Facility Managers Are Not the Only Ones Who Affect Patient Experience
The physical environment of hospitals and other medical care facilities affects the mental wellbeing of patients, which has a corresponding impact on the healing process. If the patient’s experience is negative, it can produce or augment feelings of anxiety, stress and depression.
This correlation between a hospital’s physical environment and adverse health outcomes for patients, such as slower recovery times, is impelling many care facilities across the country to create patient rooms, hospital corridors, family meeting areas and nurses stations that look and feel more home-like. New procedures also are underway to make patients more comfortable, with trained care providers more attuned to their needs.
This patient-centered model of hospital care is the centerpiece of a 2016 report co-sponsored by the American Hospital Association and the American Society for Healthcare Engineering. “Patient experience has always been important and some hospitals have done a better job than others,” says Lynn Kenney, the report’s coauthor. “But now that the Affordable Care Act and hospital value-based purchasing essentially reward facilities for the quality of care they provide to Medicare beneficiaries, this has become a real focus.”
Kenney is referring to patient scores measured through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. The survey results are tied to CMS (Center for Medicare & Medicaid Services) reimbursements via the current hospital value-based payment model.
Although only two of the survey’s thirty-two questions specifically involve a patient’s experience as it relates to the physical space, many other questions are tightly linked to the built environment. For example, research indicates that paintings of nature scenes may reduce a patient’s discomfort; consequently, survey questions regarding patient perceptions of pain would be informed by this experience.
Kenney, EDAC, SASHE, Director of Industry Relations at The Center for Health Design, a research group focused on demonstrating the value of thoughtful designs that improve health outcomes, promotes the idea of a holistic approach to patient care that takes into account people, process and place. The foundation of this approach is a culture of caring.
“Not just patients benefit from a physical environment designed to promote superior and more empathic care,” she says. “The wellbeing of the healthcare staff is similarly affected. If the design takes into account their productivity and job satisfaction, they can be more engaged in what they’re doing to become better caregivers.”
Patient Perceptions of Care
The HCAHPS survey is designed to elicit a broad range of patient experiences, measuring such healthcare dimensions as doctor and nurse communications, hospital staff responsiveness, and the facility’s cleanliness and quietness. For example, one question asks: “During this hospital stay, how often were your room and bathroom kept clean?” The patient checks one of four boxes—never, sometimes, usually or always. See the full list of HCAHPS survey questions at http://hcahpsonline.org/files/2017_Survey%20Instruments_English_Mail.pdf
To qualify for CMC reimbursement, it is incumbent that hospitals aspire to achieve the “always” response. A quick look at a hospital comparison website sponsored by CMS indicates areas of needed improvement. For instance, the national average of patients reporting that the surrounding environment was “always” quiet at night was 62 percent. Less than three-quarters of patients (74 percent) commented that their room and bathroom were “always” clean. An average 79 percent of patients checked the box that their nurses “always” communicated well.
Patient perceptions of the surrounding environment play a role in how they confide their experiences. “The bathroom can be spotless, but if there is some clutter in the area it can affect the patient’s perception of cleanliness,” says Kenney. “So it’s more of an awareness and communication issue.”
In other words, if a patient is asked if they need anything to be done in the room, or a card is put up noting that the bathroom was just disinfected, the patient’s perception of cleanliness becomes more positive. “It all goes back to the need for a holistic approach,” Kenney says. “People, process, and place and interlinked in the patient’s feelings of satisfaction.”
Each of these nonclinical building blocks must be securely in place for a hospital to provide optimum patient care. The first building block is the physical environment. Area lighting, acoustics, noise levels, smells and the personal control that patients have over their environment can affect their wellbeing and disposition.
This should not come as a surprise, as many people tend to feel uneasy and anxious if their living room is cluttered, dishes are overflowing in the sink, laundry is building up, and the trash needs to be taken out. The same experiences apply in a hospital setting. Kenney suggested ways in which many hospitals are trying to become more home-like if not hotel-like, changing the design of the rooms, equipment and lighting.
“Noise is a big issue in hospitals, disrupting a patient’s sleep and rest, which is needed for optimal healing,” she says. “On HCAHPS scores nationwide, noise receives the lowest patient scores. From a physical environment standpoint, the goal is to minimize sounds wherever possible, using materials with sound-absorbing properties such as acoustical wall panels, flooring, carpets and ceiling tiles can improve sound absorption.”
Other modifications positively affecting patient experiences include furniture arrangements that enable more intimate contact among caregivers, patients and family members; the use of white boards providing updated information on patient care; and improved venting of cooking smells and other odors.
These modifications can improve patient satisfaction, which in turn guide a better HCAHPS score. Benefits also accrue to hospital staff. “A thoughtful hospital layout can reduce the amount of time that nurses are unable to provide care,” says Kenney. “For instance, by storing supplies closer to patient rooms, nurses spend less time retrieving them and more time with the patient. This improves the likelihood the patient will rate `communication with nurses’ higher in the HCAHPS survey.”
The second building block in a holistic approach to patient care is a hospital’s operational processes. While sound-absorbing acoustical panels will muffle noise in the physical environment, a practice like requiring staff to talk or use their phones in predefined locations at certain hours of the day will reduce the cause of the clamor unsettling patients.
Similarly, by giving patients more control over their physical environment, they’re less likely to complain about being kept awake by noises when tired, not to mention being cold, hot, hungry or thirsty. “Several hospitals are giving their patients WiFi-enabled remote devices that they can use to control the lighting, window shades, television set, bed functions, and their communications with staff,” Kenney says.
The final building block is people, the workforce culture liberating hospital staff to focus on what is most important to them—the care of patients. Depending on the healthcare facility, some hospitals emphasize regular and routine staff visits with patients to ensure they’re comfortable and listen to their needs. Other hospitals have trained the nonclinical staff to respond to call lights that illuminate when a patient presses a button, similar to calling a flight attendant on a plane. It’s important to recognize that every single staff person contributes to the patient experience. A caring word, a smile or a glass of water, can make a world of difference for the patient.
Certainly, a patient’s satisfaction is dependent on many variables. If clinical care is superlative but the noise, odors, lighting, cleanliness and the communications with hospital staff are subpar, the person’s overall experience will likely be negative. Kenney advises hospitals to begin the journey toward more positive patient outcomes by starting with the end-state in place. “Once you know what you want to achieve, you can identify the steps needed to create a culture that supports these goals, measuring your progress along the way,” she says.
Since many people are likely to spend time in a hospital at some point in their lives, these many enhancements in care promise a more compassionate and positive experience, one that all healthcare professionals are eager to provide.