Using Evidence-Based Environmental Design to Enhance Safety and Quality

How to cite this paper:

Sadler BL, Joseph A, Keller A, Rostenberg B. Using Evidence-Based Environmental Design to Enhance Safety and Quality. IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2009. (Available on

Increasing evidence indicates a correlation between the physical environment in which patients receive their care and the safety and quality of that care, as well as the patient’s perception of that care. Similarly, there is a growing understanding of the connection between the environments in which people work and job satisfaction and stress.
The purpose of this paper is to show health care leaders how, as part of an integrated improvement strategy, evidence-based environmental design interventions can measurably enhance the care they provide, improve the perceptions of the experience of that care by patients, families, and staff, and actually have a positive economic impact on their organizations.
This paper aims to help bridge the gap between the worlds of safety and quality improvement and architectural and environmental design. The published literature in evidence-based environmental design, including references to two major reviews of that literature, is described.
A series of relatively low-cost recommendations are presented that virtually any health care organization should consider implementing. Recommendations that are best addressed as part of new facility construction or major renovation are also included. Examples of interventions for unit-specific microsystems are proposed, along with a facility checklist that any organization can use as a guide to determine whether its environment is actually helping or hindering care and the care experience.
A suggested framework for calculating the economic return on investment of an intervention or group of interventions is included, along with a discussion of how to balance initial, one-time capital expenditures with ongoing operating cost savings and revenue enhancement through market differentiation.
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