Buildings, Barriers, and Breakthroughs: Bridging Gaps in the Health Care Enterprise.

Health care architecture and design are critical resources that are often underestimated and overlooked. As we seek to extract every available resource at our disposal to serve patients and sustain the bottom line, it is vital that we consider the influence the building imposes on the patient and caregiver experiences. Buildings impact both caregiver behaviors and the economic enterprise and are, therefore, the business of health care executives. This understanding is not only an executive obligation, it is an executive opportunity. Furthermore, the built environment can be a source for innovation in an industry whose future depends on nurse leaders to champion ingenuity with simplicity and relevance. Nurse leaders are ideally positioned to bridge health care building design and best practice.

Evidence-Based and Value-Based Decision Making About Healthcare Design: An Economic Evaluation of the Safety and Quality Outcomes.

OBJECTIVE: This study describes a vision and framework that can facilitate the implementation of evidence-based design (EBD), scientific knowledge base into the process of the design, construction, and operation of healthcare facilities and clarify the related safety and quality outcomes for the stakeholders. The proposed framework pairs EBD with value-driven decision making and aims to improve communication among stakeholders by providing a common analytical language. BACKGROUND: Recent EBD research indicates that the design and operation of healthcare facilities contribute to an organization's operational success by improving safety, quality, and efficiency. However, because little information is available about the financial returns of evidence-based investments, such investments are readily eliminated during the capital-investment decision-making process. METHOD: To model the proposed framework, we used engineering economy tools to evaluate the return on investments in six successful cases, identified by a literature review, in which facility design and operation interventions resulted in reductions in hospital-acquired infections, patient falls, staff injuries, and patient anxiety. RESULTS: In the evidence-based cases, calculated net present values, internal rates of return, and payback periods indicated that the long-term benefits of interventions substantially outweighed the intervention costs. This article explained a framework to develop a research-based and value-based communication language on specific interventions along the planning, design and construction, operation, and evaluation stages. CONCLUSIONS: Evidence-based and value-based design frameworks can be applied to communicate the life-cycle costs and savings of EBD interventions to stakeholders, thereby contributing to more informed decision makings and the optimization of healthcare infrastructures.