The Center for Health Design hosted a webinar this year with Christine Basiliere, chief nursing officer and vice president of patient care services at Sharp Healthcare (San Diego) and Matt Richter, vice president, healthcare planner, at SmithGroupJJR (San Francisco) on the new Sharp Chula Vista Medical Center project in Chula Vista, Calif. The new hospital, which is scheduled to open in 2019, will include 138 private patient rooms (including 10 intensive care suites), five high-tech surgical suites, a versatile hybrid operating room, redesigned main entrance and lobby, and additional space for a pharmacy and kitchen.

Sharp is focused on creating a highly reliable hospital, based on the concept of a highly reliable organization (HRO), which focuses on avoiding catastrophes in an environment where normal accidents can be expected due to risk factors and complexity. For Sharp, this means focusing design efforts on decreasing the probability of an accident to make its systems and processes ultra-safe. Basiliere says Sharp aims to create a zero-harm environment for patients through its HRO.

While the HRO concept has existed for several decades in other sectors, such as the airline and power industries, it’s only recently entered the healthcare arena. In 2008, the Agency for Healthcare Research and Quality (AHRQ) published the paper, “Becoming a High Reliability Organization: Operational Advice for Hospital Leaders,” which defined five concepts at the core of an HRO to ensure the safest environment for patients and higher quality care. These concepts encompassed a sensitivity to operations, including an awareness by leaders on the state of processes that affect patient care; reluctance to simplify explanations of failure; preoccupation with failure (instead view near misses as areas that need more attention); deference to expertise, including listening to staff members who know each process well; and resilience, or knowing how to respond when failures occur.

To identify design features that could be included to advance Sharp's HRO objective, the design team was asked to think beyond the standards for safety and quality to create features and processes that hardwire a zero-harm culture and considered every aspect of care delivery, including patient and staff safety, quality of clinical operations, patient engagement, staff and physician satisfaction, and financial health.

Through this process, the design team developed 55 design features to support its highly reliable hospital, such as private space for focused work and intuitive wayfinding for patients and visitors. Multiple user groups viewed these features through virtual and physical mock-ups, and as a result, more than 100 process improvements were made to support Sharp’s HRO vision, including:

  • Separation of clean and soiled materials, both in corridors and on loading docks, to prevent clean and soiled materials from mixing, which could pose an infection risk to patients
  • Segregated vertical transport for patients, materials, and food to separate patients from potentially harmful materials
  • Dedicated spaces that support collaboration and communication, including daily team huddles and interdisciplinary collaboration
  • Clear sightlines that provide staff with visibility in the patient rooms to prevent falls and other incidents
  • Air handlers with UV disinfectant to prohibit microbial growth
  • Plumbing fixtures outfitted with antimicrobial finishes
  • ICUs located adjacent to surgery to provide the best patient care.

By including these design features, Sharp aims to drive down its serious safety event rate and progress toward its zero-harm goal. We can look forward to learning about the effectiveness of these efforts after the medical center opens in two years.

Carolyn Glaser, MA, EDAC, is vice president for strategy and operations at The Center for Health Design. She can be reached at