Designing for safety and efficiency is just the starting point

I was reading a blog post from ECRI describing healthcare and its complexities and breaking down those complexities into five critical components. They are:

• People: This includes healthcare professionals with diverse knowledge, skills, and responsibilities. Each person, from nurses to pharmacists, is essential to the system’s functionality.
• Physical environment: The spaces where care is delivered—such as patient rooms, operating theaters, and laboratories—must be designed for efficiency and safety.
• Organization: This includes the mission, vision, policies, and management structure of healthcare facilities, which directly influence how care is provided.
• Tools and technologies: The equipment and technology used in healthcare—infusion pumps, MRI machines, and electronic health records—must be user-friendly and effective to support patient care.
• Tasks and processes: The millions of daily tasks performed, from administering medication to cleaning patient rooms, are the backbone of healthcare operations.

The overarching complicating factor is that all of these components must interact on pretty much a constant basis—the “behaviors” (if you will) of each component has an impact on each of the other components in a maelstrom of activity. I will say that I was pleased to see that the physical environment is (finally) getting a little more press from a critical structure standpoint. However, I do wish that the description had gone just a little bit further and included not just the spaces where care is delivered (as you’ve probably noted, my philosophy on this is that every space in the healthcare physical environment is a space where care is delivered—direct or indirect--it’s all part of the big picture), but also the note that the physical environment must be maintained for efficiency and safety. I won’t quibble that efficiency was noted first before safety; I would be inclined to reverse the order, but I’m happy to be at the dance.

It seems that lately I’ve run into too many instances in which critical infrastructure components have failed because they have reached the end of their useful life and there’s insufficient strategic planning to ensure that systems are sufficiently robust and well-maintained to ensure that patient care can continue in the environment—as designed! Of course, it certainly doesn’t help that a lot of these system components are pricey, so there’s always a bit of sticker shock when it comes to planning. But, I figure, better to have a plan in place to thoughtfully engage the inevitability of obsolescence (that would be a good progressive rock album title—do they still have albums?) than to get to work some morning and find out that your boiler isn’t doing what it’s supposed to or your HVAC system isn’t providing your operating rooms a proper environment in which to operate. I guess, to a fair degree, this involves having a process in which facility infrastructure needs can be escalated in a fashion that provides for a seamless transition from the old to the new—how soon do you have to let your boss know that replacement time is nigh?

About the Author: Steve MacArthur is a safety consultant with The Chartis Group. He brings more than 30 years of healthcare management and consulting experience to his work with hospitals, physician offices, and ambulatory care facilities across the country. He is the author of HCPro's Hospital Safety Director's Handbook and is an advisory board member for Accreditation and Quality Compliance Center. Contact Steve at stevemacsafetyspace@gmail.com.