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A Delphi application in the developing of a pattern language approach to health facilities design guidelines

University of British Columbia

The use of Standards to reduce the complexity of Health Facilities Design has become an indispensable and integral part of the planning process. Unfortunately the structure of present Standards is inflexible, and while this structure may have been acceptable in the past, the standards it produces have become ineffective. Such Standards have been unable to adapt to the changing attitudes and needs of the planning participants who respond to the societal changes around them. It is our objective to develop a method which can build better Standards. In the first chapter we examine the structural problems of Standards and find that there is a fundamental difference between the positive purpose of Standards as used by hospitals and planners and the restrictive purposes of Standards used by government. We have used the terms Guidelines and Standards to denote these different contexts. Having established that a good Standard is one which is similar to a Guideline, we then explore an alternative structure developed at Berkeley, California, called a "Pattern" which we observe will satisfy the requirements for "good" Standards. Since Pattern formats are admirably suited to developing societally-responsive Guidelines and Standards we evolve a method to assemble these new Standards. This method is based upon the Delphi Technique. It uses the technique's inherent advantages to establish communication between two groups of experts (Planners and Medical) who then interact to explore problems and solutions in planning Newborn Nurseries and Neonatal Intensive Care Units. The methodology which is described in Chapter 2 uses the classical components of a Policy Delphi with three rounds of questionnaires sent to Medical Experts (Physicians and Nurses) in various parts of British Columbia and Alberta. It adds such variations as the including of input from the Planner Experts as one method for the feed back of information. This special Delphi design anticipates effects from independent variables and builds in compensatory steps. One of the steps included is a Mini-Survey of a larger group of potential participants, to evaluate the Patterns resulting from the Delphi Study. This larger group was sixteen hospitals in British Columbia and ten hospitals in Alberta. Chapter 3 describes the details in carrying out the three questioning rounds of this modified Delphi method, and its success in assisting the production of a series of Nursery Patterns which are usable as Guidelines. In the methodology is the inherent capability for retaining flexibility, and there are a series of process adjustments that occur. Evaluation of the method in Chapter 4 shows that despite weaknesses, both anticipated and unanticipated, the results provide an important starting point that helps create better, more usable Standards. Possible future developments are briefly mentioned in the hope that evaluation and change will occur as the planning environment changes about us.

Text

2010-03-30

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http://hdl.handle.net/2429/23136

Health Care and Epidemiology

University of British Columbia

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