We’ve got great advice on getting the most bang for your buck when planning patient-friendly design projects. During the building boom of the past decade, hospitals incorporated patient-friendly features, such as single-patient rooms, noise control, and access to nature and sunlight, into construction projects. But as new projects dwindle and hospitals hunker down for tougher economic times, will patient-friendly design elements continue to be used?

Experts say they should, noting that such features are relatively low-cost—often paying for themselves within a few years through shorter lengths of stay, higher patient satisfaction, and fewer medical errors. 

Furthermore, now that hospitals are required to report patient satisfaction scores using CMS’s Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, putting patients at ease has become even more critical. 

Hospital executives with low satisfaction scores on CMS’s Hospital Compare Web site are getting worried that they will lose marketshare, said Kimberly Montague, director of design consultation services at Planetree, a Danbury, Conn.-based cooperative focused on patient-friendly practices. When Montague visits Planetree-affiliated hospitals, she finds that those that didn’t score well are extremely interested in ways to improve their environment.

Two HCAHPS questions deal with cleanliness and noise. Although other questions probe satisfaction with staff and the general hospital experience, research studies show that physical environment influences these responses. For example, studies on patient-friendly features have demonstrated that sunlight, artwork, soundproofing, and contact with nature can aid the healing process. 

Features such as private rooms, private kitchens, and meditation rooms lure visitors, which many studies have shown are key to improving both healing and patients’ attitudes toward the hospital. Interestingly, features like hand-washing sinks and acuity-adaptable rooms (which allow patients to stay in the same room) have been shown to reduce medical errors.

“Creating a more satisfying experience is going to drive more patients [into the hospital] in the future,” predicted Blair Sadler, senior fellow at the Institute for Healthcare Improvement in Cambridge, Mass. “That is going to cause market differentiation.”

Dublin Methodist Hospital in Dublin, Ohio, which opened in January 2008, incorporates many key patient-friendly features. Cheryl Herbert, president, said she expects thesefeatures, which cost a few percentage points of construction costs, will pay for themselves within a few years.

The hospital has not yet studied return on investment, but Herbert said infection rates are low, and most areas of the hospital score above the 95th percentile in Press Ganey patient satisfaction surveys. Marketshare was initially below expectations, but the hospital’s goal was reached in less than a year, she said.

Low-cost ideas

As construction projects wind down, what features can hospitals introduce to make themselves more patient-friendly? Both Sadler and Montague said hospitals should continue with plans for construction projects that incorporate patient-friendly features, then put away the plans until they are ready to build. Sorting out the needs of various departments and studying demographic information now will shave months off the project once it starts, they said.

Meanwhile, an array of relatively inexpensive patient-friendly features can be introduced individually. Fresh paint goes a long way toward freshening up an area, and Sadler suggested a patient-friendly palette of earth-toned colors. Studies show patients react favorably to a new look, especially if the old paint is showing signs of wear. 

A key target for refurbishing is waiting rooms, where seats  can be rearranged to make patients feel more comfortable. Studies have shown that improvements to waiting rooms can reduce patient anxiety and raise perceptions of quality care and wait times. Low-cost features that have a soothing effect on patients include fish tanks, fireplaces, and artwork. “There is a lot of artwork in hospitals, but it is not well chosen,” Sadler said. “Artwork should be calming and pleasant and should include nature scenes.” 

Herbert added that some hospitals may be able to convert semi-private patient rooms into private rooms, which     have been shown to reduce errors, improve healing, and even prevent patients from withholding information. The private room was endorsed by the American Institute of Architects in its 2006 edition of Guidelines for Design and Construction of Health Care Facilities and by the Joint Commission in its November 2008 report, “Guiding Principles for the Development of the Hospital of the Future.”

Planetree’s Montague suggested converting a barren courtyard, rooftop space, or other outdoor area into a garden area that patients, visitors, and staff can use for meditation. She said volunteers from the local garden club could be recruited create the garden. To raise money for plants and supplies, the hospital could sell bricks with donors’ names on them and embed them in the walkways. For hospitals that cannot afford a garden, Sadler suggested an outdoor seating area with a mural.

To reduce noise levels, Herbert said the hospital could install relatively inexpensive ceiling tile, carpeting, and perhaps a wireless communication system to reduce use of the public address system. She noted that these measures helped Dublin Methodist become the quietest hospital she has ever entered.

Design features can also help visitors with wayfinding, helping them arrive at their destination with less anxiety and need to ask staff for directions. A study conducted at Emory University found that staffers spent 4,500 hours a year giving directions—at a cost of $200,000. 

To aid in wayfinding, Montague suggested selecting a color scheme for each department and placing identifiable features at important junctions, such as elevator lobbies. Strategically placed signs are essential, of course, but Montague cautioned that too many can be overwhelming. 

Some patient-friendly features, such as music and aromas, do not require physical changes. For example, Chicago’s Swedish Covenant Hospital invites unpaid interns from a local music school to play for patients in their rooms. Until recently, the hospital baked its own bread and cookies. Now, to save costs, it uses an aroma-therapy machine that diffuses relaxing scents in waiting areas, said Brooke Newton, Planetree coordinator at Swedish Covenant.

Jain Malkin, a healthcare design consultant based in San Diego, noted that skimping on patient-friendly features can be penny wise and pound foolish. A hospital that spends $2 million for an MRI can likely afford some ceiling artwork to help patients feel less anxious in the confined space. “The goal is to create a non-threatening environment, which can be done relatively inexpensively,” she said.

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