PAPER PRESENTATION AT INTERNATIONAL PATIENT SAFETY CONFERENCE 2017

1. 1. Swati Rane ( MHA, BScNsg)
2. Dhanjay Mankar (MHA,MD)
INTERDEPENDENCE OF hospital
PHYSICAL STRUCTURE AND POLICIES on
PATIENT SAFETY : CLINICAL PLANNER’S
VIEW
NOVEMBER 2017

2.  We chose this topic because, we are PhD Scholars
and our research is related to hospital structure
design and patient safety
 Being a Hospital planning and administration
advisors ,we come across lot of patient safety issues
related to system failures and hospital design
 The purpose is find the link between physical
structure /layout of hospital and work policies /
processes on patient safety.

3.  Recent attention in health care has been on the actual
architectural design of a hospital facility, including its
technology and equipment, and its effect on patient
safety
 Roger Ulrich academician in Hospital architecture says :
Hospital design must be evidence based like medicine
 To address the problems of errors in health care and
serious safety issues, fundamental changes of health care
processes, culture and the physical environment are
necessary and need to be aligned, so that the caregivers
and the resources that support them are set up for
enabling safe care

4. 1. What is the influence of physical structure
elements on patient safety ?
2. What is the relation of hospital policies and
process on safety culture?
3. What are the solutions for above?

5. Approach used is empirical
Secondary data is referred for the
systematic review.
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Methodology

6.  Its been 18 years since the release of the landmark
report by Institute of Medicine (IOM)- To Err Is
Human .It asserts that the problem is not bad people
in health care--it is that good people are working in
bad systems that need to be made safer
 Harvard study by Prof Jha shows that 5.2 million
medical error are happening in India annually
 The Harvard Medical Practice found that 3.7% of
hospital patients received disabling injuries due to
medical treatment errors and 58% of these injures
were caused by errors in management.
 The Quality in Australian Health Care reported 16.6%
of hospital admissions were associated with adverse
events of which, 50% were highly preventable

7. Our study showed that the following physical structure variables
contribute to work place errors:
• Noise levels
• Lighting
• Ergonomics/Furniture/ Equipment
• Heating,Ventilation and Air Conditioning
• Design/layout
The organisational variables associated with workplace errors
include:
• Fatigue/long work hours
• Staffing levels
• Stress
• Faulty judgment
• Age of worker

8. Poor Ventilation Systems and Excessive Thermal Environments
may compromise an Individual's Health and lead to stress and
negative task Performances
Noise is Distracting and Disrupts Concentration and is Highly
Likely to Contribute Towards Error
Inadequate Lighting (either too bright or too dark) can Impede
Task Performance
Inadequate Workstation Design and Tasks with Poor Ergonomics
are associated with the development of Musculoskeletal
Disorders and Higher Absenteeism levels and may be related to
Lower Levels of Patient Care and Increased Error Rates
Literature Review……..

9. Organizational Variables
• Working Long Hours Contributes to Fatigue, Resulting in
Slowed Reaction Time, Reduced Attention to Detail,
Compromised Problem Solving, and Errors of Omission
• Stressors in the Work Environment Include Time Pressures,
Deadline Pressures, an Uneven Distribution of Resources, and
a Heavy Work Volume
• More Errors Occur When Staffing Levels are Insufficient and
Due to Faulty Judgment
Literature Review……..

10. Management policies & work processes

11.  Effective
Transformational
Clinical Style
 Strong Nursing
Involvement from
Boardroom to bedside
 Evidence Based
Management Practice
 Involve patients in
Safety Culture
 Invest in Healing of
Staff eg.
Meditation,Yoga
 Unit level - Empowered
employees to improve
safety initiatives .
 Ideal Staff Ratios
 Non punitive approach
to error
 Respect, teamwork
transparency spirit all
levels.
 Staff & Patient friendly
policies
 Safe Air, Light, Sound,
Water
 Visibility
 Family Space must
 Design on form follow
functions theme
 Staff & patient friendly
Unit Layout
 Access to hand washing
 Medication preparation
area
 Grab bars in toilet and
walking area
Transformational
Leadership of
Management
Healthy Organizational
Policies ,Culture
Stress free Physical
work environment
Findings based on Empirical evidence

12.  Human Errors and Cognitive Functioning can
be handled safely by Good hospital Design
Policies and Technology with monitoring
processes. The need for training and regular
updating in the processes is key for patient
safety.

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