Critical Issues in Healthcare Environments

The catalyst for this study was the need to establish research agenda for healthcare environments. A critical step prior to selecting the important research questions, is establishing criteria and methods for the selection process. However, the choice of topics to be researched and the selection of interventions to be tested in healthcare environments are often determined by investigators and sponsors in a pre-scientific way.

This study focused on critical problem areas and unresolved issues as the universe of topics from which viable, important research questions can be generated. These questions can form a systematic, problem-driven research agenda. Ultimately, the research information will lead to more informed design, improved environments, and better healthcare.

The objective of the project was to identify and describe critical issues in three healthcare environments — hospital, ambulatory, and long-term care settings, specifically focusing on issues and problems which have a bearing on the physical environment.

A survey questionnaire was developed to address the study questions. The questionnaire was disseminated nationally via a web-based survey. The respondents could select to address one or more of three setting types — hospital, ambulatory, or long-term care environments. Respondents were asked to rank issues among and within six potential domains of issues, and add open-ended comments. The probes led to the last key question in the survey, “What is the most critical issue in healthcare environments?”

Participants in the survey included 639 individuals from 15 types of stakeholder groups, of which 443 addressed the hospital setting, 103 addressed the ambulatory care setting, and 93 addressed the long-term care setting.

The survey findings addressed four themes: critical issues, locations where problems occur, the relationship between problems across facility types, and how different stakeholders responded. Over 100 most critical issues in healthcare environments were identified. Top ranked problems included patient care and safety issues, such as hospital acquired infection (HAI), errors, and falls; patient and user satisfaction issues, such as reducing stress, increasing physical, social, and psychological comfort; and operational efficiency issues, focusing on patient care flow and care procedures. Specific places associated with either more or greater problems—or both—in all facilities were generally spaces where the most significant patient care was delivered, such as patients’ rooms, treatment and exam rooms, diagnostic and treatment spaces, preoperative and recovery spaces, and staff work areas. Waiting areas and parking areas were places where user satisfaction issues also became evident along with outdoor activity areas in long-term care. All settings shared many issues, but the extent and focus of shared problem areas varied significantly among care settings. In addition, each setting type had its own unique issues. The study revealed that different groups of stakeholders assessed differently many problems in healthcare environments.

By highlighting critical issues in need of intervention, the findings can also provide a road map for setting the priorities for research questions related to these interventions whenever new information and discovery are required.