Photo Courtesy of HKS Inc.

Photo Courtesy of HKS Inc.

Extraneous and Peripheral Factors Impeding Designing for Flexibility

Read the journal paper here


Debajyoti Pati (PI) and Tom Harvey

Dr. Carolyn Cason, School of Nursing, University of Texas, Arlington, TX
Doug Bazuin, Researcher, Herman Miller, Zeeland, MI

Herman Miller Grant

WHAT was the aim

The study objective was to identify and examine potential factors extraneous or peripheral to the design decision-making process that may obstruct or impede the optimization of operational flexibility when an inpatient unit is occupied.

Why is it important

A 2006 empirical study to identify domains of design decisions that affect flexibility on inpatient units found some indication in the context of the acuity-adaptable operational model that factors extraneous to the design process could have negatively influenced the successful implementation of the model. This raised questions regarding extraneous factors that might influence the successful optimization of flexibility.


An exploratory, qualitative method was adopted to examine the question. Stakeholders from five recently built acute care inpatient units participated in the study, which involved three types of data collection: (1) verbal protocol data from a gaming session; (2) in-depth semi-structured interviews; and (3) shadowing frontline personnel. Data collection was conducted between June 2009 and November 2010.

What did we find

 The study revealed at least nine factors extraneous to the design process that have the potential to hinder the optimization of flexibility in four domains: (1) systemic; (2) cultural; (3) human; and (4) financial. Flexibility is critical to hospital operations in the new healthcare climate, where cost reduction constitutes a vital target. From this perspective, flexibility and efficiency strategies can be influenced by (1) return on investment, (2) communication, (3) culture change, and (4) problem definition. Extraneous factors identified in this study could also affect flexibility in other care settings; therefore, these findings may be viewed from the overall context of hospital design.

What is next

Taking the grounded theory approach, the study did not begin with a list of factors to be examined at each site. Thus, it may be asserted that a greater prevalence of these factors may be observed if a different data collection strategy is adopted. This study should be followed up by one with a survey design to obtain empirical data regarding the breadth and depth of the issues identified from a larger sample of hospitals. Moreover, following a qualitative exploratory study methodology, only five sites were studied. This should be taken into consideration while assessing the current study findings. Follow up studies should expand the sample size to enhance credibility.