People/Process/ Place: Enhancing the Patient Experience
through the Build Environtment
People / Process / Place:
Enhancing the Patient Experience through the Built Environment
Sheila F. Cahnman AIA, FACHA, LEED AP
President, JumpGarden Consulting, LLC
Lynn Kenney, Senior Analyst, Advocacy, ASHE
Lorissa MacAllister ,PhD, BSW, AIA, NCARB,EDAC,
President, Enviah
Learning Objectives
• Introductions-why we do what we do!
• The people, process, place framework
• Aspects of the built environment are proven to
enhance the patient and family experience
• Review case studies and examples that illustrate
these concepts
• A suggested plan of action for incorporating the
patient experience into facility-related activities
The Wonderful World of Patient Experience and
Facilities Management…
Short 2 minute “GurneyCam” video takes a humorous
look at “seeing the facility through the eyes of the patient”
by having the patient wear a camera mounted on a
construction hat while they’re wheeled around on their
gurney.
Who is ASHE? Who is the ASHE HCAHPS
Task Force?
What Is Involved?
Approach these concepts in a holistic way to get buy in,
appreciation, understanding from the many varied stakeholders…
Process
People
Place
Patient and
Family
Experience
of Care
Survey of Patient Experiences
http://www.medicare.gov/hospitalcompare
Expansion of CAHPS Survey Program
• Hospital Consumer Assessment of Healthcare Providers
and Systems Survey (HCAHPS)
• Outpatient and Ambulatory Surgery CAHPS (OAS CAHPS)
• Emergency Department Patient Experiences with Care (EDPEC)
Survey
“The surveys provide patient experience data that enables
comparison of facilities across the nation and promotes effective
communication and coordination.” www.cms.gov
Improving Px When You Can’t Build
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Privacy curtains with photographic images of nature
Acoustical ceiling tiles and wall panels
Patient ambassadors
Blanket warmers
Eye contact
Eye masks and ear plugs or white noise
Lighting upgrades
Relaxation TV
Rolling planters (Bassett Healthcare)
Smile!
HCAHPS Question #7: How often was the area around your room quiet at night?
(The patient’s responses go beyond quiet at night.)
Place
People
Process Reengineering
Building
•Single patient rooms
•Use of sound absorbing
materials
•Design to separate noisy
entities (ice machine)
Establish Goal
• What is the current state?
decibel level, HCHAP score, &
staff satisfaction re: noise
Staff Interventions
•Nighttime care
guidelines
•Quiet voices
•Resupply and
equipment movement
Technology
•Hands-free
communication
•Beepers on vibrate
•No overhead paging
Develop Noise Reduction
Plan
•Set the stage using research
and best practices
•Clarify values, vision
Patient Interventions
•Rights
•Earplugs
•Television and radio
headphones
Equipment
•Fix squeaks
•Decrease equipment
volumes – link to handsfree devices
Measure and Reward
Progress
•Celebrate successes
•Find and tell the best stories
Visitor Interventions
•Orientation to noise
reduction
•Cell phone use
•Slide by Eileen Malone
Do patients in appealing rooms more favorably
evaluate healthcare providers and services than do
patients in typical rooms?
Health Care Management Review 2003
Mercy West
Cincinnati, Ohio
New facilities = high scores
HCAHPS SCORES
National Average
Patients who reported YES, they would definitely
recommend the hospital.
ST JOSEPH'S HOSPITAL
Saint Paul, MN
SAINT JOSEPH REGIONAL MEDICAL CENTER
Mishawaka, IN
COLUMBIA ST MARYS HOSPITAL
Milwaukee, WI
OUR LADY OF LOURDES REGIONAL MEDICAL CENTER
70%
74%
81%
73%
77%
Lafayette, LA
PROGRESS WEST HEALTHCARE CENTER
O Fallon, MO
(HCA) METHODIST STONE OAK HOSPITAL
San Antonio, TX
83%
75%
The Beryl Institute
Key elements for improving the patient experience
“How am I supposed to sleep with all this
racket?”
Reducing noise
Private rooms reduce exposure to
noise levels that can cause stress and
negative health effects
Ulrich et al., 2008.
Reduced noise levels improved sleep
and mood, better pain tolerance
Janssen et al., 2000
Grand Haven, Michigan
Percent of top box
North Ottawa Community Hospital
100
90
80
70
60
50
40
30
20
10
0
Pre
Post
Top box
Not top box
Emergency Department Overall Scores
Glass at nurse station helps reduce noise
Kaiser Permanente, Gaithersburg, MD
“ I had to wait so long to
be discharged and then
the instructions they gave
us were confusing.”
How can facility design support the discharge process and
improve communication with patients and families?
Designated quiet, meeting areas for medical staff, patients and families
Park Nicollet, Melrose Institute, St. Louis Park, MN
Family Niches
Galter Pavilion, Northwestern Memorial Hospital, Chicago, IL
Surgery Status Board
Family & patient communication
Family communication
Kaiser Permanente Westside Medical Center
Hillsboro, Oregon
Dow Health Services Headquarters
Midland, Michigan
“I’m stretched thin –
I wish I could give each of my patients
the attention they deserve.”
How can facility design best support responsiveness of staff
and effective rounding?
Decentralized work areas increase staff responsiveness
Sanford Health, Heart Hospital, Sioux Falls, SD
Decentralized Patient Supplies
Soin Medical Center, Beavercreek, Ohio
Scripps Hospital
San Diego, CA
Kaiser Permanente Westside
Hillsboro, Oregon
Activating Fitness
Lee Memorial Health System
Cape Coral, FL
Respite for Staff
Mary Bridge Children’s Hospital, Tacoma, WA
“A hospital is the last place I want
to be when I’m sick and in pain –
I feel really stressed!”
How can facility design best
reduce stress and support pain management?
Natural light
Views of nature
Virtual reality
Pain in its Environmental Context: Implications
for Designing Environments to Enhance Pain
Control, Pain, February 2008
Malenbaum, Keefe, Williams, Ulrich, and Somers
Access to nature reduce stress
Mercy Medical Center, Baltimore, MD
Natural and simulated views of nature
University of Kentucky, Albert B. Chandler Hospital - Pavilion A, Lexington, KY
Mary Free Bed Rehabilitation Hospital
Grand Rapids, MI
Natural scenes reduce stress
Stone Psychiatric Unit, Northwestern Memorial Hospital, Chicago, Illinois
Virtual reality
Philips Ambient Experience
Wayfinding
Sheila
Cahnman
Wayfinding: Reducing Anxiety
Northwestern Memorial Hospital
Chicago, Illinois
Kaiser Permanente Westside Medical Center
Hillsboro, Oregon
Concierge desks and self-service kiosks
Mary Free Bed Rehabilitation Hospital
Grand Rapids, MI
Concierge desks and self-service kiosks
Regions Hospital, Expansion, St. Paul, MN
Work Session
People
COMMUNICATION
CLEANLINESS
NOISE
RESPONSIVENESS
Process
Place
Next…
Exhibitor Reception
5:00-6:30 PM
Foyers