How To Save a Life

We are a little over halfway through the semester (time flies!) and currently, we are learning about environment of care management. For those of you who don't know, the purpose of environment of care management is to provide complete physical environment required for the mission, protect organization members and visitors against all hazards and maintain reliable guest services at satisfactory levels of economy, attractiveness and convenience (Griffith & White, 2010, p. 247). I never put too much thought as to how a hospital is designed and because of my lack of awareness, I wanted to look more into how much of an impact does the design, quality and safety of a hospital have on our overall health. 

While we're on the topic of infrastructure designs + health, I came across a Ted Talk called "Architecture that's built to heal" by Michael Murphy, an architect who specializes in improving social equity and health outcomes through design innovation.  He begins with a lecture he attended in college held by Dr. Paul Farmer, in which he stated how buildings are making people sicker and for those living in third world countries, this can cause epidemic level problems. In a hospital located in South Africa, there have been cases where a patient comes in with a broken leg, waits in an unventilated hallway and then later, walks out with a multi-drug resistant strand of tuberculosis. He says, "simple designs for infection control had not been thought about, and people had died because of it" (Murphy, 2016). This served as an inspiration for him to pursue a career designing hospitals that allow people to heal. While living in Rwanda, he worked alongside an engineer named Bruce Nizeye who introduced him to a process of building called "lo-fab"- locally fabricated way of building. "It has four pillars; hire locally, source regionally, train where you can and most importantly, think about every design decision as an opportunity to invest in the dignity of the place where you serve (Murphy, 2016). He introduced this process of design and tested in places around the world. In Haiti, they successfully designed a simple strategy to clean contaminated medical waste before it enters the water table- in an effort to help end the cholera epidemic. 

Although the environment and living situations in South Africa and the United States are vastly different, the general point being made is that the environment and design quality of a hospital can have a profound effect on the health outcomes of patients and employees.

I've mentioned in a past blog post about hospital acquired infections and medical errors- which takes the lives of 100,000 Americans each year. The United States spends nearly 18% of its GDP on healthcare and spending for hospital care increased 5.6% to $1.0 trillion in 2015 compared to 4.6% growth in 2014 (Centers for Medicare & Medicaid Services, 2015). Yet, we still face issues in terms of providing high quality of care and patient safety. Poor air quality and ventilation, as well as semi private rooms are major causes of hospital acquired infections. In a hospital, you are either situated in a private room or a semi private room, depending on your condition. Unsurprisingly, studies have shown that single bed rooms were more conducive for infection control and patient care and were associated with reduced stress and improved outcomes for patients (Reiling, Hughes & Murphy, 2016). Compared to single rooms, semi private rooms are more difficult to decontaminate thoroughly after a patient is discharged, which increases the risk of patients and employees acquiring an infection. Although the cost of a private room is higher; in the long run, the patient would be saving money due to their low risk of infection, lower rates of re-admission and transfers, as well as shorter hospital stays. By placing patients in private rooms, their risk of contracting infections decreases.

Not only are patients at risk for contracting infectious diseases but healthcare employees as well, due to airborne and surface contamination. According to a survey conducted by the American Nurses Association, 76% of the nurses stated that unsafe working conditions interfered with their ability to provide quality care (Joseph, 2006, p. 2). Factors such as poor ventilation and fungal contamination of the ventilation system that have been linked to the spread of nosocomial infections among patients may also impact staff (Joseph 2006, p. 3). In one of many steps taken to reduce the risk of infection, they found that placing sinks, handwashing liquid dispensers and alcohol rubs in each room has been successful in improving and sustaining handwashing compliance because of the convenience.

We underestimate how important the structure, design, and overall quality systems of a hospital is to our health. Simple measures such as providing better quality air ventilation and/or increasing access to sinks and handwashing dispensers can play a huge role in reducing hospital acquired infections. The evidence-based emerging to support the business case that designing for safety and quality can improve patient outcomes and safety, promote healing, increase patient satisfaction and reduce costs (Reiling, Hughes & Murphy, 2008). 

Centers for Medicare and Medicaid Services. (2015). National health expenditures 2015 highlights. Retrieved fromhttps://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/downloads/highlights.pdf

Griffith, J.R., & White, K.R. (2010). Reaching excellence in healthcare: Environment-of-care management. Chicago, IL: Health Administration Press.

Joseph, A. (2006, November). The role of the physicial and social environment in promoting health, safety and effectiveness in the healthcare workplace. Retrieved from https://www.rwjf.org/content/dam/farm/reports/reports/2006/rwjf13841

Murphy, M. (2016, February). Architecture that's built to heal. Retrieved from https://www.ted.com/talks/michael_murphy_architecture_that_s_built_to_heal/transcript

Reiling, J., Hughes, R.G., & Murphy, M.R. (2008, April). Chapter 28: The impact of facility design on patient safety. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK2633/