Simulation-based clinical systems testing for healthcare spaces: from intake through implementation

Abstract

Healthcare systems are urged to build facilities that support safe and efficient delivery of care. Literature demonstrates that the built environment impacts patient safety. Design decisions made early in the planning process may introduce flaws into the system, known as latent safety threats (LSTs). Simulation-based clinical systems testing (SbCST) has successfully been incorporated in the post-construction evaluation process in order to identify LSTs prior to patient exposure and promote preparedness, easing the transition into newly built facilities. As the application of simulation in healthcare extends into the realm of process and systems testing, there is a need for a standardized approach by which to conduct SbCST in order to effectively evaluate newly built healthcare facilities. This paper describes a systemic approach by which to conduct SbCST and provides documentation and evaluation tools in order to develop, implement, and evaluate a newly built environment to identify LSTs and system inefficiencies prior to patient exposure.

Keywords: FMEA; Healthcare design; Latent safety threats; Patient Safety.

Fig. 1

Integration of safe design principles with Reason’s Swiss cheese model of system accidents. Reason’s Swiss cheese model describing how latent conditions and active failures combine to lead to an accident or error [3, 6]. Superscript number (1) indicates evidence-based safe design principles described by AHRQ and CHD [4, 18]