Simulating the Health Care Environment to Improve Patient and Caregiver Safety

Anjali Joseph, Ph.D."The design and layout of health care facilities can contribute to the safety of care that patients receive. Thanks to funding from AHRQ, my team is developing the research base and tools that are needed to design and build health care facilities that support safer patient care."



Health care facility design can have a big impact on patient safety—a fact that's often overlooked in health care improvement efforts. The problem is that there's not a lot of evidence on how to build health care facilities that support safer care. AHRQ is helping to bridge this gap by funding research to develop and test practical tools that hospital teams can use in health care facility design and quality improvement efforts.

Anjali Joseph, Ph.D., who is the Spartanburg Regional Health System Endowed Chair in Architecture + Health Design and Director of the Center for Health Facilities Design and Testing at Clemson University in South Carolina, is discovering ways to create safer health care environments by focusing on the design and construction of health care facilities. Dr. Joseph's AHRQ-funded research uses mockups of real-world health care environments to simulate and test the effectiveness of potential design solutions and how they might affect care delivery.

Design decisions made when planning to build a health care facility can have lasting impacts on patient safety. For example, poor ventilation can affect the circulation of airborne germs, contributing to healthcare-associated infection risks. The placement and design of handwashing sinks and dispensers may impact the frequency with which they are used by clinicians while providing patient care. To reduce such risks, health care teams often conduct infection control risk assessments during the design process. The impact of design on other safety outcomes, such as patient falls and medical errors, was rarely considered, however.

Dr. Joseph began her efforts in 2011 when she received her first AHRQ grant to host a 2-day seminar to build consensus among multidisciplinary experts around the processes, tools, and approaches necessary to ensure that patient safety was considered when a health care facility is being designed. Input from these experts helped Dr. Joseph and her team create a stronger evidence base for a patient safety risk assessment and the framework for a tool to apply a PSRA.

With this information, Dr. Joseph sought additional AHRQ funding to develop an interactive toolkit to help health care designers apply a PSRA to meet Facility Guidelines Institute guideline requirements.

Dr. Joseph's team tested the Health Facility Design Safety Risk Assessment Toolkit using interactive simulated clinical scenarios and tasks—such as emergency department, patient room, and labor and delivery suite mockups—to address more than 200 potential health care environment considerations. The toolkit provides a structured way to apply evidence-based design to improve patient safety. The Facility Guidelines Institute began including the toolkit in its Guidelines for Design and Construction of Hospitals and Outpatient Facilities in 2014.

In her current AHRQ-funded project, Dr. Joseph and her team are continuing to investigate how facility design affects patient safety. Most simulation efforts are focused on training to improve clinician skill sets. Dr. Joseph's work is innovative because it uses simulation in the form of a hands-on operating room mock-up for testing new design ideas. Focusing on operating room system performance, Dr. Joseph's team is now using the mock operating room to help a multidisciplinary team of designers, engineers, nurses, surgeons, and anesthesiologists make key decisions about factors such as room size, operating room table location, anesthesia-related alarms and communications, intra-room zoning, traffic flow, and the size and placement of door openings. The ability to evaluate this environment during the design process by performing simulated surgical procedures allows clinical teams to visualize and adjust future workspaces. This project will be completed in 2019.

For her first-of-its-kind, high-fidelity operating room simulation and research, Dr. Joseph was recently named 2018 Researcher of the Year by Healthcare Design magazine, which honors industry standouts in 10 categories for their contributions to the field.

Principal Investigator: Anjali Joseph, Ph.D., EDAC, Professor, Spartanburg Regional Health System Endowed Chair in Architecture + Health Design, and Director of the Center for Health Facilities Design and Testing
Institution: Clemson University
Grantee Since: 2011
Type of Grant: Various

Page last reviewed September 2018
Page originally created September 2018
Internet Citation: Simulating the Health Care Environment to Improve Patient and Caregiver Safety. Content last reviewed September 2018. Agency for Healthcare Research and Quality, Rockville, MD.
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