I’m stuck on a Health & Medical question and need an explanation.
What event do you believe has had the biggest effect on health care facility design? Why
Human Error and Cognitive Functioning by Design
Cognitive psychologists have identified the physical environment as having a significant impact on safety and human performance.1, 2 Understanding “the interrelationships between humans, the tools they use, and the environment in which they live and work”3 is basic to any study of the design a health care facility and its effect on the performance of the nurses and other caregivers who interface with the facility and its fixed (e.g., oxygen and suctioning ports on the wall of a patient room) and moveable (e.g., a patient bed) equipment and technology. Humans do not always behave clumsily and humans do not always err, but they are more likely to do so when they work in a badly conceived and designed4 health care setting.
Organizational/system factors that can potentially create the conditions conducive for errors are called latent conditions. According to Reason,1 latent conditions are the inevitable “resident pathogens” that “may lie dormant within the system for a long time, only becoming evident when they combine with other factors to breach the system’s defenses. Latent conditions can be identified and remedied before an adverse event occurs.” Examples of latent conditions are: poorly designed facilities, including the location of technology and equipment; confusing procedures; training gaps; staff shortages or improper staffing patterns; and poor safety culture. A specific example of a latent condition effecting patient safety would be the impact of low lighting levels in the medication dispensing areas that are associated with some medication errors but not others.5 These and other conditions occur at what Reason describes as the “blunt end,” where administrators, the work environment, and resources determine the processes of care delivery. Latent conditions are present in all organizations and can be unintentionally created by those who are responsible for designing systems, ensuring adequate staffing, creating and enforcing policies, and so on.
The design of a facility/structure with its fixed and moveable components can have a significant impact on human performance, especially on the health and safety of employees, patients, and families.6 In a review of more than 600 articles, researchers found that there was a link between the physical environment (i.e., single-bed or multiple-bed patient rooms) and patient (e.g., fewer adverse events and better health care quality) and staff outcomes (e.g., reduced stress and fatigue and increased effectiveness in delivering care).7 Efforts to improve patient and staff outcomes can target latent conditions for clinicians by using evidence-based designs to decrease distractions, standardize locations of equipment and supplies, and ensure adequate space for documentation and work areas. The research done by Reason1 and Leape2 describes the value of practices based on principles designed to compensate for human cognitive failings. Thus, when applied to the health care field, human factors research (i.e., an area of research that includes human performance, technology design, and human-computer interaction; this topic is covered in chapter 5, “A Human Factors Framework,” by Henriksen and colleagues), which has emphasized the need for standardization, simplification, and use of protocols and checklists, can be used to improve health care outcomes.
By targeting human factors through facility design and ensuring that latent conditions and cognitive failures that lead to adverse events are minimized, patient safety will improve. This requires a multifaceted approach, including developing a strong safety culture, redesigning systems or facilities with their equipment and technology, focusing on eliminating the conditions of cognitive errors, and helping caregivers correct/stop an error before it leads to harm or mitigate it if it occurs.1, 2
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