Designing for Patient Safety

January 25, 2012
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Findings from a national seminar
Designing for Patient Safety
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Since the release of the 1999 Institute of Medicine report (Kohn, Corrigan, & Donaldson, 1999), “To Err is Human,” patient safety improvements have remained elusive, in spite of a host of interventions (Watcher, 2010). Recent studies have demonstrated no significant improvement for a number of healthcare-associated conditions, including the failure to reduce postoperative-, blood stream-, and catheter-associated urinary tract infections (AHRQ, 2010).

Landrigan and colleagues’ (2010) study of 10 North Carolina Hospitals over 10 years found 25.1 harms per 100 admissions; and Levinson’s (2010) Department of Health and Human Services’ Office of the Inspector General’s report found that 13.5% of hospitalized Medicare patients experienced adverse events and another 13.5% experienced temporary harm.

All of this harm significantly impacts the nation’s healthcare bill, with 1.5 million errors estimated to contribute an additional $19.5 billion dollars annually, as found in a medical claims study by The Society of Actuaries (2010). Perhaps these results reflect an incomplete understanding of the puzzle that quality healthcare represents. A growing body of research suggests that an understanding of the multiple components of the healthcare system (of which the built environment is one component) is crucial for improving patient safety.

A national seminar funded by the Agency for Healthcare Research and Quality (AHRQ) and the Facilities Guidelines Institute (FGI) brought together multidisciplinary experts to address the role of the built environment in improving patient safety in healthcare facilities. The primary focus of this meeting was on identifying the tools and processes that would support decision-making related to patient safety during the healthcare facility design process.

The two-day meeting conducted in October 2011, served as a catalyst for developing consensus around key issues to consider for the development of the Patient Safety Risk Assessment in the 2014 Guidelines for Design and Construction of Health Care Facilities from the Facility Guidelines Institute. The new Virtua Voorhees facility that opened in May 2011, was designed using a process-driven approach from the start and served as a case study and tour site during the seminar.


Why is it important to design for patient safety?

It has become increasingly clear that the problem of patient safety does not lie solely in the hands of clinicians or frontline healthcare staff. The healthcare system has many inherent latent conditions (holes and weaknesses) that interact in complex ways and result in adverse events (Reason, 2000). A growing body of research shows that features in the built environment—such as light, noise, air quality, room layout, and others—contribute to adverse patient safety outcomes, like healthcare-associated infections, medication errors, and falls in healthcare settings (Joseph & Rashid, 2007; Ulrich et al., 2008).

The conceptual model (Figure), based on Vincent (1998) and Reason’s (2000) work, shows the role of the physical environment as a latent condition that contributes to patient safety. Often, these latent conditions that adversely impact patient safety are built into the physical environment during the planning, design, and construction of healthcare facilities. For example, the location of emergency departments and intensive care units might necessitate the transport of critically ill patients over long distances, potentially causing patient complications. Handwashing sinks located in inconvenient or inaccessible locations might result in poor handwashing compliance among physicians and nurses. 

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Healthcare Risk Managers are key members of the design team

This work is a giant leap forward in the national goal to reduce preventable harm to patients. As a master's prepared nurse and certified professional healthcare risk manager for the past 16 years in a hospital setting, I have wondered why risk managers aren't more involved in the design phase of a hospital or healthcare facility. Risk managers investigate all aspects of medical errors and recognize that staff work-arounds frequently contribute to those errors. A thoughtful design will facilitate safety (pun intended!), not enable it. Kudos to the facility planners who are involved in this work. I know I can confidently say, seek out your risk manager at the beginning of any projects where patients will be provided care and they will be more than willing to work with you.
Ellen Venditti, MS, RN, CPHRM, FASHRM

Patient safety risk assessment

Looking forward to seeing these resouces, tools etc. for patient & caregiver safety risk assessments. I agree early stage prioritisation and then continuous review throughout the design process are v. important.