slide1 l.
Skip this Video
Loading SlideShow in 5 Seconds..
DESIGNING HOSPITALS FOR SAFE AND ECONOMICAL PRACTICE The Quality Colloquium Harvard University August 21, 2007 PowerPoint Presentation
Download Presentation
DESIGNING HOSPITALS FOR SAFE AND ECONOMICAL PRACTICE The Quality Colloquium Harvard University August 21, 2007

Loading in 2 Seconds...

play fullscreen
1 / 81

DESIGNING HOSPITALS FOR SAFE AND ECONOMICAL PRACTICE The Quality Colloquium Harvard University August 21, 2007 - PowerPoint PPT Presentation

  • Uploaded on

DESIGNING HOSPITALS FOR SAFE AND ECONOMICAL PRACTICE The Quality Colloquium Harvard University August 21, 2007. Blair L. Sadler, J.D. Former President & CEO Rady Children’s Hospital, San Diego, California Senior Fellow, Inst. For Healthcare Improvement Vice Chair, Center for Health Design.

I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
Download Presentation

PowerPoint Slideshow about 'DESIGNING HOSPITALS FOR SAFE AND ECONOMICAL PRACTICE The Quality Colloquium Harvard University August 21, 2007' - mandana

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.

- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript

DESIGNING HOSPITALS FOR SAFE AND ECONOMICAL PRACTICEThe Quality ColloquiumHarvard UniversityAugust 21, 2007

Blair L. Sadler, J.D.

Former President & CEO

Rady Children’s Hospital, San Diego, California

Senior Fellow, Inst. For Healthcare Improvement

Vice Chair, Center for Health Design

today s learning objectives
Today’s Learning Objectives
  • Learn about published articles on evidence-based design that correlate with improved clinical outcomes, patient satisfaction and staff recruitment and retention.
  • Understand the compelling business case (capital costs vs. operating savings and increased revenue) for building optimal hospitals.
  • Understand a continuum ofchanges that you can make to improve care
institute of medicine 1999
Institute of Medicine - 1999

“…Serious and widespread quality problems exist throughout American Medicine. These problems…occur in small and large communities alike, in all parts of the country, and with approximately equal frequency in managed care and fee-for-service systems of care. Very large numbers of Americans are harmed as a result…”

Institute for Healthcare Improvement, 2001


The patient safety problem is large.

It (usually) isn’t the fault of healthcare


Most patient injuries are due to system


Institute for Healthcare Improvement, 2001


Medical errors:

Harm more than 1.5M year in U.S.

Institute of Medicine, 2006

Hospital-acquired infections:

2M a year in U.S.; 92,000 die

Modern Healthcare, 2006

Nursing turnover:

20% per year

JCAHO, 2002

healthcare workers
Healthcare Workers

75% feel the quality of nursing care at

their organization has declined in the

past two years.

50% feel exhausted & discouraged

when they leave work.

40% feel powerless to effect change

necessary for safe, quality patient care.

Connecticut Nurses’ Association

components of quality
Components of Quality








components of quality11
Components of Quality















making a key connection
Making a Key Connection

Most healthcare environments are more stressful & riskier for patients, family members, & staff than they should be.

They actually make these problems worse!

Conversely, improved design can measurably improve care and the work environment

levels of transformational change

Six Domains of Quality







Patient Centered









Human Resources









Levels of Transformational Change
big issues in the next ten years of improvement
Big Issues in the Next Ten Years of Improvement
  • The interactions between patients and the system of care
  • The organization context of care
  • The environmental context of care

Donald M. Berwick, MD, MPP

Institute for Healthcare Improvement

1st Annual Forum for Improving Children’s Health Care

March 12, 2002

“In service industries, the environment is the most objective and visible sign of respect for the patient, family and staff.”

Leonard L. BerryAuthor, Discovering The Soul of Service


“Although the premise that physical environment affects well-being reflects common sense, evidence-based design is poised to emulate evidence-based medicine as a central tenet for healthcare in the 21st century."

Colin MartinThe LancetAugust 2000

healthcare building boom
Healthcare Building Boom
  • Aging facilities
  • Aging population
  • Bed shortages & capacity bottlenecks

Construction Cost Estimates:

$35 billion by 2009

Source: FMI


Evidence-based design is the deliberate attempt to base building decisions on the best available evidence.

ebd research literature search 1998
EBD ResearchLiterature Search - 1998
  • Johns Hopkins University
  • Rubin & Golden meta-analysis
  • 84 studies
  • Published report
ebd research literature search 2004
EBD ResearchLiterature Search - 2004
  • Robert Wood Johnson Foundation
  • Texas A&M, Georgia Tech
  • Ulrich and Zimring meta-analysis
  • 600+ studies
  • Published report, abstracts
ebd research literature search 200422
EBD ResearchLiterature Search - 2004

Rigorous studies link the environment

to outcomes in four areas:

  • Reduce patient stress
  • Reduce staff stress
  • Improve safety
  • Improve quality
ebd research patient stress scorecard

Reduce stress, improve quality of life and healing for patients and families

Reduce noise stress

Reduce spatial disorientation

Improve sleep

Increase social support

Reduce depression

Improve circadian rhythms

Reduce pain (intake of pain drugs, and reported pain)

Reduce helplessness and empower patients & families

Provide positive distraction

Patient stress (emotional duress, anxiety, depression)

EBD ResearchPatient StressScorecard

Ulrich & Zimring, 2004

ebd research staff stress scorecard

Reduce staff stress/fatigue, increase effectiveness in delivering care

Reduce noise stress

Improve medication processing and delivery times

Improve workplace, job satisfaction

Reduce turnover

Reduce fatigue

Work effectiveness; patient care time per shift

Improve satisfaction

EBD ResearchStaff StressScorecard

Ulrich & Zimring, 2004

ebd research patient safety scorecard

Improve patient safety and quality of care

Reduce nosocomial infection (airborne)


Reduce medication errors

Reduce patient falls

Improve quality of communication (patient- staff)

(staff - staff)

(staff - patient)

(patient - family)

Increase hand washing compliance by staff

Improve confidentiality of patient information

EBD ResearchPatient SafetyScorecard

Ulrich & Zimring, 2004

ebd research quality scorecard

Improve overall healthcare quality and reduce cost

Reduce length of patient stay

Reduce drugs (see patient safety)

Patient room transfers: number and costs

Re-hospitalization or readmission rates

Staff work effectiveness; patient care time per shift

Patient satisfaction with quality of care

Patient satisfaction with staff quality

EBD ResearchQualityScorecard

Ulrich & Zimring, 2004

research conclusions
Research Conclusions

Many designs make hospitals more stressful and riskier for patients and staff.

A LOT of good evidence is available.

The evidence supports that good design can reduce stress and harm.

research conclusions immediate action
Research ConclusionsImmediate action
  • Provide larger single-bed rooms
  • Provide variable acuity rooms/reduce transfers
  • Reduce noise to reduce stress & improve sleep
  • Provide stress reducing views of nature
  • Develop efficient way finding systems
  • Improve ventilation and lighting
  • Provide positive distractions through the arts
  • Design to reduce staff walking & fatigue
  • Provide equipment to reduce staff injuries
  • Install visible/accessible hand washing facilities
what is the center
What is The Center?
  • Non-profit research & advocacy organization
  • Work began in 1988
  • Research, education, advocacy, support
  • Use evidence-based design
  • Create a ripple effect
  • Provide examples
  • Establish a research model
  • Start a dialogue
  • Support a community
the pebble pioneers impact
The Pebble Pioneers --IMPACT
  • 40 active provider partners
  • 4 corporate partners
  • 2 alumni
  • Various project types
  • Different stages of design
pebble project benefits
Pebble Project Benefits
  • Research methodology
  • Research facilitation
  • Marketing opportunities
  • Learning workshops
  • Consulting & technical expertise
  • Recognition
  • Community
bronson methodist kalamazoo mi
Bronson MethodistKalamazoo, MI
  • $181 million
  • December 2000
  • $42 million less for new construction

Architecture & Interior Design: Shepley Bulfinch Richardson & Abbott

bronson methodist design features
Bronson MethodistDesign Features
  • Access to nature
  • Control
  • Positive distractions
bronson methodist areas of measurement
Bronson MethodistAreas of Measurement
  • Turnover
  • Outcomes
  • Length of stay
  • Cost per unit of service
  • Waiting times
  • Satisfaction
  • Organizational behavior
  • Productivity
bronson methodist selected data safety operations
Bronson MethodistSelected Data: Safety & Operations
  • 11% decrease in infections
  • $500,000 savings a year in transfers
  • Increased market share
  • 87% occupancy
bronson methodist selected data satisfaction
Bronson MethodistSelected Data: Satisfaction
  • 5.4% nurse turnover
  • Increased employee satisfaction
  • 96.7% patient satisfaction
bronson methodist selected data rn turnover
Bronson MethodistSelected Data: RN Turnover

Source for National Benchmark: The Advisory Board

Source for Best Practices: ANCC

the bronson lesson
The Bronson Lesson

A better building enhanced the well-being of its patients, families and staff.

It also facilitated the cultural transformation that they were trying to achieve.

the fable hospital
The Fable Hospital

How much does a better building cost?

To answer that, we invented The Fable


Based on our Pebble Project® partners’

measured experience using Evidence-

Based Design (EBD).

the fable hospital47
The Fable Hospital
  • 300-bed regional medical center
  • Urban site
  • $240M replacement facility
  • Values: quality, safety, patients, families, staff, cost, value, community responsibility
unusual culture
Unusual Culture
  • Obsessed with quality and safety
  • Driven by values
  • Patient focused
  • Family friendly
  • A good corporate citizen
  • Determined to be eco-sensitive
  • Willing to benchmark
  • Want to be held accountable
ebd design features
EBD Design Features
  • Oversized, windowed, single rooms
  • Variable acuity rooms
  • Decentralized, barrier-free nursing stations
  • Additional hand-washing facilities
  • HEPA filters
  • Ceiling lifts

Methodist HospitalIndianapolis, IN

Architecture & Interior Design:BSA LifeStructures


Methodist HospitalIndianapolis, IN

Architecture & Interior Design:BSA LifeStructures


Edward Heart HospitalNaperville, IL

Architecture & Interior Design:Matthei Colin Associates

ebd design features cont d
EBD Design Features, (cont’d)
  • Double-door bathroom access
  • Healing art, music, and gardens
  • Consultation spaces
  • Patient education center
  • Staff support facilities

Bronson Methodist HospitalKalamazoo, MI

Architecture & Interior Design:Shepley, Bulfinch, Richardson & Abbott


Bronson Methodist HospitalKalamazoo, MI

Architecture & Interior Design:Shepley, Bulfinch, Richardson & Abbott

the fable hospital56


+ $12 Million

(5% of project cost)

The Fable Hospital

Detailed Construction Cost Estimates

the fable hospital57
The Fable Hospital

Savings & Revenue Example - Transfers

  • Average cost of one transfer is $250-$300;
  • Fable’s acuity adaptable rooms helped reduce transfers by 80%.
  • Actual Pebble Project data from Methodist found a 90% decrease.

19,466 patient stays x $250 = $4,866,500

$4,866,500 x 80% = $3,893,200 savings

the fable hospital58
The Fable Hospital

Savings & Revenue Example - Patient Falls

  • Unlitigated average cost is $10,000.
  • National median is 3.5 falls/1,000 patient days.
  • Fable’s unit & room design helped reduced falls by 80%.
  • Similar to Pebble Project data from Methodist Hospital.

300 beds at 80% occupancy = 240 beds

= 87,600 patient days/1,000 x 3.5

= 306 falls/year x $10,000 = $3,066,000Reduced by 80% = $2,452,800 savings

the fable hospital59
The Fable Hospital

Savings - Infections

  • 5-10% of patients get infections; average cost is $4,000
  • Fable’s single bed rooms, HEPA filters, & location of hand-washing facilities helped reduce infections by 4 patients a month.
  • Reimbursed 58% of additional costs from infections.
  • Actual Pebble Project data from Bronson found 4-6 patients a month reduction.

4/month at $4,000 unlitigated cost

= $192,000/year x 42% = $80,640 savings

the fable hospital60
The Fable Hospital

Savings & Revenue (One-Year Savings)

Fewer Patient Falls

Fewer Patient Transfers

Fewer Nosocomial Infections

Reduced Nurse Turnover

Reduced Drug Cost

$2,452,800(- 80%)

$3,893,200(- 80%)

$80,640(- 4/m)

$164,000(- 14%-10%)

$1,216,666(- 5%)

Total Cost Savings: $7,807,306

the fable hospital61
The Fable Hospital

Savings & Revenue (One-Year Savings)



Total Revenue Gain: $3,668,100

Market Share Increase

Increased Philanthropy

+ Total One-Year Savings:$7,807,306

Total : $11,475,406

the fable hospital62
The Fable Hospital

Cost avoidance savings alone, if we

invested $7.8M at 3% for 30 years, it

would pay the capital costs of the

hospital many times over.

Life-cycle vs. one-time capital costs.

once in a lifetime opportunity
Once-In-A-Lifetime Opportunity

You are going to make an investment in new construction that can leave a lasting legacy to your organization and your community.

It can also improve quality/safety, lower operating costs and improve workforce morale.

But to do so, ask question # 6!

five traditional questions boards ceos ask
Five Traditional QuestionsBoards & CEOs ask
  • Urgency
  • Appropriateness
  • Cost
  • Financial impact
  • Sources of funds
1 urgency
1. Urgency
  • Is the expansion/replacement actually needed now to fulfill the mission or can it be deferred?
  • For example, are the market and volume assumptions sound, and have other external factors that would affect the decision been honestly and accurately considered?
2 appropriateness
2. Appropriateness
  • Is the proposed plan the most appropriate and sound?
  • For example, have all alternatives been explored, such as partnerships with other hospitals and satellite operations as opposed to expanding or upgrading the facility in question?
3 cost
3. Cost
  • Has the project been reviewed to offer the maximum value for every dollar spent?
  • Is the cost appropriate for the expected level of construction quality in light of other projects being built in the region? (The “Ford vs. Cadillac” question)
4 financial impact
4. Financial Impact
  • Has the operating impact of the additional volume been accurately analyzed financially?
  • Has the operating impact of NOT proceeding also been analyzed?
5 sources of funds
5. Sources of Funds
  • Have the sources of funds for the new facility been identified?
  • For example, is the combination of reserves, borrowing, philanthropy, and additional operating income reasonable and defensible?
the sixth question boards ceos must ask
The Sixth Question Boards & CEOs MUST ask

Has management incorporated all

the relevant evidence

based design (EBD), which has been

shown to positively impact quality,

safety, satisfaction, productivity, and

operational costs?

Incorporating EBD into the project can

be a superb long term investment.

a continuum of design changes we can make
A Continuum of Design Changes We Can Make
  • Long Term – Construction
  • Larger/variable acuity single rooms
  • HEPA filtration systems
  • Calming views and natural light
  • Wider bathroom doors
  • Short Term
  • Hand washing dispensers throughout
  • Reduce noise – acoustics, pagers, loud equipment
  • Create positive distractions through art and music
  • Install lifts
  • Improve way finding

More Details



“The hospital is a human invention and as such, can be reinvented any time.”

--Leland R. Kaiser, Ph.D.

contact information
Contact Information

Blair L. Sadler

Former President & CEO

Rady Children’s Hospital, San Diego

Senior Fellow, IHI

The Center for Health Design

1850 Gateway Boulevard

Suite 1083

Concord, CA 94520


what is the center75
What is The Center?
  • Non-profit research & advocacy organization
  • Work began in 1988
  • Research, education, advocacy, support

To transform healthcare settings into

healing environments that improve

outcomes through the creative use of

evidence-based design.


A future where healing environments are

recognized as a vital part of therapeutic

treatment; and where the design of

healthcare settings contributes to health

and does not add to the burden of stress.

multi disciplinary
  • Healthcare management
  • Quality improvement
  • Patient satisfaction
  • Medicine & nursing
  • Architecture & interior design
  • Research & education
  • Strategic planning
  • Capital finance
what the center does
What The Center Does
  • Research
    • Pebble Project
    • Special projects & reports
  • Education
    • Conferences & programs
    • Certification (late 2006)
what the center does cont d
What The Center Does (cont’d)
  • Advocacy
    • Standards
    • Awards programs
  • Information & Support
    • Website
    • Publications
    • Educational consulting & speaking
optimal environments value proposition
Optimal EnvironmentsValue Proposition
  • Strategic & business advantages
  • Safety & quality of care
  • Operational efficiency & productivity
  • Attract more patients
  • Recruit & retain staff
  • Increase community & philanthropic support