Abstract
In the process of hospital planning and design, the ability to mitigate risk is imperative and practical as design decisions made early can lead to unintended downstream effects that may lead to patient harm. Simulation has been applied as a strategy to identify system gaps and safety threats with the goal to mitigate risk and improve patient outcomes. Early in the pre-construction phase of design development for a new free-standing children’s hospital, Simulation-based Hospital Design Testing (SbHDT) was conducted in a full-scale mock-up. This allowed healthcare teams and architects to actively witness care providing an avenue to study the interaction of humans with their environment, enabling effectively identification of latent conditions that may lay dormant in proposed design features. In order to successfully identify latent conditions in the physical environment and understand the impact of those latent conditions, a specific debriefing framework focused on the built environment was developed and implemented. This article provides a rationale for an approach to debriefing that specifically focuses on the built environment and describes SAFEE, a debriefing guide for simulationists looking to conduct SbHDT.
Highlights
Healthcare is a complex adaptive system, and the interplay of its components contributes to medical errors, adverse events, employee, and organizational outcomes [1, 2]
The Institute of Medicine (IOM) and the Agency for Healthcare Research and Quality (AHRQ) promote the application of systems engineering and human factors to understand how the complex interactions between people and their environment contribute to patient safety and quality [1, 3]
Simulation-based Hospital Design Testing (SbHDT) refers to simulations conducted in the pre-construction phase of design development where the environment can be significantly altered to improve safety and optimize efficiency [13]
Summary
Healthcare is a complex adaptive system, and the interplay of its components contributes to medical errors, adverse events, employee, and organizational outcomes [1, 2]. The Institute of Medicine (IOM) and the Agency for Healthcare Research and Quality (AHRQ) promote the application of systems engineering and human factors to understand how the complex interactions between people and their environment contribute to patient safety and quality [1, 3]. In the early phase of hospital design planning, the ability to mitigate risk is imperative as design decisions can lead to unintended downstream effects that may lead to Simulation-based Hospital Design Testing (SbHDT) refers to simulations conducted in the pre-construction phase of design development where the environment can be significantly altered to improve safety and optimize efficiency [13]. Models and frameworks used to evaluate systems provide the rationale for conducting SbHDT. Reason’s Swiss cheese model for systems integration illustrates the relationship between healthcare design and system errors [16]. Weaknesses in design are inevitably introduced, and when safeguards are penetrated by an error-provoking deficiency, harm occurs (Fig. 1) [16, 17]
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