Do Fancy New Hospital Buildings Improve Paient Satisfaction · 24.10.2016 · Do Fancy New Hospital...

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October 24, 2016 1

Do Fancy New Hospital Buildings Improve Paient Satisfaction Zishan Siddiqui M.D.Assistant Professor of MedicineDivision of General Internal Medicine/Hospitalist ProgramDepartment of MedicineJohns Hopkins School of Medicinezsiddiq1@jhmi.edu

Satisfaction: Impact of aNew Clinical Building• Belief amongst leaders and frontline

providers• Halo effect

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Swan JE, Richardson LD, Hutton JD. Do appealing hospital rooms increase patient evaluations of physicians, nurses, and hospital services? Health Care Manage Rev. 2003;28(3):254–264.

Zeis M. Patient experience and HCAHPS: little consensus on a top priority. Health Leaders Media website. Available at http://www.healthleadersmedia.com/intelligence/detail.cfm?content_id=282893&year=2012. Accessed August 10, 2013

Satisfaction: Impact of aNew Clinical Building

How would the appearance and characteristics of the hospital building impact patient satisfaction with care?

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10/24/2016http://www.georgebrown.ca/vt/accessible/room.aspx?cid=7&rid=13&pid=2

10/24/2016https://www.utswmedicine.org/hospitals-clinics/clements/hospital-highlights/

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10/24/2016http://blog.gregbenson.com/category/featured

10/24/2016http://www.hopkinsmedicine.org/burn/adultclinicalservices/outpatient.html

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Golisano Childrens Hospital http://www.healthcarefacilitiestoday.com/posts/Golisano-Childrens-Hospital-project-designed-to-empower-patient-healing-Architecture--3543 9

10/24/2016Lurie Children’s Hospital Chicago

10http://archrecord.construction.com/projects/Building_Types_Study/healthcare/2013/1303-Ann-and-Robert-H-Lurie-Childrens-Hospital-of-Chicago-ZGF-Architects-slideshow.asp?slide=2

10/24/2016Cleveland Clinic Abu Dhabi

http://middleeasthospital.com/?p=1852 11

Global Hospital Construction Industry

10/24/2016General Electric: New Hospitals Perspectives and Solutions- IHF Paris presenation

Patient-Centered-DesignFeatures

• Same-handed design• Use of sound absorbent materials • Increased natural lighting• Incorporation of natural elements

10/24/2016Siddiqui, Zishan K., et al. "Changes in patient satisfaction related to hospital renovation: Experience with a new clinical building." Journal of hospital medicine 10.3 (2015): 165-171. 13

Patient-Centered-DesignFeatures

• Comfortable waiting rooms & visitor accommodations

• Hotel-like amenities (on-demand entertainment & room service)

10/24/2016Siddiqui, Zishan K., et al. "Changes in patient satisfaction related to hospital renovation:

Experience with a new clinical building." Journal of hospital medicine 10.3 (2015): 165-171. 14

Impact of a New Clinical Building: Johns Hopkins Hospital

10/24/2016http://www.hopkinsmedicine.org/the_johns_hopkins_hospital/services_amenities/places_respite

/quiet/healing_gardens.html 15

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10/24/2016http://www.hopkinsmedicine.org/the_johns_hopkins_hospital/services_amenities/places_respite/quiet/healing_gardens.html 17

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10/24/2016http://www.hopkinsmedicine.org/the_johns_hopkins_hospital/services_amenities/places_respite/quiet/healing_gardens.html 19

Background: HCAHPS

• Measurement of Patient Experience• Physician communication, Nursing

communication, Pain Control, Responsiveness, Room cleanliness and Quietness, Discharge process, and Overall Satisfaction

Siddiqui, Zishan K., et al. "Comparison of Hospital Consumer Assessment of Healthcare Providers and Systems patient satisfaction scores for specialty hospitals and general medical hospitals: confounding effect of survey response rate." Journal of Hospital Medicine 9.9 (2014): 590-593. 2010/24/2016

Patient Satisfaction: HCAHPS

• Over 4500 acute-care facilities routinely use this survey– Results publicly reported– Patients can compare different hospitals on

the measure– 25% of incentive Payments to the

hospitals are linked to performance on this survey

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Siddiqui, Zishan K., et al. "Comparison of Hospital Consumer Assessment of Healthcare Providers and Systems patient satisfaction scores for specialty hospitals and general medical hospitals: confounding effect of survey response rate." Journal of Hospital Medicine 9.9 (2014): 590-593. 21

Impact of a New ClinicalBuilding: Methods

• Natural experiment:– 12 Clinical units moved to the New Clinical

Building- Sheikh Zayed Tower (Exposure group)

– Similar number of units remained in the old hospital (Control Group)

Impact of a New ClinicalBuilding: Methods

• Natural Experiment– 12 months of baseline data prior the move– 7.5 months of data after the move– 4600 patients– Exposure group :New Clinical building

Impact of aNew Clinical Building: Results

10/24/2016Siddiqui, Zishan K., et al. "Changes in patient satisfaction related to hospital renovation: Experience with a new

clinical building." Journal of hospital medicine 10.3 (2015): 165-171. 24

Table 3. Changes in Press Ganey Patient Satisfaction Scores From Baseline to Postmove Period By Unit Status

Moved Units Unmoved Units p Value of the Difference in Odds Ratio Between Moved and Unmoved Units

% Top BoxAdjusted Odds Ratio* (95% CI)

% Top BoxAdjusted Odds Ratio* (95% CI)Satisfaction Domain Pre Post Pre Post

FACILITY RELATEDRoom

Pleasantness of room décor 33.6 64.8 3.77 (3.24‐4.38) 41.6 47.0 1.21 (1.02‐1.44) <0.0001Room cleanliness 49.0 68.6 2.35 (2.02‐2.73) 51.6 59.1 1.32 (1.12‐1.58) <0.0001Room temperature 43.1 54.9 1.64 (1.43‐1.90) 45.0 48.8 1.14 (0.96‐1.36) 0.002Noise level in and around room 40.2 59.2 2.23 (1.92‐2.58) 45.5 47.6 1.07 (0.90‐1.22) <0.0001

Visitor RelatedAccommodations and comfort of visitors

50.0 70.3 2.44 (2.10‐2.83) 55.3 59.1 1.14 (0.96‐1.35) <0.0001

Impact of a New Clinical Building: Beyond Satisfaction

10/24/2016 Siddiqui, Zishan K., et al. "Changes in patient satisfaction related to hospital renovation: Experience with a new clinical building." Journal of hospital medicine 10.3 (2015): 165-171.

Table 2. Changes in HCAHPS Patient Satisfaction Scores From Baseline to Postmove Period By Unit Status

FACILITY RELATEDHospital environment

Cleanliness of the room and bathroom

61.0 70.8 1.62 (1.40‐1.90) 64.0 69.2 1.24 (1.03‐1.48) 0.03

Quietness of the room 51.3 65.4 1.89 (1.63‐2.19) 58.6 60.3 1.08 (0.90‐1.28) <0.0001NON‐FACILITY RELATED

Nursing communicationNurses treated with courtesy/respect 84.0 86.7 1.28 (1.05‐1.57) 83.6 87.1 1.29 (1.02‐1.64) 0.92Nurses listened 73.1 76.4 1.21 (1.03‐1.43) 74.2 75.5 1.05 (0.86‐1.27) 0.26Nurses explained 75.0 76.6 1.10 (0.94‐1.30) 76.0 76.2 1.00 (0.82‐1.21) 0.43

Physician communicationDoctors treated with courtesy/respect 89.5 90.5 1.13 (0.89‐1.42) 84.9 87.3 1.20 (0.94‐1.53) 0.77Doctors listened 81.4 81.0 0.93 (0.83‐1.19) 77.7 77.1 0.94 (0.77‐1.15) 0.68Doctors explained 79.2 79.0 1.00 (0.84‐1.19) 75.7 74.4 0.92 (0.76‐1.12) 0.49

Impact of aNew Clinical Building: Results

10/24/2016Siddiqui, Zishan K., et al. "Changes in patient satisfaction related to hospital renovation: Experience with a new

clinical building." Journal of hospital medicine 10.3 (2015): 165-171. 26

Table 3. Changes in Press Ganey Patient Satisfaction Scores From Baseline to Postmove Period By Unit Status

OVERALLStaff worked together to care for you 72.6 77.2 1.29 (1.10‐1.52) 70.3 73.2 1.13 (0.93‐1.37) 0.30Likelihood of recommending hospital 79.1 84.3 1.44 (1.20‐1.74) 76.3 79.2 1.14 (0.93‐1.39) 0.10Overall rating of care given 76.8 83.0 1.50 (1.25‐1.80) 74.7 77.2 1.10 (0.90‐1.34) 0.03

Media and Industry Response

Hospital Construction: ReasonsBeyond Patient Satisfaction

• Aging Infrastructure• Improve workflow• Improve Patient Safety:

– Acuity adaptable room decrease med error– Decentralized nursing station: increased patient

visibility and decreased falls– Lower fractures from fall with wood subflooring*

• Improve Employee Satisfaction

10/24/2016*Joseph, Anjali, and Mahbub Rashid. "The architecture of safety: hospital design." Current opinion in critical care 13.6 (2007): 714-719. 29

Take home message

Improving Satisfaction• Human factor is the KEY!!• Return on investment for pricey features

incorporated in hospital design solely aimed at improving patient experience?

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Do Fancy New Hospital Buildings Improve Paient Satisfaction · 24.10.2016 · Do Fancy New Hospital...

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