Safety by Design Initiatives at AHRQ

1. Safety by DesignInitiatives at AHRQ Kerm Henriksen Sandi Isaacson Catherine Hinz

2. Three Objectives • Describe AHRQ’s 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 Children’s Hospital South London

3. Crossing the Quality Chasm:Designing 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

4. Informal cross-center workgroup Georgia Tech Small Conference Grant HIT grant to St. Joseph’s 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 AHRQ’s Involvement in Safety by Design

5. 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

6. 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

7. 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.

8. 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

9. Evidence Based Design (EBD) • Build Single Patient Rooms • Reduce Noise • Incorporate Nature • Improve Air Quality • Encourage Hand Hygiene • Improve Way-finding • Reduce Walking Distance

10. 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

11. 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 Design Principles at St. Joseph’s Community Hospital in West Bend, WI

12. 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

13. 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 Physical Environment

14. 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

15. 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

16. 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

17. Wayfinding“aah . . .which way do I go . . . . . I’ll 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?

18. 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 Expected Benefits Using EBD

19. 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. A New Way of Thinking forHealth Services Researchers

20. 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