Boca Raton Community Hospital (BRCH) is driving down the road to become the safest hospital in America. The physicians, employees, volunteers, management, design team, and the Board are committed to improving the safety for patients and staff. Helping to support the organization toward the goal is John G. Reiling, consultant to BRCH. Reiling is currently the project manager of the New BRCH and Lynn Cancer Institute.
Commenting on the safe hospital concept, Reiling said, “The safe hospital concept was inspired by the 1999 report, To Err is Human by the Institute of Medicine (IOM). The question was raised of whether the built environment along with its equipment and technology could affect the safety of patients and caregivers delivering care. With a paucity of literature on the subject, leaders throughout the U.S. that were participants of the National Learning Lab, created in 2002, were contacted to discuss this concept. The top organizations in the U.S. whose mission includes supporting quality and safety participated and many of the top leaders from those organizations were key members.”
He continued, “The results were a resounding Yes that the built environment with its technology and equipment does affect the safety of patients and those providing care. In addition, the National Learning Lab described how to focus a traditional design process on safety and engineer it to enhance a safety culture.”
Comparing the safe hospital design method to the traditional method Reiling describes how in the safe hospital approach, in advance of the design, the processes are reviewed with the focus on safety. The design process includes the anticipation, identification and avoidance of potential failures in processes and design. Using this approach throughout the design to focus on the latent conditions such as noise reduction, minimizing handoffs, minimizing patient movement and also focus on active failures such as medication errors, patient falls, and wrong site surgery helps to simultaneously engineer a safety culture within the organization.” He summarizes, “Ultimately, you are taking traditional methods and focusing on latent conditions and active failures while changing the safety culture at the same time.”
Some of the healthcare organizations which have attempted to incorporate the safe by design method into their construction projects include St. Josephs Hospital in West Bend, Wisconsin, Childrens Hospital of Orange County, California, Palomar Pomerado Health System in San Diego and, right here in Florida, Boca Raton Community Hospital.
Comparing who is involved in the design process in the traditional versus the safe hospital approach, Reiling states, “In a traditional design process a steering committee is formed typically consisting of top management and the architects work with them along with department heads and groups of employees when they need additional input. The architects are driving the design with input. However, the people that will be providing the care are not the administrators or the architects. The design should be driven by the caregivers and focused on safety with the architects and administrators supporting the effort. Safety ultimately is about caregivers delivering accurate and evidence based services. You are always trying to eliminate or minimize the conditions of error so accurate care can be achieved.”
Discussing the benefits of a hospital built using the safe hospital method, Reiling notes, “If you are focused on the caregivers in design so that they can perform their work safely and you truly design with that goal in mind, the conditions that employees will work in will be improved. Therefore recruitment and retention should be enhanced and the satisfaction rates of employees and patients should rise. Caregivers see on a daily basis the effect of human error and lack of evidence based medicine on patient safety and quality.”
Commenting on the differences patients would experience in a safe hospital, he lists such benefits as standardization in processes, a peaceful, quiet environment, enhanced privacy, collaboration among the staff and with patients, continuity of care and fewer adverse events such as medications errors. Overall, results include improved patient outcomes and a better experience with their hospital stay.
Boca Raton Community Hospital is fully implementing the recommendations of the National Learning Lab. In addition, BRCH has formed a National Advisory Committee (NAC) of National Experts to support their efforts to pursue the Safest Hospital in America. The new facility is in design development and has focused on latent conditions and active failures to improve safety and quality in the design. Simultaneously, the safety culture of BRCH is being enhanced. Active Employee, caregiver participation has been encouraged throughout the design process. Mock-ups, Matrix exercises, Failure Modes & Effects Analysis (FMEA) on design have all helped caregivers to actively participate and to create a design focused on safety.
Will the Design affect the safety of patients? The evidence is “Yes”. Certain design features have shown to lower adverse events. Safety culture has evolved in organizations focused on safety by design. A comprehensive study is being conducted by AHRQ (Agency for Healthcare Research & Quality) at St. Josephs Hospital in West Bend, WI on safe by design. The results will be published in December of 2007.
If other organizations want to pursue Safe by Design, a book “Safe by Design: Designing Safety in Health Culture-Facilities, Process, and Culture” has been recently published. For additional Information please contact John Reiling at jreiling@safebydesign.com.
