Susquehanna Health (Williamsport, Pa.) has been a Center for Health Design Pebble Partner since 2008. It’s an integrated health system that provides services throughout rural central Pennsylvania, with 228 licensed acute beds and the admission of more than 13,000 patients annually.

Its Project 2012 initiative included the addition of a new patient tower at the Williamsport Regional Medical Center. The completed Susquehanna Tower opened in March 2012 and features decentralized nurses’ stations, family spaces in all private patient rooms, a pleasing architectural aesthetic, and capabilities for wireless voice communications.

As Susquehanna Health undertook Project 2012, it incorporated an evidence-based design (EBD) process. In 2009, while evaluating evidence for the new tower, nursing leadership decided to use the building project to explore the latest innovations in patient care to further improve patient experiences and outcomes. To this end, the chief nursing executive charged nurses to use evidence-based nursing practice and research to support these changes to care delivery.

At the same time, nursing leadership instituted a shared governance model of empowering nurses to replace the more traditional practice guidelines that were challenged only when necessary.


Making the connection
A nursing research council was created that proposed several nursing research project ideas, and in 2011, several were formalized into actual research proposals. These ideas included a project focused on changing the morning medication administration time to provide nurses more time with their patients; a project focused on oncology patient compliance with neutropenic diets; an investigation into the application of a three-minute back massage into the evening nursing care for inpatient rehabilitation patients; and a project to explore breastfeeding durations among postpartum mothers discharged from the hospital.

Additionally, the research team was responsible for developing Pebble Project research based upon the new environments that were nearly completed.

Working with the vice president of facilities development and the project team at Stantec Architecture Inc. (Philadelphia) proved to be beneficial in getting up to speed on the Pebble Project, the project’s design features, and how the implementation of these features were expected to impact patient care and ultimately patient outcomes.  

As a Pebble partner, attending a Pebble colloquium was essential to gain more familiarity about research within built environments. These research discussions revealed the similarities between built-environment research and traditional types of nursing research. The environment became the variables of interest in relation to care delivery process and patient outcomes.

This was in direct alignment with the nursing metaparadigm, which includes the environment as an important factor in human well-being. Connecting with other research specialists was invaluable as well, allowing for follow-up conversations to help shape design research projects for Susquehanna.


Picking up steam
The all-important next step was working with staff nurses to help them learn the research process: developing educational modules for processes and ethics, and proposing initiatives to compensate staff for time spent working on the projects, for example. This allowed the team to develop projects into formal designs and, ultimately, proposals to submit to the organization’s institutional review board (IRB).

Without organizational buy-in from leadership, it would have been very difficult to advance a program of research.  And by taking time toeducate the organization about how research influences patient care and outcomes, support for the nursing research program has grown.

In the year prior to filling a nursing clinical research specialist position, there were 15 nursing units presenting innovative ideas in poster form during the organization’s nurses’ week celebrations—but none of the posters were research-focused, and few were evidence-based. One year later, the nurses created 22 unit based posters, six of which were evidence-based projects and one an IRB-approved research project.

Now that an established platform for research has been formed, there’s even more responsibility to assess the new building features and design using both quantitative and qualitative research methodologies for data collection and analysis. Plans to study the new built environment include looking at how decentralized nurses’ stations impact patient safety and staff efficiency, as well as patient and staff satisfaction and family engagement. Additionally, the influence of technology on staff efficiency and satisfaction when providing care to patients will be examined.


A culture of research
This experience has enabled the meshing of nursing research education and knowledge with the application of the research process in a built environment. It’s become apparent that learning the research process is not to be kept within a silo of original thought, but can be translated into areas not commonly known for research.

Whether it is nursing, medicine, or healthcare building design, the ultimate goal is shared and focused toward improving patient outcomes. If you’ve been interested in conducting a research project and don’t know how to get started, creating a culture of research is the first step. Work with someone who has familiarity with research (even if outside of your organization); establish educational opportunities; ensure internal leadership support; build a support network; and take small steps. 

Pamela C. Spigelmyer,  PhD (c), RN, CNS, is a nursing clinical research specialist with Susquehanna Health System in Williamsport, Pa. She can be reached at For more information on the Pebble Project, contact Mark Goodman at