CLEMSON — Clemson architecture professor Anjali Joseph and her multidisciplinary team of researchers and clinical specialists have received a research grant from the Agency for He­­althcare Research and Quality (AHRQ) to create a learning lab focusing on the design of a safer, more ergonomic hospital operating room.

The research team includes faculty and researchers at Clemson University, the Medical University of South Carolina (MUSC) and Heath Sciences South Carolina (HSSC). The initial grant is for $1 million, with an additional $3 million, if approved, over the following three years.

“This research is a great example of the power of multidisciplinary collaboration,” said Clemson President James P. Clements. “Dr. Joseph is leading an outstanding team of people from two universities in multiple colleges and departments, and I know that their work will make a difference for doctors, nurses and, most importantly, patients.”

Anjali Joseph

Anjali Joseph

Joseph is the principal investigator of the new research study “Realizing Improved Patient Care Through Human-Centered Design in the OR (RIPCHD.OR).” She is the Spartanburg Regional Healthcare System SmartState Endowed Chair in Architecture + Health Design, director of Clemson University’s Center for Health Facilities Design and Testing, and associate professor of architecture at Clemson.

Many hospital operating rooms are antiquated, cramped spaces that do not accommodate today’s high-tech surgical equipment, complex processes and human interactions. Distractions and interruptions are major causes of errors during surgery and often lead to patient harm. Additionally, up to five percent of patients who undergo surgery will develop a surgical site infection. Smarter, evidence-based design has the potential to make operating rooms safer for patients and health care personnel alike.

“Our team of collaborators will design, develop and test various design and systems solutions and will implement these new ideas in surgical environments at MUSC,” Joseph said. “We will have the opportunity to test innovative new operating room designs in a live clinical setting. That’s an extraordinary opportunity.”

“This groundbreaking research is a perfect example of collaboration,” said Richard Goodstein, dean of Clemson’s College of Architecture, Arts and Humanities. “Researchers from multiple disciplines across multiples institutions are bringing to bear the full weight of their knowledge and talent to reimagine one of medicine’s most critical settings.”

The group will look for ways to improve operating rooms — including pediatric operating rooms — by making them safer, not just bigger. They will search for solutions to help prevent post-operative infections, reduce mistakes and avoid workplace injuries to the medical team. To do so, the RIPCHD.OR learning lab will develop new ideas, build an operating room prototype in Charleston to test and refine these ideas and eventually implement these solutions in MUSC’s new Ambulatory Surgery Center in Charleston.

“Operating room design and function has changed very little in the past 50 years,” said Dr. Scott T. Reeves, co-director of the RIPCHD.OR learning lab and co-principal investigator from MUSC. “This grant will allow the collaborative team from MUSC, Clemson and HSSC to critically evaluate the assumptions behind a modern operating room and scientifically identify areas ripe for innovation resulting ultimately in improved patient safety.”

“Poor surgical outcomes can rarely be blamed on a single cause and are far more likely to be the result of a combination of reasons, some of which are inherent in the setting,” Joseph said. “Studying the big picture is the goal of our team, which includes architects, design researchers, human factors engineers, operations management researchers, anesthesiologists, surgeons and nurses.

“This project is one of a kind because it takes an integrated systems approach to improving patient safety outcomes in the operating room. No studies have examined the impact of the physical environment of the operating room in conjunction with other system components, such as tasks and associated workflows, equipment design and individual factors.”

Surgical leaders from the South Carolina Surgical Quality Collaborative led by HSSC Chief Medical Officer Dr. Chris Turley will help vet the group’s findings.

The team also will interact closely with graduate students across Clemson University. Graduate students will build upon the research findings to develop innovative operating room design solutions. They also will help build a physical mockup of the operating room in Charleston that incorporates some of their design ideas.

“The award of this grant builds on the founding principles of the Architecture + Health program, and years of work by Clemson faculty and students, on collaborative, interdisciplinary and integrated research projects that weave research and design activities in an iterative process,” said David Allison, FAIA, FACHA Alumni Distinguished Professor of architecture and director of Clemson University’s Graduate Program in Architecture + Health. “This work is intended to advance the understanding of these environments across multiple dimensions, and also serve as a rich learning experience for the students involved who will eventually be responsible for helping create better health care — and health care settings — of the future.”


Clemson co-principal investigators include:

  • David J. Allison, FAIA, FACHA Alumni Distinguished Professor of architecture and director of Clemson University’s Graduate Studies in Architecture + Health
  • Yann Ferrand, assistant professor in supply chain and operations management in the department of management
  • Lawrence D. Fredendall, professor of management
  • David M. Neyens, assistant professor of industrial engineering
  • Sara Lu Riggs, assistant professor of industrial engineering
  • Windsor Westbrook Sherrill, associate vice president for health research at Clemson University and chief science officer at Greenville Health System
  • Kevin M. Taaffe associate professor of industrial engineering
  • Zahra Zamani, research associate in the School of Architecture

Co-principal investigators at the Medical University of South Carolina include:

  • Scott Reeves, professor and chair, department of anesthesiology and perioperative medicine, co-director of RIPCHD.OR learning lab at MUSC
  • James Abernathy, associate professor, department of anesthesiology and perioperative medicine, MUSC
  • Cassandra Salgado, professor of medicine, hospital epidemiologist, MUSC
  • Dee San, perioperative services program manager, MUSC
  • Danielle Scheurer, chief quality officer MUSC Hospital
  • Mark Scheurer, chief medical officer, MUSC Children’s Hospital

Co-principal investigator at Health Sciences South Carolina is:

  • Christine Turley, chief medical officer, HSSC


This project is supported by grant number P30HS024380 from the Agency for Healthcare Research and Quality — an agency of the U.S. Department of Health and Human Services dedicated to improving the nation’s health care system. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.

Clemson University
Ranked No. 21 among national public universities, Clemson University is a major, land-grant, science- and engineering-oriented research university that maintains a strong commitment to teaching and student success. Clemson is an inclusive, student-centered community characterized by high academic standards, a culture of collaboration, school spirit and a competitive drive to excel. Visit

Founded in 1824 in Charleston, The Medical University of South Carolina is the oldest medical school in the South. Today, MUSC continues the tradition of excellence in education, research, and patient care. MUSC educates and trains more than 3,000 students and residents and has nearly 13,000 employees, including approximately 1,500 faculty members. As the largest non-federal employer in Charleston, the university and its affiliates have collective annual budgets in excess of $1.7 billion. MUSC operates a 750-bed medical center, which includes a nationally recognized Children’s Hospital, the Ashley River Tower (cardiovascular, digestive disease and surgical oncology), Hollings Cancer Center (one of 68 National Cancer Institute-designated centers) Level I Trauma Center and Institute of Psychiatry. For more information on academic information or clinical services, visit For more information on hospital patient services, visit

Health Sciences South Carolina
Established in 2004, Health Sciences South Carolina (HSSC) is powering South Carolina’s learning health community and is one of the nation’s first health research collaborations. Today its supported organizations include seven of the state’s largest health systems, including AnMed Health, Greenville Health System, McLeod Health, MUSC Health, Palmetto Health, Self Regional Healthcare and Spartanburg Regional Healthcare System, as well as the state’s largest research-intensive universities, including Clemson University, MUSC, and the University of South Carolina with its Schools of Medicine at Columbia and Greenville. In 2014, HSSC was presented with the AAMC Learning Health System Champion Research Award and, as a national model, and through this award is mentoring academic health centers in several states on how to achieve Learning Health System capabilities. The unique collaboration was formed with the vision of improving South Carolina’s public health and economic wellbeing through research. Visit,