Healthcare Design - December 2015 - 50

R RESEARCH | 12.15
Gray area

From some perspectives, a recent study from Johns Hopkins threw a monkey wrench into the
industry when it found no relationship between building design and patient satisfaction with care
delivery. In this exclusive report, one of the study's authors and a healthcare design researcher
weigh in on why that's not quite the end of the story By Nicholas Watkins and Zishan Siddiqui
U.S. healthcare construction continues to move
steadily along at the reliable pace of $38 billion to
$42 billion a year. Harder to quantify is the value
of healthcare design-particularly its influence on
patient satisfaction.
In today's healthcare landscape, hospitals are under increasing pressure to improve their patient satisfaction scores. These scores are publicly reported
by the Centers for Medicare & Medicaid Services
(CMS) so patients can compare various hospitals
and make informed choices. Moreover, 25 percent
of CMS incentive payments to hospitals are linked to
the scores.
How are healthcare organizations responding to
the pressure? One common belief held by healthcare administrators is that patients who feel positive
about a healthcare setting are more likely to be
satisfied with the care they receive. Consequently,
new construction and renovation have become a key
strategy for improving scores. So it's no surprise that
a study on patient satisfaction conducted before and
following a move to a new inpatient facility published
earlier this year in the Journal of Hospital Medicine
got a lot of attention and gave the healthcare design
industry a reason to pause.

visitor accommodations, and comfort. Yet overall
satisfaction scores only increased modestly and
care delivery, arguably the mission and heart of any
healthcare enterprise, saw no improvement in satisfaction scores.
Taken all together, the Johns Hopkins study concluded that patient-centered design isn't a panacea
and that the prevailing wisdom of assuming a direct
and causal link between facility design and patient
satisfaction oversimplifies more complex dynamics.
Aging facilities should not shoulder full blame for
poor patient satisfaction scores and, likewise, a new
facility isn't a magic wand that wishes away fundamental challenges with care delivery. Research and
return-on-investment analyses may show it's wiser
for more capital expenditures to be allocated toward
operational and training interventions.
Another result of the buzz was a call by some in
the healthcare design industry for more research to
quantify the value of patient-centered design. How
do we take steps in the right direction and are there
some useful precedents that begin to untangle the
complexity of these relationships?

A wrench in the works?
Completed in 2012, the Sheikh Zayed Tower is a
355-bed inpatient facility and home to the Johns
Hopkins Medicine Heart and Vascular Institute in
Baltimore. The building project offered an opportunity for a team of researchers at Johns Hopkins to test
the assumption that patient-centered design would
have a broad impact on patient satisfaction, including with care delivery. This research team analyzed
5,663 ratings on the Hospital Consumer Assessment
of Healthcare Providers and Systems (HCAHPS) and
Press Ganey surveys. From the statistical findings,
the team inferred whether patients' perceptions of
caregivers improved at the new facility compared to
the old.
What did the study find that prompted a media

Not as it seems
Many interrelated factors influence patient satisfaction, and there's a nuanced interplay among patient
satisfaction, patient health, and facility design.
Case in point: Research published in Health &
Place in 2013 by Claudia Campos Andrade and coauthors explored the relationships among a patient's
status (inpatient or outpatient), perceived quality
of physical and social environment, and satisfaction. The study strongly indicates that inpatients
have different expectations and perceptions of their
surroundings-and make different types of value
judgments about them-as compared to outpatients.
The social environment closely associated with caregivers and care delivery was important to inpatients,
whereas the aesthetics of the physical environment
were more closely scrutinized by outpatients.
As suggested by this and the Johns Hopkins

stir? For starters, the patients were quite good at
distinguishing between their care and the quality of
the facility in which they received care. There was
improved inpatient satisfaction with facility-related
features such as pleasantness of décor, noise level,

study, there are connections between facility design,
inpatients' experiences, and care delivery that need
more exploration. Design research helps us muck
around a lot more in these gray areas where unexpected relationships go to hide, such as the influence

HCDmagazine.com 12.15

Nicholas Watkins

Zishan Siddiqui

http://www.HCDmagazine.com

Healthcare Design - December 2015

Table of Contents for the Digital Edition of Healthcare Design - December 2015