Patients often judge the quality of a provider’s medical services based on their perceptions of a hospital’s physical environment. Walk into a hospital with stained walls and trash scattered along the floors and you’re likely to do a one eighty and head back out the door. Anecdotal evidence suggests that medical travelers and their companions may be even more sensitive about a healthcare facility’s physical environment than local patients, consciously (or unconsciously) comparing destination facilities to those in their own country or region. “Blemishes” that may not garner a second glance at home can stand out like a sore thumb and engender doubts about the quality of your hospital’s services.
Several studies, including a well-known one by Professor Jerry Gotlieb of Western Kentucky University, have shown that patients’ perceptions of hospital infrastructure can influence their perceptions of hospital quality. 1 While “dirty” spaces are an obvious way for a healthcare facility to cause a bad first impression, there are many other elements that can affect how traveling patients perceive your facility. The positioning, design, layout, and signage of the treatment setting are crucial factors in the way patients feel about their care environment. Even lighting and sound have an impact on the care experience. Using sound-absorbing material on ceilings, floors and walls, for example, will reduce noise, which has been shown to increase stress in both patients and staff. 2
There is also an increasing body of evidence showing that patients recover quicker in aesthetically pleasing healing environments. According to a recent New York Times article, The University Medical Center of Princeton tested a new “model room” with nice views, a sofa for guests and no roommates; it found that patients asked for 30 percent less pain medication. Reduced pain has been linked to a quicker recovery, leading to shorter stays and reduced costs. 3 The same conclusion was reached in a seminal 1984 study published by architecture professor Roger S. Ulrich that compared two groups of patients recovering from Gallbladder surgery. Patients with a nice view left the hospital on average almost one day sooner than the other group. 4
While any patient population deserves to be treated in a clean and pleasing environment, medical travelers are arguably more likely to suffer from the effects of stress and anxiety due to the unique combination of travel and treatment and associated factors such as jet lag, language barriers and having to navigate cultural differences in an unfamiliar environment.
Granted, while most healthcare facilities do not have the budget to make sweeping changes to their infrastructure, there are small and relatively inexpensive steps that can be taken to improve the healthcare environment for patients and staff. The Center for Health Design, a think tank and advocacy organization whose goal is to “transform healthcare environments for a healthier, safer world through design research, education, and advocacy,” recommends that hospitals consider the following factors when designing or upgrading their physical spaces:
Access5
1. Use simple (as opposed to medical) terms to indicate locations and provide information in multiple languages (depending on target patient populations served) and use universal symbols supplemented with text and numbers when designing signs in a multicultural setting.
2. Consider using integrated wayfinding strategies that communicate information to patients and families from different cultures.
3. Create welcoming environment for patients, families, and staff by reducing environmental stressors, providing positive nature distractions, and improving amenities.
4. Cleanliness along access areas should be monitored continually.
5. Color palette chosen for walls and furnishings should be harmonious and soothing
6. Reinforce community commitment through the selection of interior aesthetics, such as artwork and color preferences relevant to multiple patient populations represented in the clinic.
7. Use zoning to separate public, treatment, and staff functions to improve internal circulation and privacy.
Waiting areas/admission6
1. Consider acoustic properties of materials selected for waiting, check-in, and communal spaces to aid in minimizing noise.
2. Create welcoming environment for patients, families, and staff by reducing environmental stressors, providing positive nature distractions, and improving amenities.
3. Cleanliness in waiting areas should be monitored continually
4. Identify clear spacial boundaries for waiting areas that are distinguished from adjacent circulation paths.
5. Color palette chosen for walls and furnishings should be harmonious and soothing
6. Provide a variety of lighting options—controlled, natural, skylights.
7. Provide Wi-Fi and/or internet accessible computers within waiting areas.
8. Create patient spaces that also accommodate accompanying family members.
9. Provide positive distractions for patients and families in waiting areas including culturally relevant art work, reading materials in different languages, television, and information kiosks.
10. Use televisions and/or monitors as a positive distraction outlet.
Examination areas7
1. Consider sight lines into and out of rooms for visual privacy.
2. Create welcoming environment for patients, families, and staff by reducing environmental stressors, providing positive nature distractions, and improving amenities.
3. Lower the power differential between provider and patient within the exam room through furniture selections and adjustable features on technology equipment.
4. Cleanliness of consultation/exam areas should be monitored continually
5. Hospitals and clinics should strive to feature up-to-date technology and equipment
6. Color palette chosen for walls and furnishings should be harmonious and soothing
7. Create patient spaces that also accommodate accompanying family members.
8. Provide positive distractions for patients and families in waiting areas including culturally relevant art work, reading materials in different languages, television, and information kiosks.
Patient rooms
1. Consider offering private rooms and suites
2. Availability of safety box
3. A sofa bed for the companion
4. Wi-Fi internet access
5. Nurse call button accessible to the patient
6. Temperature controls accessible to the patient
7. Noise level near room should not be disturbing
8. Color palette chosen for walls and furnishings should be harmonious and soothing
Many of the recommendations stated above are advocated within the GHA standards in competencies such as care management, physical environment, cultural competency, patient advocacy, infection control, and technology. Given that patients may be tired from traveling, feeling disoriented, or experiencing cognitive or physical difficulties, every effort must be made to make access to services easy in a stress-free healing environment.
[1] Gotlieb JB. Understanding the effects of nurses, patients' hospital rooms, and patients' perception of control on the perceived quality of a hospital. Health Mark Q. 2000;18:1–14
[2] Noise Pollution in Hospitals: Impacts on Staff Erica E. Ryherd, PhD, Selen Okcu, PhD, Jeremy Ackerman, MD, PhD, Craig Zimring, PhD, and Kerstin Persson Waye, PhD. http://turner-white.com/pdf/jcom_nov12_noise.pdf
[3]https://www.sacfirm.com/blog/hospitals-rooms-improve/
[4]R. Ulrich. View through a window may influence recovery from surgery. https://mdc.mo.gov/sites/default/files/resources/2012/10/ulrich.pdf/
[5]The Center for Health Design. https://www.healthdesign.org/clinic-design/design-recommendations.Retrieved 10/23/14
[6]Ibid.
[7]Ibid.
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