One difficulty in developing projects which focus on patient safety is that the trad- itional project delivery process is a major impediment. Among other problems, it is linear, curriculum based, and first cost focused.

The linear process builds small amounts of information  which may be relevant to the task at hand, but which ignore the system aspects of healthcare delivery. Too often design decisions are made solely on what was done before or material published in the most recent magazine. There is little incentive to look at long term costs and, even if there were, information needed to do the calculations is not developed at the time when it is needed.

To improve the process, one must imagine a new metaphor or paradigm. Instead of a line, consider a series of concentric rings. The focus of the rings is the system of care (and the subcomponents of that system). From the start of the project, all disciplines participate by developing and sharing information. This proceeds in phases, each represented by a separate ring. Succeeding phases contain more detailed and specific information, but no phase is considered complete until all relevant components of the system of care have been considered.

This organization assumes that all project participants start work at the same time. In the linear system, that is not the case and it is a source of many project problems as information discovered late in the process necessitates revising decisions and redoing work to meet the new requirements.

Selecting project members before the start of project work may occasion greater cost during the planning and design phase. It is not intuitively obvious why informaticists, human factors specialists, as well as engineers and architects might be needed during programming. When the project is viewed as a part of a complex and tightly coupled system of care and when the potential implications of mistakes in early project phases is considered, the wisdom of this approach should be more apparent.

Health Facility Design for Safety  - A New Paradigm

Another problem which plagues development of patient safety focused projects (we might even say all projects) is the inevitable focus on first costs. Combined with the certainty associated with the linear process that  something will be “forgotten” which must be accom- modated at the expense of some less “important” project features, this is a  significant problem. Often decisions are made about what to cut without input from clinicians and others who will be required to work in the downsized environments.

Some assume that these problems are “built in” to projects and cannot be eliminated or mitigated. One of our principal goals at Patient Safety Design Consultants is to help owners and facility managers craft the project organization and its supporting justification which will provide the collaboration needed to achieve better outcomes.