Physical Environment Design for Improving Patient Safety

Abstract

The need to improve patient safety is well recognized (Leape et al., 2009; Pronovost, Berenholtz, & Morlock, 2011; Wachter, 2010). How to accomplish this and where to focus efforts, however, is less clear. In any health-related work system, there are five components that affect care: people (care providers, patients), tasks, technologies/ tools, organization, and the physical environment (Carayon et al., 2006). Although each of these components has a significant impact on work processes and outcomes, few-if any-patient safety improvement initiatives or research efforts have focused on the physical design of environments. Yet everything we do in healthcare is, to some extent, defined and affected by the physical environmentThe physical environment can influence patient safety directly or indirectly. For example, when an environment is designed to reduce the transmission of airborne and contact infectious agents, hospitalacquired infections plummet (Ulrich et al., 2008). In addition, illumination levels have been linked to pharmacists' medication dispensing error rates (Buchanan, Barker, Gibson, Jiang, & Pearson, 1991). The physical environment can indirectly affect patient safety by influencing other components of a care system. For example, the physical design of a setting could hinder communication and teamwork among care providers (Becker, 2007; Smith, Schoenbeck, & Clayton, 2009), two factors critical to providing safe care (Neily et al., 2010; Sutcliffe, Lewton, & Rosenthal, 2004). Nonetheless, the norm is to haphazardly redesign healthcare spaces rather than systematically and comprehensively consider the implications of these design decisions on patient safety and quality of care. In the remainder of this editorial, we discuss multiple reasons for such limited forethought and propose solutions.Limited EvidenceThere is little evidence describing how to design safer patient care environments. A major reason for this paucity of evidence is lack of funding to support research in this area. Some funding opportunities focus on other factors that have an impact on safety, such as organization/teamwork, tasks, tools, and provider performance. Very few of these, if any at all, focus on designing a safer physical environment. More research is needed to discover how to (re)design physical environments to enhance processes (e.g., to foster easier compliance with guidelines and safer intra-hospital patient transport) and reduce the incidence of preventable adverse events (e.g., the design of patient rooms to reduce the number of falls).Insufficiently Rigorous Methods and ToolsAmong the handful of studies published on environmental design, very few have used rigorous and scientifically sound methodologies. Furthermore, healthcare organizations desperately need practical yet rigorous methods to plan, implement, and evaluate new or redesigned physical space projects. Organizations should conduct usability studies that test physical design alternatives to see what works best before investing millions of dollars in a design project. Some practical tools and methods that organizations can use to test and choose appropriate designs include observations in the real world, link analysis, task analysis, simulations, and iterative mock-ups.A Non-Interdisciplinary ApproachThe majority of physical design studies are done within one discipline (such as architecture). Although important, this reflects only one viewpoint. Patient safety research is interdisciplinary in nature. Other professionals such as human factors engineers, psychologists, anthropologists, health services researchers, operations researchers, organizational managers, clinicians, and architects have valuable input when designing physical environments for safer care.Learning From Mistakes and SuccessesPhysical (re)design efforts are typically expensive and hard to modify or fix in the short term. Thus, it is imperative that healthcare organizations collaborate and learn from each others' collective successes and failures during physical environment design efforts. …