The Joint Commission Journal on Quality and Patient Safety The Role of the Physical Environment in Crossing the Quality Chasm Kerm Henriksen, Ph.D. I Sandi Isaacson, M.S.N., M.BA .1 Blair L. Sadler, J.D. Craig M. Zimring, Ph.D. j S hordy following release of the To Err is Human report exposing serious threats to patient safety, the Institute of Medicine (10M) released a second report, Crossing the Quality Chasm,' which revealed other problems in our health care system. Not only was rhe health care system shown to be zmm!e, with needless num- bers of patient deaths and injuries, it was found to be inef jective, with an overuse of unnecessary tests and underuse of necessary services; inefficient, with considerable waste of supplies, equipment, and human effort; untimelv, with respect to prolonged wait times and harmful delays; not patient-centered, because patient preferences and values go unrecognized; and not equitable, given the disparities of care that exist fl1r minority groups and other subsets ofthe population. Taken collectively, these disturbing departures from quality led the 10M to conclude that separating the health care we have and the health care we should be receiving is not just a gap but a chasm. Concurrent with eHorts to identify and bring under control the most prevalent and serious departures from quality has been a less tecognized yet exceedingly relevant area of research that focuses on the physical environment and how its design can serve to facilitate or impede the quality of care that patients receive as well as the quality of work life for their providers. Many of the existing hospi- tals in the United States, spawned by the Hill-Hurton pro- gram after World War II to support a growing and shifring population, are showing their age. With advances in tech- nology and heightened patient expectations. acute med- November 2007 Article-at-a-Glance Background: Evidence-based design findings are available to help inform hospital decision makers of opportunities for ensuring that quality and safety are designed into new and refurbished facilities. Framework for the Evidence: The Instirute of Medicine's six quality aims of patient centeredness, safety, effectiveness, efficiency, timeliness, and equity provide an organizing framework for introducing a representative portion of the evidence. Design improvements include si ngle-bed and variable-acuity rooms; electronic access to medical records; greater accommodation for families and visitors; handrails to prevent patient falls; standardization (room layoLlt, equipment, and supplies for improved effl- ciencies); improved work process flow to reduce delays and wait times; and better assessment of changing demograph- ics, disease conditions, and community needs for appro- priately targeted health care services. The Business Case: A recent analysis of the business case suggests that a slight, one-time incremental cost for ensuring safety and quality would be paid back in two to three years in the form of operational savings and increased revenues. Hospitals leaders anticipating new construction projects should take advantage of evidence- based design findings that have the potential of raising the quality of acute care for decades to come. Volume 33 Number 11 Supplement