Design of the physical environment for changing healthcare needs.

Four years ago, the Agency for Healthcare Research and Quality (AHRQ) moved into new facilities and we recall the immediate impact that the new environment had on our daily work activities. All of a sudden, we were aware of the impact of the physical environment. Today, of course, we are completely accustomed to the changes and take them for granted, yet the design of the building is still having its impact (and we are glad to report it is positive). Like most individuals, we like spaces that are aesthetically pleasing, but as individuals working in healthcare, we value highly spaces that are carefully designed to support the work functions for which they were intended. Because buildings have multiple uses and user groups, the design challenge is not insignificant. We are learning how to design our schools for multiple activities (daytime and evening) and how to design our offices for more flexible and fluid business practices. We likewise are learning to design healthcare environments tailored to the needs of multiple users: patients, their families, providers, specialists, emergency personnel, allied health professionals, the clergy, suppliers, volunteers, and the community at large. Given AHRQ's mission to improve the safety, effectiveness, and efficiency of healthcare for all Americans, it is especially gratifying to witness the design innovations and improvements that are being made. The evidence-based design principles that underlie these improvements parallel nicely the evidence-based medicine principles for which AHRQ has played an important leadership role.Every aspect of healthcare-acute care, long-term care, ambulatory care, and home care-is being examined by policymakers, payers, patients, consumers, and providers themselves. Even though strides have been made, the quality of care furnished remains questionable, the error rate is much too high, and costs do not seem to reflect the value of services. Patients and payers are rightfully expecting high quality for the cost of the care they are receiving and providers and caregivers deserve a work environment that supports their efforts. Research continues on how to improve these conditions, but much of it is focused on how the processes and technology involved in care delivery can improve outcomes. Even though we know that the physical environment influences the design of these processes and workplace culture, we have paid less attention to studying it.Workflow, organizational culture, and the physical environment are interrelated. Experts who study business workplace design report that the physical environment affects the possibility of interaction among the workforce, customers, and vendors, and it encourages or discourages specific behaviors. They also note that, to achieve maximum effectiveness, workplaces must be designed to enable distraction-free solo work and provide support for impromptu interactions. In the March 2003 AHRQ evidence report, The Effect of Health Care Working Conditions on Patient Safety, the authors state "In order for healthcare to be safe, efficacious, and of high quality, it is essential that there be optimal coordination of the structural and cultural elements of the system?. Because this requirement is not always met, medical errors occur, and patient safety is threatened."The physical environment-including light, noise, air quality, toxic exposures, temperature, humidity, wayfinding, and aesthetics-as well as other workplace design features and physical layouts have an impact on patient outcomes, communication, and job satisfaction. Although we have good information about some of the effects of design on working conditions, there is a need for additional well-executed research. For example, we know that decreasing distractions and noise leads to healthcare workers making fewer mistakes; we know that reducing the number of times a patient is transferred from one care site to another decreases the likelihood of faulty communication; and we know that patients benefit from having their families stay with them when they are hospitalized. …