Rady Children's Hospital, San Diego, LaJolla, CA 92037, USA.
HERD. 2008 Spring;1(3):22-39. doi: 10.1177/193758670800100304.
After establishing the connection between building well-designed evidence-based facilities and improved safety and quality for patients, families, and staff, this article presents the compelling business case for doing so. It demonstrates why ongoing operating savings and initial capital costs must be analyzed and describes specific steps to ensure that design innovations are implemented effectively.
Hospital leaders and boards are now beginning to face a new reality: They can no longer tolerate preventable hospital-acquired conditions such as infections, falls, and injuries to staff or unnecessary intra-hospital patient transfers that can increase errors. Nor can they subject patients and families to noisy, confusing environments that increase anxiety and stress. They must effectively deploy all reasonable quality improvement techniques available. To be optimally effective, a variety of tactics must be combined and implemented in an integrated way. Hospital leadership must understand the clear connection between building well-designed healing environments and improved healthcare safety and quality for patients, families, and staff, as well as the compelling business case for doing so. Emerging pay-for-performance (P4P) methodologies that reward hospitals for quality and refuse to pay hospitals for the harm they cause (e.g., infections and falls) further strengthen this business case.
When planning to build a new hospital or to renovate an existing facility, healthcare leaders should address a key question: Will the proposed project incorporate all relevant and proven evidence-based design innovations to optimize patient safety, quality, and satisfaction as well as workforce safety, satisfaction, productivity, and energy efficiency? When conducting a business case analysis for a new project, hospital leaders should consider ongoing operating savings and the market share impact of evidence-based design interventions as well as initial capital costs. They should consider taking the 10 steps recommended to ensure an optimal, cost-effective hospital environment. A return-on-investment (ROI) framework is put forward for the use of individual organizations.
在建立精心设计的循证设施与提高患者、家属和员工的安全性和质量之间的联系之后，本文提出了这样做的有力商业案例。它展示了为什么必须分析持续的运营节约和初始资本成本，并描述了确保设计创新得到有效实施的具体步骤。
医院领导和董事会现在开始面临一个新的现实：他们不能再容忍可预防的医院获得性疾病，如感染、跌倒和员工受伤，或不必要的院内患者转院，这些都会增加错误。他们也不能让患者和家属置身于嘈杂、混乱的环境中，增加焦虑和压力。他们必须有效地部署所有可用的合理质量改进技术。为了达到最佳效果，必须将各种策略结合起来，并以综合的方式实施。医院领导必须了解精心设计的治疗环境与提高患者、家属和员工的医疗保健安全性和质量之间的明确联系，以及这样做的有力商业案例。新兴的按绩效付费（P4P）方法因质量而奖励医院，因造成的伤害而拒绝向医院付费（如感染和跌倒），进一步加强了这一商业案例。
在规划新建医院或翻新现有设施时，医疗保健领导者应提出一个关键问题：拟议项目是否将纳入所有相关和经过验证的循证设计创新，以优化患者安全、质量和满意度以及员工安全、满意度、生产力和能源效率？在对新项目进行商业案例分析时，医院领导应考虑持续的运营节约和循证设计干预措施对市场份额的影响，以及初始资本成本。他们应该考虑采取建议的 10 个步骤，以确保一个优化的、具有成本效益的医院环境。提出了一个投资回报率（ROI）框架，供各个组织使用。
