DHHS, Agency for Healthcare Research and Quality (AHRQ)

Lewin contact: Clifford Goodman

Several noteworthy reports that have been released in the past few years raise troubling concerns about the quality and safety of health care in the United States. Many factors may contribute to the shortfalls in quality, including the way care is delivered and the adequacy of the facility within which that care takes place. A body of evidence is developing about how attributes of the various environments in which health care is provided mediate health care quality. Consistent with the growing movement to apply clinical evidence-based approaches to improve patient outcomes, hospital administrators and researchers also are placing greater emphasis on "evidence-based design" to support and facilitate clinical advances in the field. This is a process for creating hospital environments that is informed by the best available evidence concerning how the physical environment can affect patient outcomes, patient safety and satisfaction, and hospital staff safety and satisfaction. However, the field is relatively new, evidence supporting this approach is not yet robust in many areas and existing research on evidence-based hospital design is not widely known among policymakers, regulators and other decision makers and opinion leaders. This environmental scan is intended to assess what is and is not known about the relationships between hospital design and construction—the built environment—and patient outcomes and satisfaction, and staff working conditions. It discusses the following issues: What is currently driving the market for hospital design and construction? To what extent are hospitals requesting evidence-based designs? What is the research base for the hospital built environment? What are major challenges in building the field of evidence-based hospital design? What are the major gaps in current research and relevant areas of future focus? What are appropriate roles for funders of health services research interested in furthering improvements within the built environment?

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