Post on 24-Dec-2019
Architecture and D
esign Track:D
esigning for Enhanced Patient Satisfaction
Sheila F. Cahnm
an, AIA, ACH
A, LEED AP, Founding
Principal, JumpG
ardenC
onsulting LLC
Tamm
y Thompson, N
CAR
B, EDAC
, CLC
, President, Institute for Patient-C
entered Design, Inc.
Designing for Enhanced Patient Satisfaction
Sheila F. Cahnm
an, AIA, ACH
A, LEED AP
Founding Principal
JumpG
ardenC
onsulting LLC
Learning Objectives
1.Define the five proven elem
ents for enhancing patient satisfaction
2.O
utline current research on how the physical environm
ent affects the patient experience
3.Describe physical im
provements that m
ost cost effectively raise HCAHP scores Review
physical improvem
ents that most
cost effectively raise HCAHP scores.
Definition of Patient Experience
The Beryl Institute
2017 Value Based Purchasing Domains
2015 Performance Period
Patient Experience of
Care, 25%
Clinical Care, 30%
Efficiency, 25%
Safety, 20%
Medicare Spending
per Beneficiary
Selected Indicators(PSI /HAI)
HCAHPS SurveyPerform
ance Dimensions
Clinical Process &O
utcomes
(Flu Imm
unization &
Morality Rates)
Hospital
Consum
er
Assessm
ent of
Healthcare
Providers and
Systems
2017 HCAHPS Composites (25%
weight)
Category (Composite)
Summ
ary of Questions
1Com
munication –
Nurse
Courtesyand respect
Listening skillsClear explanation
2Com
munication –
Doctor Courtesy
and respectListening skillsClear explanation
3Responsiveness of Staff
Help getting to bathroomAssistance
in bathroomResponse to patient call
4Pain M
anagement
Timely m
edication Pain controlStaff assistance
5Com
munication
of Medications
ClearexplanationSide effects described
6Discharge Inform
ationClear discharge explanationW
ritten information
7Environm
ent –Cleanliness and Q
uietnessNoise level at nightCleanliness of room
and bathroom
8O
verall RatingO
verall experience
CAHPS
The Clinician and Group CAHPS (CGCAHPS) survey: Standardized tool to m
easure patient perceptions of careprovided by physicians in an office setting.
HCAHPS• Com
munication
• Quiet at N
ight• Inform
ation About Medications
• Discharge Information
• Cleanliness• Responsiveness
• Pain Managem
ent
• Ongoing Em
otional Support• Fam
ily Involvement &
Care Team Integration
• Avoidable Disruptions Minim
ized• Com
passionate, Empathetic Caregivers
• Clear, Actionable Patient Education• Up-to-Date and Thorough Inform
ation• Physical and Em
otional Needs Anticipated
Broadening Our Am
bition
Advisory Board
How can the built environm
ent enhance the Patient Experience?
Do patients in appealing rooms m
ore favorably evaluate healthcare providers and services than do patients in typical room
s?Health Care M
anagement Review
2003
Mercy W
estCincinnati, O
hio
HCAHPS SCORES
National Average
Patients who reported Y
ES
, they would definitely recom
mend the hospital.
70%
ST JOSEPH'S HO
SPITALSaint Paul, M
NSAINT JO
SEPH REGIO
NAL MEDICAL CENTER
Mishaw
aka, INCO
LUMBIA ST M
ARYS HOSPITAL
Milw
aukee, WI
OUR LADY O
F LOURDES REG
IONAL M
EDICAL CENTER
Lafayette, LAPRO
GRESS W
EST HEALTHCARE CENTERO
Fallon, MO
(HCA) METHO
DIST STONE O
AK HOSPITAL
San Antonio, TX75%
74%
81%
73%
77%
83%
HCAHPS SCORES
National Average
Patients who reported Y
ES
, they would definitely recom
mend the hospital.
70%
ST JOSEPH'S HO
SPITALSaint Paul, M
NSAINT JO
SEPH REGIO
NAL MEDICAL CENTER
Mishaw
aka, INCO
LUMBIA ST M
ARYS HOSPITAL
Milw
aukee, WI
OUR LADY O
F LOURDES REG
IONAL M
EDICAL CENTER
Lafayette, LAPRO
GRESS W
EST HEALTHCARE CENTERO
Fallon, MO
(HCA) METHO
DIST STONE O
AK HOSPITAL
San Antonio, TX75%
74%
81%
73%
77%
83%
New
facilities = high scores
Key elements for im
proving the patient experienceThe Beryl Institute 2013
“How am
I supposed to sleep with all this
racket?”
Reducing noise
Private rooms reduce exposure to
noise levels that can cause stress and negative health effectsU
lrich et al., 2008.
Reduced noise levels im
proved sleep and m
ood, better pain tolerance Janssen et al., 2000
Glass at nurse station helps reduce noise Kaiser Perm
anente, Gaithersburg, MD
Improving the
short stay environment
Good Samaritan W
estKearney, N
E
“ I had to wait so long to
be discharged and then the instructions they gave us w
ere confusing.”
How can facility design support the discharge process and
improve com
munication
with patients and fam
ilies?
1 in 5 Medicare patients is readm
itted w
ithin 30 days of discharge
3% reduction in reim
bursements
if above the acceptable CMS threshold in 2015 &
beyond
Kaiser Health N
ews August 2012
Designated quiet, meeting areas for m
edical staff, patients and families
Park Nicollet, M
elrose Institute, St. Louis Park, MN
Family N
ichesGalterPavilion, N
orthwestern M
emorial Hospital, Chicago, IL
Surgery Status Board
Family com
munication
Family com
munication
Kaiser Permanente W
estside Medical C
enterH
illsboro, Oregon
“I’m stretched thin –
I wish I could give each of m
y patients the attention they deserve.”
How can facility design best support responsiveness of staff
and effective rounding?
Decentralized work areas increase staff responsiveness
Sanford Health, Heart Hospital, Sioux Falls, SD
Decentralized Patient SuppliesSoin
Medical Center, Beavercreek, O
hio
Kaiser Permanente W
estsideH
illsboro, Oregon
Scripps Hospital
San Diego, C
A
Activating Fitness
Respite for Staff
Mary Bridge C
hildren’s Hospital, Tacom
a, WA
“A hospital is the last place I want
to be when I’m
sick and in pain –I feel really stressed!”
How can facility design best
reduce stressand support pain managem
ent?
Pain in its Environmental Context: Im
plications for Designing Environm
ents to Enhance Pain Control, Pain, February 2008M
alenbaum, Keefe, W
illiams, Ulrich, and Som
ers
Natural light
Views of nature
Virtual reality
Access to nature reduce stress M
ercy Medical Center, Baltim
ore, MD
Natural and sim
ulated views of nature
University of Kentucky, Albert B. Chandler Hospital -Pavilion A, Lexington, KY
Natural scenes reduce stress
Stone Psychiatric Unit, Northw
estern Mem
orial Hospital, Chicago, Illinois
Virtual reality
Wayfinding
Kaiser Permanente W
estside Medical C
enterH
illsboro, Oregon
Northw
estern Mem
orial Hospital
Chicago, Illinois
Concierge desks and self-service kiosks
Concierge desks and self-service kiosksRegions Hospital, Expansion, St. Paul, M
N
Patient privacy“W
hile patient choice and controlare prim
ary drivers of patient satisfaction, patient privacy is also a predictor.”
Factors predicting patients’ perception ofprivacy and satisfaction for em
ergency care. Em
ergency Medicine Journal (28). Lin, Y. K., &
Lin, C. J. (2010)
“The perception of hospital quality em
bodies amenities
as well as clinical quality“
Patient amenities
Dining AreaStafford Hospital Center, Stafford, VA
“My m
om doesn’t
mind w
aiting for the doctor, but I’m
used to getting inform
ation w
hen and how I need
it.”How do w
e incorporate differing expectations of various generations?
Silent GenerationBaby Boom
ersGeneration X
Millennials
Born before 19421943-1960
1961-19811982-
Physician DirectsEngage M
eEducate
Me
Connect with M
e
Hospital Reputation;Physician
ReferralResearch options;Physician
InfluencedHealthcare
consumer
Social Netw
orksCustom
er Experience
BrandingSelf Directed SearchesCustom
er ExperienceW
ellness & Prevention
Thompson Reuters Research Brief: M
atching the Market:
Using Generational Insights to Attract and Retain Consum
ers
What innovative
tools, techniques or processeshelp design for a better patient experience?
Engaging our clients in the process to understand their patients’ journey
Experience mapping
Mary Catherine Bunting Center at M
ercy
Park Nicollet Experience M
apping
Park Nicollet W
omen’s Center
Image and Experience M
apping Process
Image and Experience M
apping Process
Guiding Principles of Patient-Centered Design
Tamm
y Thompson, N
CAR
B, EDAC
, CLC
, P
resident
Institute for Patient-Centered D
esign
Learning Objectives Continued
4.Analyze m
ethods for addressing the needs of patients through the use of the 10 Guiding Principles of Patient-Centered Design.
5.Identify com
mon obstacles for patients and fam
ilies that are inadvertently created in the design process.
6.Describe m
ethods of gaining patient and family feedback
through design simulation.
“A thoughtful healthcare designer, no matter how
accomplished,
remains a student of the patient…
”
Design with Patients in M
ind…
Accordingto
“ToErris
Human,”
areportreleased
in1999
bythe
InstituteofM
edicine(IO
M),“at
least44,000
people,andperhaps
asm
anyas
98,000people,die[d]
inhospitals
eachyear
asa
resultofm
edicalerrorsthat
couldhave
beenprevented.”
Inaddition,estim
atedcost
resultingfrom
medicalerrorfellbetw
een“$17
billionand
$29billion
peryearinhospitalsnationw
ide.”*
*IOM
, http://ww
w.iom
.edu/~/media/Files/Report%
20Files/1999/To-Err-is Hum
an/To%20Err%
20is%20Hum
an%201999%
20%20report%
20brief.pdf
Problems associated w
ith “semi”-private patient room
s:•Lack
ofprivacy•M
edicalerror•Spread
ofinfection•Restricted
visitation•N
oise/aggravation•Safety/security
concerns
The Problem
Patient-Centered Care
8 Picker Principles of Patient-Centered Care**•
Respect for patients’ values, preferences and expressed needs•
Coordination and integration of care•
Information, com
munication and education
•Physical com
fort•
Emotional support and alleviation of fear and anxiety
•Involvem
ent of family and friends
•Transition and continuity
•Access to care
*Planetree, http://ww
w.planetree.org/PCCAM
.html
**Picker Institute, http://pickerinstitute.org/about/picker-principles/
Accordingto
Planetree*,in“a
patient-centeredapproach
tohealth
care,providerspartner
with
patientsand
theirfam
ilym
embers
toidentify
andsatisfy
thefull
rangeof
patientneeds
andpreferences.”
Patient-Centered Design"Patient-Centered
Design"is
aphilosophy
byw
hichhealthcare
facilitiesand
theirdesign
teams
compassionately
createand
developspaces
tobe
usedby
patients.The
10principles
ofpatient-centered
designaccount
forthe
needsof
patientsand
theirfam
ilies,andsupportm
ethodsfordeliveringthe
bestcareto
them.
Principles of Patient-Centered DesignPatient-centered design supports the practice of patient-centered care bycreating environm
ental conditions that facilitate healing. The following principles
may be applied to health facility design to engage patients.
1.Respect privacy
2.Facilitate com
munication, collaboration and trust
3.Encourage patient and fam
ily participation4.
Empow
er patients5.
Promote safety and security
6.Provide accessible accom
modations
7.Create a com
fortable environment
8.Facilitate healing
9.Support staff’s goals through design
10.Look for design opportunities to respond to unm
et needs
Patient Room Analysis
Caregiver’sZone
Handw
ashing sink
Hand sanitizer
Personal protective equipm
ent (PPE) organizer
Work surface
Computer/charting area
Headwall
Medical equipm
ent
Medical supplies
Patient’s Zone
Bed
Over-bed table
Bedside table/cabinet
Telephone
TV/entertainment system
Closet/Armoire
Patient bathroom
Handw
ashing sink
Patient Room Analysis
Family’s Zone
Sofa/sleeper
Desk
Guest chair
Storage
Patient Room Analysis
Nursing Rounds
Patients may be aw
akened during the day and night for care managem
ent. A standard routine is described below.*
•Take vitals signs -Average every 4 hours/more frequent per doctor’s orders
•Check urine output -usually done w
ith vital signs•C
heck or change the pain pump per hospital protocols -U
sually performed w
ith two
nurses at shift change and every 4 hours, unless special circumstances dictate
otherwise.
•Change IV fluids as needed
•Perform shift assessm
ents•Adm
inister medications per orders
•Draw
lab work per orders
•Check/change surgical dressings as required
•Check ventilator for som
e patients
*Interview w
ith LaShawna H
eflin, RN
1. Design that respects privacyDesign techniques that prom
ote privacy•U
se of single occupant patient rooms
•Planning techniques that minim
ize views of the
patient bed from the corridor
•Acoustic design to protect private conversations
•Designating patient transport elevators and corridors that shield patients from
public view
•Strategic placement of m
edical information to
conceal from public view
1. Design that respects privacy
Patient’s Voice
The pre-op room had actual w
alls but the end of the room w
as a large curtain. It was a
teaching hospital but the rooms w
ere too small to accom
modate m
ultiple providers so they flung open the curtain instead. I could see num
erous other patients directly across from
me w
ho were recovering on the other side of the hall. It w
as embarrassing to be
half naked and repeatedly examined w
hile people were w
alking by me and w
ondering w
hat the other patients could see…
-Cassie R
1. Design that respects privacy
2012 Patient Empow
ered Room W
inning Design by KahlerSlater
Provide adequate space for:•Patient com
munication w
ith caregivers•Expressed concern•Q
uestions•Patient/fam
ily education/training•Condition-specific education•Treatm
ent plan•Treatm
ent schedule•Hom
e training•Staff com
munication
•Training/mentoring
•Shift-change transfer of information
2. Design that Facilitates Comm
unication, Collaboration and Trust
2. Design that Facilitates Comm
unication, Collaboration and Trust
Patient’s Voice:
During recovery, they were m
ore focused on the computer than on sim
ply sitting next to m
e but all of the monitors w
ere behind my head so I couldn’t see w
hat was causing
the alarms and it m
ade me feel vulnerable and discredited w
hen I wanted to see them
and w
as told not to worry.
-Anonymous
2. Design that Facilitates Comm
unication, Collaboration and Trust
2. Design that Facilitates Comm
unication, Collaboration and Trust
Patient’s Voice:
My relationship w
ith my oncologist totally changed w
hen his office moved to electronic
medical records. In the past, w
e sat down together and talked about m
y plan of care. I received personal attention. N
ow, I talk to his back.
-Anonymous
2. Design that Facilitates Comm
unication, Collaboration and Trust
2. Design that Facilitates Comm
unication, Collaboration and Trust
2. Design that Facilitates Comm
unication, Collaboration and Trust
Patient-centeredcare
recognizesthat
thefam
ilyis
anim
portantpart
ofthe
careteam
.Fam
ily/friendsare
encouragedto
accompany
patientsduring
medicalvisits
andinpatienttreatm
ent.
Patient-centereddesign
accomm
odatesfam
ilyby
providingdesignated
spaceand
amenitiesforfam
ilym
embers.
Family presence m
ay:•Reduce the patient’s anxiety•Decrease the chance of m
edical error•Relieve staff by providing non-clinical patient assistance•Provide an added layer of security
Family Zone
3. Design that Encourages Patient and Family
Participation
3. Design that Encourages Patient and Family
Participation
Parent’s Voice:
There were so m
any times that I w
as there with no place to go. I rem
ember an
experience when m
y son coded and there was a vacant desk w
ith no chair so I sat underneath the desk, just praying that he w
ould survive. This has a long term
emotional im
pact; and I’m so glad that parents are now
invited to be a part of this, because the NICU becom
es our home too.
-Kelli Kelly, Founder & Executive Director, Hand to Hold hosted by the Institute for
Patient-and Family-Centered Care (IPFCC)
3. Design that Encourages Patient and Family
Participation
3. Design that Encourages Patient and Family
Participation
4. Design that Empow
ers Patients
Many patients feel vulnerable and helpless.
Design facilitates patient-centered care by allowing patients
to remain in control of their environm
ent.Designers should:•Provide access at the bedside to:
•Lighting control•Tem
perature control•Com
munication technology
•Provide direct access to the sink and toilet to promote
self-sufficiency.•Create opportunities to build trust w
ith:•Patient visibility of staff sinks•Designated areas for posting hospital standards•Sufficient collaboration space at the bedside
4. Design that Empow
ers Patients
4. Design that Empow
ers Patients
5. Design that Promotes Patient Safety and
Security
Comm
on Patient Safety Concerns:•Infection prevention and control•Reduction of m
edical error•Reduction of patient accidents/falls•Security of units from
intruders•Protection of patients’ belongings
These concerns may be addressed by:
•Proper design of hand washing stations to prevent infection
•Standardization of procedure/treatment areas to prevent m
edical error•Provisions for unobstructed, clear, and w
ell-lit circulation paths to prevent falls•Secure unit layouts w
ith designated control points to prevent intrusion•Inclusion of locking cabinets and patient safes to protect belongings
5. Design that Promotes Patient Safety
and Security
5. Design that Promotes Patient Safety
and Security
6. Accessible DesignNot only m
ust a hospital provide access by law
to individuals with disabilities; but, it
must also consider the com
promised state
of its patients.
Many patients require assistance m
oving from
the bed to other areas of the room.
Accessible design methods:
•Provide sufficient maneuvering space for patients using m
edical or m
obility assistive equipment
•Install handrails along patient routes•Provide w
ide doors for staff to assist patients
6. Accessible Design
7. Design that Creates a Comfortable
Environment
Touch: “High-touch” materials, such as w
oodSm
ell:•Natural elem
ents with pleasant scents, such
as plants•Appropriate air exchanges to elim
inate odorsHearing:
•Natural elem
ents with soothing sounds, such
as fountains•Acoustic design to reduce noise
Sight:•Creative use of color, light and shadow
•Framing of interior and exterior view
s
Often
designersconsider
creativem
ethodsfordeveloping
comfortable
environments.
Thismay
beexplored
byseeking
methodsforengaging
thesenses.
7. Design that Creates a Com
fortable Environment
Parent’s Voice:
I wanted desperately just to rest m
y head against something and m
aybe recline a few
degrees. We spent about three and half hours in the ED that night. Perhaps 20 m
inutes of that w
as actual care interaction. The rest was w
aiting. I am not sure how
much of
the waiting m
ight be avoided through process improvem
ent, but any amount of
waiting w
ould have been more tolerable if I had been com
fortable. It wouldn't have
taken much to im
prove my com
fort and it would have im
proved my satisfaction
substantially.
Empathy is a crucial com
ponent of design. As designers we m
ust seek ways during the
development of the project to understand the needs of the visitors and w
hat resources w
ill truly improve their experience. They m
ay be less costly and fancy than we think.
Jonathan M. Bykow
ski, AIA
7. Design that Creates a Comfortable
Environment
7. Design that Creates a Comfortable
Environment
7. Design that Creates a Comfortable
Environment
8. Design that Facilitates HealingEnvironm
ental factors can affect the healing process. In addition to the therapeutic nature of pleasant spaces, other exam
ples include:•Lighting control: N
ICU babies respond favorably under controlled lighting•Sound: N
oise can cause aggravation and physiological indicators of stress (elevated blood pressure) in m
any patients•Tem
perature: Cooler temperatures discourage the
growth of pathogens
•Fresh air: Air exchanges promote infection control
Research is examining how
these factors impact
specific health conditions. The
same
factorsthat
impact
patientsm
ayaffect
hospitalstaffas
well.
Studiesindicatethatcliniciansm
akefew
ererrorswith
adequatelighting
andexperience
lessfatiguew
ithnaturallight.
8. Design that Facilitates Healing
Parent’s Voice: I w
ould have stayed with m
y baby longer; but, there was really no use
for me there w
hy she slept.
-Anonymous
Kangaroocare
canbe
promoted
frombirth.
Thereare
benefitsto
holdingthe
neonatew
hileshe
issleeping.Babies
areasleep
inutero,
but,sleepis
alsoan
activetim
eof
braingrow
th.Throughcontinuous
kangaroocare,they
learnm
other’svoice,scentand
movem
ent.Thereare
thingsthathappen
inthe
mother’s
arms
thatdonothappen
inan
incubator.
Dr.RobertWhite,N
eonatologist
8. Design that Facilitates Healing
9. Design that Supports Staff’s Goals
Operational goals m
ay be supported through design. •Throughput: Clear, sim
ple circulation allows shorter w
alking distances (reduced nurse fatigue), faster access to necessities and quicker patient transport.
•Universal patient room
s allow a reduction in transfers.
•Designing to prevent accidents and infection may ultim
ately result in a shorter length of stay and few
er unreimbursed expenses.
•Patient Education
•Coordination of care allows clinicians to com
municate, reducing
medical error.
•Decentralized teaming/collaboration spaces
•Electronic Medical Records (EM
R) Infrastructure•Pods of com
plementary outpatient clinics
9. Design that Supports Staff’s Goals
Parent’s Voice:
Ifortunately
dida
tonof
researchbut
most
parentsw
erecom
pletelyoverw
helmed
andlost.Perhaps
asm
allreadinglibrary
with
literatureand
listsofreputable
websitesforpreem
iehealth
anddevelopm
ent.
-Anonymous
9. Design that Supports Staff’s Goals
10. Design that Arises from an
Unmet Need
Innovation arises through thoughtful consideration of the end user. Learning the intim
ate details of a user’s experience sparks revelation.
LessonLearned:
Shadowa
caregivertoidentify
makeshiftsolutionsthatare
usedbecause
thecurrentdesign
orproductdoesnotm
eettheneed.
Project by: Graeme Fielder, Josh Felerand
MikkelSoerensen
Course: Redesigning the NICUInstructors: Jules Sherm
an and William
Rhine, MD
Stanford University Hasso
PlattnerInstitute of Design/d.school
10. Design that Arises from an
Unmet Need
Parent’sVoice:If ALL overnightnurses had to use RED flashlights or Green Night-vision goggles, nowthat w
ould be amazing for parents and patients trying to sleep.
Some nurses and staff
would com
e in, bang the doors, and turn on all the lights in the middle of the night, to
see what they w
ere doing, every 2-4 hours depending on the meds. O
vernight nurses should have to pass a test w
here they can go into a completely dark room
, monitor the
patient with green light, infuse m
edications, take vitals, and produce noise lower than a
set decibel amount.
(We called the great night nurses "Night Ninja's".)
-Rozanne Hug
10. Design that Arises from an Unm
et Need
What is YO
UR Solution?
We appreciate your interest in Patient-Centered Design
QU
ESTION
S?
Contact:Tam
my S. Thom
psonInstitute for Patient-Centered Design, Inc.300 N
Cedar Street, Suite C-1Sum
merville, SC 29483
tthompson@
patientcentereddesign.orgw
ww
.patientcentereddesign.org
Copyright © 2015 Institute for Patient-Centered Design, Inc.