Designing for Patient Safety: Developing Methods to Integrate Patient Safety Concerns in the Design Process Funding for this seminar was made possible (in part) by grant 1R13HS020322-01A1 from the Agency for Healthcare Research and Quality (AHRQ). The views expressed in this report do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement Principal Investigator Project Dates by the U.S. government. We Anjali Joseph, PhD, EDAC 7/01/2011 – 2/29/2012 would also like to acknowledge the Facilities Guidelines Institute Team Members Project Officer for its financial and intellectual Xiaobo Quan, PhD, EDAC William Freeman support for this project. Ellen Taylor, AIA, MBA, EDAC Matthew Jelen, EDAC Grant Award Number 1R13HS020322-01A1 Organization The Center for Health Design 1 DesigningDesigning for for Patient Patient Safety: Safety: Developing Developing MethodsMethods to IntegrateIntegrate Patient Patient Safety Safety Concerns Concerns in in the the Design Design ProcessProcess Abstract Purpose The project aimed to develop consensus around important patient safety issues to be considered during various stages in the healthcare design process and to identify key activities, methodologies, and tools for improving facility design in terms of patient safety. Scope There is an urgent need for a strong methodology to identify and eliminate built environment latent conditions that impact patient safety during the planning, design, and construction of healthcare facilities. The project focused on developing the processes, tools, and approaches by which safe design features could be incorporated into building designs. Methods Resources and background materials for the seminar were developed by (1) reviewing literature for design tools/approaches and a framework for tool evaluation, (2) compiling opinion papers by industry and academic experts, and (3) developing a safe design roadmap for healthcare administrators. About 70 individuals with diverse backgrounds attended the 2-day seminar, which involved presentations and discussions in different formats—presentations, panel discussions, tours, and workgroups. After the seminar, the notes were analyzed and synthesized, and a survey was conducted to gain attendees’ feedback. Results One of the key findings from the seminar was that it is critical to focus on patient safety issues during the predesign phase of a healthcare facility building project. This affects all key decisions made downstream in the project. Seminar attendees identified high-priority design activities for patient safety: articulation of project mission/vision, operational/future state planning, simulation, process-led design, measurable goals/metrics, ongoing check-ins, post-occupancy evaluation, and safety reviews. Highly rated design tools included simulation, process analysis, link AbstractAbstract V | i Designing for Patient Safety: Developing Methods to Integrate Patient Safety Concerns in the Design Process analysis, balanced scorecard, failure modes and effects analysis, and others. Most attendees viewed the seminar as highly valuable and effective. Keywords Healthcare design process, patient safety, safe design tool, design activity. AbstractAbstract V | ii DesigningDesigning for for Patient Patient Safety: Safety: Developing Developing MethodsMethods to IntegrateIntegrate Patient Patient Safety Safety Concerns Concerns in in the the Design Design ProcessProcess Executive Summary Purpose The project aimed to develop a strong foundation for integrating patient safety considerations into the facility design process by organizing a national seminar attended by multidisciplinary stakeholders. Specific goals included: to develop consensus around important patient safety issues or concerns to be considered during various stages in the healthcare facility design process, including issues that need to be considered in a patient safety risk assessment (PSRA) in the 2014 Facility Guidelines Institute (FGI) Guidelines for Design and Construction of Healthcare Facilities; and to identify key activities, methodologies, and tools for improving the facility design process in terms of patient safety. Scope The physical environment constitutes a key latent condition in healthcare settings that impacts patient safety. However, even though research evidence has clearly indicated the significant impacts of building design on patient safety outcomes, safety considerations are addressed inadequately and not integrated into the physical environment during the design process. There is an urgent need for a strong methodology to identify and eliminate built environment latent conditions that adversely impact patient safety during the planning, design, and construction of healthcare facilities. The project focused on organizing a national seminar to develop consensus around the processes, tools, and approaches by which safe design features could be incorporated into building designs. The project also focused on developing a framework for a PSRA tool and to make changes to the text in FGI Guidelines around PSRA. Methods The project was conducted in several steps: (1) development of resources and background materials for the seminar, (2) seminar planning and logistics, and (3) postseminar survey and data analysis. Resources and background materials for the seminar were developed by (1) reviewing literature to select seven design tools/ ExecutiveAbstract Summary V | iii Designing for Patient Safety: Developing Methods to Integrate Patient Safety Concerns in the Design Process approaches from relevant fields and a framework for tool evaluation, (2) compiling opinion papers by industry and academic experts, and (3) developing a safe design roadmap for healthcare administrators. About 70 individuals with diverse backgrounds attended the 2-day seminar on October 11–12, 2011. Invitations were delivered by emails and phone calls with follow-ups. The seminar venue was located in a state-of-the-art meeting facility at the newly opened Virtua Voorhees Hospital, the design of which involved a process-driven design approach to improve patient safety and healthcare efficiency. The seminar agenda was developed to best meet the project goals and enable participants to fully understand and engage with the topic discussions. It involved presentations and discussions in different formats— presentations, panel discussions, tours, and workgroups. After the seminar, the seminar notes were analyzed and synthesized, and a survey was conducted to gain attendees’ feedback. Results One of the key findings from the seminar was that it is critical to focus on patient safety issues during the predesign phase (strategic planning, master planning, operational planning, and programming) of a healthcare facility building project. This affects all key decisions made downstream in the project. It was also noted that the design process should not be linear but happening iteratively in small cycles. Seminar attendees identified high-priority design activities for patient safety: articulation of project mission/vision; operational/future state planning; simulation; process-led design; measurable goals/metrics in the predesign stages; and simulation/ mock-ups, ongoing check-ins, post-occupancy evaluation, and safety reviews in the design/construction stages. The design team needed to be formed as early as possible and include individuals with multiple backgrounds. Almost all of the seven design tools (link analysis, root cause analysis, failure mode and effects analysis, simulation, work sampling, balanced scorecard, and process analysis) were considered relevant and applicable to the healthcare design process. Design tools highly rated on feasibility included balanced scorecard and process analysis. The most generalizable tools included balanced scorecard, link analysis, and process analysis. The safe design roadmap for healthcare administrators was perceived as a comprehensive tool providing an overarching structure that facilitated ExecutiveAbstract Summary V | iv Designing for Patient Safety: Developing Methods to Integrate Patient Safety Concerns in the Design Process multidisciplinary communication and decision making. Workgroup participants suggested that: The format should be revised and customized to fit the needs of administrators as well as other team members; supporting materials such as glossary terms, tools, and examples should be provided; the goals and roles of team members should be clearly stated at the beginning. Participant Feedback Most attendees viewed the seminar to be highly valuable and effective. The seminar was perceived to serve as a “model for improving design approach and tools” for performance improvement in general. However, respondents thought the 2-day timeframe was too short to cover many important issues in great depth. Many respondents expressed willingness of supporting further development of the safe design tools and approaches. Lessons Learned The seminar was only the beginning to achieve consensus in the development of strong design tools and methods of designing for patient safety. It would be desirable that similar meetings focusing on patient safety should be conducted in the near future to carry on the momentum of continuous development. Adjustments should be made in future meeting agendas to allow thorough discussion on topics that are perceived by participants as critical in designing for patient safety.