Blair L. Sadler

Evaluation of the built environment at a children's convalescent hospital: development of the Pediatric Quality of Life Inventory parent and staff satisfaction measures for pediatric health care facilities.

In preparation for the design, construction, and postoccupancy evaluation of a new Children’s Convalescent Hospital, focus groups were conducted and measurement instruments were developed to quantify and characterize parent and staff satisfaction with the built environment of the existing pediatric health care facility, a 30-year-old, 59-bed, long-term, skilled nursing facility dedicated to the care of medically fragile children with complex chronic conditions. The measurement instruments were designed in close collaboration with parents, staff, and senior management involved with the existing and planned facility. The objectives of the study were to develop pediatric measurement instruments that measured the following: (1) parent and staff satisfaction with the built environment of the existing pediatric health care facility, (2) parent satisfaction with the health care services provided to their child, and (3) staff satisfaction with their coworker relationships. The newly developed Pediatric Quality of Life Inventory™ scales demonstrated internal consistency reliability (average α = 0.92 parent report, 0.93 staff report) and initial construct validity. As anticipated, parents and staff were not satisfied with the existing facility, providing detailed qualitative and quantitative data input to the design of the planned facility and a baseline for postoccupancy evaluation of the new facility. Consistent with the a priori hypotheses, higher parent satisfaction with the built environment structure and aesthetics was associated with higher parent satisfaction with health care services (r = .54, p < .01; r = .59, p < .01, respectively). Higher staff satisfaction with the built environment structure and aesthetics was associated with higher coworker relationship satisfaction (r = .53; p < .001; r = .51; p < .01, respectively). The implications of the findings for the architectural design and evaluation of pediatric health care facilities are discussed.

The Role of the Physical Environment in Crossing the Quality Chasm

BACKGROUND Evidence-based design findings are available to help inform hospital decision makers of opportunities for ensuring that quality and safety are designed into new and refurbished facilities. FRAMEWORK FOR THE EVIDENCE The Institute of Medicines six quality aims of patient centeredness, safety, effectiveness, efficiency, timeliness, and equity provide an organizing framework for introducing a representative portion of the evidence. Design improvements include single-bed and variable-acuity rooms; electronic access to medical records; greater accommodation for families and visitors; handrails to prevent patient falls; standardization (room layout, equipment, and supplies for improved efficiencies); improved work process flow to reduce delays and wait times; and better assessment of changing demographics, disease conditions, and community needs for appropriately targeted health care services. THE BUSINESS CASE A recent analysis of the business case suggests that a slight, one-time incremental cost for ensuring safety and quality would be paid back in two to three years in the form of operational savings and increased revenues. Hospitals leaders anticipating new construction projects should take advantage of evidence-based design findings that have the potential of raising the quality of acute care for decades to come.

The Business Case for Building Better Hospitals Through Evidence-Based Design

Purpose: 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. Recommendations: 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.

Transplantation — A Case for Consent

Abstract The Uniform Anatomical Gift Act, drafted by the Commissioners on Uniform State Laws, provides a comprehensive and modern legal framework for the donation of human organs for medical research, education and therapy. Widespread adoption of the Act, which eliminates existing unnecessary legal formalities, will make available more human tissue for medical purposes. In building the Act on the principles of consent and voluntary donation, the Commissioners recognized and protected other important interests in a dead body. They further recognized that many nonlegal impediments to the procurement of organs exist that cannot be overcome by legislation but must be resolved. Because of this approach, the Act is widely supported by the medical and legal communities and the general public and will soon probably become the law of most states. Such acceptance obviates the need for more radical legislative measures that would eliminate the principles of consent and voluntary donation. Finally, legislation that d...

Implementing Healthcare Excellence: The Vital Role of the CEO in Evidence-Based Design

Purpose: This paper explores the role of the chief executive officer (CEO) in evidence-based design (EBD), discussing the internal and external challenges that a CEO faces, such as demands for increased quality, safety, patient-and-family-centeredness, increased revenue, and reduced cost. Background: Based on a series of interviews and case studies and the experience of the authors as researchers, consultants, and CEOs, this paper provides a model for EBD and recommends actions that a CEO can undertake to create an effective project over the life cycle of a building. Topical headings: Evidence-Based Design: A Performance-Based Approach to Achieving Key Goals; Key Approaches to Executing Evidence-Based Design; Overcoming Barriers to Innovation: The CEOs Vital Role in Implementing Evidence-Based Design Conclusions: The CEO bears special responsibility for successful facility project implementation. Only the CEO possesses the responsibility and authority to articulate the strategy, vision, goals, and resource constraints that frame every project. With the support of their boards, CEOs set the stage for the transformation of an organizations culture and fuel clinical and business process reengineering by encouraging and, if necessary, forcing collaboration between the strong disciplinary and departmental divisions found in healthcare systems.

A Community of Givers, Not Takers

The Sadlers defend the American system of organ procurement through voluntary donation against suggestions that cadaver organs should be routinely or even compulsorily salvaged to meet the need of expanding transplantation programs. They trace the legal history of procurement policy in the United States, outline the consent to donation provisions of the Uniform Anatomical Gift Act, discuss several mandatory alternatives for obtaining organs, and summarize the philosophical basis of consent. They argue that the current policy has accomplished its objectives of facilitating organ donation without infringing on other values and rights.

Transplantation and the Law: Progress toward Uniformity

Abstract New laws based on the Uniform Anatomical Gift Act had been enacted in 41 states as of February 9, 1970. Most of these states adopted the Uniform Act with little or no change. The few impor...

The physician's assistant--today and tomorrow : issues confronting new health practitioners

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How A Children’s Hospital Discovered Child Pornographers In Its Midst

A leading pediatric medical center learned a number of lessons about cybercriminals who prey on children—and found an ally in the nationwide Internet Crimes Against Children Task Forces.

Having Conversations about Organ Donation

While 90 percent of participants in a 2005 Gallup poll indicated that they would donate an organ if asked, only 40 percent of Americans have registered to do so, according to 2012 data from Donate Life America; likely even fewer have shared their donation wishes with loved ones. Undoubtedly, the single biggest reason for the discrepancy between the number of potential transplants and the number actually performed is our failure to talk with loved ones about our wishes regarding organ donation. Although many resources already exist to hold these conversations, we can do more, and the emergence of social media provides an intriguing new opportunity. Two years ago, Organize.org set out to create the first nationwide organ donation registry in the United States.