Universal Design for

“Universal Design comple-

Health Care Facilities ments a patient-centered
Addressing Safety, Access to Care approach to care because it
for a Diverse Patient Population is a concept driven by
understanding the
magine an older man waiting in front as Universal Design. Also

I of the door to a health care facility

men’s room. He stands uncomfort-
ably for a few moments before it
referred to as universal access,
Universal Design is a con-
cept that, when applied to
individual patient’s
experience of care.”
—Paul Schyve, M.D.,
becomes obvious that he can no longer environments, ensures that
hold in his need to use the bathroom. As facilities, products, and senior vice president,
his pant leg dampens, he walks away services are usable by all peo- The Joint Commission
from the door in shame. This is a scene ple. “The heavy door to the
that James Terry observed on one of his men’s room is an example of
many visits to health care facilities across the often simple ways in
the country. “The man was gone before which Universal Design can eliminate well as the products that go into them.
it occurred to me what was happening,” barriers to patient care while improving As the principles of Universal
says Terry, who is a partner in the archi- patient safety in health care facilities,” Design propose, adhering to ADA
tecture and access compliance firm Evan says Terry. “Universal Design encourages requirements still leaves room for
Terry Associates. “He was waiting for organizations to go beyond the mini- organizations to improve barriers to
someone to come out of the men’s room mum requirements set by law to make care and reduce risks to safety.
because the door was too heavy for him facilities and services universally usable.” “Certainly, safe and accessible design
to open. A few minutes of maintenance begins with the ease of admission to a
time would have made that men’s room Exceeding Minimum facility and specific protective features
accessible to this man and others like Requirements within,” says Paul Schyve, M.D., sen-
him.” Many different local and state ior vice president, The Joint
Accessibility is one of the tenets of building codes, as well as civil rights Commission. “In more precisely con-
an emerging design philosophy known laws, address the requirements of acces- sidering the needs of individuals with
sibility. On the fed- physical, communication, and cogni-
eral level, of course, tive disabilities, Universal Design
the Americans with extends to clinical areas and even clin-
Disabilities Act ical equipment. For example, it’s clear
(ADA) prohibits that a barrier to care exists in facilities
discrimination without an in-floor medical scale that
against, or segrega- can accommodate bariatric patients or
tion of, people with those in wheelchairs, since patients
disabilities in all who are not properly weighed often
activities, programs, cannot be properly diagnosed and
or services. Its treated,” Schyve says. “Universal
parameters greatly Design complements a patient-
affect the design, centered approach to care because it is
construction, and a concept driven by understanding
operation of build- the individual patient’s experience of
“Equitable Use” is the first of seven principles of Universal Design. ings and facilities as care.”
Environment of Care® News, January 2009, Volume 12, Issue 1
Page 8 Copyright 2009 Joint Commission on Accreditation of Healthcare Organizations
 The seven principles of Universal The Seven Principles
Design, which are outlined in the
of Universal Design
sidebar at right, emphasize the need
to accommodate a patient population These seven principles offer designers guidance to better integrate health care
of diverse abilities. The first step facility features that meet the needs of as many users as possible.
toward this goal is for health care pro-
Principle One: Equitable Use
fessionals to pay closer attention to
The design is useful and marketable to people with diverse abilities.
those receiving inadequate care, says
Schyve. “Once you are aware of indi- Principle Two: Flexibility in Use
vidual patient needs, you can look at The design accommodates a wide range of individual preferences and abilities.
your current environment as a whole
and determine how it can be Principle Three: Simple and Intuitive Use
improved through these principles,” Use of the design is easy to understand, regardless of the user’s experience,
he says. “Like the in-floor medical knowledge, language skills, or current concentration level.
scale, advances in technology contin-
ue to provide facilities with other Principle Four: Perceptible Information
opportunities to improve access for The design effectively communicates necessary information to the user, regard-
the hearing impaired or those with less of ambient conditions or the user’s sensory abilities.
language barriers.”
Principle Five: Tolerance for Error
The design minimizes hazards and the adverse consequences of accidental or
Involving Patients in
unintended actions.
the Process
As Schyve suggests, organizations Principle Six: Low Physical Effort
that adopt Universal Design make a The design can be used efficiently and comfortably and with a minimum of
commitment to involving patients in fatigue.
the process. “It requires a team
approach of observation and partici- Principle Seven: Size and Space for Approach and Use
pation, and patients with disabilities Appropriate size and space are provided for approach, reach, manipulation, and
have to be a central part of that use, regardless of the user’s body size, posture, or mobility.
team,” says Terry. “You can gain
Please note that the principles of Universal Design address only universally
insight into issues of care and safety
usable design, while the practice of design involves more than consideration for
through patient interviews and sur-
usability. Designers must also incorporate other considerations, such as eco-
veys as well as from health care pro-
nomic, engineering, cultural, gender, and environmental concerns, in their
fessionals who consistently observe
design processes.
the movements of patients in their
care, but people with disabilities Source: The Center for Universal Design: The Principles of Universal Design, Version 2.0. Raleigh,
should also serve as leading consult- NC: North Carolina State University, 1997.
ants alongside those professionals.”
It is through this team approach
that organizations can begin to imple- Joint Commission. “But many of its considered to be average patients.
ment particular elements of Universal principles are perfectly applicable to “Lower counters throughout a facility,
Design in their facility rather than older, existing buildings. When you better-positioned magazine racks in
put it off until the next major remod- consider the cost of even one lawsuit waiting areas, the removal or adjust-
eling project. arising from an unsafe environment, ment of protruding objects such as an
“Obviously, remodeling a facility you realize that making positive overhead television in patient rooms
or departments within a facility, or changes is more than an investment and spaces, and grab bars in bathroom
building a new facility, is the most in doing the right thing, as important shower stalls enhance safety for all
opportune time to integrate Universal as that is.” patients,” he says. “Even the selection
Design,” says John Fishbeck, R.A., In fact, as Terry contends, many of chairs in a waiting room can affect
associate director, Division of changes designed to accommodate per- the safety of patients of various ages,
Standards and Survey Methods, The sons with disabilities also benefit those Continued on page 11

Environment of Care® News, January 2009, Volume 12, Issue 1

Page 9 Copyright 2009 Joint Commission on Accreditation of Healthcare Organizations
Universal Design for Some Universal Design Principles
Health Care Facilities
(continued)
Continued from page 9
conditions, and sizes. Chairs without
arm rests can be difficult for weaker
patients to get out of, while chairs
with arm rests can be difficult for larg-
er patients to fit into. Providing a vari-
ety of different chairs considers the
needs of a diversity of patients and
their families.”

Solutions Don’t Always

Require Remodeling
In another of his visits to health
care facilities, Terry observed an elderly
woman pushing her elderly husband in
a wheelchair through a waiting area
that was partially carpeted. “There
was a bad transition where the carpet
met the floor, and it took the woman
five tries with increasing speed each
time to finally get the chair over that
bump,” he says. “This is a danger that
can easily be eliminated. The same is
true of doorway thresholds that pose
a fall risk to patients and to older
people who serve as volunteers in the
health care setting. These are design
changes that don’t necessitate a
remodeling project.”
Despite the aging U.S. popula-
tion, many of whom may soon join
the ranks of those in wheelchairs or
with vision or hearing issues, the ben-
efits of Universal Design have yet to
fully take hold in the health care
industry. “While there is still a lot of
work to do in promoting Universal
Design, its solutions register with
health care organizations once they
recognize their own safety and access
deficiencies,” says Schyve. “As the
patient population changes, these
solutions will become more evident.
This is a design concept that will help
organizations lead patients toward a
healthier future. But it is also a
concept that can benefit patients
EC
today.” NEWS

Environment of Care® News, January 2009, Volume 12, Issue 1

Page 11 Copyright 2009 Joint Commission on Accreditation of Healthcare Organizations