How can a health service environment best support the provision of safe and high-quality care for all patients?

This can be achieved through the 'safe environment' concept - a component of the National Safety and Quality Health Service Standards: Standard 1 Clinical Governance.

1. Fit for Purpose

The health service environment, including all facilities, plant and equipment, should be fit for purpose. These elements must be kept in good working order to limit the occurrence of accidents and assure patient safety (ACSQHC 2021).

But what does a facility ‘unfit for purpose’ look like? Here are some real-life examples:

• A hospital in Wales (UK) was deemed ‘not fit for purpose’ due to inadequate isolation facilities for infection prevention
• A highly specialised cancer centre in London was deemed unfit for purpose as a result of out-of-date equipment; a lack of adequate expertise among staff; and the dilapidation of the building’s exterior
• A Kalgoorlie hospital was deemed unfit to treat patients with mental illness in a report that called it ‘the worst’ facility in Western Australia as a result of staffing shortages, inadequate infrastructure, delays in patient transfers and the use of chemical restraint during delays.

(BBC News 2019; Campbell 2019; Moussalli & Stevens 2019)

2. Design

Optimum design is much more than aesthetics. Good design can reduce the potential of unwanted events. Design considerations could include ensuring adequate lighting is present in areas where medicines are dispensed; or choosing surfaces that are easy to clean and disinfect (ACSQHC 2021).

Good environmental design can even positively influence the healing process (Rasoulivalajoozi & Farzamfar 2022).

Effective design can directly result in quantifiable psychological improvements, particularly noticeable in areas such as:

• Overall patient satisfaction
• Increased feeling of safety for hospital staff and patients
• Reductions in:
  • Patient aggression
  • Staff anxiety.

(Theodore 2016)

The term for design considerations that aim to improve healthcare through architecture is ‘evidence-based design’. It isn’t hard to see how thoughtful design could improve the hospital experience, with many modern facilities moving away from the typical noisy, chaotic and dark hospital environments of old that only further intensify patient stress (Berry & Hamilton 2018).

3. Patient Experience

Having clear directions and signage can help patients locate the services they need. Patient comfort and experience of care can be improved through the correct use of furnishings, colour, artwork, light and sound (ACSQHC 2021).

‘Wayfinding’ is the ability for hospital staff, patients and visitors to navigate their way through a healthcare facility with ease. Effective wayfinding results in staff spending less time directing people, and a better patient experience overall (NSW Health 2022).

Wayfinding improvements include a combination of the following elements:

• Building and campus design (effective planning)
• Wayfinding strategy (requiring an organisation-wide, coordinated approach)
• Wayfinding systems (interior design, landscaping, signs, printed and digital information, lighting and art).

(NSW Health 2022)

4. Reduce Unnecessary Stimulation

Well-designed facilities can assist clinicians to provide the correct amount of engagement or stimulation for patients who have mental health issues. By reducing unnecessary stimulation, these spaces can also simplify the environment for those who have cognitive impairment (ACSQHC 2021).

The environment should be designed in a way that minimises stimuli that are not helpful to patients, e.g. clutter and posters. Audio stimuli can also be reduced, e.g. through the use of sound-absorbing ceilings, walls and flooring; and reduced equipment noise where possible (Berry & Hamilton 2018).

Further Guidelines to Meeting the NSQHS Clinical Governance Standard

The health service organisation should:

• Increase safety and quality of care through implementing effective environment design and maintaining fit-for-purpose buildings, plant, equipment, utilities, devices and other infrastructure.
• Pinpoint areas in the facility with a greater potential for unpredictable behaviours and develop strategies to minimise the risks of harm for all patrons; it should also grant access to calm, quiet environments when clinically required.
• Improve access to services and facilities by providing signage and directions that are easily understood and fit for purpose.
• Have after-hours patient admission processes that allow flexible visiting arrangements to meet patients’ needs and preferences (when it is safe to do so).
• Provide an environment that is welcoming of and acknowledges the importance of the cultural beliefs and practices of Aboriginal and Torres Strait Islander Peoples.

(ACSQHC 2021)