![]() ![]() As seen in the Figure, environmental latent conditions undermine system defenses, setting the stage for active failures or establishing error-provoking conditions.( 4,5) For example, multiple occupancy patient rooms that are more difficult to clean and have fewer easily accessible handwashing opportunities (bathrooms, sinks, alcohol rubs) may result in increased transmission of health care–associated infections (HAIs) through surface contact.( 6,7)Įvidence-based design is the process of basing decisions about the built environment on credible research to achieve the best possible outcomes.( 8) The Center for Health Design, a 501(c)(3) nonprofit organization, is committed to assisting health care organizations achieve this goal through their Pebble Project program ( ), a research initiative that engages health care organizations during their facility design and construction projects. Other high-risk industries have studied how environmental features can engender human responses that improve safety-related outcomes.( 2) Understanding how environmental variables contribute to adverse events in health care represents the focus of a growing body of architects, researchers, and clinicians.( 3) A systems approach allows us to evaluate error or adverse events in the context of organizational vulnerabilities. One often-neglected variable is the physical environment, which shapes every patient experience and all health care delivery, including those episodes of care that result in patient harm. Although there has been recent progress in patient safety ( 1), perhaps one reason for the troubling gaps is that all of the variables that contribute to safe and quality care have not been examined together. Now that health care reimbursement is firmly linked to a reduction in hospital-acquired conditions through the enactment of the Affordable Care Act, the entire health care industry has additional incentive to address our patient safety problems aggressively.
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