Get your concerns into facility design
Risk managers may participate in the management of a facility building or remodeling project by overseeing the myriad hazards and liabilities that can crop up along the way, but you may be missing a great opportunity to advance your own concerns if you don't immerse yourself in the earliest stages of the design process. Jump right in at the very beginning, say risk managers and designers, while you have a chance to influence the project rather than just managing it later.
By taking a seat at the table during the design process, risk managers can push to have their concerns addressed during the conception of the project, says Eric Hess, vice president of Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center (UPMC), which recently completed a $625 million redesign. As project executive, Hess was directly involved in the project from the conception and made sure that risk management concerns were incorporated into the overall design.
Many patient safety concerns, in particular, can be addressed by engineering and design improvements, he says.
"Locating services in proximity to one another, for instance, can have a significant impact on patient safety," Hess says. "We wanted to locate the cardiac cath labs near the cardiac intensive care units, for instance, so that the transport of patients was a short one. That's an example of where building design helps minimize patient risk, and that's the kind of opportunity you have when you can look at it from the start of the design process."
Children's Hospital applied the same strategy to developing a hybrid cath lab so that patients undergoing catheterization can remain in the same room, which also acts as an operating room with air exchanges, appropriate storage, and a sterile core. The emergency department also has a separate entrance for ambulances, to minimize traffic and exposure to other patients, Hess says.
The hospital also designed four separate play rooms for the young patients, so that immunosuppressed children could be isolated from others. Hess says those ideas came from about 100 user groups that met regularly to brainstorm and advise the design project leaders.
"Every space within the hospital had its own user group to advise us, and in addition to that we sought out the risk managers and others with particular expertise in patient safety, security, and other issues that are important for our hospital," he says.
Get involved early
Tim Powers, lead architect of the project at Children's Hospital of Pittsburgh and senior vice president of Astorino, an architecture and design firm, also in Pittsburgh, with a specialty in health care, says he always encourages risk managers to get involved as early as possible, while the ideas and the "what ifs" are being thrown around. Wait too long, Powers says, and it will be too late to make a suggestion, because the process is under way - and other parties have committed to a design.
"It's a good opportunity to make a difference," he says. "By providing less stressful and more efficient environments, designers enable caregivers to become less prone to mistakes and dramatically improve the care [they] provide."
In addition, early involvement in the process allows risk managers to have input right away in the design suggestions or decisions made by others. If another department is pushing for a design that favors its concerns, the risk manager may need to speak up about potential liabilities or how that design would interfere with his or her own patient safety initiatives.
"Just like patients, doctors, nurses, and families, risk managers are key stakeholders in the hospital design process and have a voice that needs to be heard. It is the job of the risk manager to inform the designers of safety issues, define the risks that must be addressed, and determine desired safety outcomes," Powers says. "At the onset of the project, the risk manager should clearly articulate the project's safety issues in order to mitigate patient harm, reduce missteps, and create a safe work environment for staff. It also is important for the risk manager to stay involved throughout the design process to ensure that the interests of patient and staff safety are not put aside in favor of a competing priority."
Powers suggests risk managers look at these potential ways to improve patient safety and address other risk management concerns in facility design:
Change layouts that are inefficient and obstruct access to much-needed records and supplies.
Maximizing usable staff space and eliminating storage spaces in favor of digitized methods not only allows facilities to go "paperless," but makes access to information easier and more ubiquitous. Also consider placing specialized units such as cardiac, intensive care, and oncology near labs and other services frequently needed by those specialties to make space more efficient. Standardizing room layouts can improve work processes, which in turn means care providers can increase efficiencies and decrease errors.
Put control in the hands of the users.
One of the most frequent complaints from patients is that they lack control of their surroundings. At the same time, caregivers are unable to maintain control and allow patient privacy at the same time. Considering private rooms is one way to allow control over infection rates and increase privacy. Other possibilities include computerized room-level observation centers and decentralized nurse stations with wireless nurse call systems to keep patients and caregivers in constant, but minimally invasive, contact.
Provide a more restful environment.
More and more, hospital design is moving to create atmospheres of positive energy to give patients, family members, and staff opportunities to recharge their batteries. For example, features such as overhead paging systems that disturb patients' rest are being replaced by pagers and other personal electronic communication devices that allow for a quiet, restful environment. Another less traditional trend is the use of healing gardens, which offer a place for reflection and an opportunity to escape the typical confines of a hospital.
Powers notes that risk managers can be particularly helpful in the design process when it comes to complying with The Joint Commission's many patient safety requirements. Many issues must be considered, and a good design can encourage good compliance with the requirements, Powers says.
Another example is the security required for a hospital, especially a children's hospital or the newborn area in other facilities, Powers says. That was a major concern at Children's Hospital, and he says the project team relied heavily on the risk managers to help them understand exactly what was needed.
"That decision-making process has such a huge impact on design. We have to know the security objectives up front, long before we even start putting pen to paper, to affect the actual physical architecture of the building," Powers says. "There are always many stakeholders around the table when you design a building, and I want to see the risk manager there as one of those stakeholders. As other stakeholders are voicing their concerns and forcing the project in the direction they want, the risk manager should be there doing the same thing, making sure that this facility will have the features to meet your objectives as well."
Risk managers may participate in the management of a facility building or remodeling project by overseeing the myriad hazards and liabilities that can crop up along the way, but you may be missing a great opportunity to advance your own concerns if you don't immerse yourself in the earliest stages of the design process.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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