The Patient Protection and Affordable Care Act signed in March will undoubtedly affect every healthcare organization in the country. What it will not change is the fact that positive patient outcomes are still the real bottom line and the ultimate mission of caregivers, administrators, and hospital staff.

Facility managers and their design and construction industry partners have an important role to play in creating the best possible environment of care. The Center for Health Design found hundreds of studies directly linking positive patient outcomes to a healthcare facility's physical environment. A 2009 Trane survey confirmed that 96% of healthcare executives have considered that connection.

Astute facility managers are using modern heating, ventilating, and air conditioning (HVAC) technology to help their organizations create both a cleaner indoor environment and a healthier bottom line. But to make operational and energy-saving HVAC improvements, facility managers need to build a business case to justify capital projects.

Energy accounts for the lion's share of healthcare facilities' utility costs, but it represents a single-digit slice of a typical hospital's total operating budget. That means that annual energy savings, even when they add up to six figures, seldom justify HVAC improvements on their own. Facility managers need to show how a project contributes to improving the quality of care. That's where a physical environment of care study becomes useful.


Physical environment of care studies uncover potential improvements

A physical environment of care study uses a structured process to help facility managers identify patient, caregiver, and staff concerns about the hospital's physical environment and find solutions that contribute to better patient outcomes. Facility managers often turn to third parties, such as an energy service company (ESCO), for help in planning and conducting the study and analyzing its findings.

For a typical study, the research team goes right to the source by interviewing top management and representatives of major departments, including the hospital units, infection control, quality, laboratories, human resources, and safety. The team members also gather a wide range of available data, including information from patient surveys, and make first-hand observations of hospital operations.

Gathering and analyzing all this information helps the team identify specific improvements that can reduce costs, improve efficiency and, most importantly, create a hospital environment that is safer, more comfortable, and more conducive to providing quality patient care.

Improvements in such factors as air flow, lighting, humidity, and temperature can also provide other significant benefits. They include bolstering a hospital's “green” reputation in the community, improving employee morale and productivity, and helping the organization attract and retain the best available affiliated and staff physicians, nurses, technicians, and support staff.

Passavant Area Hospital uses study to justify improvements

In early 2009, Passavant Area Hospital worked with an ESCO to launch a structured physical environment of care study process to evaluate the relationship between the facility's physical environment and patient outcomes. Located in Jacksonville, Illinois, Passavant Area Hospital is a 93-bed, nonprofit community hospital serving five counties in West Central Illinois.

The study team used a five-step process that included holding executive meetings, interviewing 25 key staff members, collecting data and surveying the site, analyzing information, and developing conclusions and recommendations.

Using their own observations, information gathered during interviews and other data sources, the team identified three main environmental issues that had a negative impact on hospital performance: temperature, noise level, and the aging plant and equipment.

Based on study findings, the team recommended an investment-grade systems audit that would provide financial estimates for infrastructure improvements, taking energy and operational savings into account. The audit would also cover the impact of addressing environmental issues on such performance factors as patient outcomes, patient satisfaction, staff satisfaction and performance, and financial performance. The team also recommended sharing details of the study and its findings with the hospital staff, to reassure employees that their concerns were heard and were being addressed.

The study team concluded that HVAC system improvements would have a positive effect on all performance factors. For example, improving and automating temperature controls would save staff time and enable nurses to concentrate on patient care instead of adjusting thermostats. A quieter environment would help patients rest and reduce the chances that medical instructions could be misheard. And better indoor air quality would enhance the facility's ability to control and contain hospital-acquired infections.


Study builds case for $2.3 million in infrastructure improvements

Armed with hard data from the physical environment of care study, the hospital's board of directors was able to make an informed decision about the infrastructure improvements that the team recommended knowing that the upgrades would have a positive impact on both the environment of care and their balance sheet.

The board approved a $2.3-million infrastructure improvement project launched last summer and completed in early 2010. While improving the environment of care was the primary motivation for the project, the upgrades also will deliver more than $313,000 in annual energy savings.

By using an innovative custom performance contract, the hospital was able to fund the project using future energy and operational savings. The project will pay for itself in about 6.5 years.

Improvements include installing more energy-efficient lighting and electrical systems; optimizing performance of the central chilled water and steam boiler systems, which will save both energy and water; upgrading HVAC systems and controls; and improving efficiency in hospital laundry operations.

Facility managers help hospitals achieve primary mission

Unprecedented changes in America's healthcare system are creating a variety of challenges for hospitals, their facility managers, and the design and construction companies that support them. What has not changed is the need for healthcare organizations to put patients first and continuously improve the environment of care.

With such tools as a structured physical environment of care study, hospital facility managers have the opportunity to apply their unique perspective to achieving the organization's primary mission-creating a healthy environment for patients, caregivers, staff, and visitors. HD

Laura Rygielski Preston, FACHE, is director of the healthcare market for Trane. She is a Fellow in the American College of Healthcare Executives (ACHE) and is Board Certified in Healthcare Management. For further information, visit Healthcare Design 2010 August;10(8):10-12