All right.

So.

Howdy.

Howdy, howdy.

How are you all doing today?

So everybody, today we have Dr.Xuemei Zhu and Dr. Zhipeng Lu Dr.Xuemei Zhu is a professor in Architecture and Dr.Zhipeng Lu is an assistant professor in Architecture soon to be associate professor.

Not yet.

So they're joining us from the center for Health Systems and Design at Texas A&M University.

And we're going to hold a discussion regarding design for safety perspectives from hospital design and long term care.

So, we're hoping to hold the session in an interactive format.

So there are some slides and presentations involved, but it would be great if you have any questions or even comments examples to add to the discussion to, have a conversation with our speakers and, basically jump in whenever.

Okay.

So we want to hold it, in the form of that, discussion conversation rather than a formal lecture.

Okay, okay.

Okay.

Well, howdy.

Howdy.

I hope you're already feeling good with the small pieces.

So that's a good start.

So today we'll be talking about a design for safety.

While it's such a big topic, very complex, so we cannot cover it all.

And in reality, it takes knowledge from many different disciplines to be able to really fully tackle this topic.

So I guess I'll go today is to introduce some basic concepts about, especially what it means at the intersection of architecture design and the design for safety.

So the first question for everyone, what are the top safety concerns in hospital?

If you name a few, what are you thinking in your mind right now?

Can I hear a few.

Like what are the top safety concerns for fall?

Yeah.

Infection.

Infection.

Agitated patients?

Yeah, definitely.

So those are some of the typical one.

So I guess in this seminar you guys are already like, wait a few weeks into the semester.

You're already pretty well educated about some of the top safety issues.

In reality, we often see sometimes it's be difficult for design student or even design professional to kind of look beyond the brick and mortar, the vertical aspect of building, because there are many aspect that are not visible, but really important.

So sometimes I joke with my student, I try to brainwash your tail.

You see design differently.

So that's also what I'm trying to do today to make you a little invisible.

So it could be bacteria, viruses, it could be medical errors which is otherwise not visible right in especially in the design process and how we could use design to better address those issue.

So a few things.

Have you ever thought about the when you go to bathroom, use the toilet.

The potential of what could be flying in the air after your fridge or after someone else flushed it?

And this is couple with the fact we have more and more superbugs in our hospital and even in our community.

Like Covid is a perfect example.

So how we can better adjust that?

Does design have a role to play in this process?

And also when someone sitting next to you cough or sneeze?

Do you ever get nervous more?

Second, like, oh, Covid taught us, right?

Because we know that comes with potentially a what have a job.

It is if there are some viruses, bacteria that travel in the air, it may land somewhere or it may land on you by accident.

Right.

And potentially it comes with safety as well.

And another aspect is the people.

So for a lot of designers, design students, when you work really hard, stay overnight on working on because I enjoy it and model.

Do you remind yourself to see the people?

Because typically when your job, when you're making a model, you may or may not even include people in it, right?

And you might have not thought about the actual activity taking place there.

And when we are talking about hospital, we are talking about people who are already suffering from illness or if in some cases could be critical or ill patient, like potential patient in late stages of their life, who may be super immuno compromised.

So they are super vulnerable to what has around them, whatever bacteria and viruses that are traveling in that case.

So it's really important.

And to keep the people in mind.

And it is how you work on.

So that goes beyond the lines you are drawing, the model you are making, and also the activity that takes place there.

And important people in hospital also include healthcare workers, how to their work routine like busy stressed often a lot of challenges some time life or test event that they cannot really full control right?

So is high stress high demand environment which more or less made them prone to mistakes?

Not necessarily because they are not responsible, but because of the challenge of the type of work that is naturally a part of it.

So if you think about these and then come back to safety, we are really dealing with a time that we are have to in any healthcare design project, agile to the increasing infection challenges and risks.

Our patients are in general getting sicker.

And we are in a way, it's more and more common to see those superbugs being present in not only healthcare settings nowadays, but also in community, and they can be frequently be brought into hospital, potentially exposed, high risk, vulnerable patient to those potential risks, and not to mention all the pandemics, right.

We have recently learned more and more about those insights.

Ebola, Covid, all the challenges that could put healthcare system at risk because often home, we are not fully prepared.

The facilities are not very resilient in the way to be able to address those.

So brainwashing number one hospital could be dangerous.

So I don't know if you ever pay attention to these statistics.

If you look into hospital acquired infection, it killed about 100,000 people per year.

So those are not the infections that patients already have and way into hospital to get treated.

Those are the infection that they caught in hospital.

And medical errors 3 or 4 times more than the number you are seeing for infection.

And again, the challenge is they are often not invisible.

So for designers, it's really important to be able to see how that actually link to the potential design decisions we are making.

And the second safety is a system.

So there are many different layered ways.

Physical involvement being a big part of it.

And the key is as designers, we need to understand that political involvement is not only one of the multiple layers in the safety system, it also interact with others.

It could be interacting with how the organs I, organization or procedure are taking place, where the protocol is, we invoke them or not, and where the staff are fully alert or actually being distracted by noises or others around them.

So it plays a really critical role, together with many other elements of the safety system.

So we will be trying to look at like with limited time, right, trying to cover two key topics.

So I will be addressing the first two, then Japan will take over to talk about the fall more in long term care setting.

So hospital acquired infection the invisible pillar in the way.

If you go into a hospital as a patient, potentially you'll have 5% chance of catching a hospital acquired infection.

Now come with huge cost.

That cost for the system as a whole.

Cost for individual, patient and the family and the cost for the society.

Internal financial role and other burden of the whole society.

And to fully understand how design can play a role, it's important to understand the mechanism, how infection take place.

So here you are looking at a chain infection.

How can we as a designer potentially intervene and into step in this process?

A few things to think about.

First, if we could oh that's imagine say Nisha the patient.

Mr. John okay, imagine a scenario Mr. John is a cancer patient.

Critically ill go usual chemotherapy with a very vulnerable immune system, potentially prone to, like.

So, infection and serious consequences.

So how can we help as a designer?

We are not going to be able to do the job alone.

We have to work with other.

But we need to understand what we could potentially contribute.

So one of them could be thinking about operating a chain, right?

One of them could be if we could stop what have infection that may be present at the shop.

And the second, if we could block the partial off exit.

So that doesn't it doesn't spread to other other surfaces as well as other people.

Third, if we could interrupt mode of transportation because there are many, potentially your design will have an impact on that number of floors.

Think about protect portal of entry.

So that could mean different scene depending on a patient or people around them.

It's their door and the last try to increase hold defenses.

And again in healthcare setting we are talking about people who are in general more vulnerable.

So with that in mind, and we will move into mode of transmission and how we can help in a process.

So Mr. John McCann, how could he potentially be influenced by the potential pathogen around him?

Could it be driving infection from other like medical staff, visitors or even Mr. Doe next to him in the same patient because they are being exposed to each other?

Could it be medical equipment?

Implanted devices?

The list can go on.

On hospital facility, you probably remember the blue light illuminated toilet at the beginning, right?

What are the potential risks that could come with it?

So there are many potential risk factors and one way to visualize it.

Imagine our Mr. Chang is on this patient path, and this is another patient who has much which is one of the very commonly seen infection, multi-drug resistant staph infection that typically affects skin.

So if you look at this room, imagine yourself being able to see invisible.

So blue light can help us to do that more or less.

Where are the contaminated areas.

Think about movement of the patient staff member.

If we interact with them.

Can you name those high risk location potentially that have been improved here?

And this is actually the actual study that they sample different surfaces as well as air in the space.

So you can see those high touch areas like if you touch it it stays.

It takes time for that to go away.

And what is worse.

And if you are seeing about volunteers and prospective, you know, high touch, and we have high chance to have those students stay and grow, right.

And what is even worse is saints is heavily affecting skin in most cases when the patient moves along, when the nurses make it about seeing what happened with airflow in the room, they are literally present everywhere in the room.

So in this particular case, they actually sample different surfaces as well as like air.

And they found a huge accumulation of skin, for example, in the air in this particular room.

So imagine what that could do to our Mr. John in this case being vulnerable, being exposed without sufficient protection.

So these are one example.

So think about it that way.

Direct and the indirect approaches.

So direct kind of straightforward by a touch that could carry the pattern for one person to another.

Could it be droplet square and indirect one.

Could it be different venue.

Could it be airborne?

These are all straightforward vehicle bombings, potentially through contaminated food, water, tools.

It's central vegetable means to insects and animals.

So now if you see a patient room again you see something different hopefully.

Right.

Because you want to see the invisible.

And what is making the impact on safety.

So this is a more detailed breakdown of the potential ways of spread.

So we won't go into detail, but to think about the endless possibilities in most scenario how to operate larger one.

They will go down to a surface quicker, but a smaller one will travel further away.

They could be shooting on surfaces like equipment forces, door handle and that provides opportunity for indirect contact.

So potentially going into an environment where these pathogens present, we are exposing ourselves to a lot of potential risks there.

And, another way of visualizing and seeking about how those viruses could we suspend in air and on different surfaces.

It could be as little people as people's movement when they walk.

It could be suitable vacuuming, which brought up a lot of them.

Could it be through doorway, our exchange where you closed open the door, all went through the operation from the vent fan itself.

What?

So they all introduce those opportunity to further carry the pathogens away.

Now, what can we do?

Right.

In this case, going back to Mr. Zhong knowing these sort of potential venues for transmission.

So these are just a few well documented strategies that we could use to help.

So since we don't have much time, I will be, focusing on the first two using a single bathroom private toilet.

How that can make a difference, and how providing hand hygiene facilitate at high traffic and the visible airway up could make a difference.

So the first, if you think about single room, why does it help.

And the going back to different way to stop and break the chain life.

When patients come in, if they are checked into a single patient room, if they are carrying something that was not detected at the beginning, they are more likely to be separated from other than the very natural like larger flow there.

And the second less opportunity for cloth infection.

Right.

We just went through the scenario in this room by having one patient per room.

We know you cut down the chance of infection dramatically.

It also make it easier to manage and exchange and pressure.

So depending of the patient it's him or herself.

It's actually in cultures or immunocompromised you can manage the airflow to the optimum situation.

And also related to that by having single room is much easier to clean and decontaminate a room after a patient is discharged, because you don't have to worry about the other in a private toilet.

So a lot of gut infection potential.

A toilet is a high risk location.

By having in the video pilot for individual patient, you're cutting down the risk completely.

So this is a single room.

And the second aspect handwashing versus hospital acquired infection.

So this sounds very simple and handwashing.

And we all learned during Covid.

But it's one of the most effective way to prevent the spread of infection.

If you think about healthcare workers working in a hospital unit, how well do you think they are doing in washing their hands when they need to stay with that 50%, 70%, 20%?

About 14 to 28%.

So it's not necessary.

They are not being responsible honestly, like they have a very busy have a heavy workload.

They often get so busy that they cannot.

Because if you really look into the protocol for hand hygiene is a very difficult task to do.

It involves multiple steps, frequent hand washing at frequent the location to find out after a procedure, it's very difficult to actually keep it up with what is required.

So thinking about design, maybe one setting, what we could do as a designer to make their job easier to is to offer more support for them.

So some of the example here looks very mundane, right?

But a few key idea behind it make the handwashing facility easily accessible to staff when they are moving along with their busy schedule.

Use continuous and impervious surface.

You don't want to have beautiful mosaic there because that's not going to help, right?

And, make sure it's close to patient Pat, because some procedure may be taking place there.

And make sure this patient is located at a location that's very easy for the staff to see and actually use, because that makes it different.

So this one, it may be a bit difficult to tell, but what is the story here?

You walk into a patient, you open a door.

A sink is hidden in a perfect location.

When you don't see it, it's much more likely to get it right.

So you want to offer that visibility to make an easier and high traffic area.

Have hand sanitizer available to remind everyone, patient and the staff to clean their hands as needed.

Patient room you're walking.

You have a sink right in front of you, easily accessible.

It also make it convenient for the patient and family members in case they need it.

Nurse's station on the way in and out leads to a constant reminder of easily accessible, visible, and accessible will improve that compliance in handwashing and ICU unit.

If you look closer when you open the door, when staff going, you see the visual reminder of washing your hand and you're much more likely to wash it when you see it and it's black in front of you.

So potentially how you place and provided these handwashing facilities could have a pretty good impact.

And this is one of the things that I think Ella may have mentioned some of these.

So just like if you zoom into the sink scenario, think about a surface making sure is seamless, have a difference, and also is about the location of the faucet versus the drainage area.

Because if you went to the bathroom outside, you know how the water spreads.

Terrible in a dramatic way.

That can make a lot of sense.

Wait, the minor, the splash you want to make your snap related to that deep syncopation really helps.

And also the water pressure is important.

So think about the details like these and then go back to what have a project you're working on.

And again ask yourself if you could see that invisible as well.

In addition to the physical elements you're designing.

So moving into medical errors number three killer in the way.

And they are.

That's visible because sometimes they don't even get noticed when things happen.

Patients may have no idea and sometimes even still.

So the again, back to the brainwashing go right I made it point hospital a dangerous.

So another way to think about it.

Going into the hospital as a patient, you have one intentions of suffering from a medical error and a 1 in 300 chance of dying from that error.

So this is based on how information and what we can do as a designer.

So that's a question.

And it also helps to know what types of medical errors would take place.

So they could be technical a big chunk could have a diagnosis.

Could it be failure to prevent injury?

Could it be junk and others so that these have anything to do with design?

Or do you want to say, well, this has nothing to do with me.

This is about a step if you think about it.

Right?

Because what do you design affect the work environment.

So thinking about how we could potentially help and so in this case we can turn to the staff.

So let's say this and this Kelly okay knows Kelly had a very busy work schedule.

How we as designers could help her to do a better job and her team.

So if few things to think about this, it's not a exclusive list, but at least key issue how we can reduce their fatigue and strict, if possible at all, how we can make them more satisfied about their job.

Because we see and we know not.

Turnover is a big challenge.

And other physician.

It's time to adopt the new two and as we just talk about and also reduce down nonproductive time because of reduced cognitive performance, etc., and also reduce negative distraction.

So I will again just highlight a few key sample.

So like thinking about design strategies.

You can be creative and add more here about a few key elements to consider.

Single room or even make it acuity adaptable.

I wish you are a case study.

Provide very good lighting.

This is especially important for medication preparation.

Those like table medication and making sure they are accurate and consider the opportunity to decentralize medication storage if possible.

And I will explain why not to make.

Okay.

So I will highlight the first three using some examples.

The first one what do we mean by single and the acuity adaptable room.

So this is a real project.

We are original.

You find out after we have.

Before the renovation, the unit had 23 pad for critical care and 41 beds for Stepdown unit.

So they move the patient to step with our unit when they get a part of the renovation.

The idea is to provide a bigger, more equipped the best in the room.

But they are a create a adaptable meaning.

The patient doesn't have to move from one room to the other in the process of a state.

And what I observe in the after comparison is three years after renovation.

Okay, what they accomplished last transfer, which is a no brainer, but also 70% less medical at work.

So now if you can go in as a designer, tell your client, you know what, I have some idea that can help you reduce medical errors, their eyes upon line of life, how right you really can do that.

Because those are a constant struggle that that you is every day.

And they also have less patient for in this case.

So on top of that, financial CV is huge because patients are recovering quicker.

They have less error.

We talk about how expensive errors could be.

And this is just one example to showcase their change in medical errors over time, before and after.

And they say it's when they move to the new unit.

Okay.

Then the other quick example is lighting.

Why lighting matters.

So for people like us where we're aging out, we probably understand better, right.

Because you need to see the label.

You'll read everything correctly.

ET cetera.

So on the original ordering.

So transcribing to dispensing to administering interrupt.

And what is opportunity plotting to go wrong.

And what we have seen is in a lot of health care facilities actually noted lighting levels are way far from sufficient on the workshop it where on medication is being prepared, and that on passive lighting has a strong correlation with error rate when it's insufficient.

So to kind of make it more tangible and convincing, you can see as a lighting level change how error rate would a job dramatically because of the better lighting on passive lighting, while in reality we see even much lower lighting levels in on work surfaces.

So that's one.

And the third example I hope I'm fine with time is a floor layout versus no travel.

So this is very typical.

What we see a unit with centralized supply storage.

Now if you see him on notice you have Mat.

What issues do they wear.

Clarks sneakers.

Do they ever wear heel.

No way.

Right.

Because what they do as a big part of their everyday job, they walk around a lot.

So in this particular unit, the nurses travel on average per nurse per day is shift kill me what they did.

This is very interesting.

Before and after comparison is they decentralized supply storage because a lot of walking never was done.

What to grab things, grab supply.

Just by doing that they were able to cut down the travel distance by about half.

So again this is a example about how design could potentially really impact efficiency and nonproductive time of nurses.

So overall when we put different study together, we have seen kind of on up and down.

But like comparison between traditional layout versus the mall.

Well, design for a wall similar to this one noting travel distance could differ dramatically.

And what is more important, much more care time available for on a patient when not, and no longer have to spend as much time traveling back and forth just to do that.

Hunting and caring.

So again, this example of the design impact on the actual practice.

So I would turn it over to of them for the for safety.

Thank you.

Sure.

I'm one piece of variable wise to you guys to guys in this world.

And is that always let your live park first.

So man I know each other for 30 years Mary for 17 years.

So.

And also always say yes to your wife.

Right.

And then, when, you know, this morning, she's that I need to top 30 minutes and, I will leave ten minutes for you to wrap it up.

Is there okay?

Yes.

Yes.

My baby.

Look at the life expectancy.

You know, in United States, man.

You know, 74.8 ladies, 80.4.

Right around the time they live five years longer than you.

And at the age in long term care, take a look at the long term care facilities over there.

You may stay over there.

And your wife taking care of you at the end of your life.

So, take a look at these pictures.

What's the difference between long term care and hospitals?

What's the difference?

What's the key word for a long term, long term care, right.

Nursing home.

Nursing home.

Okay.

Nursing home.

Right.

Professor.

Man.

Got it.

You know, 20%, 25%.

Right?

Right.

So, Long-Term care is more than nursing home.

You know, you know, my maybe you know, other facilities as well.

In different country, you may have different definition.

It's more residential.

Right?

Right.

It's, more cozy set.

Right?

Smaller scale and a lot of materials that warm, you know, break.

And then it's so much different.

Compare the hospital.

So the key word for long term care.

It's not care.

It's about leaving people stay there for long time even, you know, as short as two weeks.

That's long term leaving over there.

You need to take care of the living aspect of it in long term care.

Okay?

Not only about care.

Right?

That that's that's a myth.

You know, misunderstanding about long term care is health care facility design.

And but in hospital, maybe you you will be discharged within 24 hours, maybe 72 hours.

Right?

You don't have too many staff in the hospital, but in long term care, you stay 1 in 2 weeks.

Some people spend multiple years state multiple years over their that's living.

So, and long term care and then so ADLs I don't know whether you familiar with ADLs.

You need to figure out, you know, what's that?

You know, they taking care of, you know, in long term care, adult activities of daily living, right?

Including feeding, dressing, transfer from pad to, wheelchair from baths, you know, to, you know, walking, transferring right from, wheelchair to, toilet, transferring and then toileting, continence and, also bathing.

So, you can see different ADLs in different folks, but this one is from the original literature.

Okay.

That's the original one.

You can see a lot of modify one in different literature, but, you know, refer to this way and also idols taking care more, you know, usual daily stuff, instrumental daily activities, activities of daily events.

So including shopping, cooking, housekeeping, laundry and others.

Okay, so in this article, about the Sydney, cats and also, list the mobility as a one.

The important issue as well.

Okay.

So three aspects.

What long term care taking care of its ADLs, activities of daily living okay.

That's how you differentiate, you know, independent living like retirement community as a whole and long term care facilities, long term care facilities, taking care of that.

Why we talk about safety in long term care.

Right.

It's more complicated if you figure out how to deal with falling safety in long term care, you probably know how to deal with falling in hospital as well.

The different kind of settings.

Okay.

So that's the more, you know, information about long term care home, maybe, you know, they provide long term care services.

Right.

And maybe and also retirement community.

Traditionally they don't put why any assistance for adults.

We don't count them as a long term care.

And but starting from adult they care facility.

Yes they put by feeding.

They fit people over there.

Yes.

They may you know take care of other activities as well a memory care unit or outside memory care is part of that sister living right now.

And, it's different sometimes that Alzheimer's unit memory unit is different than they time may be fit into nursing home, skilled nursing or assisted living, depending on, you know, different level they are at.

So it's more complicated like that.

It's not a full list.

And so when you come by retirement community adult they care maybe an adult they care.

Assisted living and skilled nursing is a CCR.

See continuing care, retirement community.

Okay.

Only a portion of that as a long term care.

Yeah.

So let's figure out, you know, and, when you're doing a final study, final phases on that, you know, you talk about like designing something for long term care.

I will ask you, which type facility are you working on?

Long-Term care is a generic term, right.

So, and so you can see ADLs, right.

They taking care how again, in some of your time, care home, how many times a day are they taking care of?

And you see, the difference is I listed, you know, for some time.

Okay, so I said that different literature, different article, different agency, they use different timetables.

That's one of the examples.

Okay.

So is infection control infectious disease important in long term care?

Yes.

You see the number who die during you know Covid 19, right.

In skilled nursing facilities, almost one third of the total population.

You know, that the death toll.

Right.

And, that's one of the mistake, you know, Governor Cuomo, New York Governor may, he cited executive order saying that all those, people recover from Covid, even though you don't know whether they are still Covid positive or not.

March 2nd, he's saying that all that saying that you should not go back to your home, you should go to the Long-Term Care Facility.

That turned out to be a huge mistake.

Right.

And you sent those people to the most vulnerable, vulnerable population and then ended up killing a lot of people there like that, almost one third of the whole death toll.

So, you can see a lot of, you know, moving moment and then, people cannot visit, that parents, their relatives in nursing home, they, you know, they stay outside of windows to, to talk to them.

Right.

In Texas, one of the I don't know which one.

They asked that less than to stay, you know, on the sidewalk and then their relative driving by to see their, you know, parents to interact that that's that's such a moving moment.

And, the staff of becoming really, you know, creative during Covid, right?

And, so infectious disease, right now Covid still going on.

And then, most importantly, you know, colds and and also, you know, flu going on each season.

And that's really badly for older people, especially those in long term care facilities.

So talk about force.

Why force is so important.

And even those living in, you know, communities in the neighborhood.

Oh, well, one fourth of all the people die, force in each year equals to 14 million population.

Okay.

That's significant number and number one, injury related cause of that, along, among older adults, number one.

And that every one second one or the about four, I was second.

123455 people.

Four.

Okay.

And that every 90 minutes one of that, died due to four.

And then, you know, how much does it cost?

How much does it cost?

$80 billion each year.

And then the number is rising.

And this is the 2020 data okay.

How could we deal with that.

That's saving a lot of money if you can, you know, solve this kind of problem.

Right.

And how about the situation in long term care, 50% half of the population in long term care for each year the number would be 1.7 force per person per year.

Okay.

These are really vulnerable population.

And that what kind of always and weeks related to let's let's say you know personal factors right.

Individual factors and also the environment the environment where we talk about that we ultimately it's architect design that we thought about is the physical environment.

So it's not it's both so so in fiscal year one.

So some environment for example if some people watching you some people helping you, you're less likely to fall right.

As a designer, how could we deal with fiscal environment.

Right.

Let's talk about that later.

But take a look at that.

A lot of them are personal factors like for vision and lower strength, muscle strength in appropriate footwear.

Right.

Different suits with different give you different, you know, traction that would affect your like, like, like relating to force.

Well and sustainability and also if you have previous fours, it's more likely you may fall in long term care as well.

So what time of the day.

Morning.

Evening.

Night, pal.

Why?

One doesn't have magic power.

Right?

In the morning.

They're getting out of bed.

In the evening, they go to the back.

Night time.

During my time, they go to the bathroom.

They get out of the bed.

And at these times, you know, for the surveillance of the staff, it's less right.

They are during the shift and nighttime.

They don't even pay attention.

And locations.

Bedroom.

They spend most of the time in that bedroom, and a lot of them stay in the hallway, walking in the dining room.

If you have not visited long term care during dining, I encourage you to do that.

Oh, it's the most active day for all of people.

You know, getting around, moving people in and out of the dining room.

Wow.

It's just like, have a major party.

So bathroom bathroom issue.

Okay, not only about getting in into the bathroom, out out of the bathroom, but also getting in, you know, and out of the toilet as well.

That's the major location for the force.

So, you know, have two factors, right?

Talk about that is about lighting in a poor vision.

If your, environment, designed in the wrong way, they will make it worse.

We cannot, they cannot see clearly what's, you know, obstruct them from walking.

And, what's the barrier on what what kind of things?

On the ground.

What kind of materials?

Right.

From materials, conditions and also handrail crap.

Boss, you'll never pay attention to that if you don't haven't used that yet.

Right.

So, equipment and assistive, device and also supervision of surveillance.

This part of, you know, fiscal environment, but also the social environment as well, right.

How family members can help, how the staff member can provide surveillance and others.

And, this list is from the Texas Health and Human Services is pretty good.

It's pretty good.

And, this is the picture from, one of the assisted living facilities.

This, still the same six foot corridor people walk and then, on, both sides of the corridor, you have two things.

You have doors, have rooms.

You know, lay out, I got four.

So lighting.

Which one is better?

Like three.

Right.

This one, the picture on, on the left having the shadows because the lighting setup is not correct.

Yes.

Right.

Consistently.

Bright eye area.

Shadow.

Right area.

Shadow and type game.

One of my hero who created the household model for long term care.

And he did.

He was the CEO for Green Retirement Community 20 years ago.

And he did this kind of experiment.

They changed that.

And there's so much better for the picture on the right consistency, you know, layer throughout the whole court.

So design helps small change, small aperture would help people tremendously.

And then, you see you like you like the you know, the throw rug is colorful, is, having different kind of pattern look good in your living room, right.

This is a tripping hazard for other people because that's the sudden change of the material, right?

The friction is different for different kind of material.

And also this one is a little bad example about, you know, having the, the stripes black and why for people with low vision, with cognitive impairment and they would see the stripe, you know, the dark stripe as a whole.

It's a, you know, that's a perception difference.

When you have a good vision, you don't have that problem.

I can see people trying to across the Y dark stripe because they perceive that as a hole on the ground.

And they, they just, you know, that's what I can.

So, See this one?

I visited my grandma in China in one of the nursing home.

This is lobby.

Is that amazing?

I all the refraction.

You cannot even tell.

You know what's the bottom of the column?

What's the bottom of the wall?

And then having all the refraction over there and having all the black stripe over here on the black, and, it looks slippery, right?

You know, it.

That's this, that's the, quality side.

And then, for one of the, you know, the one on the rise in, in assisted living as well, using the lino floor still created that pocket.

The floor material is so important.

If you have some really busy, you know, carpet on the floor.

Think about that.

For all the people that used to walk in all the time, 90% or even 80%, they eat what they look at when they walk in.

It's the floor.

If the pattern is group is clear, that will make me dizzy.

I don't have to take any, medication to make myself easy.

Only walking along this carpet.

With the back credit, we met with these.

Or if you have too much different card.

That's right.

I'm not doing any walk so far.

So.

Right.

So.

And, we we that's the simple solution to, to divide that in or out those.

And also, you know, the red area and it's eye area.

But it turns out that's a tripping hazard.

That small detail really matters because, when they walk, they barely lift that leg, stepped foot right off the ground.

Yeah.

And some of them pushing that that, walk it and they might fall.

And I, I observe two person fall and, during my, research, I only did only two, one year that, the walking you're saying, three.

Relax.

That one is not stable at all.

So the lady fall and, at that time, I was doing my postdoc study with their, manager called me Doctor Lou.

And then, the nurses come to me saying, hey, doctor, can you handle this kind of situation?

I said, I'm not that kind of medical doctor.

I can handle that.

That's right.

So but that's the one.

That's the other one is that, I'm going to talk about that.

The room lay out later I mentioned that story and also that the fall so important for those people using cane, they most often just they met somebody, in the hallway.

They stop right now using cane and also using that force to hold that balance, to talk, interact.

People.

Okay.

If they walk this this continuation about the all really, you know, not safe for that.

But they came up empty.

They need to lift up their arms and for the to the other side.

And this one is really interesting.

And that one resident of told me I was doing the focus group over there.

And then she said that, hey, this pump, that that person touch it use and also that I should not use it at all.

Right.

And also it's very dangerous when they put their arms on that because you see slip and fall, don't do that.

And it looks okay.

Right.

As a design that you can make everything look good but also useful as well.

And then that sitting lives the help with the, the transfer from back to wheelchair and also to the partial that's really effective and used in a lot of hospitals.

And also, you know, us, nursing home as well.

And also, you see how the track layout doesn't affect the layout, but if you want to transfer that directly from the back to the bathroom, you need to think about how to save the energy of your staff, how to save the distance, you know, and then transfer the patients direct from the right to the from the back to the back.

And also, last week, author Alan Taylor talk about the fall.

Really important one study fall for the fall.

It's not that we need to side.

And also the boss of the long that for people to hub, right.

Some people are really tall and they have long pants.

They need to do that.

Something like that is really ironic.

Eventually that needs to be at least as I can remember, the number of days that 32in maybe longer provide some options for the rest.

And, supervision and surveillance right now and, just given nursing facility, they just camera a through design.

You can provide a lot of, you know, useful way to provide good surveillance.

Just like a half wall.

Right?

Half voice is really useful.

And, it helps you to define space and at the same time, provide surveillance for what's happening inside the band or the activity.

So and also, you know, the part that as well, when people fall and then they can hear the phone and to call for help and, but it doesn't work for people with dementia.

Yeah.

You know, I didn't propose something to help with that, right now.

And, so for some of you interested in hospital falls, these are the, approaches that people can use for for us.

Talk about setting live, talk about, you know, family, Places and also talk about the just to have that, you know, so, so to help people to stand up or sit down, surveillance as well.

And these are the typical whether or not there is an assistant is, you know, going to spaces for the family or.

Right.

Why?

Because a lot of people are using wheelchair and, also walkers, like, you don't you don't like just to send it out to, like, a restaurant, you know.

Yeah.

Does it cost the here the hotel is not really tight space of all people walking by.

They need to leave a lot of space for that.

Walkers, for the villages.

So people can, use that space.

They don't have to go around, you know, to make a way to get out of the family.

And also for the layout for the, one bedroom like that.

You need to think about people's behavior, right?

They don't like to use water inside pool and, the high of the furniture or the arrangement, and, so should be appropriate.

When they walk along, they lose their family.

They can hold their back by touching the floor and not, touching the, table to hold their families.

For example, they can touch that, that the console, and also the chair and also inside, the or they have something to touch to hold their balance.

Right.

So, the other four I mentioned previously, the lady fell on the ground, so because that she wanted to suddenly something but she did not get injury because they had good effect, you know, carpet.

So that was so fortunate.

I was so scared at that time.

And then, Yeah.

Me so yeah, I that's my, the last lap and yeah, this one because in London here we, we don't have a lot of people go outside to use door.

We don't have to either outdoor.

And also we have one catch these people.

And during that, you know, you go out those transitions to see whether that should go to force that.

So, this to future directions.

We can do more research on.

So the goal is to promote actively that people should be active in the future.

And that's not what men have for us.

Yeah, there are no man.

Okay.

Your old guy.

Oh okay.

Thank you guys so much.

Any questions that.

Well, thank you so much for covering such important topics in control and falls, especially for you guys who are taking the graduate level.

So, y'all, I want to on this center.

So for everybody, function control is one of the main topics that a client is focused on.

So, remember all the strategies that we're discussing today's lecture and try to find out a way to implement it into your project.

That's what okay.

So let's open the next picture.

So let's take one question.

I think we're out of time, but before taking a group picture, let's have one question from the audience.

What do you think?

Questions?

Oh, okay.

So I'm gonna go to the back and later, and maybe we get the quick question for private.

Okay?

Okay.

So when it comes to decentralizing storage units and or just storage and like hospital floors, how does that affect inventory and each individual smaller unit compared to like a centralized.

You know I are talking about a smaller not a unit when.

Yes.

Yeah.

So it's definitely proportional.

Right.

Depending.

So a good strategy, if you have a exiting existing facility you are renovating, one core strategy could be going now and looking at how they are actually operating now.

So if is already well centralized makes sense.

If it's really small efficient enough.

But you could go in and look at the actual behavior in a pattern and it's an easy match to do, right?

Like how far they are traveling.

Would it make sense to make some more even?

Like what do they like those storage called on?

Well, you can move as needed.

Those are also an option, more mobile and more flexible.

So it's definitely relative to the scale and depending on specific context.

And if you are doing a working on a brand new unit, you can do some quick math, even just based on the room you have and the storage, how many nurses potentially will be taken care of, how many patients and imagining and you want to have some basic knowledge potentially by talking to your clients, how often nurses typically need to go back and forth.

Right.

So if it's it may also depending on the type of unit.

So it's definitely context based.

But be aware of that because the long travel distance has been a well-known problem in the nursing field.

So Nola.com it would vary by the scale of the unit.

What about by the proportion of a nurse and a patient as well?

And if they already some units may already have a centralized nursing station.

So those typically come with the design, like a decentralized nursing station would already have decentralized storage.

So it's all varies by contact.

But I guess the bottom line, because we can never prescribe a building design.

But the bottom line is be aware of those typical issues.

And then when you have the actual project, study the actual contact those parameters in that actual contact, if that makes sense.

Yeah.

And some of the facility, they have advanced technology like digital twins.

They track people and, you know, device and supplies as well.

And then they may create, algorithm to figure out what kind of supplies that frequent use to be stored at the centralized location.

And what, you know is that less frequent use can be stored at the, centralized location.

Yeah, in some fancy way.

They may even for some more expensive equipment or units.

They may even use remote frequency ID to keep track and be able to, because it varies by water supply to even.

So, it's a complex situation.

But again, like a note, a bottom line, it matters.

Like even those that have to grab due to hunting on time don't get to waste time and, efficiency.

Patient care.

Yeah.

So very moving.

What was just discussed regarding technology integration and use of I, you know, that these discussions happen all the time in the field.

What are other considerations in terms of technology integration for infection control or for faults, especially in healthcare facilities?

Anything you want to take a fall for, for people saying that there's no, you know, really fancy way to deal with it and then to provide more surveillance, like, you know, you're saying that, the camera and, some of the cameras does not allow you to detect that face, which is good.

And, you know, the proposal we are writing is about that right now.

Yeah.

And, especially for people with dementia, they fall and, they forgot about that time.

Just, you know, a caregiver identified tools that they know that person fell.

So that's a huge problem for people with dementia, right?

That, you know, some, technology example for fall, I think is more prototype of the actual application, some sensors on the ground.

So every your body gesture is kind of like prone to fall.

The sensor will be able to tell it so but I I've seen no kind of idea prototype.

I haven't seen real examples of actual application of it.

But no, you know, that's a big problem.

Potentially.

Maybe in some year we'll see that being applied.

Apple watch that or more or less.

Yeah.

To say something to them.

Congratulations.

Terrific presentation to millions of fund and to the rest of you, we're taking a group of students who are interested in health facility design to Indianapolis on October 6th through eight through if I were to go as a practicing architect.

And of course, with 1400 hours for students to see is $39, however, you would have to pay your own airfare and split a hotel room.

This is your colleagues.

I highly recommend going and you should have business cards with you all the time, even if you're not coming, because you never know who you're going to walk into right now.

So, this is a once a year symposium called Healthcare Design.

We are going to send them a list of students on Monday.

And if you're interested, please communicate with Roxanna because you need to get a 14 day airfare.

And there's I don't know how many exact days there are left, so I would recommend.

And don't let your schoolwork get in the way of your education, because, you can get a glimpse into the field of the architectural exhibits and a lot of practicing architects who have firms, and they have openings and they don't have anybody to work in that firm.

So our job is to get you with them.

So if you have any questions, talk to Roxanna or with me, the preferably with Roxanna.

She's on talking.