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Chapter 28 . The Impact of Facility Design on Patient Safety

In the next few years, hospital leaders will be involved in new hospital construction projects to meet the changing marketplace demands associated with the growing demand of an aging population. Many clinicians, architects, and hospital administrators believe that the hospital built environment can benefit the satisfaction of health care providers as well as patient satisfaction and outcomes. There is some evidence that the built environment may influence patient and family perceptions of the quality of and satisfaction with care received during a hospitalization. There is also some evidence that nurse satisfaction with the built environment was related to general well-being and job satisfaction, two factors that are critical because of their impact on patient care.The evidence-base is emerging to support the business case that designing for safety and quality can improve patient outcomes and safety, promote healing, increase patient satisfaction, and reduce costs. It is thought that the cost of building or remodeling projects based on design evidence conducive to patient safety can result in organizational savings over time, without adversely impacting revenues. Investigators with the Center for Health Design have been assessing hospitals involved in the Pebbles Project, and have found that the financial incentive for investing in evidence-based design using therapeutic design elements such as single-bed rooms and decentralized nursing stations added close to $12 million in costs to hospital reconstruction—but those costs would be recouped within one year of being operational.Those building new or remodeling current facilities should consider beginning with transitioning to a culture of safety, then using a safe design as a matter of focusing on maximizing the safety features without expending additional capital resources. While relatively new, evidence is growing in objective assessments of the impact of built environments, particularly around the issue of infection control. Some safety features will cost more than traditionally designed facilities (e.g., HEPA filters and ultraviolet lighting to improve air quality) while other safety features will cost less than a traditionally designed facility, most notably standardization. In all, most of the safety features of a built environment involve a reordering of functions in most “traditionally” designed facilities, minimally affecting capital costs, to improve the quality of care and patient outcomes.