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M.E. van Heel
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Hospital planning and design projects are known for their complexity, partly attributed to the many stakeholders involved. This study aims to understand how a Dutch hospital project, with transformative change goals for its future healthcare delivery, dealt with their stakeholder engagement in the project’s planning and design phase. This study addresses heterogeneity in stakeholder relationships, an underexplored aspect within stakeholder engagement literature. A qualitative study was conducted on the stakeholder engagement during 10 years of hospital planning and design. We used an abductive approach by reviewing project documentation and transcripts of interviews with project stakeholders (n = 22) to reconstruct how the project leadership dealt with the challenges of heterogeneity in the project’s specific context. This study explores dynamism and pluralism within the relationships with seven distinctive stakeholder groups from the hospital’s multi-stakeholder setting, uncovering engagement strategies based on unique combinations of actor and process-specific characteristics. Wider transformative change goals added to the challenges faced in ownership and alignment of goals. Findings highlight the strategies and competencies the project’s owner (and leadership) deployed, such as adapting the project organisation’s structure, investing in an in-house community of practice with a dedicated stakeholder engagement role and fostering enduring collegial relations and commitment.
...
Hospital planning and design projects are known for their complexity, partly attributed to the many stakeholders involved. This study aims to understand how a Dutch hospital project, with transformative change goals for its future healthcare delivery, dealt with their stakeholder engagement in the project’s planning and design phase. This study addresses heterogeneity in stakeholder relationships, an underexplored aspect within stakeholder engagement literature. A qualitative study was conducted on the stakeholder engagement during 10 years of hospital planning and design. We used an abductive approach by reviewing project documentation and transcripts of interviews with project stakeholders (n = 22) to reconstruct how the project leadership dealt with the challenges of heterogeneity in the project’s specific context. This study explores dynamism and pluralism within the relationships with seven distinctive stakeholder groups from the hospital’s multi-stakeholder setting, uncovering engagement strategies based on unique combinations of actor and process-specific characteristics. Wider transformative change goals added to the challenges faced in ownership and alignment of goals. Findings highlight the strategies and competencies the project’s owner (and leadership) deployed, such as adapting the project organisation’s structure, investing in an in-house community of practice with a dedicated stakeholder engagement role and fostering enduring collegial relations and commitment.
Towards User-Centered Architecture
Teaching Post-Occupancy Evaluation in Design Education in Delft and Vienna
Poster
(2025)
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J.S.J. Koolwijk, Maja Kevdzija, C.J. van Oel, Milica Vujovic, M.E. van Heel, Harry Van Goor
In architectural education and practice, the evaluation of a building’s functional, psychosocial and social performance – its ability to meet user needs – is often neglected (Brown, 2018). Post-occupancy evaluation (POE), a systematic approach to assessing whether buildings fulfill their design intentions and respond to both explicit and implicit user needs, offers a promising solution to this oversight (Lehane, 2022). Despite its potential, architectural education often prioritises conceptual design, with project evaluations heavily influenced by subjective opinions of professors, visiting critics and peers. This approach leaves students with limited insight into how their designs perform in real-world contexts (Duffy, 2008). Research indicates that integrating POE into architectural training can help students better understand design effectiveness and prevent recurring design flaws (Hay et al., 2017; Brown, 2019). Furthermore, architects trained to apply POE methods are better equipped to create spaces that meet user expectations over time, thereby reducing the likelihood of premature building modifications (RIBA, 2017).
This paper presents how two courses teach POE to their students, one at the faculty of architecture at Delft University of Technology and the other at the faculty of architecture at Technische Universität Wien. We illustrate how students in these courses are taught to apply POE, focusing on healthcare environments through a structured research process. The courses at both universities teach students to conduct POE in real-life healthcare settings, such as Klinik Floridsdorf and Erasmus MC. Students are introduced to a research question and trained to develop appropriate data collection techniques, including observations and interviews. They gather both quantitative and qualitative data, which they then analyse by integrating findings from multiple methods. The process emphasises linking user feedback with observations of building performance to foster a comprehensive understanding of the relationship between physical design and user experience.
The structured POE training process enabled students to develop a deeper understanding of how design impacts users over time. By applying POE methods, students gained insights into the practical implications of designs and learned about user needs in healthcare environments. We will discuss the potential benefits of integrating POE in architectural training for students, faculty and the architectural profession as a whole. ...
This paper presents how two courses teach POE to their students, one at the faculty of architecture at Delft University of Technology and the other at the faculty of architecture at Technische Universität Wien. We illustrate how students in these courses are taught to apply POE, focusing on healthcare environments through a structured research process. The courses at both universities teach students to conduct POE in real-life healthcare settings, such as Klinik Floridsdorf and Erasmus MC. Students are introduced to a research question and trained to develop appropriate data collection techniques, including observations and interviews. They gather both quantitative and qualitative data, which they then analyse by integrating findings from multiple methods. The process emphasises linking user feedback with observations of building performance to foster a comprehensive understanding of the relationship between physical design and user experience.
The structured POE training process enabled students to develop a deeper understanding of how design impacts users over time. By applying POE methods, students gained insights into the practical implications of designs and learned about user needs in healthcare environments. We will discuss the potential benefits of integrating POE in architectural training for students, faculty and the architectural profession as a whole. ...
In architectural education and practice, the evaluation of a building’s functional, psychosocial and social performance – its ability to meet user needs – is often neglected (Brown, 2018). Post-occupancy evaluation (POE), a systematic approach to assessing whether buildings fulfill their design intentions and respond to both explicit and implicit user needs, offers a promising solution to this oversight (Lehane, 2022). Despite its potential, architectural education often prioritises conceptual design, with project evaluations heavily influenced by subjective opinions of professors, visiting critics and peers. This approach leaves students with limited insight into how their designs perform in real-world contexts (Duffy, 2008). Research indicates that integrating POE into architectural training can help students better understand design effectiveness and prevent recurring design flaws (Hay et al., 2017; Brown, 2019). Furthermore, architects trained to apply POE methods are better equipped to create spaces that meet user expectations over time, thereby reducing the likelihood of premature building modifications (RIBA, 2017).
This paper presents how two courses teach POE to their students, one at the faculty of architecture at Delft University of Technology and the other at the faculty of architecture at Technische Universität Wien. We illustrate how students in these courses are taught to apply POE, focusing on healthcare environments through a structured research process. The courses at both universities teach students to conduct POE in real-life healthcare settings, such as Klinik Floridsdorf and Erasmus MC. Students are introduced to a research question and trained to develop appropriate data collection techniques, including observations and interviews. They gather both quantitative and qualitative data, which they then analyse by integrating findings from multiple methods. The process emphasises linking user feedback with observations of building performance to foster a comprehensive understanding of the relationship between physical design and user experience.
The structured POE training process enabled students to develop a deeper understanding of how design impacts users over time. By applying POE methods, students gained insights into the practical implications of designs and learned about user needs in healthcare environments. We will discuss the potential benefits of integrating POE in architectural training for students, faculty and the architectural profession as a whole.
This paper presents how two courses teach POE to their students, one at the faculty of architecture at Delft University of Technology and the other at the faculty of architecture at Technische Universität Wien. We illustrate how students in these courses are taught to apply POE, focusing on healthcare environments through a structured research process. The courses at both universities teach students to conduct POE in real-life healthcare settings, such as Klinik Floridsdorf and Erasmus MC. Students are introduced to a research question and trained to develop appropriate data collection techniques, including observations and interviews. They gather both quantitative and qualitative data, which they then analyse by integrating findings from multiple methods. The process emphasises linking user feedback with observations of building performance to foster a comprehensive understanding of the relationship between physical design and user experience.
The structured POE training process enabled students to develop a deeper understanding of how design impacts users over time. By applying POE methods, students gained insights into the practical implications of designs and learned about user needs in healthcare environments. We will discuss the potential benefits of integrating POE in architectural training for students, faculty and the architectural profession as a whole.
Poster
(2025)
-
M.E. van Heel, J.S.J. Koolwijk, C.J. van Oel, Harry Van Goor, Maja Kevdzija, Margreet C. Vos, Auke Brugmans, Deidra Casella
Published post-occupancy evaluation (POE) studies of new or renovated hospital environments are still rare. The need for an interdisciplinary approach to understanding the complex causality of the perceived performance of new environments that may affect ‘bricks, bytes and behaviour’, is just one barrier. Often hospital organisations lack opportunities to apply findings in future projects, and also lack the resources to conduct or guide research projects needed to close the evidence-based design cycle. Similarly, POE is not a subject being taught in architectural education.
However, starting with a collaborative approach within a Dutch university medical centre (UMC), a network of collaborations with other UMCs, hospitals, universities and universities of applied science has been established recently. This innovative approach gets students, lecturers, researchers and practitioners to collaborate in order to expand the understanding of the interaction between the hospital built environment and its users. In this abstract, we explore the participation of Bachelor and Masters students in answering hospital-related POE research questions. The aim of the study is to present and reflect on how students have been involved in POE research projects for Dutch UMCs to better understand the potential of this resource, as well as looking at the preconditions to balance the interests of all stakeholders involved.
Hospitals provide case studies for student education in research methods. From 2018 onwards, students from different disciplines have contributed to POE research studies in Dutch UMCs, resulting in (Bachelor and Masters) graduation theses and (material for) scientific publications. The majority of the research projects concern qualitative research (interviews, observations), with the addition of some more quantitative survey studies. Students can contribute to data collection, analysis and presentation/dissemination as part of individual or group assignments.
Collaboration between lecturers, researchers and ‘boots on the ground’ in the UMCs is a prerequisite to successfully developing relevant research questions, organising interaction with hospital staff and offering proper tutoring of students during their research. While study results already provide value at the local level, the time and embeddedness of these kinds of research projects in a larger (potentially national) research effort seem to be serious constraints to publishing results in scientific papers.
Students may be a ‘hidden’ resource to conduct POE studies in all hospital settings. Understanding the need to facilitate education for non-medical/nursing professionals and a network of professionals with shared (research) interests enhances the chance that this resource can be deployed. ...
However, starting with a collaborative approach within a Dutch university medical centre (UMC), a network of collaborations with other UMCs, hospitals, universities and universities of applied science has been established recently. This innovative approach gets students, lecturers, researchers and practitioners to collaborate in order to expand the understanding of the interaction between the hospital built environment and its users. In this abstract, we explore the participation of Bachelor and Masters students in answering hospital-related POE research questions. The aim of the study is to present and reflect on how students have been involved in POE research projects for Dutch UMCs to better understand the potential of this resource, as well as looking at the preconditions to balance the interests of all stakeholders involved.
Hospitals provide case studies for student education in research methods. From 2018 onwards, students from different disciplines have contributed to POE research studies in Dutch UMCs, resulting in (Bachelor and Masters) graduation theses and (material for) scientific publications. The majority of the research projects concern qualitative research (interviews, observations), with the addition of some more quantitative survey studies. Students can contribute to data collection, analysis and presentation/dissemination as part of individual or group assignments.
Collaboration between lecturers, researchers and ‘boots on the ground’ in the UMCs is a prerequisite to successfully developing relevant research questions, organising interaction with hospital staff and offering proper tutoring of students during their research. While study results already provide value at the local level, the time and embeddedness of these kinds of research projects in a larger (potentially national) research effort seem to be serious constraints to publishing results in scientific papers.
Students may be a ‘hidden’ resource to conduct POE studies in all hospital settings. Understanding the need to facilitate education for non-medical/nursing professionals and a network of professionals with shared (research) interests enhances the chance that this resource can be deployed. ...
Published post-occupancy evaluation (POE) studies of new or renovated hospital environments are still rare. The need for an interdisciplinary approach to understanding the complex causality of the perceived performance of new environments that may affect ‘bricks, bytes and behaviour’, is just one barrier. Often hospital organisations lack opportunities to apply findings in future projects, and also lack the resources to conduct or guide research projects needed to close the evidence-based design cycle. Similarly, POE is not a subject being taught in architectural education.
However, starting with a collaborative approach within a Dutch university medical centre (UMC), a network of collaborations with other UMCs, hospitals, universities and universities of applied science has been established recently. This innovative approach gets students, lecturers, researchers and practitioners to collaborate in order to expand the understanding of the interaction between the hospital built environment and its users. In this abstract, we explore the participation of Bachelor and Masters students in answering hospital-related POE research questions. The aim of the study is to present and reflect on how students have been involved in POE research projects for Dutch UMCs to better understand the potential of this resource, as well as looking at the preconditions to balance the interests of all stakeholders involved.
Hospitals provide case studies for student education in research methods. From 2018 onwards, students from different disciplines have contributed to POE research studies in Dutch UMCs, resulting in (Bachelor and Masters) graduation theses and (material for) scientific publications. The majority of the research projects concern qualitative research (interviews, observations), with the addition of some more quantitative survey studies. Students can contribute to data collection, analysis and presentation/dissemination as part of individual or group assignments.
Collaboration between lecturers, researchers and ‘boots on the ground’ in the UMCs is a prerequisite to successfully developing relevant research questions, organising interaction with hospital staff and offering proper tutoring of students during their research. While study results already provide value at the local level, the time and embeddedness of these kinds of research projects in a larger (potentially national) research effort seem to be serious constraints to publishing results in scientific papers.
Students may be a ‘hidden’ resource to conduct POE studies in all hospital settings. Understanding the need to facilitate education for non-medical/nursing professionals and a network of professionals with shared (research) interests enhances the chance that this resource can be deployed.
However, starting with a collaborative approach within a Dutch university medical centre (UMC), a network of collaborations with other UMCs, hospitals, universities and universities of applied science has been established recently. This innovative approach gets students, lecturers, researchers and practitioners to collaborate in order to expand the understanding of the interaction between the hospital built environment and its users. In this abstract, we explore the participation of Bachelor and Masters students in answering hospital-related POE research questions. The aim of the study is to present and reflect on how students have been involved in POE research projects for Dutch UMCs to better understand the potential of this resource, as well as looking at the preconditions to balance the interests of all stakeholders involved.
Hospitals provide case studies for student education in research methods. From 2018 onwards, students from different disciplines have contributed to POE research studies in Dutch UMCs, resulting in (Bachelor and Masters) graduation theses and (material for) scientific publications. The majority of the research projects concern qualitative research (interviews, observations), with the addition of some more quantitative survey studies. Students can contribute to data collection, analysis and presentation/dissemination as part of individual or group assignments.
Collaboration between lecturers, researchers and ‘boots on the ground’ in the UMCs is a prerequisite to successfully developing relevant research questions, organising interaction with hospital staff and offering proper tutoring of students during their research. While study results already provide value at the local level, the time and embeddedness of these kinds of research projects in a larger (potentially national) research effort seem to be serious constraints to publishing results in scientific papers.
Students may be a ‘hidden’ resource to conduct POE studies in all hospital settings. Understanding the need to facilitate education for non-medical/nursing professionals and a network of professionals with shared (research) interests enhances the chance that this resource can be deployed.
Trade-offs in Evidence Based Design
'The Patient Door Debate'
The door between the semi-public corridor and the single-occupancy patient room of a newly built University Medical Centre in the Netherlands has been heavily debated during its Evidence Based Design (EBD) and experience-informed design. It was also heavily debated since the wards came into use in 2018. It is well known that, regarding door design, a trade-off has to be made between aspects such as privacy, visibility, and safety. This makes our case study exemplary for the trade-offs to be made in EBD practice. This study traces back to how the design decisions for the door, dating from 2011, were made. Safety, privacy, control, and support for the social and emotional wellbeing of patients, relatives, and staff were the aim, but this is not experienced as such by all concerned. This case study evaluation highlights the tension between EBD principles and everyday practice, where the interplay between ‘bricks, bytes, and behavior’ has to be considered, and every consciously debated design solution might bring new and unforeseen challenges elsewhere. Our practice-based research combines the analysis of documentation on the design decision-making process with evaluation interviews with nurse managers in 2019. Our findings on ‘the (Dutch) patient door debate’ can contribute to awareness of trade-offs to be made in health facility design, complemented with supportive IT systems and efficient and effective staff workflows. It can enhance the understanding of the many aspects that need to come into consideration during design dialogues with experts and end-users.
...
The door between the semi-public corridor and the single-occupancy patient room of a newly built University Medical Centre in the Netherlands has been heavily debated during its Evidence Based Design (EBD) and experience-informed design. It was also heavily debated since the wards came into use in 2018. It is well known that, regarding door design, a trade-off has to be made between aspects such as privacy, visibility, and safety. This makes our case study exemplary for the trade-offs to be made in EBD practice. This study traces back to how the design decisions for the door, dating from 2011, were made. Safety, privacy, control, and support for the social and emotional wellbeing of patients, relatives, and staff were the aim, but this is not experienced as such by all concerned. This case study evaluation highlights the tension between EBD principles and everyday practice, where the interplay between ‘bricks, bytes, and behavior’ has to be considered, and every consciously debated design solution might bring new and unforeseen challenges elsewhere. Our practice-based research combines the analysis of documentation on the design decision-making process with evaluation interviews with nurse managers in 2019. Our findings on ‘the (Dutch) patient door debate’ can contribute to awareness of trade-offs to be made in health facility design, complemented with supportive IT systems and efficient and effective staff workflows. It can enhance the understanding of the many aspects that need to come into consideration during design dialogues with experts and end-users.
Perspectives on Assessing the Flexibility of Hospitals for Crisis Mode Operations
Lessons From the COVID-19 Pandemic in the Netherlands
Background: The COVID-19 pandemic placed healthcare design at the heart of the crisis. Hospitals faced challenges such as rapidly increasing their intensive care unit capacity, enabling physical distancing measures, quickly converting to telehealth and telework practices, and above all, keeping patients and staff safe. Improving flexibility in hospital facility design and adaptability of hospital operations to function in “crisis mode” can be seen as ways of future-proofing for pandemics. In a design brief, flexibility is typically mentioned as an important target. Meanwhile, robustness of technical infrastructure is called for, and standardization at unit level with single-occupancy inpatient accommodation may be considered a way to enhance flexibility and adaptability in dealing with a surge in infectious patients. Aim: To future-proof facility design with pandemic preparedness and resilience in mind, this study evaluated what kinds of interventions were taken in Dutch hospital facilities and what perspectives need to be considered when hospitals operate in crisis mode. Methods: We have collected data from facility and estate professionals from 30 Dutch hospitals. Using a practice-based approach, in-depth interviewing helped uncover and compare successful operational strategies and design elements that provided the flexibility needed in the early stages of the recent crisis. Results: As we looked at existing facilities and alterations made to allow hospitals to operate during the COVID-19 pandemic, we discovered that staff availability and adaptability were deemed crucial. Conclusion: We add the perspective of staff as an essential factor to be considered when future-proofing hospital facility desigr crisis mode operation.
...
Background: The COVID-19 pandemic placed healthcare design at the heart of the crisis. Hospitals faced challenges such as rapidly increasing their intensive care unit capacity, enabling physical distancing measures, quickly converting to telehealth and telework practices, and above all, keeping patients and staff safe. Improving flexibility in hospital facility design and adaptability of hospital operations to function in “crisis mode” can be seen as ways of future-proofing for pandemics. In a design brief, flexibility is typically mentioned as an important target. Meanwhile, robustness of technical infrastructure is called for, and standardization at unit level with single-occupancy inpatient accommodation may be considered a way to enhance flexibility and adaptability in dealing with a surge in infectious patients. Aim: To future-proof facility design with pandemic preparedness and resilience in mind, this study evaluated what kinds of interventions were taken in Dutch hospital facilities and what perspectives need to be considered when hospitals operate in crisis mode. Methods: We have collected data from facility and estate professionals from 30 Dutch hospitals. Using a practice-based approach, in-depth interviewing helped uncover and compare successful operational strategies and design elements that provided the flexibility needed in the early stages of the recent crisis. Results: As we looked at existing facilities and alterations made to allow hospitals to operate during the COVID-19 pandemic, we discovered that staff availability and adaptability were deemed crucial. Conclusion: We add the perspective of staff as an essential factor to be considered when future-proofing hospital facility desigr crisis mode operation.
Balancing bricks, bytes and behavior
Lessons learned from inpatient wards with 100% single occupancy rooms
The design of a new hospital is typically used as a catalyst for change, redesign, and the implementation of new work processes to improve health services. Perceived outcomes after relocation may be linked to the success of co-design and stakeholder engagement processes. Especially in striking the right balance between the building (bricks), processes and supporting IT (bytes), and work processes (behavior). Even when stakeholders are engaged in the design, that does not guarantee that their needs will be safeguarded during trade-offs in various phases of decision making. Furthermore, the time window between engagement and project delivery may contribute to a mismatch in perceived outcomes after relocation. This study aims to gain insight into the possible causes of the perceived mismatches as expressed by ward managers some 12 months after relocation. This was some six years after the design of the facility was completed. It will increase our understanding of the complexity of design, construction, and transition processes that have to deal with a gap in time between design and use. We adopt an interpretive case study approach in which in-depth interviewing is combined with an extensive analysis of documents collected over time. We found transformative change requiring an integrative approach to the Bricks and Bytes throughout the whole process of designing, constructing and taking them into use, with stakeholder engagement as a key element. Additionally, we found that health care worker behavior was not considered sufficiently in a predominantly rational design and implementation process focusing on patient centeredness.
...
The design of a new hospital is typically used as a catalyst for change, redesign, and the implementation of new work processes to improve health services. Perceived outcomes after relocation may be linked to the success of co-design and stakeholder engagement processes. Especially in striking the right balance between the building (bricks), processes and supporting IT (bytes), and work processes (behavior). Even when stakeholders are engaged in the design, that does not guarantee that their needs will be safeguarded during trade-offs in various phases of decision making. Furthermore, the time window between engagement and project delivery may contribute to a mismatch in perceived outcomes after relocation. This study aims to gain insight into the possible causes of the perceived mismatches as expressed by ward managers some 12 months after relocation. This was some six years after the design of the facility was completed. It will increase our understanding of the complexity of design, construction, and transition processes that have to deal with a gap in time between design and use. We adopt an interpretive case study approach in which in-depth interviewing is combined with an extensive analysis of documents collected over time. We found transformative change requiring an integrative approach to the Bricks and Bytes throughout the whole process of designing, constructing and taking them into use, with stakeholder engagement as a key element. Additionally, we found that health care worker behavior was not considered sufficiently in a predominantly rational design and implementation process focusing on patient centeredness.
Journal article
(2022)
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J. Pirzadian, T. Souhoka, M. Herweijer, L. van Heel, W. J.B. van Wamel, R. H.M. Goossens, J. A. Severin, M. C. Vos
In hospitals, sinks act as reservoirs for bacterial pathogens. To assess the extent of splashing, fluorescein dye was added to four hospital sinks previously involved in pathogen dispersal to the environment and/or transmission to patients, and one sink that was not. Applying dye to the p-trap or tailpiece did not result in any fluorescent droplets outside of the drain. When applied to the drain, droplets were found in all but one wash basin, and this was more common in the absence of a drain plug. Sink design considerations to install drain plugs, reduce dripping and offset the tap may help to prevent transmission from drains.
...
In hospitals, sinks act as reservoirs for bacterial pathogens. To assess the extent of splashing, fluorescein dye was added to four hospital sinks previously involved in pathogen dispersal to the environment and/or transmission to patients, and one sink that was not. Applying dye to the p-trap or tailpiece did not result in any fluorescent droplets outside of the drain. When applied to the drain, droplets were found in all but one wash basin, and this was more common in the absence of a drain plug. Sink design considerations to install drain plugs, reduce dripping and offset the tap may help to prevent transmission from drains.