The action states

The health service organisation maximises safety and quality of care:

  1. Through the design of the environment
  2. By maintaining buildings, plant, equipment, utilities, devices and other infrastructure that are fit for purpose

Intent

The physical environment supports safe and high-quality care and reflects the patient's clinical needs.

Reflective questions

How does the health service organisation ensure that the design of the environment supports the quality of patient care?

How does the health service organisation ensure that buildings and equipment are safe and maintained in good working order?

Key tasks

Regularly conduct environmental audits to see whether the environment is safe and promotes best practice

Implement a schedule of review to ensure that all buildings, plant and equipment are fit for purpose, safe and in good working order at all times.

Strategies for improvement

Hospitals

Develop maintenance strategies

Develop a comprehensive maintenance plan that includes:

  • clear and easy-to-use documentation of maintenance and repairs
  • records of all plant and equipment, including (as a minimum) the date of purchase, preventive maintenance schedule, location and serial number
  • details of routine and preventive maintenance performed for each item of equipment and plant, including electromedical equipment
  • records of dates when equipment is regularly tested to ensure its readiness, including information relating to generators and battery backup.

Where equipment is regularly tested to ensure its readiness, record these dates, including information relating to generators and battery backup.

Australian standards are available for devices and equipment, and these should be reflected in the organisation’s policies and procedures so that purchases, repairs and replacements are carried out following a specified standard. Similarly, the Building Code of Australia articulates the technical provisions for the design and construction of buildings and other structures throughout Australia, and should also be reflected in the organisation’s policies and procedures. Manufacturers also set guidelines for the use and tolerance of equipment and devices. Faulty devices may need to be reported (for example, to the Therapeutic Goods Administration) or may be subject to a recall.

Use evidence-based design principles to promote safe practice

The physical environment can have a major impact on safety and quality performance. Good design can contribute to safe and high-quality care by promoting safe practices and removing potential hazards. It can reduce healthcare-associated infections and medical errors1, improve patient and workforce satisfaction, and increase organisational performance.2

Consider the following design principles when redesigning or upgrading amenities:

  • Automating processes, if appropriate (for example, dispensing medicines, handwashing facilities)
  • Designing spaces to prevent adverse events (for example, removing tight corners, selecting appropriate furnishings and surfaces that can be easily decontaminated, providing enough lighting)1
  • Designing spaces to prevent adverse events relating to self-harm (for example, removing ligature points and installing safety glass, if relevant)
  • Designing rooms for scalability, adaptability and flexibility, which can help to minimise patient transfers and provide space for family members
  • Standardising the layout and placement of supplies and equipment in rooms to improve efficiency and reduce errors2
  • Providing information that is visible and easily accessible to patients and the workforce
  • Positioning nursing stations centrally on the ward to minimise workforce fatigue and maximise workforce overview
  • Using soft furnishings to reduce the impact of background noise on patients
  • Providing clearly marked signs, maps and instructions to help patients and visitors navigate the health service.

Examples of evidence

Select only examples currently in use:

  • Policy documents that describe the health service organisation’s
    • requirements for maintaining buildings, plant, equipment, utilities and devices
    • reporting lines and accountability for actions, including during emergency situations
  • Strategic plan for facilities and capital works
  • Maintenance schedule for buildings, equipment, utilities and devices
  • Audit results of compliance with maintenance schedules and inspections of equipment
  • Register of equipment that is assigned to meet individual patients’ needs
  • Audit results of the use of a pre-purchase checklist and risk assessment to identify suitability of all new equipment
  • Observation of design and use of the environment to reduce risks relating to self-harm (for example, removal of ligature points, collapsible curtain rails)
  • Observation that the different types of accommodation (for example, private and shared rooms, designated palliative care rooms, patient/ consumer/carer lounge) are allocated based on clinical need
  • Observation that the physical environment includes consideration of safety and quality (for example, interview rooms in high-risk areas that have double doors, use of CCTV surveillance, duress alarms, access to security services, a secure environment after hours)
  • Business continuity plan
  • Analysis of incident reports and action taken to deal with issues identified
  • Risk register and quality improvement plan that includes information from an analysis of incidents.

Day Procedure Services

Develop maintenance strategies

Develop a comprehensive maintenance plan that includes:

  • Clear and easy-to-use documentation of maintenance and repairs
  • Records of all plant and equipment, including (as a minimum) the date of purchase, preventive maintenance schedule, location and serial number
  • Details of routine and preventive maintenance performed for each item of equipment and plant, including electromedical equipment
  • Records of dates when equipment is regularly tested to ensure its readiness, including information relating to generators and battery backup.

When equipment is regularly tested to ensure its readiness, record these dates, including information relating to generators and battery backup.

Australian standards are available for devices and equipment, and these should be reflected in the organisation’s policies and procedures so that purchases, repairs and replacements are carried out following a specified standard. Similarly, the Building Code of Australia articulates the technical provisions for the design and construction of buildings and other structures throughout Australia, and should also be reflected in the organisation’s policies and procedures. Manufacturers also set guidelines for the use and tolerance of equipment and devices. Faulty devices may need to be reported (for example, to the Therapeutic Goods Administration) or may be subject to a recall.

Use evidence-based design principles to promote safe practice

The physical environment can have a major impact on safety and quality performance. Good design can contribute to safe and high-quality care by promoting safe practices and removing potential hazards. It can reduce healthcare-associated infections and medical errors1, improve patient and workforce satisfaction, and increase organisational performance.2

Consider the following design principles when redesigning or upgrading amenities:

  • Automating processes, if appropriate (for example, dispensing medicines, handwashing facilities)
  • Designing spaces to prevent adverse events (for example, removing tight corners, selecting appropriate furnishings and surfaces that can be easily decontaminated, providing enough lighting)1
  • Providing information that is visible and easily accessible to patients and the workforce
  • Using soft furnishings to reduce the impact of background noise on patients
  • Providing clearly marked signs, maps and instructions to help patients and visitors navigate the health service.

Examples of evidence

Select only examples currently in use:

  • Policy documents that describe the health service organisation’s
    • requirements for maintaining buildings, plant, equipment, utilities and devices
    • reporting lines and accountability for actions, including during emergency situations
  • Strategic plan for facilities and capital works
  • Maintenance schedule for buildings, equipment, utilities and devices
  • Audit results of compliance with maintenance schedules and inspections of equipment
  • Register of equipment that is assigned to meet individual patients’ needs
  • Audit results of the use of a pre-purchase checklist and risk assessment to identify suitability of all new equipment
  • Observation of design and use of the environment to reduce risks relating to self-harm (for example, removal of ligature points, collapsible curtain rails)
  • Observation that the different types of accommodation (for example, private and shared rooms, designated palliative care rooms, patient/consumer/carer lounge) are allocated based on clinical need
  • Observation that the physical environment includes consideration of safety and quality (for example, interview rooms in high-risk areas that have double doors, use of CCTV surveillance, duress alarms, access to security services, a secure environment after hours)
  • Business continuity plan
  • Analysis of incident reports and action taken to deal with issues identified
  • Risk register and quality improvement plan that includes information from analysis of incidents.

MPS & Small Hospitals

MPSs and small hospitals need to consider the following design principles when redesigning or upgrading amenities:

  • Automating processes, if appropriate (for example, dispensing medicines, handwashing facilities)
  • Designing spaces to prevent adverse events (for example, removing tight corners, selecting appropriate furnishings and surfaces that can be easily decontaminated, providing enough lighting)1
  • Designing spaces to prevent adverse events relating to self-harm (for example, removing ligature points and installing safety glass, if relevant)
  • Designing rooms for scalability, adaptability and flexibility, which can help to minimise patient transfers and provide space for family members
  • Providing information that is visible and easily accessible to patients and the workforce
  • Using soft furnishings to reduce the impact of background noise on patients
  • Providing clearly marked signs, maps and instructions to help patients and visitors navigate the health service.

MPSs and small hospitals also need to:

  • Regularly conduct environmental audits to see whether the environment is safe and promotes best practice
  • Implement a schedule of review to ensure that all buildings, plant and equipment are fit for purpose, safe and in good working order at all times
  • Develop a comprehensive maintenance plan that includes
    • clear and easy-to-use documentation of maintenance and repairs
    • records of all plant and equipment, including (as a minimum) the date of purchase, preventive maintenance schedule, location and serial number
    • details of routine and preventive maintenance performed for each item of equipment and plant, including electromedical equipment
    • records of dates when equipment is regularly tested to ensure its readiness, including information relating to generators and battery backup.

Australian standards are available for devices and equipment, and these should be reflected in the organisation’s policies and procedures so that purchases, repairs and replacements are carried out following a specified standard. Similarly, the Building Code of Australia articulates the technical provisions for the design and construction of buildings and other structures throughout Australia, and should also be reflected in the organisation’s policies and procedures.

Examples of evidence

Select only examples currently in use:

  • Policy documents that describe the health service organisation’s
    • requirements for maintaining buildings, plant, equipment, utilities and devices
    • reporting lines and accountability for actions, including during emergency situations
  • Strategic plan for facilities and capital works
  • Maintenance schedule for buildings, equipment, utilities and devices
  • Audit results of compliance with maintenance schedules and inspections of equipment
  • Register of equipment that is assigned to meet individual patients’ needs
  • Audit results of the use of a pre-purchase checklist and risk assessment to identify suitability of all new equipment
  • Observation of design and use of the environment to reduce risks relating to self-harm (for example, removal of ligature points, collapsible curtain rails)
  • Observation that the different types of accommodation (for example, private and shared rooms, designated palliative care rooms, patient/ consumer/carer lounge) are allocated based on clinical need
  • Observation that the physical environment includes consideration of safety and quality (for example, interview rooms in high-risk areas that have double doors, use of CCTV surveillance, duress alarms, access to security services, a secure environment after hours)
  • Business continuity plan
  • Analysis of incident reports and action taken to deal with issues identified
  • Risk register and quality improvement plan that includes information from an analysis of incidents.

Hospitals

Develop maintenance strategies

Develop a comprehensive maintenance plan that includes:

  • clear and easy-to-use documentation of maintenance and repairs
  • records of all plant and equipment, including (as a minimum) the date of purchase, preventive maintenance schedule, location and serial number
  • details of routine and preventive maintenance performed for each item of equipment and plant, including electromedical equipment
  • records of dates when equipment is regularly tested to ensure its readiness, including information relating to generators and battery backup.

Where equipment is regularly tested to ensure its readiness, record these dates, including information relating to generators and battery backup.

Australian standards are available for devices and equipment, and these should be reflected in the organisation’s policies and procedures so that purchases, repairs and replacements are carried out following a specified standard. Similarly, the Building Code of Australia articulates the technical provisions for the design and construction of buildings and other structures throughout Australia, and should also be reflected in the organisation’s policies and procedures. Manufacturers also set guidelines for the use and tolerance of equipment and devices. Faulty devices may need to be reported (for example, to the Therapeutic Goods Administration) or may be subject to a recall.

Use evidence-based design principles to promote safe practice

The physical environment can have a major impact on safety and quality performance. Good design can contribute to safe and high-quality care by promoting safe practices and removing potential hazards. It can reduce healthcare-associated infections and medical errors1, improve patient and workforce satisfaction, and increase organisational performance.2

Consider the following design principles when redesigning or upgrading amenities:

  • Automating processes, if appropriate (for example, dispensing medicines, handwashing facilities)
  • Designing spaces to prevent adverse events (for example, removing tight corners, selecting appropriate furnishings and surfaces that can be easily decontaminated, providing enough lighting)1
  • Designing spaces to prevent adverse events relating to self-harm (for example, removing ligature points and installing safety glass, if relevant)
  • Designing rooms for scalability, adaptability and flexibility, which can help to minimise patient transfers and provide space for family members
  • Standardising the layout and placement of supplies and equipment in rooms to improve efficiency and reduce errors2
  • Providing information that is visible and easily accessible to patients and the workforce
  • Positioning nursing stations centrally on the ward to minimise workforce fatigue and maximise workforce overview
  • Using soft furnishings to reduce the impact of background noise on patients
  • Providing clearly marked signs, maps and instructions to help patients and visitors navigate the health service.

Examples of evidence

Select only examples currently in use:

  • Policy documents that describe the health service organisation’s
    • requirements for maintaining buildings, plant, equipment, utilities and devices
    • reporting lines and accountability for actions, including during emergency situations
  • Strategic plan for facilities and capital works
  • Maintenance schedule for buildings, equipment, utilities and devices
  • Audit results of compliance with maintenance schedules and inspections of equipment
  • Register of equipment that is assigned to meet individual patients’ needs
  • Audit results of the use of a pre-purchase checklist and risk assessment to identify suitability of all new equipment
  • Observation of design and use of the environment to reduce risks relating to self-harm (for example, removal of ligature points, collapsible curtain rails)
  • Observation that the different types of accommodation (for example, private and shared rooms, designated palliative care rooms, patient/ consumer/carer lounge) are allocated based on clinical need
  • Observation that the physical environment includes consideration of safety and quality (for example, interview rooms in high-risk areas that have double doors, use of CCTV surveillance, duress alarms, access to security services, a secure environment after hours)
  • Business continuity plan
  • Analysis of incident reports and action taken to deal with issues identified
  • Risk register and quality improvement plan that includes information from an analysis of incidents.

Day Procedure Services

Develop maintenance strategies

Develop a comprehensive maintenance plan that includes:

  • Clear and easy-to-use documentation of maintenance and repairs
  • Records of all plant and equipment, including (as a minimum) the date of purchase, preventive maintenance schedule, location and serial number
  • Details of routine and preventive maintenance performed for each item of equipment and plant, including electromedical equipment
  • Records of dates when equipment is regularly tested to ensure its readiness, including information relating to generators and battery backup.

When equipment is regularly tested to ensure its readiness, record these dates, including information relating to generators and battery backup.

Australian standards are available for devices and equipment, and these should be reflected in the organisation’s policies and procedures so that purchases, repairs and replacements are carried out following a specified standard. Similarly, the Building Code of Australia articulates the technical provisions for the design and construction of buildings and other structures throughout Australia, and should also be reflected in the organisation’s policies and procedures. Manufacturers also set guidelines for the use and tolerance of equipment and devices. Faulty devices may need to be reported (for example, to the Therapeutic Goods Administration) or may be subject to a recall.

Use evidence-based design principles to promote safe practice

The physical environment can have a major impact on safety and quality performance. Good design can contribute to safe and high-quality care by promoting safe practices and removing potential hazards. It can reduce healthcare-associated infections and medical errors1, improve patient and workforce satisfaction, and increase organisational performance.2

Consider the following design principles when redesigning or upgrading amenities:

  • Automating processes, if appropriate (for example, dispensing medicines, handwashing facilities)
  • Designing spaces to prevent adverse events (for example, removing tight corners, selecting appropriate furnishings and surfaces that can be easily decontaminated, providing enough lighting)1
  • Providing information that is visible and easily accessible to patients and the workforce
  • Using soft furnishings to reduce the impact of background noise on patients
  • Providing clearly marked signs, maps and instructions to help patients and visitors navigate the health service.

Examples of evidence

Select only examples currently in use:

  • Policy documents that describe the health service organisation’s
    • requirements for maintaining buildings, plant, equipment, utilities and devices
    • reporting lines and accountability for actions, including during emergency situations
  • Strategic plan for facilities and capital works
  • Maintenance schedule for buildings, equipment, utilities and devices
  • Audit results of compliance with maintenance schedules and inspections of equipment
  • Register of equipment that is assigned to meet individual patients’ needs
  • Audit results of the use of a pre-purchase checklist and risk assessment to identify suitability of all new equipment
  • Observation of design and use of the environment to reduce risks relating to self-harm (for example, removal of ligature points, collapsible curtain rails)
  • Observation that the different types of accommodation (for example, private and shared rooms, designated palliative care rooms, patient/consumer/carer lounge) are allocated based on clinical need
  • Observation that the physical environment includes consideration of safety and quality (for example, interview rooms in high-risk areas that have double doors, use of CCTV surveillance, duress alarms, access to security services, a secure environment after hours)
  • Business continuity plan
  • Analysis of incident reports and action taken to deal with issues identified
  • Risk register and quality improvement plan that includes information from analysis of incidents.

MPS & Small Hospitals

MPSs and small hospitals need to consider the following design principles when redesigning or upgrading amenities:

  • Automating processes, if appropriate (for example, dispensing medicines, handwashing facilities)
  • Designing spaces to prevent adverse events (for example, removing tight corners, selecting appropriate furnishings and surfaces that can be easily decontaminated, providing enough lighting)1
  • Designing spaces to prevent adverse events relating to self-harm (for example, removing ligature points and installing safety glass, if relevant)
  • Designing rooms for scalability, adaptability and flexibility, which can help to minimise patient transfers and provide space for family members
  • Providing information that is visible and easily accessible to patients and the workforce
  • Using soft furnishings to reduce the impact of background noise on patients
  • Providing clearly marked signs, maps and instructions to help patients and visitors navigate the health service.

MPSs and small hospitals also need to:

  • Regularly conduct environmental audits to see whether the environment is safe and promotes best practice
  • Implement a schedule of review to ensure that all buildings, plant and equipment are fit for purpose, safe and in good working order at all times
  • Develop a comprehensive maintenance plan that includes
    • clear and easy-to-use documentation of maintenance and repairs
    • records of all plant and equipment, including (as a minimum) the date of purchase, preventive maintenance schedule, location and serial number
    • details of routine and preventive maintenance performed for each item of equipment and plant, including electromedical equipment
    • records of dates when equipment is regularly tested to ensure its readiness, including information relating to generators and battery backup.

Australian standards are available for devices and equipment, and these should be reflected in the organisation’s policies and procedures so that purchases, repairs and replacements are carried out following a specified standard. Similarly, the Building Code of Australia articulates the technical provisions for the design and construction of buildings and other structures throughout Australia, and should also be reflected in the organisation’s policies and procedures.

Examples of evidence

Select only examples currently in use:

  • Policy documents that describe the health service organisation’s
    • requirements for maintaining buildings, plant, equipment, utilities and devices
    • reporting lines and accountability for actions, including during emergency situations
  • Strategic plan for facilities and capital works
  • Maintenance schedule for buildings, equipment, utilities and devices
  • Audit results of compliance with maintenance schedules and inspections of equipment
  • Register of equipment that is assigned to meet individual patients’ needs
  • Audit results of the use of a pre-purchase checklist and risk assessment to identify suitability of all new equipment
  • Observation of design and use of the environment to reduce risks relating to self-harm (for example, removal of ligature points, collapsible curtain rails)
  • Observation that the different types of accommodation (for example, private and shared rooms, designated palliative care rooms, patient/ consumer/carer lounge) are allocated based on clinical need
  • Observation that the physical environment includes consideration of safety and quality (for example, interview rooms in high-risk areas that have double doors, use of CCTV surveillance, duress alarms, access to security services, a secure environment after hours)
  • Business continuity plan
  • Analysis of incident reports and action taken to deal with issues identified
  • Risk register and quality improvement plan that includes information from an analysis of incidents.

References

  1. Huisman ERCM, Morales E, van Hoof J, Kort HSM. Healing environment: a review of the impact of physical environmental factors on users. Build Environ 2012;58:70–80.
  2. Reiling J, Hughes R, Murphy M. The impact of facility design on patient safety. In: Hughes RG, editor. Patient safety and quality: an evidence-based handbook for nurses. Rockville (MD): Agency for Healthcare Research and Quality; 2008.