To use an evidence-based design process, you have to know what the best available evidence is. But research is published faster than anyone can read it. In this blog series, The Center for Health Design’s research team will provide insight into a few healthcare design research matters through a snapshot of 10 studies published since the 2016 Healthcare Design Expo & Conference. Serving as an inside look at a session held at the 2017 HCD Expo, the blogs will identify why this research matters and help readers ride the waves of an ocean of research without drowning.

The research
A recent study by Emily S. Patterson, Elizabeth B.N. Sanders, Carolyn M. Sommerich, Steven A. Lavender, Jing Li, and Kevin D. Evans investigated what patients and their families want from a hospital room, with a focus on those who require multiple-night stays. It resulted in a model of patient-centered rooms based on four main themes: comfort to facilitate healing, control over the environment and privacy, a sense of connection to the outside world, and access to the things patients need (e.g., their own property, the bathroom, etc.).

Why does it matter?
As the authors say, “The traditional design approaches of the past have resulted in hospital rooms that do not reliably deliver what really matters to the patient.” This study proposes a design framework for patient centered rooms that may help designers bridge the gap between what patients want and need, and what historical design practice has delivered.

Beyond the impact on designers, this may lead to hospital rooms that reduce stress and allow patients to focus on healing, potentially to improve both physical health outcomes and overall well-being. This may also benefit healthcare organizations financially, because their reimbursement rates are increasingly tied to patient outcomes and patient experience survey scores.

How was the study done?
This study took a qualitative, grounded theory approach based on survey data as well as the reactions of patients and caregivers to different full-scale prototypes of different hospital room designs. It included 61 participants. Thirty-seven were patients who had recently completed a hospital stay including three days or more in a medical-surgical unit, and 24 were their family caregivers.

Before seeing the simulated hospital rooms, patients were asked to rate the importance of 12 design characteristics for medical/surgical rooms, such as “while in bed, the patient can see people as they enter the room.”

There were five room designs altogether. Due to time constraints, each participant was exposed to two of these. Participants were given a guided tour of each of these two rooms, which included an explanation of key features and furnishings, and were also given printed layouts of the two rooms to aid in their comparisons. Following the tour, participants were brought together for a group discussion and asked what they liked best/disliked most about each room.

The prototype room designs were all based on extensive prior research on patients/families and hospital staff, and all included a set of more than a dozen patient-centered design features. Some of these design features are more common in current practice than others (for instance, placement of the patient bed close to the bathroom vs. a universal remote control that controls not only the entertainment system but also the lights, temperature, blinds, and privacy curtains, and also functions as a nurse call button).

What was learned?
The researchers found that many of the most important features for patients/caregivers related to the ability of patients to control their environment and maintain situational awareness from a comfortable position in the patient bed. The ability to control lighting and entertainment, and to read the electronic whiteboard (which displays things like who is expected to come into the patient room and when) were among the highest-scoring items in the survey. Ensuring visual privacy also scored very highly.

Similar themes arose in the analysis of group discussions. For instance, patients wanted to be able to comfortably see the entryway and anyone entering the room, while also ensuring privacy through the use of a privacy curtain. And they did not want to be disturbed by activity taking place in the hallway.

The 10 most frequent themes that arose from the group discussions are shown (sometimes paraphrased for clarity) below:

  • Entry--visual privacy
  • Bathroom--easy to get through the bathroom door
  • Patient zone--control the environment from the bed; accessible power outlets; a place to put belongings (flowers, cards) where the patient can see them; ability to see key elements (TV, whiteboard, window) as well as visitors from a comfortable position on the bed
  • Tray table--a tray table that works for patients (adjustable, easy to move, a food tray that slides out, support for computers)
  • Whiteboard-- a whiteboard that is useful and readable from the bed
  • Window--presence of a window

Based on these findings, the authors developed a grounded theory of what patients want from a hospital room: “Patients expect a hospital room that provides them with the comfort needed to support healing and with the perception of connection to the outside world. The hospital room should provide them with quick and independent access to their belongings and offer increasing levels of control throughout the course of their hospital stay.”

Finally, the authors proposed a theoretical design framework, in which patient comfort is the product of design that supports control, access, and connection for patients.

Are the results definitive?
The authors identified a number of limitations to this research. The participants may not have been representative of the broader population, and may especially fail to reflect the views of special needs populations. The test scenario did not prompt discussion of issues such as lighting, smells, or background noise that might also be important to patients. And each study participant was only exposed to two of the five prototypes, which made ranking of the room designs impossible. In addition to these limitations, it is possible that cultural differences may limit the generalizability of these findings to other countries/regions.

Overall, however, this paper provides a useful and testable framework for designing patient-centered hospital rooms.

The takeaway
What do patients want in a hospital room? They want the comfort that comes from control over their environment, easy access to the things they want or need, and a sense of connection to the outside world. And as they recover over the course of their stay, patients want the built environment to support their increasing levels of autonomy. Both the high-level design framework and the detailed qualitative data in this study may help designers achieve the design outcomes patients are waiting for.

Interested in the topic? Visit The Center for Health Design Knowledge Repository for more.

Alan J. Card, PhD, MPH, CPH, CPHQ, CPHRM is a Research Associate at the Center for Health Design. He can be reached at acard@healthdesign.org.

Summary of:
Patterson ES, Sanders EB, Sommerich CM, Lavender SA, Li J, Evans KD. Meeting
Patient Expectations During Hospitalization: A Grounded Theoretical Analysis of
Patient-Centered Room Elements. HERD. 2017 Oct;10(5):95-110. doi:
10.1177/1937586717696700.