Skip to main content

The Role of Architecture and Physical Environment in Hospital Safety Design

  • Chapter
  • First Online:
Surgical Patient Care

Abstract

The purpose of this chapter is to develop an awareness of important elements in hospital perioperative architectural and interior design leading to safe, high-quality surgical facilities. Intended for the non-designer, the focus will be on functional programmatic elements, fundamental planning concepts, physical organization, and future trends. Engineering systems are not discussed (mechanical, electrical, and structural), although their importance should not be underestimated. The sources and references provided will lead the interested reader to materials which will broaden the knowledge of design and evidence-based research.

“Architectural space, however large or small, joins and then bends attention to new thoughts.”

—Ann Cline, Architect

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 139.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 179.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Rostenberg B, Barach P. Design of cardiovascular operating rooms for tomorrow’s technology and clinical practice, part 1. Progr Pediatr Cardiol. 2011;32:121–8.

    Article  Google Scholar 

  2. Krupka DC, Sandberg WS. Operating room design and its impact on operating room economics. Curr Opin Anaesthesiol. 2006;19(2):185–91.

    Article  PubMed  Google Scholar 

  3. Rostenberg B, Barach P. Design of cardiac surgery operating rooms and the impact of the built environment. In: Barach P, Jacobs J, Laussen P, Lipshultz S, editors. Outcomes analysis, quality improvement, and patient safety for pediatric and congenital cardiac disease. New York: Springer Books; 2014. ISBN 978-1-4471-4618-6.

    Google Scholar 

  4. Becker F, Douglass S. The ecology of the patient visit: physical attractiveness, waiting times, and perceived quality of care. J Ambul Care Manage. 2008;31(2):128–41.

    Article  PubMed  Google Scholar 

  5. Nanda U, Pati D, Ghamari H, Bajema R. Lessons from neuroscience: form follows function, emotions follow form. Intell Build Int. 2013;5 Suppl 1:61–78.

    Article  Google Scholar 

  6. Pati D, Barach P. Application of environment psychology theories and frameworks in evidence-based healthcare design. In: Valentin J, Gamez L, editors. Environmental psychology: new developments. Hauppauge: Nova Publishers; 2010. p. 1–36. ISBN 978-1-60876-911-7.

    Google Scholar 

  7. Galvan C, Bacha EA, Mohr J, Barach P. A human factors approach to understanding patient safety during pediatric cardiac surgery. Progr Pediatr Cardiol. 2005;20(1):13–20.

    Article  Google Scholar 

  8. Barach P, Johnson J, Ahmed A, Galvan C, Bognar A, Duncan R, Starr J, Bacha E. Intraoperative adverse events and their impact on pediatric cardiac surgery: a prospective observational study. J Thorac Cardiovasc Surg. 2008;136(6):142.

    Google Scholar 

  9. Rostenberg B, Barach P. Design of cardiovascular operating rooms for tomorrow’s technology and clinical practice, part 2. Progr Pediatr Cardiol. 2012;33:57–65.

    Article  Google Scholar 

  10. Schraagen JM, Schouten T, Smit M, Haas F, van der Beek D, Barach P. Assessing and improving teamwork in cardiac surgery. Qual Saf Health Care. 2010;19(6):e29.

    PubMed  Google Scholar 

  11. Waring J, Harrison S, McDonald R. A culture of safety or coping: ritualistic behaviours in the operating department. J Health Serv Res Policy. 2007;12 Suppl 1:s1–3–9.

    PubMed  Google Scholar 

  12. Barach P, Potter-Forbes M, Forbes I. Designing safe intensive care units of the future, intensive and critical care medicine, World Federation of Societies of Intensive and Critical Care Medicine. Springer; 2009. p. 525–41.

    Google Scholar 

  13. Balik B, Conway J, Zipperer L, Watson J. Achieving an exceptional patient and family experience of inpatient hospital care. IHI innovation series white paper. Cambridge: Institute for Healthcare Improvement; 2011.

    Google Scholar 

  14. Seiden SC, Barach P. Wrong-side/wrong-site, wrong-procedure, and wrong-patient adverse events: are they preventable? Arch Surg. 2006;141(9):931–9.

    Article  PubMed  Google Scholar 

  15. Kohn LT, Corrigan J, Donaldson M. To err is human: building a safer health system. Washington, DC: Institute of Medicine, National Academy Press; 2000.

    Google Scholar 

  16. Rostenberg B, Barach P. Desperately seeking safety. Asian Healthcare Manage. 2007;14:54–6.

    Google Scholar 

  17. The Commonwealth Fund. In focus: Improving patient flow—in and out of hospitals and beyond. Quality Matters quarterly newsletter 2013. [cited 2015 Feb 28]. http://www.commonwealthfund.org/publications/newsletters/quality-matters/2013/october-november.

  18. Carayon P, Schoofs Hundt A, Karsh B, Gurses AP, Alvarado CJ, Smith M, et al. Work system design for patient safety: the SEIPS model. Qual Saf Health Care. 2006;15(1):150–8.

    Google Scholar 

  19. Barach PR, Rostenberg B. Design of cardiac surgery operating rooms and the impact of the built environment, pediatric and congenital cardiac care, Quality improvement and patient safety, vol. 2. London: Springer; 2015.

    Google Scholar 

  20. Barach P. Strategies to reduce patient harm: understanding the role of design and the built environment. Stud Health Technol Inform. 2008;132:14–8.

    PubMed  Google Scholar 

  21. Brown T. Harvard business review [internet]. Boston: Harvard Business Review; 2008. [cited 2016 Mar 21]. http://hbr.org.

    Google Scholar 

  22. Arthur J. Lean Six Sigma for Hospitals. New York: McGraw-Hill; 2011.

    Google Scholar 

  23. Graban M. Lean hospitals: improving quality, patient safety, and employee engagement. Boca Raton: CRC Press; 2012.

    Google Scholar 

  24. Evans J, Waggener LT. Why design matters: Maslow’s hierarchy for healthcare design. Nurses as leaders in healthcare design: a resource for nurses and interprofessional partners. Zeeland: Herman Miller; 2015.

    Google Scholar 

  25. Vetter TR, Goeddel LA, Boudreaux AM, Hunt TR, Jones KA, Pittet JF. The perioperative surgical home: how can it make the case so everyone wins? BMC Anesthesiol. 2013;13(1):6.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Kain ZN, Vakharia S, Garson L, Engwall S, Schwarzkopf R, Gupta R, et al. The perioperative surgical home as a future perioperative practice model. Anesth Analg. 2014;118(5):1126–30.

    Article  PubMed  Google Scholar 

  27. Coleman E, Nielsen GA. Perform enhanced admission assessment of post-hospital needs. Cambridge: Institute for Healthcare Improvement; 2011. p. 1–19.

    Google Scholar 

  28. Institute for Healthcare Improvement [website]. Cambridge, MA: Institute for Healthcare Improvement; State actions on avoidable readmissions; 2015 [cited 2015 Jul 27]. http://www.ihi.org/Engage/Initiatives/Completed/STAAR/Pages/Improvement.aspx.

  29. Giulio T, Albolino S, Tartaglia R, Guidi S, Molisso A, Venneri F, Peris P, Pieralli F, Magnelli E, Librenti M, Morelli M, Barach P. The collaborative communication model for patient handover at the interface between high-acuity and low-acuity care. BMJ Qual Saf. 2012;21 Suppl 1:i58–66. doi:10.1136/bmjqs-2012-001178.

    Article  Google Scholar 

  30. Nanda U, Malone EB, Joseph A. Achieving EBD goals through flooring selection & design. Concord: The Center for Health Design; 2012. http://www.healthdesign.org.

    Google Scholar 

  31. Harris DD, Detke LA. The role of flooring as a design element affecting patient and healthcare worker safety. HERD. 2013;6(3):95–119.

    PubMed  Google Scholar 

  32. The United States Pharmacopeia–National Formulary (USP–NF). Chapter 1066: Physical environments that promote safe medication use. The United States Pharmacopeia–National Formulary (USP–NF); 2010 [cited 2016 Mar 9]. http://www.usp.org/sites/default/files/usp_pdf/EN/USPNF/gc1066PhysicalEnvironments.pdf

  33. Rutala WA, Weber DJ, Committee HICPA. Guideline for disinfection and sterilization in healthcare facilities, 2008: U.S. Department of Health and Human Services, Center for Disease Control and Prevention; 2008. U.S. Department of Health and Human Services website: http://www.cdc.gov.

  34. The Facility Guidelines Institute. Guidelines for design and construction of hospitals and outpatient facilities. Dallas: American Society of for Healthcare Engineering of the AHA; 2014.

    Google Scholar 

  35. Spurrier B. Mayo Clinic Center for Innovation [internet]. Rochester: Mayo Clinic; Design Thinking; [cited 2015 Apr 3]. http://www.mayo.edu/center-for-innovation/what-we-do/design-thinking.

  36. Pati D, Nanda U. Influence of positive distractions on children in two clinic waiting areas. HERD. 2011;4(3):124–40.

    PubMed  Google Scholar 

  37. Solet J, Barach P. Managing alarm fatigue in cardiac care. Prog Pediatr Cardiol. 2012;33:85–90.

    Google Scholar 

  38. Quan X, Joseph A, Malone E, Pati D. Healthcare environmental terms and outcome measures: an evidence-based design glossary. The Center for Health Design Phase I [Internet]. 2011. http://www.healthdesign.org.

  39. Sanchez J, Barach P. High reliability organizations and surgical microsystems: re-engineering surgical care. Surg Clin North Am. 2012;92(1):1–14. doi:10.1016/j.suc.2011.12.005.

    Article  PubMed  Google Scholar 

  40. Schraagen JM, Schouten A, Smit M, van der Beek D, Van de Ven J, Barach P. Improving methods for studying teamwork in cardiac surgery. Qual Saf Health Care. 2010;19:1–6. doi:10.1136/qshc.2009.040105.

  41. 2012 International Building Code. Country Club Hills: ICC; 2011.

    Google Scholar 

  42. AHRQ Patient Safety Network patient safety primer [internet]. Rockville: Agency for Healthcare Research and Quality. [updated 2012, Oct; cited 2015 Feb 20]. http://psnet.ahrq.gov/printviewPrimer.aspx?primerID=18.

  43. Cassin B, Barach P. Making sense of root cause analysis investigations of surgery-related adverse events. Surg Clin North Am. 2012;92(1):101–15. doi:10.1016/j.suc.2011.12.008.

    Article  PubMed  Google Scholar 

  44. The Joint Commission. Sentinel Event Data Summary. 2015. Oakbrook Terrace: The Joint Commission; 2004 [updated 2016 Feb 2; cited 2016 Apr 26]. http://www.jointcommission.org/assets/1/18/2004-2015_SE_Stats_Summary.pdf.

  45. Kao LS, Thomas EJ. Navigating towards improved surgical safety using aviation-based strategies. J Surg Res. 2008;145:327–35.

    Article  PubMed  Google Scholar 

  46. Schraagen JM, Schouten A, Smit M, van der Beek D, van de Ven J, Barach P. A prospective study of paediatric cardiac surgical microsystems: assessing the relationships between non-routine events, teamwork and patient outcomes. BMJ Qual Saf. 2011;20(7):599–603. doi:10.1136/bmjqs.2010.048983.

    Article  PubMed  Google Scholar 

  47. Wiegmann DA, ElBardissi AW, Dearani A, Daly RC, Sundt TM. Disruptions in surgical flow and their relationship to surgical errors: an exploratory investigation. Surgery. 2005;142:658–65.

    Article  Google Scholar 

  48. Moorthy K, Munz Y, Adams S, Pandey V, Darzi A, et al. Self-assessment of performance among surgical trainees during simulated procedures in a simulated operating theater. Am J Surg. 2006;192:114–8. ISSN: 0002-9610.

    Article  PubMed  Google Scholar 

  49. Lilford R, Chilton PJ, Hemming K, Brown C, Girling A, Barach P. Evaluating policy and service interventions: framework to guide selection and interpretation of study end points. BMJ. 2010;341:c4413.

    Article  PubMed  Google Scholar 

  50. Kroemer KH, Grandjean E. Fitting the task to the human: a textbook of occupational ergonomics. 5th ed. Bristol: Taylor & Francis; 2005.

    Google Scholar 

  51. Hemphälä H. How visual ergonomics interventions influence health and performance-with an emphasis on non-computer work tasks. Lund: Lund University; 2014.

    Google Scholar 

  52. Hemphälä H, Eklund J. A visual ergonomics intervention in mail sorting facilities: effects on eyes, muscles and productivity. Appl Ergon. 2012;43:217–29.

    Article  PubMed  Google Scholar 

  53. Hemphälä H, Johansson G, Odenrick P, Åkerman K, Larsson, PA. Lighting recommendations in operating theatres, CIE, Commission Internationale de L’eclairage, conference paper, South Africa. 2011.

    Google Scholar 

  54. Konz SA, Johnson SL. Work design: occupational ergonomics. 7th ed. Scottsdale: Holcomb Hathaway; 2008.

    Google Scholar 

  55. D’Anci KE, Vibhakar A, Mahoney C, Taylor HA. Voluntary dehydration and cognitive performance in trained college athletes. Percept Mot Skills. 2009;109:251–69.

    Article  PubMed  Google Scholar 

  56. Ulrich R. View through a window may influence recovery. Science. 1984;224(4647):224–5.

    Article  Google Scholar 

  57. Ulrich RS, Zimring C, Zhu X, DuBose J, Seo H-B, Choi Y-S, et al. A review of the research literature on evidence-based healthcare design. HERD. 2008;1(3):61–125.

    PubMed  Google Scholar 

  58. Pati D, Harvey T, Barach P. The impact of exterior views on nurse stress: an exploratory study. HERD. 2008;2:27–38.

    Google Scholar 

  59. Kreideit A, Kalkman C, Barach P. Role of handwashing and perioperative infections. Br J Anesth. 2011. doi:10.1093/bja/aer162.

    Google Scholar 

  60. Stichler JF. Facility design and healthcare-acquired infections: state of the science. J Nurs Adm. 2014;44(3):129–32.

    Article  PubMed  Google Scholar 

  61. Zimring C, Denham ME, Jacob JT, Kamerow DB, Lenfestey N, Hall KK, et al. The role of facility design in preventing healthcare-associated infection: interventions, conclusions, and research needs. HERD. 2013;7:127–39.

    Google Scholar 

  62. Salgado CD, Sepkowitz KA, John JF, Cantey JR, Attaway HH, Freeman KD, et al. Copper surfaces reduce the rate of healthcare-acquired infections in the intensive care unit. Infect Control Hosp Epidemiol. 2013;34(5):479–86. doi:10.1086/670207.

    Article  PubMed  Google Scholar 

  63. Lopez C, Hanson C, Yorke D, Johnson J, Mill M, Brown K, Barach P. Improving communication with families of patients undergoing pediatric cardiac surgery. Prog Pediatr Cardiol. accepted July 9, 2016.

    Google Scholar 

  64. Barach P, Johnson J. Designing the hospital to reduce harm, improve sustainability, lower costs. In: Albolino, editor. Healthcare systems ergonomics and patient safety. London: Taylor and Francis Group. ISBN: 978-0-415-68413-2.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Charles D. Cadenhead FAIA, FACHA, FCCM, B. Arch .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Cadenhead, C.D., Waggener, L.T., Goswami, B. (2017). The Role of Architecture and Physical Environment in Hospital Safety Design. In: Sanchez, J., Barach, P., Johnson, J., Jacobs, J. (eds) Surgical Patient Care. Springer, Cham. https://doi.org/10.1007/978-3-319-44010-1_12

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-44010-1_12

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-44008-8

  • Online ISBN: 978-3-319-44010-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics