1R33: Enhancing Patient Satisfaction Through the Built Environment

R33

Enhancing Patient Satisfaction Through the Built Environment

HCD 2013 Track: Innovative Models

Tuesday, November 19, 2013

1:15 pm - 2:15 pm

Jim Lewison, CID, IIDA, Interior Design Director, AECOM

Christine Hester Devens, IIDA, LEED AP, Senior Interior Designer, AECOM

In the 2012 HealthLeaders Media Patient Experience Survey, 84% of top-level US healthcare executives identified patient experience among their top three priorities with 24% indicating it a top priority. The physical environment can be a major factor in enhancing the patient experience. This discussion will review recent studies and outline five key elements identified by research organizations that directly improve patient experience, including improved staff responsiveness and more efficient rounding. Attendees will explore how healthcare facility design can support operational and environmental changes translating into higher patient satisfaction/HCAHPS scores and increased hospital revenues, with the least capital costs.

Improving the Patient Experience 16

TOP PRIORITIES IN ADDRESSING THE PATIENT EXPERIENCE REMAIN FOCUSED ON TACTICAL ISSUES

To explore in what ways healthcare organizations are acting to improve the patient experience, the survey again asked respondents to list their organization’s top three priorities. This item, as in 2011, was an open-ended question where individual responses were reviewed and grouped into the most frequent themes. No specific direction was given on the response suggesting they list strategies, tactics or outcomes in order to gather the most natural responses. The word cloud that resulted (Figure 9) represents the frequency with which a grouped theme appeared in the responses. The larger the word or phrase, the more often it was mentioned in the responses.

What was revealed through this process was that the top overall priorities identified remained focused on tactical and tangible actions. Perhaps more intriguing is that the top reported items in 2013 almost mirrored the 2011 results exactly. The top five priorities for action identified in 2011 were reducing noise, discharge process, rounding, responsiveness of staff/communication, and pain management. As you look at the 2013 results in Figure 9 you too see reduce noise, hourly rounding, pain management, discharge process and communication. The data reveal that the top five priorities remained in essence the same with a reprioritization of importance. Also reduce noise still remains the top priority.

As noted in 2011 and found again in 2013, with each of the priority items, there are specific tactics associated with accomplishing them. Reduce noise, pain management, discharge process and hourly rounding are all tied to tangible processes that can be designed for tactical implementation. This is not reported as a positive or negative result, but rather

the 2013 study reinforces that hospitals continue to look for specific “things” they can do to address and improve patient experience.

The one behavioral priority remains communication, which while broad in scope has significant implications for patient experience performance. If we return to the definition of patient experience as “the sum of all interactions,” it is only in these personal moments, touch-points of communication, through which the patient experience is delivered. How individuals interact, what they say, how they say it, how effectively it is delivered and received, impact so much of the care experience. It has impact if patients or family members feel listened to, creating an engaged patient. It impacts how they understand care plans and other information to ensure an activated patient. It results in the very way patients and families will share their experience with others with stories about how they were treated, versus what was done while there were there. Communication clearly remains an open and broad challenge in the patient experience conversation; one clearly needing continued focus.

The 2013 survey did not inquire deeper into why organizations identified these items as a priority, yet the same insights as shared in 2011 seem to hold true. As tangible activities, these priorities are easier to identify as issues, build plans around and act on. As noted also in 2011, noise, discharge instructions and pain management are directly related to questions asked on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. The remaining items, rounding and communication, continue to be seen in both popular literature and research as a lever to impacting satisfaction and HCAHPS scores as well.

What is interesting in reviewing the 2013 findings is that while responses solidified top patient experience priorities over time, the list of priorities also expanded. It

FIGURE 9. Top Patient Experience Priorities

Image courtesy of The Beryl Institute, A Report On The Beryl Institute Benchmarking Study The State Of Patient Experience In American Hospitals 2013 Positive Trends And Opportunities For The Future

Top Patient Experience Priorities

2R33: Enhancing Patient Satisfaction Through the Built Environment

“How am I supposed to sleep with all this racket?!?”

Discussion: • How have you addressed noise reduction in

your facility design solutions?

• What key methods have you used to enhance patient privacy?

Use of glass at the nurse station helps reduce noise on the patient floor.AECOM Project: University of Kentucky, Albert B. Chandler Hospital - Pavilion A, Lexington, KY

1.

3R33: Enhancing Patient Satisfaction Through the Built Environment

I’m stretched thin – I wish I could give each of my patients the attention they deserve.”

Discussion: • How can facility design best

support staff, increase responsiveness and enhance effective rounding?

2.

Decentralized work areas increase staff responsiveness.AECOM Project: Sanford Health, Heart Hospital, Sioux Falls, SD

4R33: Enhancing Patient Satisfaction Through the Built Environment

Discussion: • How can facility design support the discharge process and improve

communication with patients and families?

“I had to wait so long to be discharged and then the instructions they gave us were confusing.” 3.

Designated quiet, meeting areas for medical staff, patients and families.AECOM Project: Park Nicollet, Melrose Institute, St. Louis Park, MN

5R33: Enhancing Patient Satisfaction Through the Built Environment

Discussion: • How can facility design best reduce stress for patient and families?

• How can the physical environment support pain management?

“A hospital is the last place I want to be when I’m sick and in pain – I feel really stressed!”4.

Views to nature may reduce stress.AECOM Project: Kaiser Permanente, Westside Medical Center, Hillsboro, OR

6R33: Enhancing Patient Satisfaction Through the Built Environment

Discussion: • How is your organization addressing the

differing expectations of the various generations in your facility design?

• What amenities have you incorporated for maximum value?

“My mom is comfortable waiting to meet with the doctor, but I want information when and how I need it.” 5.

Concierge desks and self-service kiosks allow for a variety of patient check-in and information options.AECOM Project: Regions Hospital, Expansion, St. Paul, MN

7R33: Enhancing Patient Satisfaction Through the Built Environment

Discussion: • What innovative tools, techniques or processes

are you using to design for a better patient experience??

Design Process Initiatives to Enhance the Patient Experience6.

Top left: Patient experience mapping; Bottom left: Full-scale mock-ups; Bottom right: Design charrette

8R33: Enhancing Patient Satisfaction Through the Built Environment

Noise Reduction / Patient PrivacyLin, Y. K., & Lin, C. J. (2010). Factors predicting patients’ perception of privacy and satisfaction for emergency care.

Emergency Medicine Journal (28).

Watkins, N., Kennedy, M., Ducharme, M., & Padula, C. (2011). Same-handed and mirrored unit configurations: Is there a difference in patient and nurse outcomes? JONA: The Journal of Nursing Administration, 41(6), 273-279.

Ulrich, R. S., Zimring, C., Zhu, X., DuBose, J., Seo, H., Choi, Y., ... & Joseph, A. (2008). A review of the research literature on evidence-based healthcare design. Health Environments Research & Design Journal (HERD), 1(3), 61-125.

Janssen, P. A., Klein, M. C., Harris, S. J., Soolsma, J., & Seymour, L. C. (2000), Single Room Maternity Care and Client Satisfaction. Birth, 27: 235–243.

Responsiveness of Staff / Staff Support / Effective RoundingRodriguez, S. (2013). Patient experience: Perception is everything. Hospital Peer Review, 38(7), 76-78

Blakley, D., Kroth, M., & Gregson, J. (2011). The Impact of nurse rounding on patient satisfaction in a medical-surgical hospital unit. MEDSURG Nursing, 20(6), 327-332.

Discharge Process / CommunicationYing, H., Becker, F., Wurmser, T., Bliss-Holtz, J., & Hedges, C. (2012). Effects of nursing unit spatial layout on nursing

team communication patterns, quality of care, and patient safety. Health Environments Research & Design Journal (HERD), 6(1), 8-38.

Stress Reduction / Pain ManagementMalenbaum, S., Keefe, F. J., Williams, A., Ulrich, R., & Somers, T. J. (2008). Pain in its environmental context:

implications for designing environments to enhance pain control. Pain, 134(3), 241.

Altringer, B. (2010). The Emotional Experience of Patient Care: a Case for Innovation in Health Care Design. Journal of Health Services Research & Policy, 15(3), 174-177.

Generational Expectations / AmenitiesWilliams, K. C., & Page, R. A. (2011). Marketing to the generations. Journal of Behavioral Studies in Business, 5(1), 1-17.

Goldman, D., & Romley, J. A. (2008). Hospitals as hotels: the role of patient amenities in hospital demand (No. w14619). National Bureau of Economic Research.

Swan, J. E., Richardson, L. D., & Hutton, J. D. (2003). Do appealing hospital rooms increase patient evaluations of physicians, nurses, and hospital services?. Health Care Management Review, 28(3), 254-264.

Goldman, D.P., Vaiana, M., & Romley, J.A. (2010). The emerging importance of patient amenities in hospital care. The New England Journal Of Medicine, 363 (23), 2185-2187.

OrganizationsThe Beryl Institute

Association for Patient Experience (Cleveland Clinic)

Samueli Institute

Institute for Patient- and Family-Centered Care

Patient Experience Initiatives15 Steps Challenge, National Health Service, UK

Kaiser Total Health Environment

Resources