As my colleagues and I have stated in these blogs on designing for HCAHPS, there are three important factors related to the holistic patient experience. With the utilization of HCAHPS as a primary criteria for hospital organizational reimbursement, the patient experience is now directly related to specific survey topics.

One of these important survey questions within the Hospital Environment Section of the survey involves cleanliness in the patient room and the bathroom. From the survey:

During the hospital stay, how often was your room and bathroom kept clean?

The built environment’s impact on this question is very important, because cleanliness has both a direct and indirect relationship to patient satisfaction. There are three specific elements based on this aspect of the built environment. First, a clean room and bathroom contribute to higher patient satisfaction. Second, an unclean room and bathroom may contribute to the perception of poor care. Third, a contaminated patient room might contribute to hospital-acquired infections in patients.

There are two primary planning and design criteria that greatly influence the real and perceived cleanliness of the patient room and bathroom. The first criteria is the design of the room and whether the rooms have acute angles and other narrow areas that are difficult to adequately clean. Heavy furniture and medical equipment can create areas that trap dirt and dust because of their difficulty to move and clean.

The second criteria is the specification and selection of the finishes on fixed elements, furniture, and moveable equipment in the patient room and bathroom. It's important to note that when patient satisfaction involves finishes, there are real and perceived types of cleanliness. There are certain types of finishes that look unclean and dirty despite the fact that they may actually be clean and free of bacteria. 

The first step to overcoming these challenges is to understand the changing healthcare landscape. Then, using a balanced approach of innovative and cutting edge thought leadership, planning and design experts can use evidence-based design, lean design, and healthcare research to solve these built environment problems and improve patient outcomes and satisfaction.

Gary Vance is the Director of National Healthcare for BSA LifeStructures.Gary is a recognized thought leader in healthcare planning and design, providing hospitals with creative solutions to their facility problems. He also collaborates with various healthcare constituent groups to develop innovative solutions to operational, facility and organizational problems. He can be reached at For more information, please visit