Safety: Priority No. 1

Abstract

Safety must be Priority No. 1 for everyone concerned with healthcare, including those who care for patients, those who manage and lead others in healthcare organizations, those who pay the bills, the visionaries who strategize for the future, and the designers who create the environments where the work of healing occurs. There are many variables that contribute to breaches of safety in hospitals and other healthcare settings; these include individual, system, and organizational factors. But one major factor is the physical environment.Sadly, hospitals have the potential to be unsafe environments for patients, providers, and families. An unsafe physical environment can escalate the possibility of human error in patient care and create a hazardous working environment for staff. Lack of proper lighting, too much noise, distractions in areas that demand critical thinking, overcrowded rooms, too few rooms to manage patient volume, lack of storage space for equipment, door openings that are too small, lack of visibility of patients, impure air, inappropriate flooring materials, and hand-washing sinks or gel dispensers that are inappropriately placed or absent are all environmental factors that can impede the safe delivery of care (Baehr, Fogg, & Eastman, 1999; Joseph, 2006; Morrison Haas, Shaffner, Garrett, & Fackler, 2003; Topf & Dillon, 1988; Ulrich, 2004). Nurses are exposed to many occupational hazards while caring for patients; they are exposed to infectious pathogens transmitted through the air or by direct contact during patient care. Patients are also at risk of nosocomial infections transmitted through dirty air ducts, faulty ventilation systems, and by staff who simply do not wash their hands between patients. Pushing heavy equipment and mobilizing, turning, or positioning the patient in bed are activities that are influenced by the environment and that increase the potential for serious employee injuries. Patients are at risk of falling as they get out of bed unattended, walk to the bathroom in a dark room at night, or trip over the myriad of IV poles, monitors, and furniture in rooms that are too small. The potential for injury, errors, and permanent disability or death is greatly influenced by the physical environment of care.The challenge to design safer hospital and healthcare environments must be Priority No. 1, and this is the mandate set forth by The Joint Commission International Center for Patient Safety (JCICPS, 2007) with the publication of the National Patient Safety Goals to promote specific improvements in problematic areas and to foster expert-based solutions to system problems that adversely affect patient safety. Safety as Priority No. 1 is also the concern of the Agency for Healthcare Research and Quality.Every aspect of healthcare?is being examined by policymakers, payers, patients, consumers, and providers themselves. Even though strides have been made, the quality of care furnished remains questionable, the error rate is much too high, and costs do not reflect the value of services?.Even though we know that the physical environment influences the design of these processes and workplace culture, we have paid less attention to studying it. (Clancy, Isaacson, & Henriksen, 2007, p. 13)To achieve success in improving the safety of the healthcare environment, an evidence-based design process should be employed (Stichler, 2007). Every design meeting convened to discuss possible design alternatives, explore concepts, or decide on design solutions for healthcare projects must clearly identify the impact of each and every design element on safety-that of patients, family, and staff. To achieve the mandate of ensuring safer healing and work environments, all other considerations on the priority list must take a back seat to safety as Priority No. 1.First, Do No HarmThe root word for hospital is hospes (host), which is also the root word for hospitality, hotel, and hostel. …