Could Designing a Hospital Like a Medical Device Contribute to Patient Safety?

Abstract

Can the healthcare design process be treated similarly to medical equipment design? If so, could such an approach contribute to patient safety? Radical as the proposition may seem, I argue that the approach may make further contributions to a cause that seems to persist, despite growing awareness and intervention efforts. While patient safety has been a continuous challenge, it caught national attention with the publication of the Institute of Medicine's (IOM) report in 1999 ([Institute of Medicine, 1999]). A wide range of professionals have since focused their attention on improving patient safety. However, subsequent updates have demonstrated few improvements in patient safety outcomes in American hospitals and have instead suggested the problem may in fact have exacerbated ([Allen, 2013]). Interventions over the past decades have been seen in multiple domains - clinical processes, operations, and procedures, work culture, medical devices and equipment, and staff and patient education, to name a few. However, patient safety continues to be a concern in American and world healthcare....patient safety continues to be a concern in American and world healthcare.The patient safety challenge may actually further intensify in the coming years. When the Affordable Care Act (ACA; [Patient Protection and Affordable Care Act, 2010]) was promulgated, in personal discussions with thought leaders in the healthcare industry, they predicted a sharp decrease in inpatient census. There were even some discussions, which still continue, airing the possibility that acute care hospitals may shrink considerably in size, as most of the care delivery is expected to be diverted to ambulatory facilities. However, it seems inpatient facilities have continued to experience the same or higher levels of patient census, with one difference. Patients in inpatient facilities today typically have higher acuity levels as compared to those in the past, suggesting that patient safety may become an even greater concern and challenge in the coming years.In this context, can the hospital physical design be expected to contribute in any manner to the goal of improving patient safety, or should we even entertain such expectations? A few decades back we would not be raising the possibility that the design of a facility could affect patient safety. Historically, architecture, and all design professions contributing to the completed built environment and immediate outdoor environment, was rarely expected to play a role in improving patient safety. For centuries architecture was viewed as an artifact of collective cultural production, where the focus was, and rightly continues to be, on emotions evoked by the built form, on non-verbal communication engrained in its semiotics, and on symbolic portrayal of higher-order actors' ideologies (state, religious institutions). It was only in the twentieth century that instrumental factors such as visual acuity, thermal comfort, and so forth, were expected from architecture and building engineering ([Pati, 2011]).Since then, the expectations from the built environment have continued to expand. For instance, workplace studies have examined associations between the physical design and worker outcomes such as productivity and performance (see for instance [Becker & Kelley, 2005]; [Peponis et al., 2007]; [Rashid, Wineman, & Zimring, 2009]). Several seminal works were produced by Francis Duffy during the concluding decades of the twentieth century ([Duffy, 1993]).Perhaps, subsequent research and design inquiries in the healthcare design sector meaningfully and significantly expanded the role of and expectations from the built environment in targeting organizational objectives and performance. Incidentally, these changing expectations are also gradually changing the architect's role from one of a vendor to a partner in jointly addressing and solving organizational issues. For a detailed discussion on this topic, the reader is referred to my article in Design Intelligence ([Pati, 2011]). …