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An agent for change.

The last few years have set the stage for enormous change. As the economy stabilizes in this new decade the beat of daily life will find a new rhythm. What will your rhythm be? Will you come out of this a changed person or will you become an agent for change?

At the HEALTHCARE DESIGN conference in Orlando, The Center for Health Design bestowed the honor of "Change-maker" to Eileen Malone, an agent for change within the Military Healthcare System and in the healthcare design industry through her work with the Evidence-Based Design Accreditation and Certification (EDAC) program. Below is an excerpt from remarks Eileen did not deliver at conference because of a timing issue, but they are worthy of being shared.

Thank you Debra, Roz, and Center's Board of Directors for this amazing honor. Frankly, I am quite humbled and overwhelmed, especially when I think of the phenomenal individuals with whom I have worked over the past four years to embrace and institutionalize evidence-based design (EBD). Let me begin by recognizing the members of the Military Healthcare System team and their many partners, to include staff from The Center for Health Design, design and construction team members, and countless healthcare industry colleagues.

Together, we have worked to begin creating the next generation of military healthcare facilities that embrace EBD to serve our nation's warriors and their families.

Through our journey together, I have come to appreciate what an EBD environment most represents--an important, but poorly recognized and even less understood healthcare quality improvement tool. Last month, I listened to an interview with US Airways Captain "Sully" Sullenberger, who described the 208 seconds he and his team had to make the right decisions to safely land his crippled plane on the icy Hudson River in New York City last January. Based on years of human factors research about the best cockpit design to support the best pilot response, a transformed airline industry culture unwilling to further enable accidents and fatalities, and reengineered protocols and processes ingrained with intense and frequent simulation training "Sully" and his co-pilot who he had only met three days before were able to execute a landing that safely delivered 155 people.


We can create similar healthcare environments that engender the same kind of safe and reliable responses during the most critical and high-risk episodes of care, as well as designing environments that reduce stress and enable healing during healthcare's more mundane moments--except that there are really no mundane moments from the patient's perspective. The trick is, how do we get there and the answer in my view is through partnerships and research. We must intensely partner with the healthcare quality improvement community--perfectly timed given the current national scrutiny. Collectively we can solve the most challenging issues, such as the fact that 4.5% of all hospitalized patients acquire an infection, patients are injured through falls and medical errors, staff time with patients is suboptimal and sometimes dangerous, and of course, cost--which now consumes 17% of the GDP. To accomplish this, we need to leave our comfortable silos and create multidisciplinary teams with members from clinical, healthcare, manufacturing, academic, and Federal organizations dedicated to improving the quality and cost of care through study and research.

Rigorous research remains the coin of the realm to incentivize the successful transformation of healthcare processes and politics. EBD research should be considered along its entire continuum from the rare randomized double-blind clinical trials appropriate to our focus all the way to the routine performance improvement activities that each healthcare organization completes to meet accreditation requirements. Many performance improvement checklists and processes have been developed and promulgated by national organizations such as the Institute for Healthcare Improvement and the National Quality Forum. Proven EBD features need to be included on those checklists and routinely considered for improvement. I fully understand the effort this will take. Performance improvement work is complex and challenging and change is the hardest thing we ask of any team, but it is possible, and the results are worth it.

I am indeed fortunate to enjoy the love and support of my husband Dale, who is with me today, and the rest of my family. In fact, it is my family's healthcare experiences that inspire me in this work. My mother contracted a drug resistant, hospital-acquired infection which hastened her demise from leukemia in 2005, and last year my brother -in-law developed acute respiratory distress requiring emergent intubation and another week in the ICU after contracting ventilator-acquired pneumonia as an unintended consequence of successful ground-breaking robotic surgery to remove a tumor at the base of his tongue. They were treated in two of the very best hospitals in this country by talented teams, who I can assure you did not wake up any of the mornings that they cared for my mother or Max and determine that they would not wash their hands as recommended. We can help the healthcare team to reflexively do the right things by creating healthcare environments which include proven evidence-based design features.

Change is never easy but I remain optimistic about the future given the promise of all of the initiatives underway to improve patient, staff, and resource outcomes. Our community has a singular opportunity to make substantial contributions to improve the quality of the most personal service provided--healthcare. So, if you arc new to the EBD community, welcome. Please get engaged with The Center to become smarter through the EDAC process and bring your multidisciplinary team members with you. Attending this conference is a great first step. And if you are an old hand and you have days when the Journey is difficult, remember your family and all the people you care about and let that thought give you the inspiration, energy, and focus to keep pushing forward to improve the quality of healthcare, the real value proposition. Because, as Captain Sullenberger would remind us, it is our highest duty.

Thank you,

Eileen B. Malone, RN, MSN, MS, EDAC

Congratulations, Eileen, for an award well deserved and for being an inspiration for those who will follow you as Agents for Change.

Rosalyn Cama, FASID, EDAC is Board Chair for The Center for Health Design located in Concord, California. For more information, visit www.

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Title Annotation:FROM THE CENTER
Author:Cama, Rosalyn
Publication:Healthcare Design
Geographic Code:1USA
Date:Jan 1, 2010
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