WHAT IS HUMAN-CENTERED SAFETY®?
Human-Centered Safety® is an integrated design approach, which specifically addresses the complex needs of today’s behavioral health centers.
This integrated approach puts the safety and security of patients, families, staff and providers at the center of the design process while creating a compassionate and healing environment. It looks at care through a comprehensive and holistic view, seeing safety and security as seamless elements enhancing the care environment and enabling staff to focus on the first priority – delivering the most compassionate and effective care.
An optimal treatment environment is one that creates a safe, therapeutic, healing place through the appropriate use of safety devices, technology and staff safety protocols, designed in harmony through careful use of color, light, textures, architectural design, clinical programming and a positive staff culture.
HUMAN-CENTERED SAFETY® INITIATIVES
The Human-Centered Safety® approach has been developed over many years with the insights, ideas and experiences from dedicated care teams, patient and family focus groups, and the architectural and design professionals at BWBR. Incorporating safety issues throughout the design process has proven to be the most effective way to create safe, healing concepts of behavioral care and innovate behavioral healthcare design. Some of the goals and initiatives guiding Human-Centered Safety® include:
- Go beyond anti-ligature applications of hardware solutions.
- Reduce the negative stigma of behavioral health through a compassionate and thoughtful design approach.
- Establish a clear and comprehensive vision to create a healing and safe environment for people suffering from behavioral health issues.
- Design an extraordinary workplace for caring, professional staff to feel safe and find a supportive and collaborative environment for delivering effective care.
- Generate a thoughtful and responsive health care experience from patient, family, and care-giver’s point of view.
- Connect and integrate all elements of a care environment: medical models, provider needs, security, facility maintenance, and institutional culture.
Creating safe environments for behavioral health is much more than deterring sentinel events through the selection of appropriate hardware. It requires a dedication to include safety in every dialogue about the design of a facility.
Looking at care that begins from the moment a patient enters a facility, good design inspires people to imagine a renewed attitude and commitment to support the physical and emotional safety of both patients and the care team.
There are six critical Categories of Focus to strategically and creatively integrate safety through the design process:
Environments for De-Escalation (Calm)
Access is about setting a positive and safe feeling for the first and last impression of a behavioral health facility. It takes a deliberate design effort to support an authentic and nurturing relationship between patients, their families and the care team.
Access is both physical and emotional – how people engage with behavior health care facilities. It is an experiential and practical approach at the points of entry and exit. Because front doors do more than unlock and open, Access is about setting a tone and developing a safe and seamless flow for care.
- Caring/healing/calm/welcoming/dignified/reduced negative stigma
- Designed for individuals in crisis
- Universal design approach
- Secure portal to care
- Light-filled, colorful, quiet, safe/secure
- Access to nature
- Create places of choice/normalization
- Intentional spaces for exercise, meditation, wellness and healing
- Controlled experience for facility support (food service, housekeeping, maintenance)
SECURE EXTERNAL INTAKE
- Law enforcement
Connections is about the continuum of care and how safety and compassion coexist within a behavioral health care environment. It recognizes the dynamic relationship of a healing environment to safe and effective care.
Connections is creating intuitive design solutions between care spaces by establishing intentional thresholds and transitions, designing clear and safe sightlines, and planning for future adaptability.
EASE OF MOVEMENT
- Clear connections from space to space
- Thinking beyond ‘corridor concepts’
- Ability to gather as a group and for individual care
INTENTIONAL THRESHOLDS & TRANSITIONS
- Designed transitions from one space to another
- Place-making strategies for spaces
- Places of refuge for patients and staff
- Nurse stations central to easily observe, hear and react
- Removal of hiding places/alcoves
- Visual connections between staff
DYNAMIC SPACE PLANNING
- Logical layout of shared and private spaces — encourage patient-staff relationship-building: Patient/Staff Care Partnership
- Adaptable 24/7 planning model
- Destination Spaces to promote patient movement
PLANNING FOR REDUCED AREAS OF RESTRICTIONS, BOTTLENECKS & CONGESTION
- Secure portal to care
- Light-filled, colorful, quiet, safe/secure
Technology can be a powerful tool for safety.
Technology is a key component in designing a secure facility that is healing and dignified. Seamless and unobtrusive, technology connects, supports and enables staff to do their best work…safely. It can create a “smart” facility to protect patients and provide choice and control.
INTEGRATED TECHNOLOGY FOR SEAMLESS OBSERVATION/MONITORING
- Staff communication
- Wearable panic alarms/staff locators
- Connection to building security systems
- Tele-psych/tele-court solutions
- Space sensors for movement
- Intuitive controls of air, temperature and light
AUTOMATED/SMART ENVIRONMENT/’INTERNET OF THINGS’
- Interactive architectural elements: doors, thresholds, water, windows, beds, power
- TV Programming monitoring (violence/disturbing imagery)
- iPad technology
- Real time access to EMR
ENVIRONMENTS FOR DE-ESCALATION
A calm, healing environment is a safe environment.
De-Escalation Design looks at environments empathetically from the view of a patient to understand and mitigate negative environmental triggers. By incorporating nature, natural light, and a sense of beauty into spaces, environments can help patients avoid negative triggers and gain a better understanding of one’s self.
DESIGN FOR CALM, HEALING SPACES
- Design environments with control choices — temperature, lighting, light color, clock/time, music
- Design themes that support — natural light materials, colors, textures, soft lighting; age/gender-specific issues
- Furniture layouts: non-vulnerable, safe, flexible
PROVIDE MULTIPLE LEVELS OF INTERVENTION
- Designed for variable patient acuity
- Relationship-building design solutions — ease of places for staff to quickly communicate with patients; respecting privacy/dignity; trigger-response design: noise, temperature, images, spatial congestion
ACCESS TO NATURE/NATURAL LIGHT
- Areas of respite for views, light, comfort and reflection
- Positive distractions of art, views, interactive elements
NON-INSTITUTIONAL, DURABLE DESIGN SOLUTIONS
- Softer design approach: not block walls or bars
- Quiet acoustics where possible
EMPATHETIC DESIGN APPROACH
- Design from a ‘crisis’ point of view
- Design from a caregiver’s point of view
- Immersion design
SENSORY DESIGN SOLUTIONS
- Music, light, aroma, textural therapies
- Sensory rooms, quiet rooms, meditation areas
Integrated Safeguards becomes part of the conversation early in the design process for safe patient care and secure environments. It goes beyond anti-ligature issues and solutions and allows staff to imagine a healthcare environment, one that is durable, safe and secure, that makes a positive impression.
The small and not-so-small elements that make a space complete can have some of the largest impacts to the design of safe and human-centered environments. Integrated Safeguards encompasses those elements, from handles that help staff open doors without losing control of patients to break-away doors and two-way hinged doors.
APPROPRIATE SAFETY HARDWARE/CONSTRUCTION
- Doors/door closures/windows
- Furniture elements/casework
- Wall construction
- Interactive technology, such as Wii fitness
TAMPER-RESISTANT DESIGN ELEMENTS
- Ceiling/ceiling access
- Flooring/base solutions
- Bathroom fixtures & accessories
- Kitchen/nourishment fixtures & equipment
Design is more than an outcome. It is a tool to create desired outcomes. With staff involved, they are empowered to know how to use the tool. An empowered staff is a staff confident that the environment will protect them, and that creates a compassionate and caring environment in which the staff experience will drive the patient experience.
Walk through the doors of a mental health facility, and the experience immediately begins. The question to answer is “whose experience?”
The Culture of a care team has a direct impact on the quality of the care environment and should be considered an integral part of the design process. The process, itself, has the power to affect institutional change. Bringing staff culture into the process enables positive team dynamics and fosters an innovative spirit.
- When staff feels safe, they can provide the right care
CARING/HEALING MEDICAL CARE MODEL
- Compassionate care model
- Partnership with patient and their family
- Collaborative, supportive, educated and mentored team
- Areas for staff to heal, mourn, celebrate, take a break
CRISIS INTERVENTION PHILOSOPHY AND STRATEGIES
- Relationships, talking, physical restraint
- Connected and aware of staff/patient issues
- Relationship with outside/community support: law enforcement/emergency/crisis services; hospital services for medically complex cases; social workers/care coordinators; integrative care
CULTURE OF CONSTANT IMPROVEMENT
- Dealing with constant change and patient needs
- Improvise and develop alternative strategies for care
HUMAN COMMISSIONING OF STAFF
- Purposeful/planned introduction of staff to the new environment
- ‘A day in the life’ experience simulations