Physical Environment in Crossing the Quality Chasm

Shordy following release of the To Err is Human report exposing serious threats to patient safety, the Institute of Medicine (10M) released a second report, Crossing the Quality Chasm,' which revealed other problems in our health care system. Not only was rhe health care system shown to be zmm!e, with needless numbers of patient deaths and injuries, it was found to be inef jective, with an overuse of unnecessary tests and underuse of necessary services; inefficient, with considerable waste of supplies, equipment, and human effort; untimelv, with respect to prolonged wait times and harmful delays; not patient-centered, because patient preferences and values go unrecognized; and not equitable, given the disparities of care that exist fl1r minority groups and other subsets ofthe population. Taken collectively, these disturbing departures from quality led the 10M to conclude that separating the health care we have and the health care we should be receiving is not just a gap but a chasm. Concurrent with eHorts to identify and bring under control the most prevalent and serious departures from quality has been a less tecognized yet exceedingly relevant area of research that focuses on the physical environment and how its design can serve to facilitate or impede the quality of care that patients receive as well as the quality of work life for their providers. Many of the existing hospitals in the United States, spawned by the Hill-Hurton program after World War II to support a growing and shifring population, are showing their age. With advances in technology and heightened patient expectations. acute med-