title: The business case for building better hospitals through evidence-based design.
abstract: OBJECTIVE
  After establishing the connection between building well-designed evidence-based facilities and improved safety and quality for patients, families, and staff, this article presents the compelling business case for doing so. It demonstrates why ongoing operating savings and initial capital costs must be analyzed and describes specific steps to ensure that design innovations are implemented effectively.
  
  
  BACKGROUND
  Hospital leaders and boards are now beginning to face a new reality: They can no longer tolerate preventable hospital-acquired conditions such as infections, falls, and injuries to staff or unnecessary intra-hospital patient transfers that can increase errors. Nor can they subject patients and families to noisy, confusing environments that increase anxiety and stress. They must effectively deploy all reasonable quality improvement techniques available. To be optimally effective, a variety of tactics must be combined and implemented in an integrated way. Hospital leadership must understand the clear connection between building well-designed healing environments and improved healthcare safety and quality for patients, families, and staff, as well as the compelling business case for doing so. Emerging pay-for-performance (P4P) methodologies that reward hospitals for quality and refuse to pay hospitals for the harm they cause (e.g., infections and falls) further strengthen this business case.
  
  
  CONCLUSIONS
  When planning to build a new hospital or to renovate an existing facility, healthcare leaders should address a key question: Will the proposed project incorporate all relevant and proven evidence-based design innovations to optimize patient safety, quality, and satisfaction as well as workforce safety, satisfaction, productivity, and energy efficiency? When conducting a business case analysis for a new project, hospital leaders should consider ongoing operating savings and the market share impact of evidence-based design interventions as well as initial capital costs. They should consider taking the 10 steps recommended to ensure an optimal, cost-effective hospital environment. A return-on-investment (ROI) framework is put forward for the use of individual organizations.
authors.affiliation: Rady Children's Hospital, San Diego, LaJolla, CA 92037, USA. bsadler@chsd.org
authors.forename: Blair L
authors.initials: BL
authors.lastname: Sadler
authors.forename: Jennifer
authors.initials: J
authors.lastname: DuBose
authors.forename: Craig
authors.initials: C
authors.lastname: Zimring
mesh_terms: D003132:Commerce; D003363:Cost Control; D055317:Evidence-Based Practice; D005377:Financial Management, Hospital; D006272:Health Facility Environment; D006749:Hospital Design and Construction / Q000191:economics*; D006801:Humans; D007857:Leadership; D019300:Medical Errors / Q000191:economics / Q000517:prevention & control; D019982:Organizational Case Studies; D061214:Patient Safety; D017060:Patient Satisfaction; D058996:Quality Improvement; D012052:Reimbursement, Incentive; D014481:United States