Balancing bricks, bytes and behavior: Lessons learned from inpatient wards with 100% single occupancy rooms

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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.
Original languageEnglish
Number of pages11
JournalThe Evolving Scholar
Publication statusPublished - 2023
EventARCH22 - 5th Architecture Research Care and Health Conference: Enabling Health, Care and Well-Being Through Design Research - TU Delft/Erasmus MC, Delft/Rotterdam, Netherlands
Duration: 22 Aug 202224 Aug 2022


  • post occupancy evaluation
  • stakeholder engagement
  • transformation
  • hospital design


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