Anjali Joseph, Clemson University – How O.R. Design Can Transform Patient Care

Photos by Renée Ittner-McManus/RIM Photography

Design matters.

Anjali Joseph, professor of architecture at Clemson University, discusses how the design of the operating room could help your surgeon perform their job at the most crucial moments.

Anjali Joseph, Ph.D., EDAC is the Spartanburg Regional Health System Endowed Chair in Architecture + Health Design and Director of the Center for Health Facilities Design and Testing at Clemson University. Dr. Anjali Joseph is focused on using simulation and prototyping methods to research and test effectiveness of promising design solutions that may impact patient safety in high stress healthcare environments. She has focused her research on multidisciplinary approaches to improving patient safety in healthcare through the development of tools and built environment solutions. She is also interested in understanding the role of the built environment in improving population health outcomes. She is currently leading a multidisciplinary AHRQ funded project to develop a learning lab focused on improving patient safety in the operating room. She led the research activities at The Center for Health Design before joining Clemson. Here, she served as principal investigator on several grants from different organizations such as Robert Wood Johnson Foundation, the Agency for Healthcare Research and Quality, U.S. Green Building Council and the Kresge Foundation. Anjali’s work has been published in many academic journals and magazines. She frequently peer reviews articles for journals. She currently serves on an independent review panel on military medical construction standards for the Defense Health Agency. Anjali obtained her Ph.D. with a focus on Architecture, Culture and Behavior from the Georgia Institute of Technology, master’s degree in Architecture from Kansas State University and bachelor’s degree in Architecture from the School of Planning and Architecture in New Delhi, India.

How O.R. Design Can Transform Patient Care


Despite significant efforts to improve safety through training, tools and technology, problems still exist.

Since 2015, I’ve been working with a multidisciplinary team of researchers to address how ORs can be designed to better promote patient and staff safety.

Our research includes 35 surgery observations, visits to surgery centers and an in-depth literature review. We found that frequent door openings, excessive movements inside the OR, and constricted space around the surgical table contribute to the disruptions that lead to errors. Based on our research, we designed and built physical mock-ups to test with clinicians to better understand how different features impacted disruptions, injuries and errors.

The result, a new human centered operating room design that simultaneously tackles problems related to workflow, equipment design and the built environment. Overhead booms, well defined functional zones and integrated storage improve flow and reduce clutter. Stainless steel modular wall panels, minimal horizontal surfaces and rubber flooring reduce surface contamination. Creating induction rooms will also allow parents to be with their children while they’re being induced for surgery, helping to reduce anxiety.

Elements of our award-winning design will come to life in Medical University of South Carolina’s new ambulatory surgical center in Charleston, S.C. We’ll continuing working over the next year while also developing a proactive tool to help other teams design safer operating rooms.


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