Safety by Design Initiatives at AHRQ

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Safety by DesignInitiatives at AHRQ

• Kerm Henriksen
• Sandi Isaacson
• Catherine Hinz

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Three Objectives

• Describe AHRQs involvement in safety by design
• Provide some examples of safety by design in the
  hospital environment
• Show DVD on how design of the hospital
  environment can have a a transforming effect

• Evelina Childrens Hospital South London

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Crossing the Quality ChasmDesigning in Safety
and Quality

• Current 250 billion building boom in US in new
  hospital construction
• Design has a direct impact on patients, families
  providers
• Emerging evidence base from past two decades
  affirms that safety quality can be designed
  into construction of new facilities.
• Ulrich et al. 2004

• First we shape our buildings, and then
• our buildings shape us. - Winston Churchill

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AHRQs Involvement in Safety by Design

• Informal cross-center workgroup
• Georgia Tech Small Conference Grant
• HIT grant to St. Josephs Community Hospital
• Mistake-Proofing with Dr. John Grout
• QSHC Safety by Design Supplement

• Blueprint for Change Podcast with Dr. Clancy
• AHRQ Presentation Role of Physical Environment
• Transforming Hospitals by Design DVD
• Articles in press

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Quality Safety in Health Care Safety by
Design
Rather than continuing to try to measure the
width and depth of the quality chasm . . . . .
how does one actually begin to close the quality
chasm? One way to think about the problem is as
a design challenge rather than as a quality
improvement challenge. It is time to move from
reactive measurement to a more proactive use of
proven design methods, and to involve a number of
professions outside health care so that we can
design out system failure and design in quality
of care. Battles, Dec. 2006
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Quality Safety in Health Care Safety by
Design

• Supplement includes articles on design of
• High reliability organizations (HROs)
• Clinical microsystems
• Training initiatives
• Clinical work processes
• Healthcare worker performance
• System latent conditions
• Healthcare software usability

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No Environment is Neutral

• The design of facilities,
• work processes, technology,
• and organizations impact one
• another as well as providers
• patients, and their families.
• Either positively or negatively,
• the design will exert its
• impact.

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Evidence-Based Design (EBD)

• In parallel with evidence-based medicine, EBD
  uses the best available information from credible
  research
• Utilizes findings expertise from architecture,
  health design, clinical work processes, HIT,
  human factors ergonomics, industrial system
  engineering, environmental psychology
  organizational theory
• Employs function task analyses, failure mode
  effects analyses, learning labs for design teams,
  mock-ups, modeling, simulations, iterative
  testing evaluation, usability testing, and
  operational try-outs in addition to experimental
  designs

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Evidence Based Design (EBD)

• Build Single Patient Rooms
• Reduce Noise
• Incorporate Nature
• Improve Air Quality
• Encourage Hand Hygiene
• Improve Way-finding
• Reduce Walking Distance

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Small Conference Grant to Georgia Tech
Healthcare Environments Research Summit
2006 http//hcdesign.coa.gatech.edu 
Summit focused on 1. High priority research
directions 2. Research to application
pipelines 3. Call to action near mid-term
goals
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Design Principles at St. Josephs Community
Hospital in West Bend, WI

• Patient to Staff Visibility
• Standardization
• New Technology
• Noise Reduction
• Quick Access to Information

• Involve Patients with Care
• Scalability Adaptability
• Minimize Fatigue
• Design for Precarious Events
• Minimize Patient Transfers/Handoffs

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Evidence Based Design DVD
Transforming Hospitals Three Case Studies DVD
examines three hospitals that have incorporated
evidence-based design in renovations or initial
construction Release Date October 2007
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Physical Environment

• Facility design layout
• Lighting
• Noise
• Temperature humidity
• Vibration
• Air flow
• Contamination pollutants

• Workplace hazards
• Safety features
• Security features
• Signage way-finding
• Workstation ergonomics
• Special user group requirements equipment

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Acuity Adaptable RoomsBringing different levels
of acute care to the patient

• Operationalizes concept of patient-centeredness
• ICU capable headwall
• Sink for hand hygiene
• Adjacent nurse work station
• LCD Window Observation
• Flat Screen Monitoring
• Family Accommodation
• Patient Education

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Use of Natural Full Spectrum Lighting

• Helps reduce depression
• Restores disrupted circadian rhythms
• Less perceived stress, pain, use of analgesic
  medication
• Shorter length of stay
• Ulrich, Quan, Zimring, Joseph Choundhary,
  2004

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Reduce Noise Levels

• Install sound-absorbing ceiling tiles/wall panels
• Treat hallways to reduce equipment sounds
• Decentralize nursing stations
• Eliminate overhead paging systems
• Evaluate alarm appropriateness
• Mask noxious sounds with pleasant sounds
• Establish quiet zones interrupt-free zones
• Build single-patient rooms

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Wayfindingaah . . .which way do I go . . . . .
Ill just sit here.

• Are entrances and exits obvious?
• Are directional signs used appropriately at
  intersections?
• Is the visual environment free of clutter?
• Do icons clearly convey intended meaning?
• Do you are here maps also show where users want
  to go?
• Are floor and room number schemes easy to
  understand?
• Is terminology used on signage plain and simple?

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Expected Benefits Using EBD

• Safer environment for patients providers
• Improved work processes flow
• Greater standardization for efficiency
• Electronic access to medical records
• Improved hand hygiene
• Single bed rooms to reduce HAI
• Better air filtration systems
• Mistake proofing for devices
• Improved patient lifts handling

• Kinder working conditions
• Improved transitions of care
• Prevention of falls
• Shorter wait times
• Adjustable lighting
• Noise reduction
• Improved signage way-finding
• Shorter healing recovery time
• Better family/ visitor accommodation

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A New Way of Thinking forHealth Services
Researchers

• Focuses on quality safety before hospital is
  built rather than later as an after-thought
  eliminates adoption problem
• Achieves maximum leverage by informing capitol
  budget decision- making rather than limited
  operating budgets

• Reaps daily savings in terms of safety,
  effectiveness efficiency that accrue for
  decades decades
• Hospital building boom is on national radar
  screen now is the time to be involved.

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Evidence Based Design Sources

• The Role of the Physical Environment in the
  Hospital of the 21st Century A
  Once-in-a-Lifetime Opportunity (Center for
  Health Design)
• Improving Healthcare with Better Building Design
  (Center for Health Design)
• Planning, Design, and Construction of Health Care
  Facilities (Joint Commission Resources)
• Guidelines for Design and Construction of
  Hospital and Healthcare Facilities (The American
  Institute for Architects)
• Enhancing the Traditional Hospital Design
  Process A Focus on Patient Safety (Joint
  Commission Journal on Quality and Safety)
• Play video

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