Improving Patient Satisfaction: The physical environment matters!
Cindy Nuesslein, R.N., MBA, FACHE
Principal, Consulting Business Development Leader
“I HAVE HAD IT WITH THAT BANGING NOISE. WOULD SOMEBODY PLEASE FIX THAT DOOR?” – I will come back to that comment in just a moment.
I have had the opportunity to experience hospitals and health facilities from several perspectives – as a clinician, as a patient, and as a family member. And, as I will share in this post, the condition of facilities and management of facility services can and does have a major impact on my satisfaction in each of those roles. The importance of that translates into how well I delivered care, hence how satisfied were the patients that I cared for, and how well I perceived care was delivered, how satisfied I was as a patient.
With the implementation of the HCAHPS survey in 2006, patient satisfaction began to have an impact on the hospital’s bottom line, sans the few categories of providers that continue to be exempt. The 32 questions on the survey are driving a significant investment in number of people participating on teams trying to drive performance improvement and achieve higher “top box” scores. And, although only two of those questions are directly about the condition of the environment, science is demonstrating that the environment has an impact on them all. Therefore, let’s look at the questions and some of the science.
The first seven questions examine the perception of care by the nurses and physicians. Read any of the science behind the success at companies that really understand happy staff equals happy customers, and you will see organizations that invest in the physical environment. From good lighting, to well-maintained floor and walls, chairs in good repair, each has an impact on staff satisfaction. Think of all the providers that could trip over a badly maintained threshold before they enter a patient room for the umpteenth time–not the best way to keep them focused on great patient care. Also, Question #4 addresses call button response. But, what if the call button isn’t working? I’ll leave it there for now.
QUESTIONS #10 – 20 and 22 – 28
These questions address the view of the patient in regards to care, communication, education, and their health status throughout the hospital stay, including a focus on pain. Several credible studies validate how the physical environment can reduce pain or limit its duration as well as how it can enhance communication. (Check out NIH’s, “Pain in it’s Environmental Context: Implications for Designing Environments to Enhance Pain Control.”) That body of science continues to grow, supporting the importance of a well-maintained facility for the health, safety and satisfaction of our patients and their families, hospital and medical staff.
Recently (MARCH 2016), Hospitals in the Pursuit of Excellence (HPOE) and the American Society of Healthcare Engineers (ASHE) published a monograph documenting how we can improve the patient experience through changes in the physical environment. The link follows and is well worth the time to read. There are a number of valuable suggestions that could be impactful. Part of “Table 1” is below, illustrative of some of the ideas.
Table1:How the physicalenvironmentcanaffect the patientexperience
» Use nonporous surfaces without joints or seams to enable effective and efficient cleaning.» Use impervious (nonporous) upholstery to enable cleaning and avoid stains (i.e., fabric should not be used in patient care areas or heavily used areas such as cafeteria or visitor areas).» Carpet tiles should be used minimally for sound absorption and to ease foot fatigue. When used, environmental services should be educated about proper cleaning methods.» Consider using rounded corners where surfaces meet (i.e., flooring and inside wall corners) to prevent the buildup of dust and particles. Integrated floor bases can be made of the same products as the floor.
» Consider chairs with “clean-out gaps” where the chair and seat meet so that debris drops to the floor.
» Use darker-colored floors or flooring with flecks to help hide shoe marks.
» Select furniture that enables eye-to-eye contact between caregivers, patients and family members.» Position communication white boards so the patient can easily see the board, and ensure thorough information is communicated (so that pieces of paper do not need to be taped to the wall to supplement the white boards).» Design rooms and units in ways that promote better communication between patients, caregivers and family members.
» Design a large and well-planned family zone to engage home caregivers.» Use enhanced communication features such as a resource area with a computer and Wi-Fi in the family zone.
Transition in care
» Design a large and well-planned family zone to engage home caregivers.» Use features to enhance communication, such as stacking chairs that can be brought in if needed or a tabletop for showing special items such as bandages, dressings or medication application.
» Use positive distractions, such as views of nature or art depicting calming nature scenes (not abstract art).» Provide entertainment systems that are strategically placed, user-friendly and in good repair.
The last four questions are demographic in nature. These might lead us to consider additional ways to favorably impact the patients such as wayfinding in more than one language, picture-assisted wayfinding, and additions to our “soothing strategies” in the physical environment.
The only two questions I haven’t discussed directly, address the environment–Q#8 clean rooms and Q#9 noise at night. Rooms in disrepair never look “clean” and noise, in my opinion, is one of the toughest of all the issues to address, especially night noise. In fact, the most recent report of national averages on the HCAHPS survey shows “noise at night” as the second lowest of all areas scored. Given that I worked night shift as a nurse for several years, I can personally attest to this. Let me attest to a few other facility-related irritations for my patients: no hot water, drippy faucet noise, ceiling leaks post rainfall, broken televisions, sticky doors on the wardrobe closets, dirty windows, inoperable light bulbs, squeaky wheels on all the carts we push…
Therefore, I strongly advocate that facility services staff participate in the patient satisfaction performance improvement effort. It might be insightful to read the survey questions with Facility Services in mind. Better yet, send it to your Facilities Director and request feedback from the department’s staff in regards to improvement ideas–the ASHE monograph can help catalyze conversation. HCAHPS survey tool here, for your convenience.
Back to the banging… As a family member, I was sitting in a hospital room tending to a loved one. I was only there for two hours, but we experienced more than 20 episodes of the door opening and closing – breakfast brought and retrieved, vital signs checked, EVS room cleaned, doctor visit, nurse assessment, nurse on medication run, volunteer delivering flowers, lab blood draw, and on and on. Something was amiss with the hardware–the noise dampers were worn or missing. The noise was terribly annoying for me and certainly for my relative-patient. Limiting the “necessary noise” in the patient environment is difficult, but this is an easy fix. Put a routine door check in your CMMS as a routine PM.
There is much we can do, but it takes a collaborative effort to get there. Although your Facilities Team may not have been historically involved in these efforts, their involvement today necessitates priority.
One final thought: In this area, the squeaky wheel should literally get the grease–your patient satisfaction and the health of your bottom line depend on it.