Dept of HealthDeveloping an Integrated System for the Optimal Selection Of Hospital Finishes

Martin Edge was co-investigator on this Department of Health funded project

Start date: April 2005       End date: March 2007
Investigators: Dr Richard Laing, Dr Mohammed Kishk, Professor Martin Edge
Funds: £128,000


Research background

Historically, the selection of finishes was mostly based on their initial capital costs. Building finishes are often regarded as a separate and final application to the fabric, sometimes even the last part of the building to be specified, and consequently may be subject to compromise in their quality by late cost-control exercises. Recently, there has been a desire to adopt a whole-life attitude to the design and management of buildings because of the dramatic shift in the balance from the initial capital cost to the running costs of buildings.

This aim has faced a number of obstacles.

There has been little progress towards achieving an integrated system that decomposes the process of selecting building elements including finishes into a flexible and logical series of activities that can be followed by decision makers.

Research aims and objectives

These arguments are especially true in the complex environment of healthcare buildings, in which, for example, the desire to reduce variation for economic reasons has to be balanced against a wide variety of specialist uses and a large number of user groups with widely differing needs. Reducing variation may help to control maintenance and cleaning as well as capital costs. On the other hand the use of different spaces varies from office and general use to very high wear circulation areas and indoor ‘streets’, to ward areas, to highly specialised theatre areas. Within many of these spaces a range of issues distinguishes healthcare environments from most other building types and needs to be considered in the development of the proposed WLC tool. Perhaps the most important of these issues relates to the control of infection.

Hospital environments in particular are subject to spillage of a range of potentially dangerous substances, in areas of general use such as circulation areas, as well as in wards. Here the choice of finishes is not only important in determining cleaning regimes, but may for example incorporate resistance to the spread of infection through the use of antimicrobial agents, fungicides etcetera, as additives to applied finishes. In addition, the choice of finishes in the future may for example assist in humidity control to help in the prevention of MRSA infection. This may involve consideration of joints within and between finishes as well as the choice of finish per se. Linked to cleaning issues is the resistance of finishes to cleaning agents such as solvents. Another issue is the impact and disruption of the application process, given that many finishes are applied in areas in hospitals which continue in use during the application period.

As well as these important physical issues, research has shown that design and specification, even down to the level of choice of finishes, may have implications for psychological well-being and hence, again, for recovery rates. For example research by Lawson and others has shown that detailed design factors such as colour, as well as wider issues such as privacy, may have implications for recovery speeds for patients admitted with both physical and mental problems. The same research has shown that acoustics is a major issue for patients which may have a very profound effect on the choice of finishes. This work builds on earlier research looking at the effect of external views on patient recovery. The importance of art and other aspects of decoration in hospital environments is another area which may impact on choice of finishes. As well as specific design guidance (NHS 1995), an increasingly large body of literature is stressing the importance of design for a whole range of physical and psychological factors affecting patients and other users of healthcare buildings.

In the development of the proposed system within this project, the research team will take account of the complexity of these relevant but often unquantifiable issues. The tool will be developed to ensure future adaptability to incorporate such issues and that it can act as a persuasive instrument to encourage good design and thoughtful finishes specification.

Research methodologies / process

The measurable objectives of this project and the main work components in achieving them are as follows:

1. Various finishes being used in hospitals and their relevant selection criteria are identified. Questionnaires will be administered to relevant managers in hospital trusts and suppliers; as well as an extensive review of the literature, specifications and other official documents will be conducted.

2. A finishes resource database to house the information collected in phase 1. A recently developed WLC resource database by our research team within an EPSRC-funded research project will be tailored for hospital finishes and extended to house minimum performance thresholds and other trade-off criteria. A compatible facility-specific database is developed to manage actual performance and cost data of finishes in occupied hospital buildings.
3. Develop an extended decision-making application based on the theory presented by Kishk previously.

4. Develop the system by integrating the decision-making application and the two databases through an interactive interface.

Test and validate the system. This will be done in three phases. First, the usability of the system’s interface will be tested in a laboratory environment. A second phase will be to demonstrate the system to relevant NHS personnel and experts to get feedback on further refinements to the system’s capabilities. A third phase will be to use case studies to demonstrate the validity of the model.

Selected References

Kishk, M, Laing, R. Scott, J. and, Edge, M, (2007) A Novel System for the Optimal Selection of Finishes for Healthcare Facilities The Fourth Salford Centre for Research & Innovation (SCRI) International Symposium

Kishk, M., Laing, R., Scott, J., & Edge, M. (2007). A Generic Finishes Database for Healthcare Facilities. In the Proceedings of Boyd, D (Ed) Procs 23rd Annual ARCOM Conference, pp. 883-892.


Kishk, M, Laing, R and, Edge, M, (2007) An Extended Whole-Life Application for the Selection of Hospital Finishes” In: Boyd, D (Ed) Procs 22nd Annual ARCOM Conference, 4-6 September 2006, Birmingham, UK, Association of Researchers in Construction Management, 719-728.

Kishk, M, Laing, R, Edge, M, & Scott, J (2006).

 An integrated framework for the optimal selection of hospital finishes - system algorithm and methodology. In the Proceedings of The Joint International Conference on Decision Making in Civil and building Engineering, Montreal, June 14-16, pp. 840-847.

Laing, R, Kishk, M, Scott, J, & Edge, M (2006). On the selection criteria of hospital finishes. In the Proceedings of The Joint International Conference on Decision Making in Civil and building Engineering, Montreal, June 14-16, pp. 822-829.