The media went bonkers last week over a study, published in the March 2015 Journal of Hospital Medicine, that analyzed patient satisfaction survey results to see what role the physical environment played in improving inpatient hospital scores. Provocative headlines included “Fancy Hospital Flourishes Often Fail to Impress Patients” (NPR) and “Hospital Design may not Boost Patient Satisfaction” (U.S. News & World Report); even Johns Hopkins proclaimed: “Johns Hopkins Researchers Find New Patient-Centered Hospital Design Has Little Effect on Patient Satisfaction.”

I read the study and here are the real conclusions:

Researchers led by Drs. Zishan Siddiqui and Daniel Brotman of the Johns Hopkins University School of Medicine analyzed data from HCAHPS and Press Ganey surveys returned by patients in existing Johns Hopkins inpatient facilities and in its new Sheikh Zayed Tower, completed in 2012. The team analyzed 7.5 months of post-move patient satisfaction survey results and 12 months of pre-move patient satisfaction results. A total of 5,663 patients were surveyed. The expectation was that, similar to other smaller studies, patients would perceive physicians, nurses, and overall care as better in new surroundings with evidence-based design features. But the results showed that this could not be contributed to the new facility design.

What the researchers did find was significant improvement in facility-related satisfaction scores such as noise level (39.9 percent vs. 59.3 percent), pleasantness of décor (33.6 percent vs. 66.2 percent), and visitor (family) accommodation and comfort (50 percent vs. 70.3 percent). Likewise, there was great improvement in perception of room cleanliness (49 percent vs. 68.6 percent). Also there was a significant (5 percent) increase in patients who would recommend the hospital to others.

Regarding non- facility-related items, only “staff attitude toward visitors (family)” showed significant improvement in the new facility. There was improvement in how patients perceived their clinical care, but it had consistently improved in both the old and new facilities so could not be “associated with the new clinical building when compared to concurrent controls.” Their conclusion was that “patients appeared able to distinguish their experience with hospital environment from their experience with providers and other services.” The researchers surmise that provider-level interventions will have a greater impact on overall satisfaction. But they also conclude that study should continue on design interventions that improve safety, workflow, efficiency, and time spent in direct care, which may affect clinical practice and, subsequently, patient satisfaction with caregivers. The final conclusion is that hospitals “should not use outdated facilities as an excuse for achievement of suboptimal satisfaction scores.”

In general, I find their results quite heartening. This was a comprehensive study of one well-designed, new, large academic facility with a specific population that obviously improved the experience of patients and family. As healthcare facility designers partner with hospitals to improve patient satisfaction, several questions come to mind that deserve further discussion and analysis:

  1. Of all the topics surveyed, what has the biggest impact on patient and family satisfaction and in what order of importance? It may be interaction with caregivers, but studies by the Beryl Institute and others have shown that noise reduction is the biggest factor in improving the patient experience.
  2. What design interventions can improve the day-to-day practice of clinical and support staff so they can interact more successfully with patients and family?
  3. How can research be designed to capture what environmental features provide the best “payback” in improving patient experience?

For those who are interested in reading this study and not just reading headlines, it can be accessed here.