The Built Environment: Enhancing Flow and Functionality in Healthcare

By Kelly M. Pyrek

While patients and healthcare personnel see the provision of care as the primary focus in the hospital setting, other professionals such as healthcare engineers and physical plant managers are tasked with keeping the environment of care (EOC) running as smoothly and seamlessly as possible. The healthcare “built environment” may be taken for granted or fade into the background, but it plays a critical role in how successful healthcare may be delivered and ultimately, the outcomes derived from that care.  Zimring, et al. (2013) define the built environment in healthcare as “the hospital structure and any other fixed or semi-permanent components of the facility with which healthcare personnel, patients, and their families must interact.”

The intersectionality of the built environment, the environment of care and infection prevention is critical to the success of patient outcomes, confirms Linda Dickey, RN, MPH, CIC, CPHQ, FAPIC, formerly with UC Irvine Health, APIC immediate-past president, and CEO of Linda L. Dickey Consulting, LLC.

“There are so many different patient-care environments, everything from field hospitals where people are in in very rudimentary situations, to sophisticated clinical environments, but obviously for those who are providing direct care, their focus is on the patient,” she says. “It’s not that clinicians are not cognizant of the healthcare built-environment, it's just not their primary focus in the moment. The most obvious state of the environment, which is cleanliness, is likely the most immediate perception related to the environment of care. And the safety of the environment -- for not only the patient but the caregivers who are working in that space – but also the level of comfort of the surroundings, which is important because you want to be able to work well and effectively care for patients.  I think of it as a three-legged stool representing the basics of safety, comfort, and cleanliness. The healthcare environment must also  flow and function well in order for clinicians to provide great patient care.”

While attention is often placed on the healthcare provider if there is a medical error or adverse event, Dickerman and Barach (2008) remind us that, “There is growing recognition that the risks and hazards of injury and harm associated with healthcare are a result of problems with the design of systems of care rather than of poor performance by individual providers. Furthermore, substantial evidence suggests that the design of hospital physical environments contributes to medical errors, increased rates of infection and injuries from falls, and to slow patient recovery and high nurse turnover.” They state further, “Hospitals occupy a unique place in our sensibilities. For some, they are safe havens; for others, they are the locus of dynamic civic and financial activity; and for still others, they have an image of being stressful places that provide only fragmented or even unsafe care. These mixed messages have created interest in obtaining a greater understanding of the relationship between quality of care and the physical environment. One of the dangers in any emerging concept is that it will be taken over by forces that borrow the language but ignore the detail. Such appears to be the case in ‘patient-safe’ design for health care buildings. The need for a new approach to health care design is a byproduct of the national movement to reduce medical errors and prevent hospital-acquired infections.”

Read further from the August 2023 issue HERE