{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T12:05:18Z","timestamp":1791201918512,"version":"4.2.0"},"reference-count":39,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["HERD"],"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study quantifies differences in hospital area outcomes when applying four national measurement standards and identifies key sources of variation relevant to international benchmarking.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Reliable area metrics support hospital programming, cost estimation, and facility management, yet international comparisons are complicated by differences in terminology, boundary definitions, and inclusion criteria. In Part 1 of this study, Viergutz and Apple compared theoretical similarities and differences among national hospital area standards in Germany, Canada, Australia, and the United States\u2014countries representing mature healthcare systems with established but differing regulatory and planning contexts. The prior study proposed an adaptive framework to improve comparability. This study quantifies these differences and evaluates whether the empirical results support the theoretical distinctions identified in Part 1.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Two contemporary hospital case studies, one in the United States and one in Germany, were analyzed using all four national standards. Results were compared across three tiers: Building Gross Area, Department Gross Area, and Department Net Area, with deviations traced to specific inclusion and boundary rules.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Department gross areas showed minimal variation (with most differences below 1%), although the German standard required subjective interpretation at this tier. Larger differences occurred at the building gross area and department net area levels due to varying treatment of shell space, research and education areas, unenclosed engineering space, central energy plants, and wall thickness conventions. The quantitative findings support and empirically confirm the theoretical distinctions identified in the prior qualitative study (Part 1), with no substantial contradictions observed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/19375867261481147","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T03:24:50Z","timestamp":1790825090000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Quantifying Differences in Hospital Area Measurement in Germany, Canada, Australia, and the United States"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5912-322X","authenticated-orcid":false,"given":"Hannah-Kathrin Silja","family":"Viergutz","sequence":"first","affiliation":[{"name":"TU Vienna"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6803-3616","authenticated-orcid":false,"given":"Mike","family":"Apple","sequence":"additional","affiliation":[{"name":"Health Planning, HDR"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"key":"e_1_3_3_2_1","unstructured":"Adams T. Epstein S. Gregory W. L. Wilkening T. (2010). Operations and maintenance. Benchmarks for health care facilities report."},{"key":"e_1_3_3_3_1","unstructured":"Allison D. Hamilton D. K. (2008). Analysis of departmental area in contemporary hospitals: Calculation methodologies & design factors in major patient care departments. Clemson University & Center for Health Systems & Design Texas A&M University."},{"key":"e_1_3_3_4_1","unstructured":"Australasian Health Infrastructure Alliance (AHIA). (2018). Australasian health facility guidelines. Part C\u2014Design for access mobility safety and security. AHIA."},{"key":"e_1_3_3_5_1","volume-title":"Measuring up: Benchmarking in health care architecture","author":"Badlato K.","year":"2016","unstructured":"Badlato K. (2016). Measuring up: Benchmarking in health care architecture. HKS, Inc."},{"key":"e_1_3_3_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2022.5831"},{"key":"e_1_3_3_7_1","unstructured":"Baukosteninformationszentrum (BKI) [German Construction Cost Information Centre]. (2021). Statistische Kostenkennwerte. Neubau 2021 [Statistical cost indicators. New construction 2021]. Baukosteninformationszentrum (BKI) [German Construction Cost Information Centre]."},{"key":"e_1_3_3_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.autcon.2018.09.015"},{"key":"e_1_3_3_9_1","volume-title":"A Z317.11, Area measurement for health care facilities","author":"CSA Group","year":"2017","unstructured":"CSA Group. (2017, reaffirmed in 2022). A Z317.11, Area measurement for health care facilities (3rd ed.).","edition":"3"},{"key":"e_1_3_3_10_1","unstructured":"Deckert L. Gregory W. L. Wilkening T. Rees S. Smith D. Zhang Y. (2013). Benchmarking 2.0. Health care facility management report. A critical sampling of North American health care facilities."},{"key":"e_1_3_3_11_1","volume-title":"DGNB system kriterienkatalog geb\u00e4ude neubau version 2018","author":"Deutsche Gesellschaft f\u00fcr Nachhaltiges Bauen","year":"2018","unstructured":"Deutsche Gesellschaft f\u00fcr Nachhaltiges Bauen. (2018). DGNB system kriterienkatalog geb\u00e4ude neubau version 2018 (9th ed.) [DGNB system criteria catalogue\u2014New construction buildings version 2018] (9th ed.). Deutsche Gesellschaft f\u00fcr Nachhaltiges Bauen (DGNB) e.V. [German Sustainable Building Council].","edition":"9"},{"key":"e_1_3_3_12_1","unstructured":"Deutsches Institut f\u00fcr Normung. (2016). DIN 13080:2016-06: Division of hospitals into functional areas and functional sections. Beuth Verlag GmbH."},{"key":"e_1_3_3_13_1","volume-title":"DIN 277:2021-08: Areas and volumes in building construction","author":"Deutsches Institut f\u00fcr Normung.","year":"2021","unstructured":"Deutsches Institut f\u00fcr Normung. (2021). DIN 277:2021-08: Areas and volumes in building construction. Beuth Verlag GmbH. https:\/\/doi.org\/10.31030\/3278234"},{"key":"e_1_3_3_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/CNQ.0b013e31822b8fb0"},{"key":"e_1_3_3_15_1","volume-title":"8 Considerations for benchmarking","author":"Fricke K.","year":"2017","unstructured":"Fricke K. (2017). 8 Considerations for benchmarking. Healthcare Design."},{"key":"e_1_3_3_16_1","doi-asserted-by":"publisher","DOI":"10.3390\/en11092279"},{"key":"e_1_3_3_17_1","unstructured":"Hamilton D. K. Lavy S. Kircher A. Jiang Y. (2012). Preliminary benchmarking results: Departmental gross and building gross data 2012 PDC Summit Phoenix Arizona."},{"key":"e_1_3_3_18_1","unstructured":"Hamilton D. K. Lavy S. Kircher A. Jiang Y. Dixit M. K. (2017). Area calculation method for health care (D. K. Hamilton & S. Lavy Eds.). American Society for Healthcare Engineering."},{"key":"e_1_3_3_19_1","doi-asserted-by":"publisher","DOI":"10.3390\/atmos12010115"},{"key":"e_1_3_3_20_1","doi-asserted-by":"publisher","DOI":"10.1177\/193758670900300102"},{"key":"e_1_3_3_21_1","first-page":"191","volume-title":"Baumanagement und bau\u00f6konomie: Aktuelle entwicklungen [Construction management and construction economics: Current developments]","author":"Kalusche W.","year":"2007","unstructured":"Kalusche W. (2007). Bemessung von geb\u00e4uden \u2013 einfach aber richtig! [Design of buildings\u2014Simple but correct!]. In Liebchen J. H., Viering M. G., Zanner C. (Eds.), Baumanagement und bau\u00f6konomie: Aktuelle entwicklungen [Construction management and construction economics: Current developments] (pp. 191\u2013206). Vieweg + Teubner Verlag. https:\/\/books.google.de\/books?id=j6b6ddlvIYsC"},{"key":"e_1_3_3_22_1","doi-asserted-by":"publisher","DOI":"10.1177\/19375867211043848"},{"key":"e_1_3_3_23_1","first-page":"121","volume-title":"Krankenhausbau \u2013 Architektur und Planung, bauliche Umsetzung, Projekt- und Betriebsorganisation [Hospital construction\u2014Architecture and planning, structural implementation, project and operational organization]","author":"Labryga F.","year":"2018","unstructured":"Labryga F. (2018). Die neue DIN 13080 \u2013 eine planungsgrundlage f\u00fcr krankenh\u00e4user [The new DIN 13080\u2014A planning basis for hospitals]. In Stockhorst H., Hofrichter L., Franke A. (Eds.), Krankenhausbau \u2013 Architektur und Planung, bauliche Umsetzung, Projekt- und Betriebsorganisation [Hospital construction\u2014Architecture and planning, structural implementation, project and operational organization] (pp. 121\u2013128). 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AREA j\u00e4mf\u00f6relse mellan NKS och fem Nordiska sjukhus [Area comparison between NKS and five Nordic hospitals]."}],"container-title":["HERD: Health Environments Research &amp; Design Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/19375867261481147","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/19375867261481147","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/19375867261481147","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T11:46:16Z","timestamp":1791200776000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/19375867261481147"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,30]]},"references-count":39,"alternative-id":["10.1177\/19375867261481147"],"URL":"https:\/\/doi.org\/10.1177\/19375867261481147","relation":{},"ISSN":["1937-5867","2167-5112"],"issn-type":[{"value":"1937-5867","type":"print"},{"value":"2167-5112","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,30]]},"article-number":"19375867261481147"}}