× You are not currently logged in. To receive all the benefits our site has to offer, we encourage you to log in now.

Butler County Health Care Center, David City, NE

September 2011
EDAC Advocate Firm Project
Visions in Architecture


Firm's role on the project:  Planning, Programming, Architecture, Design, Interiors 


EBD Goal

The goals are to improve infection control flow patterns and to reduce surgery room turn around time.


With a surgery department that was built over 50 years ago with inadequate clean/soiled separation and flow patterns, the surgical nursing staff and the environmental staff have compensated for the inadequate physical conditions through excessive cleaning. This increased operating room turn around time to 2.5 times the national average, resulting in unhappy surgeons and poor financial performance. The challenge was to alter the perception of the nursing and environmental services staff to recognize that changes in the built environment can result in better work flow patterns. The culture of “who does what when” becomes ingrained in an organization and can result in resistance to change.


The solution to this challenge was to create a virtual mock up of the new surgical rooms providing surgical booms, equipment, lighting and mechanical systems. The amount and location of storage within the room was shown. In addition, animated flow patterns were shown within the department depicting the movement of surgeons, patients, surgical nurses and clean and soiled materials. This allowed the surgical staff to observe each step of the process and to voice their comments and concerns. By placing the staff in virtual spaces, they can more easily understand the new processes and expectations. This exercise resulted in a commitment to reduce operating room turn around time by 150 percent and significantly improve the project return on investment.
The design architect used the HERD article written by Kirk Hamilton and others on the relationship between cultural change and design to form the hypothesis “Can image and video technology depicting the principals of evidence-based design be used to effect cultural change?” It is our intent to measure results based on surgical room turnaround time using current times as baseline and measuring the new surgical suite turnaround times and the new benchmark.