Hospitals Realizing the Link Between Hospital Environment and Patient Outcomes
There’s good and then there’s better. Hospitals understand that medical-care quality is the key concern of patients, but other patient experiences, such as their perceptions of a facility’s cleanliness, noise levels and smells, are nearly as important.
Hundreds of studies have concluded that the physical environment of a hospital — its architecture, interior design, lighting, furniture placement, art, building systems and maintenance programs — play a significant role in patient outcomes, affecting stress levels that cause slower recoveries, longer hospital stays and higher overall costs.
“The physical environment either eases the patient’s anxiety or adds to it,” explained Lynn Kenney, EDAC, 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. “Truly, the patient experience begins the moment the person arrives at the campus.”
Hospitals are aware of the need to upgrade their physical environments and are dedicated to this effort. In part, these actions are driven by a desire to enhance patient scores measured in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, which is tied to Centers for Medicare and Medicaid (CMS) reimbursements via the hospital value-based payment model.
An industry leader in recognizing the healthful relationship between patient surroundings and patient experience is Cleveland Clinic. The large nonprofit multispecialty academic medical center comprises nine facilities and an administrative campus. It is routinely ranked as one of the nation’s top five hospitals, in no small part due to its high patient-satisfaction scores. “We do all we can here to make the patient’s experience the best it can possibly be,” said Larry F. Rubin, senior director of facilities management.
Sights, Sounds and Smells
Just about anyone who has ever spent time in a hospital will attest that the experience can be discomforting — not exactly a hotel stay. Yet, many health-care facilities like Cleveland Clinic are borrowing from the hospitality industry to improve the comfort and experience of a hospital stay. Under Rubin, who brings more than 25 years of experience in health-care operations to his work, the hospital group has improved its design and maintenance practices to reduce noise and odor and improve cleanliness, lighting and patient comfort.
With respect to noise levels, the clinic eliminated all messaging from its public-address system other than critical emergency announcements. It also instituted periods during night hours when staff are instructed to speak quietly, with their phones on vibrate. Wheels on movable carts and doorknobs and latches were replaced with quieter versions, sound-absorbing ceiling tiles were installed, earplugs and headphones are routinely handed out and white noise is implemented upon patients’ request to muffle remaining sounds.
Such tactics are useful in reducing noise levels, which are tracked by CMS in the HCAHPS survey, Kenney noted. “Noise is a big problem in many hospitals, contributing to higher levels of stress and anxiety and disrupting patient sleep,” she said. “For an optimal healing environment, patients need quiet.”
Patient perceptions of uncleanliness are another area of concern, particularly as it relates to a person’s room and bathroom. Cleveland Clinic’s environmental services (EVS) team follows a clear set of procedures in cleaning each room prior to a new patient’s stay.
“It takes half a day to get the room where it needs to be,” said Rubin. “But rooms don’t stay clean on their own. Equally important is for EVS to communicate with patients throughout the day. They quietly knock on the door and ask if there is anything that needs to be cleaned up.”
The combination of a scrupulous cleanup and ongoing dialogues with patients has earned the clinic some of the highest HCAHPS scores for “cleanliness,” ranking it within the top two to four percent of health-care facilities nationwide on an annual basis.
Seeing Is Believing
Lighting also plays a part in patient perceptions of cleanliness, as well as safety and security, Kenney noted. “We’ve seen bathrooms cleaned spotlessly that patients subsequently complain about,” she said. “The lighting was the problem; it just made the room look dark and dank.” A cost-effective solution is LED lighting, which can improve patient experience while supporting sustainability efforts.
Cleveland Clinic has incorporated environmentally sustainable LED lighting throughout hospital rooms, corridors, family meeting rooms and other locations. To make the facility “more home-like,” said Rubin, each room is equipped with a sofa bed or a reclining chair for family members, to accommodate sleepovers. Walls are painted or papered in comforting color schemes and images of nature. And the staff is dressed in color-coded uniforms so patients and their families can see who does what.
“For example, our patient ambassadors, who provide guests with information and support the floor staff, wear red uniforms,” Kenney said.
Another positive trend in many health-care facilities is the move toward patient control of the hospital-room environment. At Cleveland Clinic, patients are given a technology tool to draw the shades, lower or increase the temperature, control the level of white noise, turn the TV on and off, and darken or brighten the lighting. The hospital has also improved the airflow through rooms and corridors to vent cooking and other odors, and it allows patients to bring in vaporizers for aromatherapy.
If all this is starting to sound like a reputable hotel, it should: At the clinic, patients can also order room-service food from their television sets.
Tomorrow’s Hospital Today
All the above (and then some) is represented at Cleveland Clinic’s new hospital in Avon, Ohio. The facility opened in November 2016 and was built from the ground up with input from physicians, nurses and, yes, patients.
This “patient-friendly hospital of the future,” as Rubin calls it, features an interactive TV allowing patients to directly access their electronic medical records and view educational videos specific to their medical condition and care, among other advanced concepts, all of which help shorten patient stays, improve patient outcomes and curb hospital expenses. “It’s a healing environment that puts patients’ needs first and foremost, where they should be,” said Rubin.
Patient Experience Checklist
Of course, there is still work to be done. But Kenney said, “Overall, hospitals are moving toward patient and family-centered care to improve experiences.” Below are some of the items she considers to create an optimal physical environment for patients:
- Build surfaces that are nonporous and have no joints or seams to allow for easier cleaning.
- Consider chairs with easy-to-clean gaps between the seat backs and bottoms.
- Select furniture that enables eye-to-eye contact between caregivers, patients and family members.
- Design a family zone with amenities such as a place to sleep, plug in, and connect to the Internet.
- Introduce a variety of WiFi-enabled communications methods.
- Hang up art that depicts calming, familiar nature scenes that help decrease the distance between hospital and home.
- Include clinicians in the design of hospital rooms to improve ingress and egress and the location of equipment in relation to furniture.
- Proactively involve patients — even after they’re released from the facility — in the Patient and Family Advisory Council to guide continual improvements.
Kenney said, “Pleasant surroundings and friendly staff can produce dramatic improvements in patient experiences. However, to do that, you have to engage patients and staff in an ongoing discussion. It has to be part of the culture.”
Russ Banham is a veteran business journalist and the author of more than two dozen books.