Designing a Tool to Support Patient Safety: Using Research to Inform a Proactive Approach to Healthcare Facility Design

Healthcare architecture has become an increasingly specialized field, marked by a complex interaction between people, operations and the physical environment and an ever changing landscape of regulation and reimbursement. Patient safety is often considered in a behavioral context – what can someone do differently to improve outcomes? However, as a complex system of interactions, patient safety is better advanced through a systems-thinking lens of Human Factors/Ergonomics (HFE). Attaianese and Duca commented on the use of HFE principles in design, stating that, “when the system is the built environment, the systemic approach requires that designers move from an attention exclusively reserved for building functions towards the set of actions that users actually perform and that building has to support.” This paper reports the development of a proactive Safety Risk Assessment (SRA) tool which will contribute to the 2014 Facility Guidelines Institute (FGI) Guidelines for the Design and Construction of Hospitals and Outpatient Facilities. Six hazard areas have been considered as underlying conditions to injury or harm in the design of healthcare environments: 1) Hospital Associated Infections, 2) Falls/Immobility, 3) Medication Safety, 4) Patient Handling, 5) Security, and 6) Behavioral Health/Psychiatric Injury. These categories have been developed using iterative cycles of Delphi and nominal group methods to achieve consensus of categories and question sets for inclusion in the SRA.