Facility Design Focused on Patient Safety

Abstract

LEONARD BERRY, Derek Parker, the late Russ Coile, Jr., D. Kirk Hamilton, David O'Neill, and Blair Sadler should be strongly complimented for their effort to raise awareness of the impact facilities have on behavior and systems. In addition, the efforts to use evidence-based design (i.e., using data with imagination) are well received. The thesis of their lead article stresses as defined by the authors as well as Jain Malkin (2001), Roger Ulrich (1984), and others. Ulrich is a pioneer in the field of healing environments and has influenced many organizations with his research and his insights. Jain Malkin (2001) defined healing environments as having a connection to nature, providing options and choices (e.g., patients involved with care), accommodating social support (family and/or significant others involved with care), eliminating environmental Stressors (e.g., noise, poor air quality), and having pleasant diversions (e.g., window views, art, water features, music). Berry and colleagues, in addition to the factors just mentioned, also touch on safety and ecological health as important elements in evidence-based design. The economic argument (the business case) is that the increased capital investment to create a healing environment is returned through operational savings, lower infection rates, fewer falls, less turnover, increased market share, and more donations. I present two key observations in response to their underlying thesis and business case: First, the focus on healing environments as the primary effort is not aligned with the most significant issue in healthcare-patient safety. Second, the additional capital allocations (as available or needed) are not focused on patient safety, and the returns identified in the article on that capital are not convincing, especially the market share and donation components. As a chief executive officer of a health system comprising an 80-bed hospital; an approximately Go-physician clinic; and a foundation that functions in an environment of increased competition from other health systems and physician groups; rising labor rates and labor shortages; increased demand for expensive technology, equipment, and medications; and evidence of adverse events, preventable medical deaths, near misses, and errors affecting many patients we serve, I still have reservations whether the investments in additional capital as outlined in the lead article would create a return necessary to justify the investment (the business case). I do believe, though, that a business case exists for better buildings through facility design that features equipment and technology focused on patient safety. PATIENT SAFETY FIRST First and foremost, we should be providing safe care to patients. Harm and death that are preventable should be eliminated. The near misses, errors, and mistakes that create the potential for preventable harm and death should be minimized and managed. The 1999 Institute of Medicine (IOM) report To Err Is Human identifies the service level of adverse events and preventable medical deaths occurring in hospitals throughout the U.S. health system. According to studies identified in the report, 1 in 343 to 1 in 764 persons admitted to hospitals die from preventable medical events, and 1 in 27 to 1 in 34 are harmed by an adverse event. These errors are errors of planning (i.e., diagnosis and treatment plan errors) and errors of execution (i.e., errors in delivery of services to patients). The cost of these preventable adverse events and preventable medical deaths is estimated at $17 to $29 billion annually, of which half is related to healthcare costs. The IOM report does not document the number of near misses, which are errors that do not result in adverse events (harm) or preventable medical deaths. Many speculate that these are higher than those categories that are documented. The resulting cost from the rework or redo of these events is material. …