1. © Bridgepoint Collaboratory for Research and Innovation 2013© Bridgepoint Collaboratory for Research and Innovation 2014 Celeste Alvaro, PhD Research Scientist, Bridgepoint Collaboratory for Research and Innovation, Toronto, Canada Adjunct Professor, Department of Architectural Science, Ryerson University, Toronto, Canada Applied Research & Evaluation Consultant and Founder, CARE Andrea Wilkinson, PhD Postdoctoral Research Fellow, Bridgepoint Collaboratory for Research and Innovation, Toronto, Canada Deyan Kostovski, AMA Knowledge Translation & Communications Strategist, Strongbow Strategies, Toronto, Canada Evaluating theory and reality: The user experience at Bridgepoint Active Healthcare December 8, 2014 Canadian Centre for Healthcare Facilities Conference, Toronto

2. Slide 2 © Bridgepoint Collaboratory for Research and Innovation 2014 Scientific Research Team Celeste Alvaro, PhD (Lead) Research Scientist, Bridgepoint Collaboratory for Research and Innovation; Adjunct Professor, Department of Architectural Science, Ryerson University; Applied Research & Evaluation Consultant/Founder, CARE Paula Gardner, PhD Assistant Professor, Department of Health Sciences, Brock University; Affiliate Research Scientist, Bridgepoint Collaboratory for Research and Innovation Collaboratory Scientists Kate Wilkinson, BSc, RN, MHSc Former Director, Patient Quality and Safety, Bridgepoint Active Healthcare; Current Associate Vice President Patient Quality, Markham-Stouffville Tony Khouri, PhD, PEng, OSPE Former Vice-President, Redevelopment, Bridgepoint Active Healthcare; current VP Facilities and Capital Redevelopment Mount Sinai Hospital Ministry of Health and Long Term Care Cheryl Atkinson, OAA MRAIC Assistant Professor, Department of Architectural Science, Ryerson University Gregory Colucci, OAA MRAIC Principal, Diamond + Schmitt Architects Clifford Harvey, OAA, MRAIC Former Senior Architect, MOHLTC VP Planning, Facilities and Support Services, NYGH Stuart Elgie, OAA, MRAIC Principal, Stantec Architecture Mitchell Hall, OAA, MRAIC Principal, KPMB Architects Architects Hospital Directors/VPs Andrea Wilkinson, PhD Postdoctoral Research Fellow Bridgepoint Collaboratory for Research and Innovation Deyan Kostovski, AMA Knowledge Translation & Communications Strategist Strongbow Strategies Core Research Personnel Renee Lyons, PhD Founding Chair and Scientific Director Emeritus, Bridgepoint Collaboratory for Research and Innovation Professor, Dalla Lana School of Public Health and Institute for Health Policy, Management and Evaluation, University of Toronto

3. Slide 3 © Bridgepoint Collaboratory for Research and Innovation 2014 The Opportunity Fact: The Province of Ontario plans to invest over $3.5 billion in capital grants to hospitals over three years 2013 Ontario Budget

4. Slide 4 © Bridgepoint Collaboratory for Research and Innovation 2014 The architects sought to: The Design Intentions Create an environment of wellness Enhance connection to nature, the community, and the city Enhance social interaction Inspire activity Foster optimism and hope Encourage patients to re-engage in life

5. Slide 5 © Bridgepoint Collaboratory for Research and Innovation 2014 The Design Intentions Image courtesy of William Suarez

6. Slide 6 © Bridgepoint Collaboratory for Research and Innovation 2014 A quasi experiment Bridgepoint Hospital West Park Health Care Centre The Research Design Pre-test Phase August 2012 to March 2013 Post-test Phase August 2013 to March 2014

7. Slide 7 © Bridgepoint Collaboratory for Research and Innovation 2014 Computer Assisted & Online Quantitative Surveys Image courtesy of William Suarez

8. Slide 8 © Bridgepoint Collaboratory for Research and Innovation 2014 Qualitative Methods Naturalistic Observation iPad app Image courtesy of William Suarez Go Along Interview

9. Slide 9 © Bridgepoint Collaboratory for Research and Innovation 2014 Hospital Database Variables Comparison of data from hospital administrative databases pre and post move Architectural Documentation

10. Slide 10 © Bridgepoint Collaboratory for Research and Innovation 2014 Impressions of the Hospital Design Visiting Neighbourhood Wayfinding Wellness Nature City Safe Comforting Cheerful Except…for patients: Except…for staff: Overall

11. Slide 11 © Bridgepoint Collaboratory for Research and Innovation 2013 Pretest Posttest nM nM NeighbourhoodPatientBridgepoint902.10 (1.01) a1 1052.43 (1.13) b1 West Park632.17 (.89) a1 661.98 (1.02) a2 StaffBridgepoint1242.90 (.81) a1 1822.69 (.94) a1 West Park1392.87 (1.84) a1 1792.41 (.86) b2 NaturePatientBridgepoint912.71 (1.05) a1 1053.09 (.89) b1 West Park623.18 (.84) a2 652.98 (1.02) a1 StaffBridgepoint1252.74 (.78) a1 1812.75 (.91) a1 West Park1383.14 (.79) a2 1802.90 (1.02) b1 CityPatientBridgepoint922.29 (1.08) a1 1052.97 (1.00) b1 West Park622.23 (1.03) a2 652.12 (1.07) a2 StaffBridgepoint1252.86 (.83) a1 1802.85 (.91) a1 West Park1392.12 (.87) a2 1772.27 (.89) a2 Sense of Belonging Note. Within rows, means with different subscript letters are significantly different at p ≤.05. Within columns, means with different subscript numbers are significantly different at p ≤.05. Post hoc paired comparisons based on Fisher’s LSD.

12. Slide 12 © Bridgepoint Collaboratory for Research and Innovation 2014 Well-being outcomes Staff General well-being (Diener, 1984)Workplace satisfaction (Alvaro & Kuluski, custom) Optimism (Scheier & Carver, 1985)Workplace interactions Burnout (MBI-R; Maslach, et al., 1997) Patients Depressive symptoms (CESD-10; Andersen et al., 1997) Satisfaction (Malik, Alvaro & Kuluski, under review) Optimism (Scheier & Carver, 1985)Perceptions of improvement (adapted from McFarland & Alvaro, 2000) Self-efficacy in mobility (adapted from Fleiss-Douer, 2009) No DifferencesImproved Outcomes

13. Slide 13 © Bridgepoint Collaboratory for Research and Innovation 2014 Impressions & Outcomes Overall Index Visiting Greater satisfaction (overall & facility specific) patients and staff Wellness Neighbourhood Nature City Safe Wayfinding Comforting Cheerful Enhanced impressions that the building facilitates workplace interactions Decreased staff burnout Greater self-efficacy in mobility for patients

14. Slide 14 © Bridgepoint Collaboratory for Research and Innovation 2014 Overall Impressions of the Hospital Design on Optimism (Patients and Staff) Total nM Overall Low overall impressions43316.44 (4.17) 1 High overall impression41917.26 (4.05) 2 PatientsLow overall impressions11914.87 (4.39) 1 High overall impression17816.65 (4.08) 2 StaffLow overall impressions31417.04 (3.93) 1 High overall impression24117.71 (3.97) 2 Note. Within columns, means with different subscript numbers are significantly different at p ≤.05. Post hoc paired comparisons based on Fisher’s LSD.

15. Slide 15 © Bridgepoint Collaboratory for Research and Innovation 2013 Outcome NeighbourhoodPatientIncreased satisfaction (overall and facility specific) StaffEnhanced workplace interactions Decreased burnout Decreased intention to quit NaturePatientIncreased satisfaction (overall and facility specific) Increased optimism Perceived improvement in mental* and health overall Greater self-efficacy in mobility* StaffIncreased satisfaction (overall and facility specific) CityPatientIncreased satisfaction (overall and facility specific) Perceived improvement in financial health Greater self-efficacy in mobility Staff Increased overall satisfaction Enhanced workplace interactions Enhanced Sense of Belonging & Outcomes

16. Slide 16 © Bridgepoint Collaboratory for Research and Innovation 2013 The Hospital Destinations Example: Rooftop Terrace measures Quality of spaces Rooftop Favourable ratings Coveted spot Observations and experience Variety of users Variety of uses Well-defined seating areas People seem to be attracted to spaces where they find other people Range of social activities and contemplative activities Recreation therapy Self-directed rehabilitative activities

17. Slide 17 © Bridgepoint Collaboratory for Research and Innovation 2014 Knowledge Translation Final Report Images courtesy of William Suarez Forthcoming in December 2014 (Alvaro, Kostovski, Gardner, & Wilkinson, 2014) Photodocumentation

18. Slide 18 © Bridgepoint Collaboratory for Research and Innovation 2014 Knowledge Translation Establishing a New Normal The inclusion of POEs as part of any redevelopment project POE Planning Guide Database to store and retrieve information on past projects Working with regulatory bodies to incorporate new standards Research and evaluation literacy Interventions for undervalued spaces

19. Slide 19 © Bridgepoint Collaboratory for Research and Innovation 2013 Questions? http://www.bridgepointhealth.ca/Desig nandEvaluation This research is funded by the Canadian Institutes of Health Research (CIHR) Partnerships for Health System Improvement (PHSI) grant, with partnered funding from the Ontario Ministry of Health and Long Term Care awarded to Dr. Celeste Alvaro.