A Special Report onAn Approach to Patient Satisfaction:

Are We Missing the Point?By: Tom Centore, Emily Dunn,

Nicholas Ramos, and Vinnie Pierino

Henry Ford: West Bloomfield Hospital

Henry Ford: West Bloomfield Hospital

Baylor Medical Center Kansas City Health Clinic Children’s Hospital of Minnesota

Benjamin Russell Hospital for Children

Mount Sinai Medical Center

11

Currently, there has been a growing number of initiatives to increase patient satisfaction and

efficiently improve overall quality of care in hospitals. Hospital leadership has begun spending vast amounts of money redesigning facility layouts, implementing new services, and developing more patient-centered cultures to the healthcare environment. With various hospitality service models increasing in popularity in today’s healthcare facilities, it is important for administrators to fully understand the various aspects and approaches to patient care and the effects each model has on patient relations, overall satisfaction, and health outcomes. In addition to examining existing research, we interviewed high-level healthcare and hospitality executives and explored the benefits and limitations of each technique. In an effort to simplify these complex ideas and demonstration a solution in a digestible

manner, we have developed a graphic to illustrate our approach. Our hope is that this spectrum will provide interested administrators with ideas and suggestions on which aspects of hospitality to focus on and to what extent, so that they can improve patient quality and satisfaction and adequately compete against other hospitals in the market.

From our research, we have chosen to categorize the various techniques and service models into three main approaches to health care: Hospital Design, Patient-Centered Care (PCC), and Hospitality Service and Culture.

Many new hospitals operate in one the three areas of the spectrum or choose to offer services that cross all three areas. Further researching these different approaches, we have outlined the effects each model has on satisfaction and care.

22Vanderbilt Hospital, Nashville, TN

HOSPITAL DESIGN

Even though there is only a three-letter difference between the words “Hospitality” and “Hospital”, the images and the emotions that they evoke are

quite different. For many years comparing hospitals to hotels would be unfathomable to most people, equating the swank luxury of the Ritz Carlton to the drab and bare local general hospital was just depressing. As healthcare has evolved, so has this way of thinking. Recently, there has been an emphasis on making that comparison not seem out of the realm of possibility. Whether it is a transition to single-person rooms or having a large and welcoming lobby, there have been several design elements that are more reminiscent of a resort requirement than a hospital necessity. This trend of designing spaces to be more welcoming and reflect a more hospitable environment can very often start in the architectural drawings of a building. When the architect and the healthcare organization come together and discuss what they feel are important aspects of the building, the conversation is not simply limited to infection control and size of the operating rooms. The conversation now will often delve into how can the institution, through design, provide the best experience for the patient. Although the intention of the design of the facility may be to better enhance the patient experience, what actually comes out may have little to do with the patient and more to do with the architect’s vision. One of the most prominent examples of this is found when someone first walks into the building and looks around the lobby. Some may find the architecture to be quite beautiful, with vaulted ceilings and a multi-

story atrium. However, are these large expenditures completely necessary? What are the actual costs of these structures to the organization and what are its benefits to those who are the consumers? The design team would also have to figure in the opportunity cost of the design and what could this money have been spent on instead of this large atrium?

33

It has been found that only 19% of overall patient satisfaction is attributed to facilities as compared to 48% in luxury hotels (J.D. Power Associates, 2012). When looking at this topic the lines are often blurred between a hotel and a hospital. It is quite easy to find virtual tours of hospitals and these films highlight the architectural beauty of the location. One example is the Toronto Hospital for Sick Children. Easily accessible on their website is a virtual tours of the building and all that it has to offer. It begins with a tour of their atrium and opening lobby. This building has multi-story atrium with many of the patient rooms facing this large indoor space. Inside this space was littered with water fountains and foliage that made it much more reminiscent of a Ritz Carlton or an upscale mall than a place to care for the sick and the infirmed. When looking at spaces like this, it is easy to grasp the beauty and the elegance, what is much harder to see is how this affects patient outcomes and satisfaction. Do these

elegant spaces really provide a significant benefit to the patient related to the cost of construction?

Currently, health care settings that are undergoing construction are attempting to use design to help overcome the wait times plaguing the system. Some of these include multiple steps and areas as part of the waiting process. For example, instead of waiting for 15 minutes in a single large waiting area with magazines scattered across a coffee table, you could wait in that area for 5 minutes, wait in a secondary area for an additional 5 minutes filling out private paperwork, and then finally wait in the patient room for 5 additional minutes for the doctor. Although the length of time was the same, having the process broken down into more manageable pieces appears to minimize the perceived wait time for the patient. This idea can be traced directly to places like Disney World and their queue management system, often incorporating several breaks, steps and opportunities for interaction before actually getting on the ride to make the wait seem more bearable.

For years, hospitals were typically designed with one large nursing desk where all nurses would be clustered. This often leads to nurses being farther away from their patients, which creates issues such as delays in response time and monitoring patient falls. Many institutions are utilizing a different approach of a pod style layout, stationing nurses directly outside patients’ rooms, addressing some of the concerns associated with a centralized station. By utilizing this approach the Cardiac Critical Care

Unit at Methodist Hospital in Indianapolis, IN saw a 75% reduction in patient falls (Robert Wood Johnson Foundation, 2004).

[ ]By utilizing this pod-style approach the Cardiac Critical Care Unit at Methodist Hospital in

Indianapolis, IN saw a 75% reduction in patient falls

(Robert Wood Johnson Foundation, 2004)

Toronto Hospital for Sick Children Atrium

44

However, since this approach spreads out the nursing staff, the communication amongst the staff is affected by this change. The Joint Commission has concluded that the root cause of 70% of sentinel events in hospitals is attributed to miscommunication (The Victorian Quality Council, 2010). As such, this dispersed staff approach, although fixing one problem maybe worsening another. In our conversation with Dr. Prakash Ramsinghani, an ED doctor at Kaiser’s Oakland facility, we discussed his perceptions of centralized versus distributed workstations for doctors.

With a “decentralized hub” approach, Dr. Ramsinghani expressed his concerns about increased interruptions with that design model citing increased risk of medical errors due to distractions in the

workspace. As a doctor, he said, the communication with other doctors during the diagnostic and charting process is an essential part of properly caring for the patient. This is where design solutions need to be further investigated to ensure that there is consistent communication and decreased interruptions while still enabling staff to provide quality care for a patient.

In order to create a more enjoyable patient experience, designers are also working to incorporate some of the basic hotel ideas and bring them to the hospital. One of these ideas is attempting to provide more windows with external views that bring in natural light. The use of natural light not only benefits the patient experience, but also helps with sustainability efforts of many hospitals, potentially reducing energy and the related expenses associated with

interior lighting. Furthermore, emphasis is being placed on using softer lighting throughout a facility. All of these factors help the patient feel more comfortable and will aid in recovery time. Designers are also trying to include more comfortable spaces for the family members through more improved seating and privacy pockets for family interaction. Research has demonstrated that the enjoyability of the family’s experience is directly correlated the patient’s experience (Chand, 2013).

Utilization of an elegant, creative design is not something that should be completely disregarded. Just because a facility is providing health care to individuals does not mean it needs to be

aesthetically unappealing. However, design for the sake of beauty is art, and that is not the goal of a hospital design. A hospital’s primary function is to promote health, deliver care to those in need, and support the patient through recovery. Design can do that, and should do that. The design of a hospital should be based on how to provide the best patient care experience, not just the prettiest and most impressive building. Every aspect of it should be critically examined to determine if it fills a need of the client. While a hotel is designed to provide a vacation for a family, and make money for the owner, a hospital is there to help and treat people when they are most vulnerable. In either case, both require evoking emotions of positive feelings, well-

Floorplan Showing Pod Design from Healthcare Design Magazine

Image of Centralized Nursing Station from Array Architects

55

being and optimism. If that is the thought process going into the design, and one can ensure the respect and dignity deserved to those patients then, “the result will be design outcomes that are ‘hospitable’ without sacrificing efficiency in medical treatment” said Sarita Chand.

Future Outlook and PlanWith the current boom in construction of healthcare facilities, there is a large amount of potential for innovation with design. Building a new hospital or even a new section of a hospital is not something that happens frequently and some of these large scale ideals will be hard to incorporate into current structures. However, with all new construction, many of these examples associated with Evidence Based Design should be considered. Furthermore, after talking with several healthcare design experts many believe we are moving to more of a wellness-center model, whereby we can provide support services and retail shops that can increase the overall health of a person before they ever step into the clinical facilities of the building. As these spaces

are often retail in inspiration, it would not be hard to imagine them emulating that image, as some of the architectural designs previously mentioned. However apart from that, we believe facilities are distancing themselves from these grandiose building ideas to a more patient-centered focus. Many of the new strategies and areas of implementation look to directly affect the patient experience, mostly through proven clinical outcomes. As more research is completed and more inventive solutions are developed, the future of hospital design looks promising. Long gone are the days of extensive talks about multi-story atrium and heightened discussion on how to make the room as pleasant as possible for the patient.

Myths and MisconceptionProbably one of the biggest misconceptions about architecture and design is that there is always a high cost for its implementation. However, some features are relatively affordable with the initial design. For example, ensuring that a reception area desk

Reduce Staff Stress and Fatigue and Increase Effectiveness in Delivering CareImprove Staff Health and Safety through Environmental MeasuresIncrease Staff Effectiveness, Reduce Errors, and Increase Staff Satisfaction by Designing Better Workplaces

Improve Patient SatisfactionHospital-Acquired InfectionsReducing Infections Caused by Airborne PathogensReducing Infections by Increasing Hand WashingReducing Infections with Single-Bed RoomsReducing Medication ErrorsReduce Patient FallsImprove Patient Confidentiality and Privacy

Reduce Stress and Improve OutcomesReduce NoiseImprove SleepReduce Spatial DisorientationReduce DepressionProvide Nature and Positive DistractionProvide Social SupportProvide Communication to Patients

Improve Overall Healthcare QualityProvide Single-Bed Patient RoomsReduce Length of StayIncrease Patient Satisfaction with Quality of Care

A report to The Center for Health Design suggests focusing design efforts on the following areas to ensure a more patient centered experience

(Ulrich, Zimring, Joseph, & Choudhary, 2004):

66

is low enough for people in a wheelchair to have eye contact with the people they are speaking to. Another misconception is the recent trend in single person rooms is due solely to hospitality ideals. Although some rationale may be attributed to that, single person rooms can cause better patient outcomes in areas of infection control and healing time. One additional myth is that designers and architects are the only ones that should care about architecture. Every person who is affiliated with a hospital is impacted by the design, and therefore should be a part of the process. It will be necessary to consistently include a wide range of individuals and stakeholders in future building processes to ensure that you are reflecting the true needs of the stakeholder, instead of the perceived needs.

As hospital spaces become redesigned, administrators may have growing concerns over whether the new styles, equipment, and layouts have an impact on their medical staff. In fact, one misconception is that new layouts hinder and confuse physicians and personnel, which causes a delay or a lower quality in care. During our research, we asked the same question to ]Dr. Ramsinghani described to us the effects that his recently redesigned ED had on medical service. He explained that the new renovations actually improved the quality of care. The emergency department was redesigned to have its own, easily accessible X-ray machines that mitigated the hassle of coordinating with a centralized radiology department. This allowed physicians to diagnose the patients quickly, provide accurate treatment treatment faster, and resulted in more expedient discharges in a high-traffic environment. These kinds of design implementations can have significant improvements to patient care, and subsequently, patient satisfaction. However, Dr. Ramsinghani did mention that a few design elements have actually caused some confusion for both patients and physicians. This shows that administrators must take a careful look at future renovation plans, incorporating the insights from staff as well.

PLANETREE AND PATIENT-CENTERED

CARE (PCC)

Planetree is defining what it means to provide patient

centered care. Essentially, they have created a foundation or structural

blueprint designating the different components of patient centered care and

the key elements to this approach are what a facility needs to focus on to be successful. The philosophy behind this is an understanding of the culture within a facility and engaging patients, their families, and staff of all levels as part of the transformation of care to a patient centered approach. Planetree’s methods are founded upon the idea that every hospital is different, and understanding the culture and the fabric of the healthcare community within your facility is the first step to making a shift. In speaking with Sara Guastello, Director of Knowledge Management at Planetree, “creating buy-in is ultimately essential for the sustainability of the culture you are creating and…especially important if things get tricky.”

Patient-centered care is also built on the idea that beyond the patient, the staff experience must also be part of the equation. An employee’s ability and desire to care for patients effectively and with compassion can be compromised if the staff does not feel that they are cared for by the organization.

Designation CriteriaBeyond gaining a better understanding of the culture within a facility, Planetree has created a Designation that “represents the highest level of achievement in patient/person-centered care based on evidence and standards.” This designation criteria attempts to use language that allows for flexibility and innovation to encourage hospitals to create an approach to care that is customized to their specific patient needs.

77

As with other broad-based criteria, some hospital administrators may be uncomfortable without specific policies and procedures to follow. To address these concerns, Planetree has fostered a comprehensive online member community to allow the sharing of policies and examples of best practices in line with the Planetree Designation criteria. As Sara explains it, “Designation is a powerful incentive” but not something that happen overnight. As this is essentially a cultural transformation, Planetree conducted market research among its members and has recently created lower-level tiers as stepping stones for healthcare facilities to help maintain momentum. Ironically, the first year these new tiers (75% of criteria for bronze, 88% for silver, 100% for gold) were introduced, no one applied, Sara explained this by reminding us that even at a lower level tier, there is still heavy lifting to be done.

Effectiveness of PCC Empirical evidence in recent studies (Stone, 2007) has shown that a patient centered approach, similar to the

methods prescribed by Planetree resulted in:Shorter hospital stays, statistically lower cost per case ratio, improved economics resulting from a change in the mix of nurse and auxiliary personnel, overall above-average patient satisfaction scores

(as defined by HCAHPS measures)

However, the concern of many hospital administrators is whether or not this approach is cost effective. Generally, there is a belief that the Planetree model is too costly as it requires high staffing ratios to accommodate increased staff and patient interaction time. Once Planetree Designation is achieved, the term is 3 years and it is expected that a facility will meet the new criteria that is updated every 2 years. While it is not Planetree’s goal to promote an environment of perpetual change, maintaining the facilities and the service model to the standards of evolving criteria is also a concern of hospital leadership when choosing to implement this approach to healthcare.

In a cost-benefit analysis done earlier this year (Coulmont, M. et al, 2013), researchers conducted a study to better understand the various expenses associated with implementing a PPC approach. Expenses such as the annual Planetree membership

fee, external support for training, change management and other consulting fees and any architectural design changes to develop an environment supportive of the patient-centered care model were incorporated into the analysis. While there are several myths and misconceptions

surrounding the expenses associated with this approach, the results of the study alleviate some of these concerns. Overall, the research showed that utilizing the PCC approach, the benefits outweighed the costs. The researchers further proposed that “integration of this approach in the future could become relevant for managers of health

][• Shorter hospital stays• Statistically lower cost per

case ratio• Improved economics

resulting from a change in the mix of nurse and auxiliary personnel

• Overall above-average patient satisfaction scores

Planetree Methods Resulted in:

88

facilities, who are constantly seeking ways to improve the quality of services at a lower cost.” (Coulmont, M. et al, 2013)

Health facilities such as Griffin Hospital in Derby, Connecticut have seen dramatic results upon implementing the Planetree, patient-centered care approach. When reduced market share and a projected loss over $1MM forced a change, Griffin chose to implement a patient-centered approach. Years later, Griffin is still a growing hospital with increased admissions, and realizing gains in revenue. In addition to improved impact on the balance sheet,

they also have shown lower turnover rates and even earned themselves a spot on the list of Fortune’s top 100 companies to work for in 2008 (Gearon, 2009).

Future Outlook and PlanWith over 500 healthcare facilities currently a part of the Planetree network, the next step for considering this approach is understanding how to implement the patient-centered care model into an existing facility. While the Planetree network has been in existence for almost 35 years, the designation program has only been in place for the

Category Examples of CriteriaStructures and FunctionsNecessary for Implementation,Development, and Maintenanceof Patient-Centered Concepts

Processes are in place to obtain and use feedback from patients and families on avariety of hospital practices and initiatives.

Human Interactions A model that embraces continuity, consistency, and accountabil-ity in care andpermits staff to personalize care for each patient.

Patient Education and Access toInformation

Educational materials are available for patients and families and accessible tostaff.

Family Involvement Flexible, 24-hour, patient-directed visitation.Nutrition Program 24-hour access to a variety of foods and beverages.Healing Environment:Architecture and Interior Design

Removal of barriers at nurses’ stations, such as high counters and counter-toceilingglass partitions, as well as those in family lounges and unit-based kitchens.

Arts Program A therapeutic-distractions program involving music, visual arts, crafts, animalvisitation, and bedside reading.

Spirituality and Diversity Documenting and addressing the needs of diverse cultural groups.

Integrative Therapies Assessment of staff and patient interest in and need for alterna-tive,complementary, and integrative therapies.

Healthy Communities A plan to improve community health.Measurement Satisfaction of inpatients and outpatients assessed using a vali-

dated instrument,with performance exceeding national averages.

The Patient-Centered Hospital Designation Program: Categories andSelected Criteria

99

last 8 years. Generally, healthcare organizations are a member of the network for 3-5 years before achieving the Planetree Designation. With 11 core dimensions of patient-centered care, consultants from Planetree work with hospital staff and administrators to help them start the process with an onsite culture assessment that includes focus groups and a “cultural audit” over the course of several days. The information gathered during this time assists the hospital administration in prioritizing and focuses them on the initial components of the criteria that are essential to building out the rest of the model. Once Planetree Designation is achieved, the goal is to keep the patient-centered approach embedding within the culture. Planetree’s aim is not to keep promoting change by adapting the model, but rather modify it to an evolving healthcare environment, pulling out items that have become commonplace and improving upon existing standards based on new research focused on improving patient care.

HOSPITALITY SERVICES AND CULTURE

As opposed to patient-centered care, hospitality services emphasize extra amenities and therapies, as well as the

superior customer service provided by staff. This provides patients with a better experience for the duration of their stay. The shift towards incorporating hospitality elements within a hospital was developed by newer hospitals who began using data on environment and healing to build better facilities. All these changes occurred after the American Hospital Association (AHA) reported a decrease in public trust of hospitals in the late 90’s. In addition, earlier reports showed that individuals felt that hospitals were becoming “business enterprises” and not “charitable organizations”. Hospitals knew they had to address this growing dissatisfaction and stigma in order to remain viable in the health care industry.

Creating CultureThe most important component of hospitality is providing superior customer service. This crucial aspect of hospitality is often overlooked in healthcare settings across the country, which is surprising as nearly all other facets of American life are defined in part by service. As a society we have grown accustom to even the most rudimentary conveniences such as drive-thru car washes, dining out, and home delivery services. Health care has traditionally focused solely on patient outcomes, but with increasing competition and reimbursement for services growing thin,

[ ]The Planetree Visionary Design Network provides a list of designs with a focus and/or expertise in the implementation of the Planetree, patient-centered care model.

1010

many organizations are turning their focus to customer service to improve their bottom line.

Creating superior customer service, however, is no easy task. Therefore, healthcare executives are looking to the hospitality industry for guidance. In 2006, Nancy Schlichting, CEO of Henry Ford Health System, appointed Gerard van Grinsven as president and CEO of Henry Ford West Bloomfield Hospital. Van Grinsven is a former vice president and area manager for the Ritz Carlton Hotel Company and has held several other managerial roles in hospitality. “The focus in healthcare should be and always should be around patient experience,” says van Grinsven. He believes that by providing the patient with a better experience, hospitals will be able to improve the quality of care and realize increased revenue and cost savings. The main driver of the patient experience is providing the best possible customer service. According to van Grinsven, the primary objective is to meet both the expressed and unexpressed wishes of the customer, in this case, the patient.

The path to satisfy the wishes of the patients begins by creating a culture within the organization. According to Fottler, Ford and Heaton, “an organization’s culture is the shared philosophies, ideologies, values, assumptions, beliefs, attitudes, and norms that knit the organization’s members together” (2002). It is not possible to provide superior customer service if the entire organizational structure does not believe in the purpose behind their actions. “If you don’t create a culture where the ladies and gentlemen that work for you feel that they are treated with trust, respect and dignity, and involved and empowered to do what they are best at, then you can never create world class service” says van Grinsven. In support of this approach, it is critical that leadership defines and practices the culture that they wish their employees to subscribe to. One common criticism

of healthcare administrators is that they often fail to walk the talk. Many agree that providing excellent customer service and a pleasant work environment for employees is important, however, rarely do they invest in either (Fottler et al., 2002). Van Grinsven agrees. “Too many people talk about service, but have no clue what it takes to deliver a highly personalized, engaged experience for their customers.”

To create world-class service, managers must define the behaviors that constitute service. For example, a nurse manager might be instructed to personally introduce him or herself to each new patient and provide their direct line in the case the patient has any questions or concerns. This is an example of an organization’s norm. “Norm”, in this case, is the organization values, service and individualized contact with the patient. It is up to each organization to establish its own set of beliefs, values and norms, which are the crucial components of culture. The manner in which culture is communicated to

Gerard van Grinsven, President and CEO Cancer Center Treatments of

America

][“The focus in healthcare should be and always

should be around patient experience”

Gerard van Grinsven

1111

employees is equally important as the culture itself. Myron Fottler, Robert Ford and Cherrill Heaton suggest the following methods to properly communicate culture within an organization (2002):

• Laws and Language• Stories, Legends, and Heroes• Symbols and Rituals

An organization must clearly define its rules, policies and regulations; they must be written out and made widely available to all employees. By outlining appropriate behaviors, the organization is defining their expectations to each employee and making them aware of the consequences of not meeting those standards. In addition, an organization is encouraged to make use of “stories” that emphasize real life examples of the outstanding performances of particular individuals. The goal of these stories is to inspire other employees to achieve the same excellence. Furthermore, the formation of “rituals” will result in cohesiveness between employees. By requiring all new employees to participate in an orientation, leaders can promote unity within their organization and emphasize the importance of its

beliefs, values, and norms (Fottler, Ford, & Heaton, 2002). Often times, employees will not modify their behaviors based on these changes alone. It is absolutely crucial that employees experience their role models and leaders upholding the same values that are of expected of them. Tom Centore, a graduate healthcare management student in the Sloan Program at Cornell University, witnessed this very phenomena from his preceptor during a summer internship assignment. On their walks over to the hospital his preceptor would bend over and pick up every piece of trash littered along the way. Soon, Centore found himself doing the very same thing. In another instance, Centore recalls seeing a hospital administrator escorting a confused elderly man out of the hospital who had lost his way. “We were on our way to a meeting with his boss, the chief operating officer. I remember thinking that if the tables were turned, I would under no circumstance be late for a meeting with my boss,” says Centore. However after some thought, Centore says that he would be late for a meeting with his boss under one condition: providing superior customer service to a patient or visitor. Creating culture is highly dependent on the leadership of the organization inspiring the rest of the organization to be the very best they can be.

Hiring the right employees also plays an important role in establishing and maintaining culture. While skill is still important to consider when hiring employees, more organizations are hiring those who have the necessary qualities to fit the culture. According to Fottler, Ford, and Heaton, the fit between an employee and culture often determines the success and satisfaction of that employee within an organization (2002). Gerard van Grinsven used a unique talent search firm to hire physicians for the Henry Ford West Bloomfield hospital. “We don’t select people just based on their skill set, we select people based on their natural talents”, says Mr. van Grinsven. According to Mr. van Grinsven, he wanted to identify which physicians had a talent for building relationships and going above and beyond the call of duty.Creating a culture within an organization is essential to the organization’s success and longevity. It is up to healthcare leaders to influence their employees to fulfill the organization’s beliefs and values. Although creating a culture takes tremendous effort, it is

1212

extremely beneficial to employees and patients. In addition, it is suggested that it is not very expensive to create and maintain (Fottler, Ford, & Heaton, 2002). All it takes is a vision, and a few highly motivated individuals.

Offering Hospitality ServicesThe hospital culture becomes more enhanced when accompanied by services aimed at accommodating the patient. There are a variety of amenities that hospitals have begun to offer to improve the patient experience. These may directly or indirectly affect a patient’s treatment and sometimes require a change to hospital design.

High Quality Food and DiningSome progressive healthcare facilities now offer hotel-style on-site dining and room service for their patients and visitors to enhance the facility’s patient and family orientation, improve patient satisfaction,

and gain a niche in a very competitive market (Sheehan-Smith, 2006). Some facilities also offer lavish organic food meals, along with a 24-hour meal program that allows the patients to choose the meals they want, when they want them. This type of hospitality increases patient independence and eases anxieties and fear about not having control over their care. Sheehan-Smith’s (2006) study on hospitals with hotel-style room service has shown

Washington Hospital Cafe

that the benefit of offering patients control over their food choices and meal times increase patient satisfaction.

Hospital Concierge and Guest Services Another growing area of hospitality services includes concierge or special services for patients. Some hospitals have begun using greeters to facilitate wayfinding within their facility. This reduces the time that patients spend navigating the hospital, and mitigates the stress and frustration associated with an already uncomfortable situation. In addition, more hospitals are beginning to use seamless clinical referral programs for patients and personalized services, such as dietary consultants and life coaches

to assist patients with issues beyond their immediate hospitalization. This demonstrates to the patient that the medical practitioners and staff are concerned with their condition and displays to the patient that the hospital has a high-quality of care (Hines, 2009).

However, the data on whether or not these services improve satisfaction is inconclusive. While some hospitals have reported great success in adopting concierge and similar programs (Hines, 2009), other organizations have not achieved the positive outcomes they had expected. Therefore, the implementation of a similar program must be carefully conceived.

1313

Complimentary Services and TherapiesThere are also an increasing number of hospitals that offer additional amenities such as massage therapy, spa treatments, and meditation therapy. Numerous studies have indicated the health benefits associated with massage therapies and stress reduction techniques like meditation (Wu, Robson, and Hollis 2013). By bringing these more alternative treatments to patients in need, outcomes and patient satisfaction are improved. Since insurance companies won’t pay for unnecessary non-medical services, the cost for these added amenities are likely to be absorbed by the hospital in order to increase patient satisfaction and loyalty. These alternative treatments also give the patients the ability to choose their care to a certain degree.

Services Linked to Hospital Design

Entertainment and Positive DistractionsSome hospitals have begun offering areas designed solely for entertainment. While these are very common for children’s hospitals and youth wards, designers have begun adapting them to older age groups. These areas contain video games, computers with high-speed internet, and multiple television

screens. Research has shown that positive distraction for both adults and children helps reduce pain and anxiety, improves energy, and generates other desirable physiological and psychological outcomes (Pati, 2010). This will contribute to faster healing times and increased patient satisfaction.

Single-Patient/Private/Luxury SuitesAn increasing number of hospitals have begun to redesign inpatient units to be single-patient rooms. While at first these single rooms seem unnecessary, research has shown that these spaces reduce noise levels, sleep disturbances, and stress reduction - all of which can help with patient recovery. In addition, there are several hospitals that offer expensive private rooms similar to hotel luxury suites. These suites include high-end kitchens, living rooms, and are staffed with private nurses. All these factors have resulted in increased patient satisfaction and reduced infection rates (Chaudhury, Mahmood, and Valente 2005).

Myths and MisconceptionThe vision of transforming a hospital – an organization focused on treating sick and injured people – into a hotel-like facility with non-traditional accommodations can be concerning. However, we hope to alleviate these concerns by addressing several common misconceptions. One of the largest misconceptions is the cost associated with the implementation of these services. Many of the hospitals that have implemented hotel-style services, especially dining, have actually seen a reduction in costs. In 2011, the University of Alabama at Birmingham (UAB) Hospital became one of the largest facilities in the country to implement hotel-style room service. After analyzing their financial reports, the administration saved as much as $250,000 per year by transitioning to this hospitality-based service style (Klein and Webb, 2012). However, there are some hospitality elements that have higher initial costs or may become too expensive to maintain if not developed efficiently. Other areas of hospitality, such as concierge services and complementary therapies, are also subject to the misconception that they may be too costly to maintain. Research has shown that complementary services are in fact cost-savings measures due to their lower technology intervention use and emphasis on preventative care (Tais and Oberg 2013).

Baptist Hospital, Miami, Florida

1414

SUMMARY

In conclusion, it is clear that there are various ways to design for a quality patient experience within a healthcare facility. Many of these options, when designed and implemented correctly, can lead to increased patient satisfaction and may provide a competitive edge, in a cost efficient manner. Hospital administrators may find themselves in the dilemma of wanting to provide quality service and improve patient experiences, but are unaware of the best method and how to approach the solution. With options such as a strong focus on hospitality, the patient centered approach as outlined by Planetree or structural changes focused on aesthetic architectural elements, it may not be simply choosing one approach, but a combination of the three. Overall, it is

important to know what your facility needs. Utilizing satisfaction scores such as HCAHP and Press Ganey, allows one to understand what areas are lacking in patient satisfaction. This is an important component to determining which solutions should be implemented.

The final key to determining the best method for your facility is understanding the culture of your community and its stakeholders. In addition to having the right components blended into your design, a well-formulated implementation plan is essential to achieving the benefits of your approach. Remembering that the goal is not to get an architectural award for your lobby, or work to get the gold standard designation, or even to have the best room service available, the goal is patient satisfaction. Don’t miss the point.

1515

Bibliography/ References:

Chand, S. Director - Core Project PTY LTD. Electronic Communication. November 27, 2013.

Chaudhury, H., Mahmood, A., and Valente, M. (2005) The Use of Single Patient Rooms versus Multiple Occupancy Rooms in Acute Care Environments. Coalition for Health Environments Research.

Christianson, J., Finch, M., Findlay, B., Jonas, W. B., and Goertz Choate, C. (2007). Reinventing the Patient Experience: Strategies for Hospital Leaders. Health Administration Press. Chicago, IL.

Coulmont M, Roy C, and Dumas L. (2013). Does the Planetree patient-centered approach to care pay off?: a cost-benefit analysis. The health care manager. 32(1): 87-95.

DiNardo, A. (2013, September 23). Take Five With Mark VanderKlipp. Healthcare Design. Retrieved December 10, 2013. http://www.healthcaredesignmagazine.com/article/take-five-mark-vanderklipp

Fottler, M. D., Ford, R. C., & Heaton, C. P. (2002). Achieving service excellence: Strategies for healthcare. Chicago: Health Administration Press.

Frank Becker, PhD. Professor of Design and Environmental Analysis. Personal Interview/Meetings October 30 - November 18, 2013.

Gearon, C. (2009). Planetree (25 Years Older). Hospitals & Health Networks, www.hhnmag.com, Dec 12, 2013.

Guastello, S. (2013). Adopting the Patient Perspective: A New Breed of Recognition Programs. Medical Home News: Sept. Vol. 5, No. 9.

Guastello, S. Director of Knowledge Management - Planetree. Phone Interview. December 5, 2013.

Hines, L. (2009). Riverside hospital banks on concierges to build business, employee satisfaction. http://www.pe.com/localnews/inland/stories/PE%20News%20Local%20S%20concierege27.3a13f5e.html

J.D. Power Associates. (2012). Patient Satisfaction Influenced More by Hospital Staff than by the Hospital Facilities. West Lake Village: Mcgraw-Hill.

Klein, B. and Webb, J. (2012). Room Service Continues to Deliver for Hospitals. Foodservice Equipment and Supplies. http://www.fesmag.com/features/foodservice-perspectives/6074-room-service-continues-to-deliver-for-hospitals

Martin, D., Diehr, P., Conrad, D.A., Davis, J.H., Leickly, R., and Perrin, E.B. (1998). Randomized trial of a patient-centered hospital unit. Patient Educ Couns. 34:125-133.

Pati, D. (2010). Positive distraction. Healthcare Design, 10(3), 28-34.

Planetree.org. Data Retrieved: November 10, - December 8, 2013.

Ramsinghani, P., MD. Phone Interview. November 25, 2013.

Robert Wood Johnsonn Foundation. (2004, June 7). Evidence-Based Hospital Design Improves Healthcare

1616

Bibliography/ References:

Outcomes For Patients, Families and Staff. Retrieved: December 10, 2013, http://www.rwjf.org/en/about-rwjf/newsroom/newsroom-content/2004/06/evidence-based-hospital-design-improves-healthcare-outcomes-for-.html

Sheehan-Smith, L. (2006). Key facilitators and best practices of hotel-style room services in hospitals. Journal of the American Dietetic Association, 106(4), 581-586.

Stone S. (2007). A Retrospective Evaluation of the Planetree Patient-Centered Model of Care Program’s Impact on Inpatient Quality Outcomes [dissertation]. San Diego, CA: University of San Diego.

Tais, S. and Oberg, E. (2013). The Economic Evaluation of Complementary and Alternative Medicine. Natural Medicine Journal. Retrieved December 1, 2013. http://www.naturalmedicinejournal.com/article_content.asp?article=402

The Victorian Quality Council. (2010). Promoting effective communication among healthcare professionals to improve patient safety and quality of care. Melbourne: State of Vicotria, Department of Health.

Ulrich, R., Zimring, C., Joseph, A., & Choudhary, R. (2004). The Role of the Physical Environment in the Hospital of the 21st Century: A Once-in-a-Lifetime Opportunity. Center for Health Design. van Grinsven, Gerard . President/CEO - Cancer Treatment Centers of America. Phone Interview. November 15, 2013.

Ziqi Wu, Stephani Robson, and Brooke Hollis. (2013). The Application of Hospitality Elements in Hospitals. The Journal of Healthcare Management, Vol 58, No 1.

About the Authors:

Tom Centore is a first year graduate student in the Sloan Program in Health Administration at Cornell University, where he is develop-ing a robust appreciation for the nuances of the health care system. He is currently interested in process improvement within hospitals. He holds a BS in Chemistry from SUNY Geneseo.

Emily Dunn is a first year graduate student in the Design and Envi-ronment Analysis Program at Cornell University. Focused on envi-ronmental psychology with a passion for health care and facilities management, her goal is to incorporate her current studies with her background in business into a consulting career upon graduation. Emily also holds a BSBA from the University of Arizona and an MBA in Strategy and Human Capital Management from Vanderbilt.

Nick Ramos graduated from Cornell University in 2013 with a BS in Human Biology, Health, and Society. During his undergradu-ate career, Nick completed research with Dr. Gary Evans in design and environmental analysis focusing on childhood poverty and the environmental effects it has physical and mental development. He is currently seeking a Masters in Health Administration at Cornell and hopes to use previous research experience to innovate, redesign, and administer children’s hospitals in local communities.

Vinnie Pierino is a current first-year Masters of Health Administration student in the Sloan program at Cornell University. He strives to work in an environment that emowers its employees to do the best for their patients. He graduated with a Bachelors of Health Science from the University of Florida.