Special Issue "Improving Patient and Staff Safety through Evidence-Based Healthcare Design"

Special Issue Editors

Prof. Anjali Joseph
E-Mail Website
Guest Editor
Center for Health Facilities Design and Testing, School of Architecture, Clemson University, Clemson, SC 29634, USA
Interests: patient safety; evidence-based design; healthcare architecture; operating room design; simulation
Dr. Ellen Taylor
E-Mail Website
Assistant Guest Editor
The Center for Health Design, 1850 Gateway Blvd # 1083, Concord, CA 94520, USA
Interests: patient safety; evidence-based design; healthcare architecture; falls, safety risk assessment

Special Issue Information

Dear Colleagues,

In 2000, the Institute of Medicine (IOM) report “To Err is Human” shocked the world by highlighting the significant number of adverse events resulting in patient harm, injuries, and deaths in the US healthcare system. The IOM report emphasized that these events were often preventable, resulting not from the actions of individuals but as the result of faulty and poorly designed systems. A call to action was issued to improve patient safety through system design.

Twenty years later—where are we? The built environment is a critical component of system design for healthcare delivery, and in the early 2000s, the term evidence-based design (EBD) appeared. EBD is defined as the process of basing decisions about the built environment on credible evidence, with the goal of improving healthcare outcomes. Researchers in EBD focus on the role of facility design in improving patient and staff outcomes, including through safety, and the status of healthcare-associated infections, patient falls, medical errors, staff burnout, injuries, etc. Research on safety in EBD has evolved over 20 years, incorporating theories and methods from other fields including environmental psychology, human factors, and systems engineering. For this Special Issue, we invite theoretical, methodological, and empirical papers focused on improving patient and staff safety through the design of built environments.

Prof. Anjali Joseph
Dr. Ellen Taylor
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2300 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.


  • patient safety
  • staff safety
  • healthcare facility design
  • hospitals
  • evidence-based design
  • architecture
  • health systems
  • simulation
  • post-occupancy evaluation
  • teamwork

Published Papers

This special issue is now open for submission, see below for planned papers.

Planned Papers

The below list represents only planned manuscripts. Some of these manuscripts have not been received by the Editorial Office yet. Papers submitted to MDPI journals are subject to peer-review.

Title: The impact of surgical table rotations on flow disruptions in the operating room
Authors: Anjali Joseph; Sahar Mihandoust,; Kevin Taaffe
Affiliation: Center for Health Facilities Design and Testing, School of Architecture, Clemson University, Clemson, SC 29634, USA
Abstract: Operating rooms are particularly challenging environments and poor room and equipment ergonomics are a major factor impacting interruptions and flow disruptions and associated errors and surgical site infections (SSI) in the OR. The surgical table and the surrounding sterile field is the most critical and protected space in the OR and there are significant concerns around protecting the sterility of this space during a surgery. While operating rooms and the equipment in these rooms are often designed and aligned around the surgical table, the table itself is often moved in different ways during the procedure to support access to the patient or equipment. The purpose of this study is to understand how changes to the bed orientation during pediatric surgeries impacts flow disruptions during the surgery, intrusions into the surgical area as well as number of undesirable contacts between team members. Video recordings of 25 pediatric surgeries were coded to obtain information on bed positioning during intraoperative phase, flow disruptions and other outcomes of interest.

Title: Designing for Safety - A DEEP SCOPE Model
Authors: :Ellen Taylor; Sue Hignett
Affiliation: The Center for Health Design, 1850 Gateway Blvd # 1083, Concord, CA 94520, USA
Abstract: The aim of this paper is to theoretically explore how we think about the challenge of safety, more specifically mitigating the risk of patient falls through healthcare facility design. Thinking in patient safety has evolved over time from accident causation to more robust models of work system design. Throughout this evolution, there is less consideration given to the role of the built environment in effectively supporting safety goals. There is significant worth in discussing evidence-based design in healthcare facilities as a systems problem. We review the evolution of thinking in safety as a safety science. Using falls as a case study example, we focus on proactive thinking specific to healthcare facility design. We use a previously published model (SCOPE: Safety as Complexity of the Organization, People, and Environment) to develop an expanded framework inclusive of five HF/E design principles. The resulting theoretical model and matrix, DEEP SCOPE (DEsigning with Ergonomic Principles), provides a way to synthesize design interventions into a systems-based model for ergonomic healthcare facility design. The DEEP SCOPE framework establishes building design as an ergonomic problem by defining stability of built environment categories; identifying interventions in three interacting categories; and establishing connections to HF/E design principles. Using HF/E design principles is proposed to reframe designing safe healthcare facilities into an ergonomic problem of design that fits the environment to the user by understanding built environments that support the “human” factor.

Back to TopTop