Understanding the Heterogeneity of Labor and Delivery Units: Using Design Thinking Methodology to Assess Environmental Factors that Contribute to Safety in Childbirth

Abstract

Objective There is limited research exploring the relationship between design and patient safety outcomes, especially in maternal and neonatal care. We employed design thinking methodology to understand how the design of labor and delivery units impacts safety and identified spaces and systems where improvements are needed.

Study Design Site visits were conducted at 10 labor and delivery units in California. A multidisciplinary team collected data through observations, measurements, and clinician interviews. In parallel, research was conducted regarding current standards and codes for building new hospitals.

Results Designs of labor and delivery units are heterogeneous, lacking in consistency regarding environmental factors that may impact safety and outcomes. Building codes do not take into consideration workflow, human factors, and patient and clinician experience. Attitude of hospital staff may contribute to improving safety through design. Three areas in need of improvement and actionable through design emerged: (1) blood availability for hemorrhage management, (2) appropriate space for neonatal resuscitation, and (3) restocking and organization methods of equipment and supplies.

Conclusion Design thinking could be implemented at various stages of health care facility building projects and during retrofits of existing units. Through this approach, we may be able to improve hospital systems and environmental factors.

Keywords

design thinking - neonatology - obstetrics - labor and delivery - hospital design - environmental factors

^* Members of the Safety Learning Laboratory for Neonatal and Maternal Care are listed in [Supplementary Material] (available in the online version).

• References

• 1 Pfuntner A, Wier LM, Stocks C. Most Frequent Conditions in U.S. Hospitals, 2010: Statistical Brief #148. Rockville, MD: Agency for Healthcare Research and Quality; 2013
• 2 Makary MA, Daniel M. Medical error-the third leading cause of death in the US. BMJ 2016; 353: i2139
• 3 Kohn LT, Corrigan JM, Donaldson MS. , eds. To Err Is Human: Building a Safer Health System. Washington, DC: National Academies Press; 2000
• 4 The California Pregnancy-Associated Mortality Review. Report from 2002 and 2003 Maternal Death Reviews. Sacramento, CA: Department of Public Health, Maternal, Child and Adolescent Health Division; 2011
• 5 Reason J. Human Error. Cambridge, England: Cambridge University Press; 1990
• 6 Reason J. Human error: models and management. BMJ 2000; 320 (7237): 768-770
• 7 Downe S, Stringer E. Formative research and development of innovative tools for “Better Outcomes in Labour Difficulty” (BOLD). Int J Gynecol Obstet 2017; 139 (S1): e1-e4 , 1–73
• 8 Pourdehnad J, Wexler ER, Wilson DV. Systems & Design Thinking: A Conceptual Framework for Their Integration. Organizational Dynamics Working Papers 10. University City, PA University of Pennsylvania 2011
• 9 School Sd. A virtual crash course in design thinking. 2017 . Available at: https://dschool.stanford.edu/resources-collections/a-virtual-crash-course-in-design-thinking . Accessed September 27, 2017
• 10 Hasso Plattner Institute of Design at Stanford. An introduction to design thinking PROCESS GUIDE. 2017 . Available at: https://dschool-old.stanford.edu/sandbox/groups/designresources/wiki/36873/attachments/74b3d/ModeGuideBOOTCAMP2010L.pdf . Accessed December 13, 2018
• 11 Kalaichandran A. Design thinking for doctors and nurses. 2017 . Available at: https://www.nytimes.com/2017/08/03/well/live/design-thinking-for-doctors-and-nurses.html . Accessed December 13, 2018
• 12 Johns Hopkins Medicine. How we apply design thinking. . Available at: https://www.hopkinsmedicine.org/technology_innovation/what_we_do/design_thinking.html . Accessed December 13, 2018
• 13 Medical Design UVA. At UVA's medical design program, we train tomorrow's physicians in design thinking to address the challenges of our changing health system. 2018 . Available at: http://uvamedical.design/ . Accessed December 13, 2018
• 14 Sherman J. Redesigning healthcare. Available at: http://www.redesignhealthcare.org/ . Accessed December 13, 2018
• 15 Joseph A. The role of the physical and social environment in promoting health, safety, and effectiveness in the healthcare workplace. Concord, CA: The Center for Health Design; 2006
• 16 Labs A. Designing Capacity for high value healthcare: the impact of design on clinical care in childbirth. 2017 . Available at: https://www.ariadnelabs.org/wp-content/uploads/sites/2/2017/04/170223_Ariadne-Report_Final.pdf . Accessed December 13, 2018
• 17 Austin N, Kristensen-Cabrera A, Sherman J. , et al. Analyzing the heterogeneity of labor and delivery units: a quantitative analysis of space and design. PLoS One 2018; 13 (12) e0209339
• 18 Facilities Guidelines Institute. Guidelines for Design and Construction of Hospitals and Outpatient Facilities. Chicago, IL: American Society for Healthcare Engineering; 2018. Available at: https://www.fgiguidelines.org/guidelines/2018-fgi-guidelines/ . Accessed April 14, 2019
• 19 Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press; 2001
• 20 Menard MK, Kilpatrick S, Saade G. , et al; American College of Obstetricians and Gynecologists and Society for Maternal–Fetal Medicine. Levels of maternal care. Am J Obstet Gynecol 2015; 212 (03) 259-271
• 21 Joseph AQ, Xiaobo Q, Taylor E, Jelen M. Designing for patient safety: developing methods to integrate patient safety concerns in the design process. The Center for Health Design; 2011 . Available at: https://www.healthdesign.org/sites/default/files/chd416_ahrqreport_final.pdf . Accessed December 13, 2018
• 22 Taylor E. FGI Guidelines Update #1: designing for safety. Facilities Guidelines Institute. 2013 . Available at: https://www.fgiguidelines.org/wp-content/uploads/2015/10/FGI_Update_SRA_130711.pdf . Accessed September 19, 2017
• 23 Stelfox HT, Palmisani S, Scurlock C, Orav EJ, Bates DW. The “To Err is Human” report and the patient safety literature. Qual Saf Health Care 2006; 15 (03) 174-178
• 24 Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion. Pregnancy mortality surveillance system. 2017 . Available at: https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-mortality-surveillance-system.htm . Accessed December 13, 2018
• 25 Austin N, Goldhaber-Fiebert S, Daniels K. , et al. Building comprehensive strategies for obstetric safety: simulation drills and communication. Anesth Analg 2016; 123 (05) 1181-1190
• 26 Finer NN, Rich W, Halamek LP, Leone TA. The delivery room of the future: the fetal and neonatal resuscitation and transition suite. Clin Perinatol 2012; 39 (04) 931-939
• 27 Leone TA, Rich W, Finer NN. A survey of delivery room resuscitation practices in the United States. Pediatrics 2006; 117 (02) e164-e175
• 28 Grundgeiger T, Harris B, Ford N, Abbey M, Sanderson PM, Venkatesh B. Emergency medical equipment storage: benefits of visual cues tested in field and simulated settings. Hum Factors 2014; 56 (05) 958-972
• 29 Lyndon A, Malana J, Hedli LC, Sherman J, Lee HC. Thematic analysis of women's perspectives on the meaning of safety during hospital-based birth. J Obstet Gynecol Neonatal Nurs 2018; 47 (03) 324-332