o l o g y f o r s p a c e c a l c u l a t i o n a n d now deals with larger policy issues but not planning.  13.  With the i n t r o d u c t i o n o f the major planning legislat i o n , N a t i o n a l H e a l t h P l a n n i n g and Resources D e v e l o p ment A c t (PL93-641) i n J a n u a r y 1975, a c o m p l e t e l y new s t r u c t u r e was e s t a b l i s h e d a c r o s s t h e U n i t e d S t a t e s t o c o n t r o l t h e p l a n n i n g o f h e a l t h s e r v i c s and f a c i l i t i e s particularly with respect to requests f o r government based funding. P r i o r t o t h i s t h e impact o f t h e 1947 H i l l - B u r t o n A c t a n d t h e 1 9 6 4 H i l l - H a r r i s Amendment was to c r e a t e an e x p l o s i o n o f standards and r e g u l a t i o n s see Donald F. P h i l l i p s , "Health Regulations i n 1977: A p e r i o d o f Adjustment." H o s p i t a l , V o l . 51 ( F e b . 1, 1 9 7 7 ) , p . 61.  14.  Peckham,  15.  In producing these g u i d e l i n e s , mock-ups were made t e s t i n g l o c a t i o n s o f beds i n rooms and t o i l e t fixtures within bathrooms to provide optimal working spaces. The b a t h r o o m a r r a n g e m e n t s w e r e d r a w n u p a n d p u t i n t h e g u i d e w i t h a l l t h e f i x t u r e s e x a c t l y from t h e mock-up. Later, continued use o f t h i s l a y o u t showed t h a t a s sumptions made concerning how staff would assist p a t i e n t s proved t o be wrong. A l t h o u g h i t i s now b e i n g r e v i s e d , f o r t h e o r i g i n a l document s e e ; Department o f Health Services and Hospital Insurance of B.C., H o s p i t a l s f o r Extended Care: A Program and Design Guide, prepared f o r R. L o f f m a r k Minister of Health, 1974.  16.  Alan Campbell, e t a l . , Changing S t r a t e g i e s f o r B r i t i s h Columbia Health Management, Health Servics Planning Discussion Paper, No. 1, D e p t . o f H e a l t h Care and Epidemiology, University of British Columbia, May, 1981. p . 3.  17.  I b i d . , p . 8.  J r . , "Standards  i n Planning,"  p . 52.  194  CHAPTER ONE  —  continued  18.  With the need for clearer definition of the design problems i n complex b u i l d i n g s , p a r t i c u l a r l y h o s p i t a l s , i t i s common p r a c t i c e t o d e v e l o p a d e t a i l e d P r e - D e s i g n document c a l l e d a F u n c t i o n a l Program which o u t l i n e s : existing and future workloads; activities taking p l a c e ; a n t i c i p a t e d s t a f f n u m b e r s ; t h e number and size of spaces r e q u i r e d ; d e t a i l s of the o p e r a t i n g systems and usually pre-construction capital and operating cost estimates. T h i s work i s u s u a l l y u n d e r t a k e n by a specialist.  19.  Thomas L. Blair, Fragmore, England:  20.  T h i s term i s used t o d e s c r i b e the p e r i o d i n European and American architecture from 1910 to the mid1970's. Noticeable about the founders o f t h i s architecture was the f a s c i n a t i o n f o r the clean, smooth, p o l i s h of the machine. T h e r e was an e x c i t e m e n t for m a c h i n e r y , p a r t i c u l a r l y mass p r o d u c t i o n , and t h e ability to use steel and glass to represent simplistic forms. For a b r i e f review of the b e g i n n i n g s of the Modern Movement s e e : Gerd H a t j e , gen., ed., Encyclopaedia of Modern Architecture, (2nd ed.; London: T h a m e s a n d H u d s o n , 1 9 6 5 ) , p p . 11 - 2 7 .  21.  Scholars believe the failure of the architecture of the Modern Movement to deal with human p r o b l e m s is best symbolized by the demolition of the 12 storey public housing p r o j e c t at Pruitt-Igoe i n St. Louis i n 1973. A f t e r c r e a t i n g what became a v e r t i c a l s l u m the U.S. Dept. of Housing and Urban Development were forced to demolish their own project after i t was a b a n d o n e d w h i l e s t i l l new. T h i s has become a symbolic end to the Modern Movement and the opening of the P o s t - M o d e r n Movement i n a r c h i t e c t u r e . Heimsath says; "the Modern Movement b e g a n as the world changed to industralization, behavioural architecture begins as the world shifts to conservation and an ecological world view." C l o v i s Heimsath, Behavioural Architecture. New York: M c G r a w - H i l l Book Co., 1977, p. 181.  22.  For a d i s c u s s i o n r e g a r d i n g the societal values which are the basis of Alexander's beliefs there is a critical review of the Pattern Language a p p r o a c h by Jean-Pierre Protzen, "The Poverty of the Pattern Language," and a retort by Christopher Alexander, "Value," in Concrete, Vol. 1, No. 8. The College of Environmental Design, Berkeley, (November 15, 1977).  The International Urban Crisis. P a l a d i n B o o k s , 1974. p. 117.  195  CHAPTER ONE  —  continued  23.  C h r i s t o p h e r A l e x a n d e r , The T i m e l e s s Way New York: O x f o r d U n i v e r s i t y P r e s s , 1979.  24.  Ibid,  p.  157.  25.  Ibid.  p.  95.  26.  Christopher Alexander and Barry Environmental S t r u c t u r e , Working for Planning and Development C a l i f o r n i a , 1969, p . 3.  27.  Christopher Alexander, et al. , A Pattern Which Generates M u l t i - S e r v i c e C e n t e r s , Report Center f o r Environmental Structure, Berkeley, nia, 1968. p. 15.  28.  C h r i s t o p h e r Alexander, e t a l . , A P a t t e r n Language, York: Oxford U n i v e r s i t y Press, 1977.  29.  Ibid,  30.  There are a number of "Ethnographers" who express concern that social scientists describe behaviour, events, structure, e t c . , without recognizing their own social frame o f r e f e r e n c e i n making judgements about the societies they observe. This is particularly noticeable with respect to "Mental Illness" from a u t h o r s such as E r v i n Goffman, A l f r e d Schutz, Harold Garfinkel, Jeff Coulter, et a l .  31.  Harold Garfinkel, Studies i n Ethnomethodology, wood C l i f f s , N.J.: P r e n t i c e - H a l 1 , 1967. See c i a l l y p p . 18 - 24 a n d p p . 35 - 3 7 .  32.  A l f r e d S c h u t z was r e c o g n i z e d among s o c i o l o g i c a l t h e o r i s t s f o r h i s s t u d i e s i n the "seen but u n n o t i c e d " a t t i tudes o f the world of everyday life, particularly a series of studies done between 1962 and 1966, see e s p e c i a l l y , Alfred Schutz, Collected Papers: I. The Problem of S o c i a l Reality, ed. by M. Natanson, The Hague: Nijhoff, 1962.  33.  Alfred S c h u t z , The Frame o f U n q u e s t i o n e d Constructs, cited by Mary Douglas, Rules and Meanings (London: P e n g u i n B o o k s , 1973) p . 18.  34.  Harold Garfinkel, Background Expectancies, Mary Douglas, Rules and Meanings (London: B o o k s , 1973) p . 22.  p.  of Building, p. 75.  Poyner, The Atoms o f P a p e r No. 4 2, Center Research, Berkeley,  Language from the Califor-  New  xiii.  Engleespe-  i  cited by, Penguin  196  CHAPTER TWO NOTES AND REFERENCES  1.  The t e r m i s u s e d w i t h r e f e r e n c e to a deliberately u n s t r u c t u r e d m e e t i n g i n w h i c h i d e a s a r e p r e s e n t e d and explored f r e e l y with the objective o f a r r i v i n g a t a previously unanticipated result.  2.  T h i s i s a very s t r u c t u r e d committee process i n which the i n t e r a c t i o n o c c u r s o n l y t h r o u g h t h e m o n i t o r and the group although present a r e "nominal" ( i n name o n l y ) s e e ; A n d r e D e l b e c q , Andrew V a n de Ven a n d D a v i d Gustafson, G r o u p T e c h n i q u e s f o r Programme P l a n n i n g , Glenview: S c o t t F o r e s m a n a n d Co., 1 9 7 5 .  3.  N. D a l k e y a n d 0 . H e l m e r "An E x p e r i m e n t a l A p p l i c a t i o n of the Delphi Method t o t h e Use o f Experts", Management S c i e n c e 9 , No. 3 ( A p r i l 1 9 6 3 ) , p . 4 5 8 a s c i t e d i n H a r o l d A. L i n s t o n e a n d M u r r a y T u r o f f , e d s . , The D e l p h i M e t h o d : T e c h n i q u e s a n d A p p l i c a t i o n s , Don Mills: A d d i s o n - W e s l e y P u b l i s h i n g Co.-, 1 9 7 5 . p^ 1 0 .  4.  Linstone  5.  I b i d . p. 3 .  6.  R o s s P l a n n i n g A s s o c i a t e s , D e s i g n f o r O b s t e t r i c a l and P e d i a t r i c F a c i l i t i e s , Ohio: Ross L a b o r a t o r i e s , 1 9 7 2 .  7.  Kurt Finsterbusch Research Tool", 1976).  and T u r o f f ,  p. 8 1 .  Ibid.  "The M i n i S u r v e y : An U n d e r e m p l o y e d Social Science Research, (March,  8.  Harold A. Linstone, Eight C h e c k l i s t , as c i t e d i n Harold T u r o f f , eds. , I b i d , p. 5 7 8 .  9.  There a r e numerous general references to these p r o b l e m s i n Andrew D e l b e c q e t . a l . , I b i d . a n d i n H a r o l d A. L i n s t o n e -and M u r r a y T u r o f f , e d s . , I b i d . p a r t i c u l a r l y p. 8 6 .  10.  F i n s t e r b u s c h , The M i n i S u r v e y , p . 9 2 .  11.  Murrary Turoff, "The D e s i g n o f a P o l i c y Del-phi", T e c h n o l o g i c a l F o r e c a s t i n g a n d S o c i a l Change 2 , No. 2 ( 1 9 7 0 ) , as c i t e d i n H a r o l d A. L i n s t o n e and M u r r a y T u r o f f , eds., I b i d . p. 9 4 .  Basic Pitfalls: , A A. L i n s t o n e and M u r r a y  197  CHAPTER TWO  —  continued  12.  Colin W. C l i p s o n and Joseph J . Wehrer, P l a n n i n g for Cardiac Care: A Guide t o t h e P l a n n i n g and Design of Cardiac Care Facilities, Michigan: The Health A d m i n i s t r a t i o n P r e s s , 1973. p. 85.  13.  Turoff, Policy  14.  The d i s c u s s i o n of Rationalist versus Incrementalist approaches to planning refers to two extremes in a spectrum of approaches (Developmental, Adaptive, A l l o c a t i v e , etc.) which are not being c o n s i d e r e d here for the purposes of simplification.  15.  Amitai E t i z i o n i , "Mixed Scanning: A 'Third' Approach to Decision-Making", Public Administration Review, December, 1967, r e p r i n t e d i n , A. F a l u d i e d . , A R e a d e r i n P l a n n i n g T h e o r y U r b a n and R e g i o n a l P l a n n i n g S e r i e s , Vol. 5 (Oxford: Pergamon P r e s s , 1976).  16.  Ibid,  p.  217.  D e l p h i , p.  84.  198  CHAPTER FOUR NOTES AND  REFERENCES  1.  See the statement of a concept by Mr. Maruyama, " C o m m e n t a r i e s on the 'Quality of L i f e ' concept," unpublished, cited in Harold A. Linstone and Murray Turoff, eds., The Delphi Method: Techniques and Applications, Don Mills: Addison-Wesley Publishing Co., 1975. pp. 494-495.  2.  I b i d , pp.  3.  I b i d . p.  4.  An experimental Delphi was i n f o r m a t i o n was d e l i b e r a t e l y and W. Gant, "The Delphi Teacher Education, Vol. 21, cited in Harold A. Linstone I b i d , p. 586.  5.  I b i d , p.  6.  Linstone introduces the idea of "Singerian Inquiry System" i n h i s work on D e l p h i . This system i s s i m i l a r i n o b j e c t i v e s to our o b j e c t i v e s i n that i t broadens the c l a s s of p a r t i c i p a n t s to include the designer. This i s done for, the p a r t i c i p a n t s to add to their knowledge of the subject and themselves. See Ibid. p. 35.  7.  In p a r t i c u l a r see t h e C h a p t e r V I I . Computers Future of Delphi in Harold A~ Linstone and T u r o f f , eds., I b i d , p. 487.  573-586. 6. conducted i n which false i n t r o d u c e d s e e F. C y p h e r t Techniques", Journal of No. 3, 1970, p. 422 as and Murray T u r o f f , eds.,  583.  and the Murrary  BIBLIOGRAPHY  Alexander, York:  Christopher. The T i m e l e s s Oxford U n i v e r s i t y Press,  Alexander, Christopher; Ishikawa^ Murray. A Pattern Language. University Press, 1977.  Way of 1979. Sara; New  Building.  New  and Silverman, York: Oxford  Alexander, C h r i s t o p h e r and Poyner, Barry. The Atoms of E n v i r o n m e n t a l S t r u c t u r e , W o r k i n g P a p e r No. 4 2. Center for Planning and Development Research, Berkeley, Calif., 1969. Alexander, Christopher; Ishikawa, Sara; and Silverman, Murray. A Pattern Language which Generates MultiService Centers. Report from the Center f o r E n v i r o n mental S t r u c t u r e , Berkeley, C a l i f . , 1968. Blair, Thomas L. The I n t e r n a t i o n a l Urban more, England: P a l a d i n Books, 1974.  Crisis.  Frog-  Campbell, A l a n ; M i l l e r , James; Mysok, M a r l e n e ; and Warner, Morton. Changing Strategies for British Columbia H e a l t h Management. Health Services Planning Discuss i o n P a p e r No. 1. D e p t . o f H e a l t h C a r e and Epidemiolo g y , U n i v e r s i t y o f B r i t i s h C o l u m b i a , May 1981. Clipson, C o l i n W.; and Wehrer, Joseph J. Cardiac Care: A Guide to the P l a n n i n g Cardiac Care F a c i l i t i e s . Michigan: The istration Press, 1973. Delbecq, A n d r e ; Van de Ven, Andrew; Group Techniques f o r Programme S c o t t F o r e s m a n and Co., 1975.  Planning for and Design of H e a l t h Admin-  and Gustofson, David. Planning. Glenview:  Department of Health S e r v i c e s and H o s p i t a l Insurance of B.C. H o s p i t a l s f o r Extended Care: A Program and Design Guide. Prepared f o r R~. L o f f m a r k M i n i s t e r of" Health, 1974. Diaz,  James and Porter, B i l l . " C o n s i d e r a t i o n s About New Standards for Projecting Space Requirements for Community H o s p i t a l s " . Paper presented a t the Quarterly Meeting, o f the American Institute of Architects, Committee on Architecture for Health, Washington, D.C, March 1981.  Douglas, Mary. Rules Books, 1973.  and  Meanings.  London:  Penguin  200  BIBLIOGRAPHY —  Continued  v  F a l u d i , Andreas. ed. A Reader i n Planning Theory. Urban and Regional Planning Series, Vol. 5. Oxford: Pergamon P r e s s , 1976. Finsterbusch, Kurt. Research Tool." 1 9 7 6 ) , 81 - 9 3 .  "The Mini-Survey: An Underemployed Social Science Research 5, (March,  Finsterbusch, Kurt. "Demonstrating the Value of Mini Surveys i n S o c i a l Research". S o c i o l o g i c a l M e t h o d s and Research. V o l . 5, No. 1 ( A u g u s t 1 9 7 6 ) , 117 136. Garfinkel, Harold. C l i f f s , N.J.:  S t u d i e s i n Ethnomethodo'logy. Prentice-Hall, 1967.  Englewood  H a m i l t o n , J a m e s A., and A s s o c i a t e s . A H o s p i t a l P l a n and a Professional Education/Progamme of the Province of B r i t i s h Columbia, Canada. Minneopolis, 1949. Hatje, Gerd. Encyclopaedia ed. London: Thames and Health and Welfare Maternity and Canada, 1975.  o f Modern A r c h i t e c t u r e . Hudson, 1965.  2nd  Canada. Recommended Standards for Newborn Care. Ottawa: Information  Health and Welfare Canada. Guidelines for Minimum S t a n d a r d s i n t h e P l a n n i n g , O r g a n i z a t i o n and Operations of S p e c i a l Care U n i t s in Hospitals. Report of the Working Party on Special Care Units in Hospitals, 1976. Heimsath, Clovis. Behavioural M c G r a w - H i l l Book Co., 1977.  Architecture.  New  Linstone, Harold A., and Turoff, Murray, editors. Delphi Method: Techniques and Applications. Mills: A d d i s o n - W e s l e y P u b l i s h i n g Co. , 1975. Peckham, Arthur H. Jr. Planning Process". Canada. (May 1975).  "The Use of Standards in Hospital Administration  P h i l l i p s , D o n a l d F. of Adjustment."  "Health Regulations i n 1977: Hospitals. V o l . 51 ( F e b . 1,  Rosenfield, York:  Hospitals; Integrated P u b l i s h i n g Corp., 1947.  Ross  Isadore. Reinhold  Planning Pediatric  Associates. Facilities.  York:  The Don  the in  A Period 1977).  Design.  New  Design for Obstetrical and Ohio! Ross L a b o r a t o r i e s , 1972.  201  BIBLIOGRAPHY —  Continued  Schutz, Alfred. Collected Papers: I. Social Reality> The Hague: Nijhoff,  The Problem 1967.  of  Souder, James J. Estimating Space General Hospital Construction. H o s p i t a l A s s o c i a t i o n , 1963.  Needs and Chicago:  Costs i n American  Wheeler, E. Todd. Hospital Design M c G r a w - H i l l Book Co., 1964.  Function.  New  and  York:  202  APPENDIX A Round One  Questionnaire  203  r  DO NOT  COPY PP.  203-^16  INTRODUCTION The Study i s d e s i g n e d to look a t t h r e e broad aspects which are i n themselves s e p a r a t e but i n t e r a c t t o g e t h e r . I t w i l l be the t a s k of the respondents to i d e n t i f y and d e v e l o p each o f the three areas s e p a r a t e l y and then respond to the s y n t h e s i s developed by the m o n i t o r s . In t h i s way a s e t o f Long Term O b j e c t i v e s , F u n c t i o n a l C r i t e r i a and Space P l a n n i n g elements w i l l be d e v e l o p e d . I t i s t h e l i n k i n g o f these t h r e e areas t h a t i s the b a s i s o f the proposed Design S t a n d a r d o r P l a n n i n g G u i d e l i n e i n t h a t these a s p e c t s are dependent upon one a n o t h e r and cannot be t a k e n i n i s o l a t i o n t o r e p r e s e n t s u f f i c i e n t i n f o r m a t i o n t o be a g u i d e .  THE STUDY The Study t a k e s p l a c e as a s e r i e s o f q u e s t i o n n a i r e s o v e r t h r e e r o u n d s . The d a t a c o l l e c t e d i s f e d back t o respondents a t the n e x t round and they are asked to comment and vote upon i s s u e s .  T h i s i s a study i n P o l i c y I s s u e s , so we are t r y i n g t o develop as many d i v e r s e o p i n i o n s as p o s s i b l e r a t h e r than to a c h i e v e c o n s e n s u s . It i s i m p o r t a n t t h a t the Design Guide be a b l e t o c o v e r a l l the o b j e c t i v e s a unit could foreseeably require. We w i l l be l o o k i n g t o e x p l o r e the i s s u e s which cause p o l a r i z a t i o n and most l i k e l y j u s t a c c e p t the ones upon which t h e r e i s agreement.  THE  DESIGN  The t h r e e rounds can be c l a s s i f i e d as to t h e i r primary i n t e n t as f o l l o w s : Round One i s to D i s c o v e r . The keyword i s What - what are the i s s u e s , what are the o b j e c t i v e s t h a t s h o u l d be a c h i e v e d and what c r i t e r i a examined. Round Two i s to E x p l o r e . The keyword i s Why - why do respondents d i s a g r e e , why do they h o l d t h a t p o i n t o f view and why w o n ' t something d i f f e r e n t w o r k . The f i n a l round i s t o E v a l u a t e . The keyword i s I f - i f t h i s i s done the outcome w i l l b e , o r i f t h i s i s not done the outcome w i l l b e .  V T£>P-*-F  QUESTIONNAIRES Each o f the Q u e s t i o n n a i r e s w i l l m a i n t a i n t h r e e s t r e a m s . The f i r s t one i s o v e r a l l o b j e c t i v e s , which p r o v i d e a l o n g range p e r s p e c t i v e . This i s i m p o r t a n t i f plans a r e to accommodate f u t u r e changes. T h i s means t h a t p r i o r i t i e s i n p l a n n i n g can be made w i t h a f u t u r e s p e r s p e c t i v e r a t h e r than t o o n l y seek p r e c e d e n t i n the p a s t .  The Second s t r e a m d e a l s w i t h F u n c t i o n a l I s s u e s . These are the c o n s i d e r e d i m p o r t a n t i n o p e r a t i n g a u n i t and a r e the b a s i s o f e n s u r i n g the spaces w h i c h accommodate them a r e a d e q u a t e .  criteria  The T h i r d stream d e a l s w i t h t h e Space P l a n n i n g i s s u e s . T h i s s e c t i o n a l l o w s the m o n i t o r s t o communicate w i t h t h e respondents by i n i t i a t i n g a s e r i e s o f a r c h i t e c t u r a l p o l i c y i s s u e s i n response t o the c r i t e r i a b e i n g e s t a b l i s h e d i n the f i r s t two s e c t i o n s . The o p i n i o n s and c r i t i c i s m i n terms o f t h e i m p o r t a n c e and v a l i d i t y o f t h i s c r i t e r i a a l l o w s the s y n t h e s i s t o t a k e p l a c e and t h e a r c h i t e c t u r a l model to d e v e l o p .  PATTERN LANGUAGE What we w i l l have developed as a r e s u l t o f t h i s i n q u i r y w i l l be a series of "patterns". These are based upon t h e work o f a C h r i s t o p h e r A l e x a n d e r who, between 1968 and 1 9 7 7 , developed a P a t t e r n Language f o r l i n k i n g a s e r i e s o f d e s i g n problems and s o l u t i o n s t o g e t h e r . It w i l l be t h e b a s i s o f our new d e s i g n s t a n d a r d s . We w i l l use t h i s method t o describe a s e r i e s of patterns f o r the n u r s e r i e s . The p a t t e r n d e s c r i b e s a problem which o c c u r s o v e r and o v e r a g a i n , then d e s c r i b e s t h e c o r e o f the s o l u t i o n t o the problem such t h a t i t can be s o l v e d i n many ways. By t h i s method we hope t o a c h i e v e a f o r m a t l i k e t h i s : I f X (a p l a n n i n g s i t u a t i o n o r i s s u e t o be s o l v e d ) : then Y (a b e s t s o l u t i o n ) : s o l v i n g Z ( t h e problem b e i n g overcome). This i s the p a t t e r n . T h i s has the d i s t i n c t advantage o f b u i l d i n g a number o f t h e s e p a t t e r n s i n t o a l a r g e r p a t t e r n network and each g r o u p i n g o r " l a n g u a g e " forms a unique s o l u t i o n . W h i l e t h e problems and s o l u t i o n s are d e f i n i t e , they are c l e a r l y ' v i s i b l e ' and c h a l l e n g e a b l e when i n a p p r o p r i a t e to t h e s p e c i f i c s e t o f c i r c u m s t a n c e s b e i n g accommodated i n p l a n n i n g . There a r e numerous c o m b i n a t i o n s a v a i l a b l e . A l l t h a t m u s t b e agreed i s t h e l i n k i n g o f problem and s o l u t i o n i n each p a t t e r n .  We w i l l have d e v e l o p e d t h e s e p a t t e r n s d u r i n g t h e s t u d y and a p o s s i b l e network a f t e r t h e t h i r d round o f q u e s t i o n n a i r e s .  DELPHI -STUDY  a  ROUND  206  r  INSTRUCTIONS In this series of questionnaires we are seeking your personal answer. We expect that where you wish, you will use your assistants and colleagues who are not already involved in this study to assist. Don't feel compelled to answer all the questions yourself, however, they will be processed as i f done by an individual. Since we are dealing with two subject areas (Neonatal I.C.U. & Nurseries) which could ultimately be looked at quite independently, we would appreciate your addressing each segment of questions separately. This will help to orient your frame of mind. Overlaps between the two subject areas should be avoided.  If you feel you don't have great depth in some area don't feel you can't give an opinion. This is a policy issue and opinions are what we are seeking. If, however, you feel you can't give an opinion on one aspect just f i l l in the other aspects and proceed. This will in no way eliminate you since you can s t i l l vote or rate other's, answers in the next round. Maximum partcipation helps the whole exercise become meaningful. If you feel you need additional space to fully explain your answer or point of view please do so on an additional piece of paper. However, you must prefix this with the question and section number. At the completion of the questionnaire, please f i l l out what you feel to be a reasonable assessment of the time i t took to complete the questionnaire. While this may be a d i f f i c u l t task, i t is important to the monitor group's decisions about their estimate of respondent times for later questionnaires.  P l e a s e f i l l out y o u r answers d i r e c t l y on t h e s e pages where space i s p r o v i d e d and r e t u r n the WHOLE q u e s t i o n n a i r e i n a s e a l e d e n v e l o p e t o : Thompson, B e r w i c k , P r a t t & P a r t n e r s 1553 Robson S t r e e t , Vancouver, B . C . V6G 1C6 Attention:  Please f i l l  Ian  Forbes  out:  1.  NAME OF RESPONDENT:  2.  MY ESTIMATE OF THE TIME REQUIRED TO FILL OUT THIS QUESTIONNAIRE IS:  3.  ARE THERE EXTRA PAGES ADDED?  YES  BACKGROUND TO STUDY We f e e l t h a t i t i s i m p o r t a n t i n u s i n g a m u l t i - d i s c i p l i n a r y team o f respondents t o l e t each respondent know where he/she s t a n d s n o t o n l y w i t h r e g a r d t o the t o t a l g r o u p , but t o the s p e c i f i c p o i n t o f view o f the v a r i o u s d i s c i p l i n e s i n v o l v e d . S i m i l a r l y where i n d i v i d u a l s f e e l they have a s p e c i a l a r e a o f e x p e r t i s e t h i s s h o u l d be r e f l e c t e d i n t h e f e e d b a c k . A t y p i c a l example m i g h t be " o f those c l a i m e d t o be e x p e r t i n t h i s a r e a o n l y 30% agreed w i t h t h i s idea."  The f o l l o w i n g segment o f the f i r s t q u e s t i o n n a i r e seeks t h i s P l e a s e answer from y o u r own p e r s o n a l p o i n t o f v i e w .  Bl.  data.  ORIENTATION OF INTEREST  I would c o n s i d e r my p o i n t o f view t o most c l o s e l y r e p r e s e n t e d  PREDOMINANT POINT OF VIEW  ACADEMIC FAMILY  PRACTICE  NEONATOLOGY OBSTETRICS PEDIATRICS CONSUMER OTHER  o o  (EXPLAIN)  S e l e c t and check o n l y ONE  NURSING  OOOOOO  ADMINISTRATION  MEDICAL  OOOOOO  AREA OF MOST ACTIVITY  by:  209  r  B2.  AREA OF EXPERTISE  In b e i n g asked t o g i v e y o u r o p i n i o n i n r e g a r d t o t h e f o l l o w i n g i s s u e s o f the Newborn, r a t e y o u r s e l f as t o y o u r c o n f i d e n c e i n b e i n g a c c u r a t e i n y o u r r e s p o n s e , i n r e g a r d t o e x p e c t e d outcomes. ACCURATE 100% OF THE TIME  ACCURATE 50% OF THE TIME  VERY LIKELY TO BE ACCURATE  A.  National or Provincial Planning P o l i c i e s  0  1  2  3  4  5  6  7  8  9  10  B.  L e g a l and E t h i c a l Outcomes  0  1  2  3  4  5  6  7  8  9  10  C.  Intra-departmental functions within a hospital  0  1  2  3  4  5  6  7  8  9  10  D.  Inter-departmental functions within a hospital -  0  1  10  E.  S t a f f Organization Issues  0  1  IP  F. . S t a f f T r a i n i n g I s s u e s  0  1  2  3  4  5  6  7  8  9  10  G.  P a t i e n t F a m i l y Issues  0  1  2  3  4  5  6  7  8  9  10  H.  Environmental Safety  0  1  2  3  4  5  6  7  8  9  10  J.  Equipment  0  1  2  3  4  5  6  7  8  9  10  K.  Unit Administration  0  1  2  3  4  5  6  7  8  9  10  PLACE A CIRCLE AROUND ONE NUMBER IN EACH LINE  SECTION 1 For a p l a n n e r needing a d e f i n i t i o n o f the f o l l o w i n g items g i v e a s i n g l e s t a t e m e n t which conveys what you see t o be the e s s e n t i a l concept o f : 1.1.  NEWBORN NURSERY  1.2.  INTENSIVE CARE NURSERY  L i s t under each s e c t i o n s e p a r a t e l y t h e most i m p o r t a n t long term OBJECTIVES t h a t s h o u l d be a c h i e v e d i n the p l a n n i n g o f new u n i t s o v e r the n e x t 10 y e a r s . You s h o u l d d e s c r i b e what are the problems t o be overcome and what i s the b e s t s o l u t i o n t o overcome them.  To g i v e you some c o n c e p t o f t i m e take a look back t o 1968 and see what has happened i n t e n y e a r s and what might the o b j e c t i v e s f o r 1978 have been i n 1968.  1.3.  NEWBORN NURSERIES  1.4.  INTENSIVE CARE NURSERIES  SECTION 2 2.  With r e g a r d t o F u n c t i o n a l A s p e c t s (normal a c t i v i t i e s performed i n o r d e r t o have p u r p o s e f u l c o m p l e t i o n o f t a s k s ) l i s t up t o 5 p o l i c y c r i t e r i a t h a t you c o n s i d e r IMPORTANT t o a c h i e v e ( i n t h e i r e f f e c t upon p l a n n i n g ) under each g e n e r a l t o p i c a r e a b e l o w . Answer t o i s s u e s i n Newborn N u r s e r i e s s e p a r a t e l y from I . C . N . A g a i n you s h o u l d i d e n t i f y the problem t o be a d d r e s s e d and the p o l i c y t o overcome i t . To a s s i s t you w i t h y o u r answer an example o f " P o l i c y C r i t e r i a " i s g i v e n f o r a q u e s t i o n on S u r g e r y "Infection 1)  Issues  N u r s i n g s t a f f s u p p l y i n g O . R . ' s w i t h i n s t r u m e n t s and equipment h e l d i n t h e c e n t r a l s t e r i l e s t o r e s h o u l d be t h e o n l y ones w i t h a c c e s s t o t h a t a r e a t o ensure c o n t r o l o f c r o s s i n f e c t i o n . "  T h i s example a d d r e s s e s (1) a key i s s u e (2) i t has a s p e c i f i c o b j e c t i v e t o work t o (3) solve a s p e c i f i c problem. NEWBORN NURSERIES 2.1.  U n i t S i z e and P a t i e n t Mix  2.2.  P a t t e r n s o f Care  2.3.  Infection  Issues  NEWBORN NURSERIES 2.4.  Staffing Issues  2.5.  Parent Access Issues  2.6.  Training/Education Iss  NEWBORN NURSERIES 2.7.  Location i n Relation to other Departments  2.8.  Staff issues related to stress i n the working environment  2.9.  Supply Methods (to/from) & Materials Management Distribution Methods (within) the unit  4-  P  r NEWBORN NURSERIES .10.  V i s u a l S u p e r v i s i o n of P a t i e n t s and S t a f f L o c a t i o n a l Issues  COMMENTS (PLEASE REFER TO SECTION NUMBER)  Again you s h o u l d i d e n t i f y p o l i c y t o overcome i t .  the p r o b l e m t o be a d d r e s s e d and t h e  P l e a s e add f u r t h e r F u n c t i o n a l A s p e c t s as you see f i t . Add comments on any s e c t i o n i n the space a t t h e end o r on an a d d i t i o n a l p a p e r .  I.C.N. 2.11  U n i t S i z e and P a t i e n t Mix  2.12  Patterns of  2.13  Infection  Care  Issues  I.C.N. 2.14  S t a f f i n g Issues  2.15  P a r e n t .Access Issues  2.16:.  Training/Education  Issues  I.C.N. 2.17  Location i n R e l a t i o n to o t h e r Departments  2.18  S t a f f issues r e l a t e d to s t r e s s i n w o r k i n g environment  2.19  Supply Methods ( t o / f r o m ) & M a t e r i a l Management D i s t r i b u t i o n Methods ( w i t h i n ) the u n i t  the  r I.C.N.  2.20  Visual Supervision of P a t i e n t s and S t a f f L o c a t i o n a l Issues  COMMENTS (PLEASE REFER TO SECTION NUMBER)  .•Hi i •  I  • •• K PREMATURE NURSERY • •  • Li  1  'in mm • .1  1=  • • 1 TERM NURSERY  STORAGE  WORKROOM  • ••  WORKROOM  PUBLIC C O R R I D O R  WORKROOM  d  •  •  • •  SUSPECT NURSERY  •  •  • •  •  • •  TERM NURSERY  •  FORMULA ROOM WORKR6OM  TERM NURSERY  • •  I  •  '° .n ZEE  p  Conventional Nursery Suite.  From P l a n n i n g G u i d e l i n e s by Ross L a b o r a t o r i e s , M i l w a u k e e , W i s . U . S . A .  • •  From P l a n n i n g G u i d e l i n e s by Ross L a b o r a t o r i e s , M i l w a u k e e , W i s .  U.S.A.  SECTION 3 3.  3.1.  This s e c t i o n deals w i t h a r c h i t e c t u r a l a s p e c t s , please give your o p i n i o n i n each case even i f you may n o t have any p e r s o n a l e x p e r i e n c e i n one s p e c i f i c a r e a . Your c o l l e c t i v e response w i l l guide o u r a c t i o n on t h e n e x t q u e s t i o n n a i r e . NEWBORN NURSERIES  The S i n g l e - c o r r i d o r system o f Diagram 1 has been u n f a v o u r a b l y compared w i t h t h e D o u b l e - c o r r i d o r system o f Diagram 2 . U s i n g t h e diagrams s u p p l i e d , answer t h e f o l l o w i n g : (NOTE: The Diagrams a r e f o r t h e purpose o f i l l u s t r a i n g s p e c i f i c concerns n o t e v a l u a t i o n as examples o f p l a n n i n g generally).  3 . 1 . 1 . S t a f f i n g and Work f l o w p a t t e r n c r e a t e d by Diagram 1 are i n e f f i c i e n t due t o t h e m u l t i p l e w o r k r o o m s , and t r a v e l between n u r s e r i e s and/or washrooms i s time consuming because o f c o n t i n u a l gowning and s c r u b b i n g . T h i s type o f l a y o u t w o u l d be u n a c c e p t a b l e f o r a new facility. Do y o u : Strongly  Agree  Agree Have N e u t r a l Strongly  Feelings  Disagree  No O p i n i o n Comments:  O O O O (^)  (select  one)  ' • - " ••' •  3 . 1 . 2 . The workroom i t s e l f i s u n s a t i s f a c t o r y i n Diagram 1 , because i t must s u p p o r t many d i s s i m i l a r f u n c t i o n s such as e n t r y , g o w n i n g , c l e r i c a l , c h a r t i n g , u t i l i t i e s and e x a m i n a t i o n - t r e a t m e n t o f the i n f a n t . D i s s i m i l a r f u n c t i o n s r e q u i r e formal s e p a r a t i o n . Do y o u : Strongly  Agree  Agree  Q  Have N e u t r a l F e e l i n g s Strongly  Disagree  No O p i n i o n Comments:  (select  one)  223  r 3.1.3.  The American Academy of Pediatrics, Standards and Recommendations for Hospital Care of Newborn Infants (5th Ed.) says about Isolation rooms: Isolation rooms per se are unnecessary when (1) there is adequate nursing (see page 14) and medical staff so movement between patients is unhurried and there is always time for thorough hand washing; (2) there is sufficient space in the intensive care, observation, and intermediate care areas for a physical separation of 3 or 4 ft between- infants (and the temptation is reduced to move from patient to patient without washing hands); (3) there are two wash basins for each nursery area; and (4) there is a continuing program of instruction for all nursery personnel on the mode of spread of infections.  Do you Strongly Agree Agree Neutral  (select one)  Strongly Disagree No Opinion Comments:  21  l.|.r-niiWjiiifctr^ilii*'-  ' _'• |  MHVICt SHEIF SYSTtM  3>  CD  • •• c MAXIMAL CARE  .  CLERICAL CENTER  D • • • ••  TREATMENT LAB  Q  @||  0 INFANT SPECIAL CARE UNIT CO  „ D  O  Q  2  Q  • • I—|  0JAKS/N DEMOCONF.  0 B  •  U  —'1 —  <  •  1  •  1  UJ  411 sD:V Q  SCRUB;  ENTRY  f—]  M A I N CORRIDOR | T O POST P A R T U M  U <  i5 • • §5 • •  1° ®  i  10 S T O R A G E j  RESTRICTED A C C E S S W O R K CORRIDOR  M A I N CORRIDOR TO L&D  ELL/  0 05  xJlLll  INTERMEDIATE CARE  SOILED UTILITY  CLEAN UTILITY L-l  ta  • a  RELOCATED M A I N CORRIDOR  S C A L E : '/." = I ' O "  Conceptual Plan, Newborn Nursery Suite.  From Plannlng'^uidelines by Ross  Laboratories,  Milwaukee,  Wis. U.S.A.  t  225  3.1.4.  In b o t h Diagrams 2 and 3 the t r a f f i c p a t t e r n s have been b u i l t around the c o n c e p t t h a t i t i s e s s e n t i a l f o r n u r s e r y - s t a f f t r a f f i c t o be p o s i t i v e l y s e p a r a t e d from g e n e r a l h o s p i t a l and public t r a f f i c patterns. T h i s n e c e s s i t a t e s an i n t e r n a l c o r r i d o r l i n k i n g a l l n u r s e r y components and a n o t h e r c o r r i d o r f o r g e n e r a l t r a f f i c and p a r e n t v i e w i n g . T h i s would then be a b a s i c r e q u i r e m e n t o f any new n u r s e r y f a c i l i t y . Do y o u :  Strongly  Agree  Agree Neutral Disagree Strongly  Disagree  (select  one)  No O p i n i o n Comments:  3.1.5.  The s p a c i n g shown on t h e i n s e r t o f Diagram 2 p r o v i d e s the f o l l o w i n g s t a n d a r d s f o r Term o r M i n i m a l Care n u r s e r i e s . (i) (ii) (iii)  C l e a r space between s i d e s o f b a s s i n e t s o f 2 ' - 0 " (60 cm) C l e a r space o f a i s l e between s i d e s o f c r i b s o f 4 ' - 0 " (120 cm) A minimum a r e a o f 21 s q . f t . (2 s q . m) p e r b a s s i n e t o f f l o o r f o r t h e e n c l o s e d room space c o n t a i n i n g t h e i n f a n t s . B a s s i n e t s e t c l e a r o f w a l l o r o b s t r u c t i o n by 6 " (15 cm)  (iv) These a r e :  An a c c e p t a b l e minimum (select Not a c c e p t a b l e E x p l a i n : (or  comment)  one)  226  In Diagram 3 a Special Care Unit is included with two levels of care, Intermediate (below "intensive" and might include stabilized, lowbirth-weight infants and graduates from "intensive" care) and Maximal (infants with l i f e threatening conditions). The standards are: 3.1.6.  Intermediate (i) (ii) (iii)  (iv)  Clear space between the sides of the incubator or bassinets to be a minimum of 3'-0" (90 cm) Clear aisle width of 4'-0" (120 cm) from any protrusion on incubator or bassinet. An area of 30 sq. f t . (2.8 sq. m) in addition to the size of each incubator or bassinet (assume 6 sq. f t . (56 sq. cm) for the enclosed room space containing the infants. Bassinets or incubators set 6" clear of wall or unit.  These are: An acceptable minimum Not acceptable  (select one)  Explain: (or comment)  3.1.7.  Maximal Care would be the same as NICN . spaces, namely: (i)  (ii) (iii) These are:  Space between 4'-0" (120 cm)  Aisles clear of protrusion 5'-0" (150 cm) An area of 55 sq. f t . (5 sq. m) in addition to the size of each incubator for the enclosed room space containing the infants.  An acceptable minimum Not acceptable  (select one)  Explain: (or comment)  24  227  r 3.1.8.  Where the r e q u i r e m e n t s f o r d o i n g w i t h o u t an i s o l a t i o n n u r s e r y cannot be met ( r e f . 3 . 1 . 3 . ) the f o l l o w i n g a r e the proposed m i n i mums: (i)  R e q u i r e d t o have a minimum o f two spaces w i t h an a c u t e room and n u r s e r y p r o p e r . Access t o n u r s e r y i s through anteroom. The anteroom must c o n t a i n space f o r a s c r u b u n i t , gowning s p a c e , c h a r t i n g a r e a and s u p p l y c a b i n e t o r s h e l v e s and c a r t and s o i l e d l i n e n hamper.  (ii)  (iii)  The I s o l a t i o n n u r s e r y must c o n t a i n a maximum o f two i n c u b a t o r s w i t h an e n c l o s e d space o f 33 s q . f t . (3 s q . m) per i n c u b a t o r . I n c u b a t o r s must be spaced 3 ' - 0 " (90 cm) a p a r t . A i s l e w i d t h o f 4 ' - 0 " (120 cm) r e q u i r e d .  (iv) (v) These a r e :  An a c c e p t a b l e minimum Not a c c e p t a b l e Explain:  (or  (select  one)  comment)  2.6  r  soviet  r~^~  b i t SYSTEM  •  INFANT O.R.  MAXIMUM CARE  •  •  6 INCUBATORS  If  • 34- • •4"|  rj  CAUWOK "p" g  H-CARE  H-CARE  CLEAN EQUIPMENT STORAGE  S  t  INTERMEDIA  •(• D D  OVERHEAD SERVICE MODULE I—I  D DID • u a » • '« i — CARE • . • DMINIMAL D D D D  ^  K  n n u u E CARE  12 INCUBATORS  POWER POLE  M  H-CARE  v»tt (oeou  J  EOUIR CLEAN-UP AND SERVICE  ra 0  16 BASSINETS OK INCUBAlORS OtAITINC  000  SOILED HOLDING.  •  ©0© / ii  DEMO. AND FEEDING  1=  NURSES' STATION  FOLDING DIVIDER  | / " '  wC  ,D DEMO. V / I AND j FEEDING v  \ IFOLDING \,J DIVIDER  MALE S  V  SCRUB  1  S  J  *  CONTROLLED ACCESS CORRIDOR FEMALE | DESK") \ 7 r D T S K  DR-CALl AND RESIDBNT  D '<0 EONATOIOG^TJ^,^ NURSERY  1  .SUPERVISOR^  • MES£—'  1 BENCH  CHAI* » N O ' ' \ » A M 1 »IO«. | •  DSECRETARYV  .  ' :  f| • Q Q D G G G D D Q  ff)  CONFERENCE CLASPS ROOM i D . j j j  » i BENCH !  Q Q  i  DIAGRAM  TBrVP  • • • • • • ODO J|  BLACK BOARD W / R O L l SCREEN  SCALE.?  r  '  "  3.2.  NEONATAL INTENSIVE CARE UNITS  3.2.1.  The most desirable shape or configuration for a N.I.C.U. nursery is one that is as square as possible with a maximum of open space. Do you: Agree  (^)  Disagree  (^)  (State why)  Explain: (or comment)  3.2.2.  An N.I.C.U. should operate within its own environmental area, exclusive of other hospital functions and activities (such as at a dead-end corridor or in a by-pass). Do you: Agree  Explain:  3.2.3.  (^)  (State why)  (or comment)  Spacing between and around bassinets and incubators in the N.I.C.U. nursery would be dependent upon the mix of levels of care appropriate to the specific unit. They would, for each l e v e l , be the same as for Minimal, Intermediate or Maximal Care as suggested under Newborn Nurseries Section 3.1.5., 3.1.6., 3.1.7. Do you: Agree  Explain:  Disagree  Disagree  (State why)  (or comment)  27  3.3.  MECHANICAL CONSIDERATIONS  3.3.1.  Heating Ventilating and Air Conditioning (Choose the appropriate answer in each column.) N. NURSERY  1.  In addition to any stabilized incubator a i r , the unit must have controlled air by: Heating only  N.I.C.U.  Q  Cooling only  Q  Heating and Cooling (Air Conditioning) Other (explain)  2.  3.  4.  Q  A temperature range of 68°F to 72°F (20°C to 22°C) i s : Acceptable  Q  ^  Q  Should be otherwise (state range)  Q  Q  A relative humidity of 50 percent + or - 5 percent i s : Acceptable  ^ (_J  Q  Should be different (state range)  O  O  Incoming clean air should be f i l t e r e d , not recirculated and room air changed a minimum of 12 times,per hour. Acceptable Should be different (state range)  O  (^)  3.3.2.  Plumbing (Check the a p p r o p r i a t e answer i n each column) N. NURSERY  1.  S i n k s i n w o r k t o p s s h o u l d be: Stainless Steel Porcelain Material  2.  Wall mounted s i n k s used f o r hand washing s h o u l d b e : Stainless  Steel  Porcelain Material  N.I.C.U.  o o o o  o o o o  o o o o  o o o o  (Combine t h e a p p r o p r i a t e number c o m b i n a t i o n s i n each column) With r e g a r d t o t h e o p e r a t i o n o f taps they s h o u l d b e :  4.  A.  A l l taps  1.  Knee o p e r a t e d  B.  Taps i n 2. Nursery Areas  Foot o p e r a t e d  C.  Taps i n 3. A n c i l l a r y Areas  W r i s t o r elbow action  D.  Other ( e x p l a i n ) ^ . -  Other  (explain)  Give y o u r p r e f e r e n c e f o r ONE o f the f o l l o w i n g . In I n f a n t Care Areas s i n k s s h o u l d be p l a c e d : . One p e r room o f up t o 12 i n f a n t s . Two p e r room o f up t o 12 i n f a n t s .  In rooms l a r g e r than 12 i n f a n t s a t l e a s t one p e r 12 i n f a n t s  . In rooms l a r g e r than 12 i n f a n t s a t l e a s t one per 6 i n f a n t s  232  B r i e f l y describe (or give the model of a similar type) the sink(s) required in the Soiled U t i l i t y Room. Also explain what function this unit performs.  3.3.3.  Gas Outlets (Check the appropriate box - one per area)  OUTLETS  LEVEL  Oxygen (State)  Vacuum  Compressed A i r (State) 3.3.4.  MINIMUM  INTERMEDIATE  MAXIMAL (N.I.C.U.)  1 per 2 i n f a n t s Q 1 per 2 infants Q  2 per infant  1 per infant  Q  1 per infant  Q  3 per infant  Other  Q  Other  Q  Other  Q  O O  Q  Q  1 per 2 i n f a n t s Q 1 per 2 infants ^ Q 2 per infant 1 per infant Q 1 per infant Q Q Other Other Q Other Q  Q  1 per 4 i n f a n t s Q 1 per 2 infants Q  2 per infant  Q  1 per 2 i n fants Q  1 per infant  Other  Other  Other  Q  Q Q  Heights of the gas outlets above the floor should be: (state range)  Q  3.4.  ELECTRICAL CONSIDERATIONS  3.4.1.  Power  1 . OUTLETS  LEVEL  MINIMUM  INTERMEDIATE  MAXIMUM NURSERY  1 Duplex p e r 2 i n f a n t s 1 Duplex p e r i n f a n t 2 to 4 per i n f a n t 4 per i n f a n t 4 t o 6 per i n f a n t 6 t o 8 per i n f a n t 8 t o 10 p e r i n f a n t 10 t o 16 p e r i n f a n t  --O -O  •o o o  I.C.U.  o o -o o- -o - -o  2 . Emergency Power O u t l e t 1 per i n f a n t 2 pen;infant 2 to 4 per i n f a n t 4 to 6 per i n f a n t 6 t o 8 per i n f a n t  3.4.2.  o -o o -o  H e i g h t s o f e l e c t r i c a l o u t l e t s above f l o o r s h o u l d b e : (State range)  A suggested performance specification for illumination ( a r t i f i c i a l & natural) is as follows: (Briefly outline criteria)  Telephone and Communications systems should consist of at 1 the following:  (Briefly outline criteria)  APPENDIX Round  Two  B  Questionnaire  INSTRUCTIONS  READING THE QUESTIONNAIRE We r e q u e s t t h a t you read c a r e f u l l y through the q u e s t i o n n a i r e BEFORE you s t a r t t o answer. T h i s w i l l a v o i d the p o s s i b i l i t y o f p r o v i d i n g answers i n one s e c t i o n t h a t are more a p p r o p r i a t e l a t e r . This occurred i n a number o f cases not a l l o w i n g the panel members to u t i l i z e the space provided f o r the appropriate concept. HANDLING THE VOLUME OF WORK A number o f people had g r e a t d i f f i c u l t y w i t h g e t t i n g s t a r t e d because of what they p e r c e i v e t o be the g r e a t volume of work i n v o l v e d . I t caused o t h e r s t o rush because they may have f e l t i t r e q u i r e d a b l o c k o f time and l e f t i t too l a t e . In o u r i n i t i a l premise we r e c o g n i z e d y o u r time as l i m i t e d and as such the t h r e e s e c t i o n s i n t o which we have broken the q u e s t i o n n a i r e s h o u l d a l l o w you the o p t i o n o f : (i) (ii) (iii) (iv)  Doing i t i n t h r e e d i s t i n c t phases i n d e p t h , D e v e l o p i n g i n depth a s e c t i o n o r p a r t s o f a s e c t i o n i n which you have a g r e a t deal to c o n t r i b u t e and moving over o t h e r areas r a p i d l y , Doing p a r t a t a time as you get time f r e e w i t h o u t l o s s o f c o n t i n u i t y a c r o s s the s t u d y , Doing the whole q u e s t i o n n a i r e i n one p i e c e .  P l e a s e get s t a r t e d as soon as the q u e s t i o n n a i r e a r r i v e s r e c e i v e y o u r responses q u i c k l y .  so t h a t we can  CONDENSATION OF MATERIAL GENERALLY Due to the q u a n t i t y o f answers s u p p l i e d i t was n e c e s s a r y to reduce the i n f o r m a t i o n i n o r d e r t h a t you c o u l d cope w i t h a f u r t h e r r e s p o n s e . This was done i n the f o l l o w i n g way:  237  r  CONDENSATION OF MATERIAL GENERALLY (i)  (ii) (iii) (iv) (v)  ...continued  By i d e n t i f y i n g where people were s a y i n g the same t h i n g i n d i f f e r e n t ways and rewording these i n t o one statement. Where t h e r e was any doubt as to whether t h e r e was a c t u a l l y the same t h i n g b e i n g s a i d statements are i n c l u d e d which vary from the reworded one. By summarizing a statement keeping as much o f the o r i g i n a l statement as p o s s i b l e , By c o p y i n g the statement as w r i t t e n when i t would l o s e i t s meaning i f a l t e r e d , Where answers were more a p p r o p r i a t e to another s e c t i o n we have moved them.  We r e a l i z e t h a t i n d o i n g t h i s we may have missed nuances you i n t e n d e d and they have been o m i t t e d . I f t h i s i s the case p l e a s e use the space p r o v i d e d to e x p l a i n the o m i s s i o n and i t w i l l be r e c o r d e d f o r the next round. SOLICITING COMMENTS The s e c t i o n s r e q u i r e d to be r a t e d are a l s o designed o p p o r t u n i t y to comment o r e s p e c i a l l y e n l a r g e on the T h i s i s where you can develop an i d e a t h a t has been e l s e but you have some i d e a s a b o u t . P l e a s e use the t h i s w i l l enhance the r e s u l t s .  Please f i l l 1.  2.  to g i v e you the issue i d e n t i f i e d . p r e s e n t e d by someone space p r o v i d e d as  out:  NAME OF RESPONDENT:  ARE THERE EXTRA PAGES ADDED?  YES  (STATE  2  238  r SECTION 1  In l o o k i n g a t the d e f i n i t i o n s s u p p l i e d i t would seem t h a t the e s s e n t i a l elements o f N u r s e r i e s and Neonatal I n t e n s i v e Care would be encompassed i n the f o l l o w i n g .  1.1  NEWBORN NURSERY  A Newborn Nursery would be an a r e a which i s d e s i g n e d f o r holding: (i) (ii) (iii)  selectively  Well b a b i e s , Newborns who a t b i r t h appear n o r m a l , F u l l - t e r m newborns  d u r i n g t h e i r h o s p i t a l s t a y , when not i n the c a r e o f t h e i r mothers the purpose o f : (iv)  for  R o u t i n e care w i t h c o n t i n u e d o b s e r v a t i o n ( v i s u a l and a u r a l ) and assessment by e x p e r i e n c e d s t a f f to d e t e c t a b e r r a t i o n s from normal b e h a v i o u r .  The b u i l t space p r o v i d e d must: (v) (vi) (vii) (viii)  Have a l l the f a c i l i t i e s to c a r e f o r these i n f a n t s safely (feeding, bathing, monitoring - weight, temperature, j a u n d i c e ) , Be g e o g r a p h i c a l l y s e p a r a t e i n each post partum u n i t , Be c l o s e i n p r o x i m i t y to the post partum ward so t h a t m o t h e r - i n f a n t i n t e r a c t i o n i s encouraged as w e l l as father-infant-mother interaction. Be s u p p o r t i v e o f a c t i v i t i e s aimed a t f u r t h e r i n g the e d u c a t i o n o f p a r e n t s , s i b l i n g s , n u r s i n g and medical staff.  Do you agree t h a t t h i s d e f i n i t i o n i n c l u d e s a l l p r o v i d e a c l e a r concept o f Newborn N u r s e r i e s ? YES  the elements s u f f i c i e n t NO  (if  no e x p l a i n  to  why)  PLEASE ADD FURTHER COMMENTS OR INCLUSIONS  V  1.2  INTENSIVE CARE NURSERIES  An I n t e n s i v e Care Nursery i s a s p e c i a l care u n i t w i t h i n a h o s p i t a l f o r the s e l e c t i v e p r o v i s i o n o f 24 hour c o n t i n u o u s c a r e and o b s e r v a t i o n o f any h i g h r i s k (compromised) i n f a n t , i n c l u d i n g the care o f w e l l neonates w i t h whom an emergency s i t u a t i o n has o c c u r r e d . This care includes provision: (i) (ii) (iv) (v)  Through e x t e n s i v e and c o m p l i c a t e d procedures u s i n g advanced technology s u p p o r t i v e to b a s i c p h y s i o l o g i c a l systems. By ensuring s t a f f h a v i n g s p e c i a l i z e d t r a i n i n g w i t h the provision of on-going education, Of graded areas o f care f o r management o f acute and intermediately i l l infants, That t h e i n t e n s i t y o f c a r e w i l l not v a r y d u r i n g the 24 hours o f any one day.  The b u i l t space p r o v i d e d must a l l o w (vi) (vii) (viii)  (ix)  for:  The c a t e g o r i e s o f c a r e o f i n t e n s i v e , i n t e r m e d i a t e , c o n v a l e s c e n t / g r o w i n g and i s o l a t i o n , P r o v i d i n g p s y c h o l o g i c a l a s p e c t s - b o n d i n g , t o u c h i n g and v i s i t i n g areas. T r a n s i t i o n o r o b s e r v a t i o n n u r s i n g where i n f a n t s a t r i s k can be observed d u r i n g the f i r s t few c r i t i c a l hours of l i f e as a s e p a r a t e p a r t o f ICN so t h a t unnecessary s t a f f anxiety i s reduced, Being s e l f c o n t a i n e d w i t h r e s p e c t t o p r o v i d i n g equipment, s u p p l i e s , m a t e r i a l s , s t a f f and easy access t o R a d i o l o g y and l a b o r a t o r y s u p p o r t .  Do you agree t h a t t h i s d e f i n i t i o n i n c l u d e s a l l the elements s u f f i c i e n t t o p r o v i d e a c l e a r concept o f I n t e n s i v e Care N u r s e r i e s ? YES PLEASE ADD FURTHER COMMENTS OR INCLUSIONS  NO  (if  no e x p l a i n why)  INSTRUCTIONS Your responses to the f i r s t round are c o l l e c t e d i n the f o l l o w i n g s e c t i o n . You are asked to r a t e each answer a c c o r d i n g to a v a l u e o f between 1 and 5 f o r each of the three s c a l e s . The t h r e e s c a l e s a r e d e s c r i b e d i n general terms i n the f o l l o w i n g pages. Read them and r e l a t e the s c a l e d e f i n i t i o n s to each q u e s t i o n to g i v e you a basis for deciding. NOTE: The t h r e e s c a l e s are s e p a r a t e and can be a t v a r i a n c e . It i s , example, q u i t e p o s s i b l e f o r something t o be very i m p o r t a n t , h i g h l y d e s i r a b l e and c o m p l e t e l y u n f e a s i b l e .  for  T h i s round g i v e s you the o p p o r t u n i t y to see the c o l l e c t e d responses to the f i r s t round q u e s t i o n s . Because i t i s not the r o l l o f the m o n i t o r s to d e c i d e what s h o u l d be c o n s i d e r e d v a l i d , i m p o r t a n t , e t c . , you must c o l l e c t i v e l y d e c i d e by the r a t i n g system which s h o u l d be i n c l u d e d . F u r t h e r comments are welcome and i m p o r t a n t .  IMPORTANCE SCALE  Scale  Reference  Definitions  1.  Very Important  A most r e l e v a n t p o i n t F i r s t order p r i o r i t y Has d i r e c t b e a r i n g on major i s s u e s Must be r e s o l v e d , d e a l t with or treated  2.  Important  Is r e l e v a n t to the i s s u e Second o r d e r p r i o r i t y S i g n i f i c a n t impact but not u n t i l o t h e r items are t r e a t e d Does not have to be f u l l y r e s o l v e d  3.  Moderately  4.  Unimportant  I n s i g n i f i c a n t l y relevant Low p r i o r i t y Has l i t t l e impact Not a d e t e r m i n i n g f a c t o r to major issue  5.  Most Unimportant  No p r i o r i t y No r e l e v a n c e No measurable e f f e c t Should be dropped as an consider  Important  May be r e l e v a n t to the i s s u e T h i r d order p r i o r i t y May have impact May be a d e t e r m i n i n g f a c t o r to major i s s u e  item  to  DESIRABILITY/BENEFITS  Scale  Reference  SCALE  Defini tions  1.  Highly Desirable  W i l l have a p o s i t i v e e f f e c t and l i t t l e o r no n e g a t i v e e f f e c t B e n e f i t s w i l l f a r outweigh c o s t s J u s t i f i a b l e on i t s own m e r i t Valued i n and o f i t s e l f  2.  Desirable  W i l l have a p o s i t i v e e f f e c t w i t h minimum n e g a t i v e e f f e c t s B e n e f i t s g r e a t e r than c o s t s J u s t i f i a b l e i n c o n j u n c t i o n with other items L i t t l e value i n and o f i t s e l f  3.  Neither Desirable nor U n d e s i r a b l e  W i l l have equal p o s i t i v e and negative effects B e n e f i t s equal c o s t s May be j u s t i f i e d i n c o n j u n c t i o n with o t h e r d e s i r a b l e o r h i g h l y d e s i r a b l e items No v a l u e i n and o f i t s e l f  4.  Undesirable  W i l l have a n e g a t i v e e f f e c t with l i t t l e o r no p o s i t i v e e f f e c t Costs g r e a t e r than b e n e f i t s May o n l y be j u s t i f i e d i n c o n j u n c t i o n with a h i g h l y d e s i r a b l e item Harmful i n and o f i t s e l f  5.  Highly Undesirable  W i l l have major n e g a t i v e e f f e c t Costs f a r outweigh any b e n e f i t Not j u s t i f i a b l e Extremely harmful i n and o f i t s e l f  FEASIBILITY/PRACTICALITY SCALE  S c a l e Reference  Definitions  1.  Definitely Feasible  Can be implemented No r e s e a r c h and development work required (necessary technology is presently available) No risk in i t s implementation. D e f i n i t e l y w i t h i n a v a i l a b l e resources No major p o l i t i c a l r o a d b l o c k s W i l l be a c c e p t a b l e t o general p u b l i c and s t a f f .  2.  Probably F e a s i b l e  Some i n d i c a t i o n t h i s can be implemented Some r e s e a r c h and development work required ( e x i s t i n g technology needs to be expanded and/or adopted) L i t t l e risk in implementing A v a i l a b l e r e s o u r c e s would have to be supplemented Some p o l i t i c a l r o a d b l o c k s Some i n d i c a t i o n t h i s may be a c c e p t a b l e to the general p u b l i c and s t a f f  3.  May o r May Not be Feasible  C o n t r a d i c t o r y e v i d e n c e t h i s can be implemented Indeterminable r e s e a r c h and development e f f o r t needed ( e x i s t i n g t e c h n o l o g y may be inadequate) Possibly a risk i n implementing Increase i n a v a i l a b l e r e s o u r c e s would be needed P o l i t i c a l roadblocks Some i n d i