Hessam Sadatsafavi

Evidence-Based and Value-Based Decision Making About Healthcare Design An Economic Evaluation of the Safety and Quality Outcomes

Objective: This study describes a vision and framework that can facilitate the implementation of evidence-based design (EBD), scientific knowledge base into the process of the design, construction, and operation of healthcare facilities and clarify the related safety and quality outcomes for the stakeholders. The proposed framework pairs EBD with value-driven decision making and aims to improve communication among stakeholders by providing a common analytical language. Background: Recent EBD research indicates that the design and operation of healthcare facilities contribute to an organization’s operational success by improving safety, quality, and efficiency. However, because little information is available about the financial returns of evidence-based investments, such investments are readily eliminated during the capital-investment decision-making process. Method: To model the proposed framework, we used engineering economy tools to evaluate the return on investments in six successful cases, identified by a literature review, in which facility design and operation interventions resulted in reductions in hospital-acquired infections, patient falls, staff injuries, and patient anxiety. Results: In the evidence-based cases, calculated net present values, internal rates of return, and payback periods indicated that the long-term benefits of interventions substantially outweighed the intervention costs. This article explained a framework to develop a research-based and value-based communication language on specific interventions along the planning, design and construction, operation, and evaluation stages. Conclusions: Evidence-based and value-based design frameworks can be applied to communicate the life-cycle costs and savings of EBD interventions to stakeholders, thereby contributing to more informed decision makings and the optimization of healthcare infrastructures.

Do cost savings from reductions in nosocomial infections justify additional costs of single-bed rooms in intensive care units? A simulation case study

PURPOSE Evidence shows that single-patient rooms can play an important role in preventing cross-transmission and reducing nosocomial infections in intensive care units (ICUs). This case study investigated whether cost savings from reductions in nosocomial infections justify the additional construction and operation costs of single-bed rooms in ICUs. MATERIALS AND METHODS We conducted deterministic and probabilistic return-on-investment analyses of converting the space occupied by open-bay rooms to single-bed rooms in an exemplary ICU. We used the findings of a study of an actual ICU in which the association between the locations of patients in single-bed vs open-bay rooms with infection risk was evaluated. RESULTS Despite uncertainty in the estimates of costs, infection risks, and length of stay, the cost savings from the reduction of nosocomial infections in single-bed rooms in this case substantially outweighed additional construction and operation expenses. The mean value of internal rate of return over a 5-year analysis period was 56.18% (95% credible interval, 55.34%-57.02%). CONCLUSIONS This case study shows that although single-patient rooms are more costly to build and operate, they can result in substantial savings compared with open-bay rooms by avoiding costs associated with nosocomial infections.

Factors influencing evaluation of patient areas, work spaces, and staff areas by healthcare professionals

Previous research reported that healthcare professionals rate the physical work environment more negatively than other characteristics of the environment. This study investigated salient dimensions of employees’ perceptions of healthcare facilities and differences across demographic groups. A total of 496 healthcare professionals from eight acute care hospitals participated in this cross-sectional study. Employees’ perceptions of 27 different architectural and physical features in patient areas, work spaces, and staff areas were measured. Common factors were extracted through principal component analysis, levels of association between employees’ perceptions and each architectural and physical feature were determined through confirmatory factor analysis, and differences across demographic groups were defined through invariance analysis. Findings of this study highlight the importance of attention to caregiver needs for a safe and comfortable work environment via finishing materials, indoor air quality, and furniture design. In comparison, features that address the visual quality of the work environment, such as window views and artwork, were found to have smaller associations with positive evaluations by employees. However, in non-clinical staff areas, employees appreciate features improving the visual quality of their rest area. The study also found that younger employees and those newer to the facility would appreciate improvements in the architectural/physical features to a greater extent.

Alert Workplace From Healthcare Workers’ Perspective: Behavioral and Environmental Strategies to Improve Vigilance and Alertness in Healthcare Settings:

Objective: This study aims to identify the behavioral and environmental strategies that healthcare workers view as helpful for managing sleepiness, improving alertness, and therefore optimizing workplace safety. Background: Reduced alertness is a common issue in healthcare work environments and is associated with impaired cognitive performance and decision-making ability as well as increased errors and injuries. Method: We surveyed 136 healthcare professionals at a primary care clinic, an acute care hospital, and a mental health clinic. Nonstructured, semistructured, and structured questionnaires were used to elicit relevant information which was analyzed using qualitative content analysis and logistic regression models, respectively. Results: In order by frequency of endorsement: dietary intervention; physical mobility; cognitive, sensory, or social stimulation; personal lifestyle strategies; and rest/nap opportunities were reported as behavioral strategies used to address workplace alertness. Compared to other environmental features, daylight and thermal comfort were perceived to be more important to addressing workplace alertness (p < .05). Conclusions: By optimizing the physical environment and organizational policies and providing education programs, we have an opportunity to support healthcare professionals in managing sleepiness and maintaining alertness at work. In addition, such system level interventions may reduce unhealthy choices such as frequent caffeine intake to keep alert. The development of multidisciplinary evidence-based guidelines is needed to address sleepiness and alertness to improve workplace safety in healthcare facilities.

Strategies to Improve Quality of Life at the End of Life: Interdisciplinary Team Perspectives:

This ethnographic study draws on the experiences of members of interdisciplinary care teams working with end-of-life care patients to identify strategies to improve quality of life through care practices. We surveyed 133 staff and volunteers (physicians, physician assistants, nurse practitioners, registered nurses, social workers, chaplains, administrators, and volunteers) who provide end-of-life care to patients in both home and institutional settings for 4 organizations in 2 counties in Upstate New York. Survey responses were analyzed using qualitative content analysis. The results identified numerous strategies to enhance and safeguard quality of life for end-of-life care patients and their family members. These strategies can be categorized into 6 domains: organization philosophy and mission; organizational policies; caregivers’ behaviors and practices; symptom management; facility design, operation and management; and patient, family member, and caregiver experience. The diverse list of identified strategies indicates that improving care to address the unique, complex, multilayered dimensions of quality of life at the end of life requires a multidisciplinary approach and consistency among care providers, including administration, clinical management, front-line caregivers, and support staff. When all of these strategies are used in harmony, care can truly be enhanced.

Probabilistic Return-on-Investment Analysis of Single-Family Versus Open-Bay Rooms in Neonatal Intensive Care Units—Synthesis and Evaluation of Early Evidence on Nosocomial Infections, Length of Stay, and Direct Cost of Care

Background: There is increasing evidence that the physical environment of neonatal intensive care units (NICUs), including single-family rooms (SFRs) versus open-bay rooms (OPBYs), has tangible effects on vulnerable patients. The objective of this study was to illustrate the financial implications of SFR versus OPBY units by synthesizing and evaluating the evidence regarding the benefits and costs of each unit from a hospital perspective. Methods: We assumed a hypothetical NICU with 40 beds in OPBY rooms, to be replaced with a new NICU with 32 SFRs and 8 OPBYs. We synthesized evidence regarding the comparative benefit of each option on 3 outcomes—nosocomial infections, length of stay, and direct costs. We calculated incremental benefit-cost ratio separately considering each outcome over an analysis period of 5 years. A ratio of more than 1 indicates that the investment is worthwhile. Input parameters were assigned probability distributions representing the degree of uncertainty around their true values. Monte Carlo simulation with 5000 iterations was used to quantify the distribution of benefits and costs. Results: The mean value of the incremental benefit–cost ratio was 0.730 (95% credible interval: 0.724-0.735) when nosocomial infections were considered, 1.298 (1.282-1.315) when reduced length of stay was considered, and 1.794 (1.783-1.804) when direct costs of care were compared. The probability of a benefit–cost ratio of lower than 1 was about 91%, 31%, and 2% in each case, respectively. Conclusion: Cost savings associated with SFR units would justify additional construction and operation costs compared to OPBY units only when evidence on inclusive outcomes such as length of stay or direct costs of care is considered. A specific outcome such as infection rate potentially fails to capture all benefits of SFRs. As more evidence becomes available on full benefits and hazards of SFRs versus OPBYs, future studies should investigate the broader return-on-investment outcomes.

Effective Communication Practices for Implementing ERP for a Large Transportation Agency

AbstractState transportation agencies have implemented enterprise resource planning (ERP) for real-time access to financial and human resource information across divisions and districts. In 2013, the Texas Department of Transportation (TxDOT) started the transition of 22 mainframe and legacy applications to an enterprise-wide computing environment, comprised of four areas of business: payroll, human resources, supply chain, and finance. The fragmented nature of the organization, limited budget, and short time frame created various challenges. Using data collected though an organization-wide survey of employees and targeted follow-up interviews, this study identifies key change management and communication strategies adopted by TxDOT and lessons learned from the ERP implementation. Successful drivers include the unique makeup of the implementation team, top-management support, change management activities that promoted awareness, use of ambassadors to further break down the communication barrier, and measu...

Megaproject Success: Hoover Dam Construction and Pre-Construction Management Ingenuity

Construction of the Hoover Dam was the largest public project in the United States to date and ushered in an age of infrastructure megaprojects by federal agencies. Confronting technical, organizational, and physical risks, the Hoover Dam was delivered two years ahead of schedule and within the budgeted cost for construction. The technical challenges and successful results for this megaproject are well documented but the pre-construction planning and construction management innovations have received little attention. In retrospect, the Hoover Dam remains unique as it created the mold of structuring the relationship between government requirements and private-sector expertise to successfully deliver on megaproject objectives, cost, and schedule. Modern megaproject construction, pre-project planning, and construction management often do not follow the Hoover Dam best practices that incorporated ingenuity and creativity. The best practices and lessons learned during the planning and construction of the Hoover Dam can and should be applied to current and future federal megaprojects.

Preparing for the Future of Transportation Construction: Strategies for State Transportation Agencies

AbstractThe objective of this paper is to develop a conceptual framework that explains the implications and corresponding strategies of changes for state transportation agencies (STAs) to ensure long-term satisfactory performance in the area of construction. The researchers used their collective knowledge to identify key drivers of change using the systems dynamic methodology and their implications in the context of a range of plausible futures using the scenario planning methodology. The implications were then used to develop strategies to meet the future needs of STAs. The findings suggest that commonly in all scenarios, sustainability, information technology, workforce training, and innovative financing should have priority for STAs. Technology supports sustainable construction practices, while technology development requires an adequate level of funding and human interface. As a result, effective training programs are needed. Public-private partnerships were also identified as a strategy that can prov...