Browsing by Subject "evidence-based design"
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Item Examination of Process Implementation of Evidence-based Design Initiatives on United States Army Medical Construction(2011-08-08) Marsh, Glenn EdwardThe objective of this research is to review the degree of United States Army compliance in the implementation of evidence-based design practices within the Military Health System construction cycle. This research looks at the impact of the 2007 Assistant Secretary of Defense for Health Affairs memorandum directing the use of evidence-based design within the Military Healthcare System construction process. The memorandum impacted the military medical construction process that includes over 6.2 billion dollars in government programmed military medical construction covering 9.2 million beneficiaries. An analysis of federal construction documents, interviews, and an online survey was conducted with 85 government and civilian healthcare facility planners to measure general evidence-based design knowledge, direct knowledge of medical construction policy requirements, and the level to which the Military Health System Evidence-based Design Principles matrix has been implemented within four selected military medical construction projects. Results of the review of construction publications show minimal evidence of evidence-based design incorporation with key federal regulatory documents. The results of an online survey conducted during the research had a 65.8% response rate (39 government personnel, 17 civilian personnel). The survey showed that basic knowledge of evidence-based design was present, but revealed severe deficiencies in specific knowledge and application of construction policies. Review of selected medical facilities demonstrated non-standardized incorporation of evidence-based design features. This research concludes that evidence-based design has achieved minimal integration into the Military Health System general knowledge base and project execution. Achieving compliance with the 2007 directive memorandum requires that significant efforts be made in personnel training and reconciliation with federal military medical construction documents.Item Simulations of Design Modifications in Military Health Facilities(2012-07-16) Kiss, Christopher WilliamThe Military Health System (MHS) is a worldwide network of healthcare facilities and personnel. The healthcare facility inventory is aging and requires extensive facility management, renovations and replacement construction to maintain the environment of a high quality of care. Recent developments in sustainability and evidence-based design (EBD) have created additional requirements for the design and construction of facilities. These areas of design emphasis, sustainability and EBD, are developing best practices according to the respective theory. Existing facilities in the MHS have been directed to undergo restoration and modernization by Department of Defense (DoD) civilian leadership. Governmental directives have mandated that these restorations and new construction complies with current building codes and that EBD design features be included in healthcare facility planning. The hospital building type has changed over history due to innovations in building technology, such as HVAC and steel frame construction, as well as healthcare initiatives, such as treatment of tuberculosis and the mentally ill. The design concepts of environmental sustainability and EBD are currently altering the hospital typology. Building professionals have found significant differences in facilities that are categorized as evidence-based and those noted as sustainable. The future of successful healthcare designs relies on a balance of these concepts. The hospital building type has one of the highest energy intensities out of all commercial building types. Hospitals have become more energy intense due to the evolution of the deep-plan hospital. The design of the building envelope is the most lasting feature affecting the energy use of a hospital, due to its service-life typically equaling the life of the facility. The building envelope design consists of the shape of the building, material selection, as well as its orientation. This research demonstrates the relationship between incorporating positive building occupant features, such as increased day lighting and views of nature, and efficient energy design choices. The use of energy simulation software and early design collaboration between multiple professional disciplines is recognized as critical to optimal design solutions.