Improving the Patient Experience: People, Process, Place Model

In this day and age of hospitals working to provide better care and outcomes for a cheaper price, one of the ways to gauge the impact that the implemented changes are having is through measuring patient satisfaction. Hospitals, health systems, and some private practice groups are working actively and diligently to improve patient satisfaction scores.

The most commonly used measure of patient satisfaction is the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). Through this survey patients answer approximately 32 questions regarding their inpatient stay. In 2015, hospitals either lost or gained 1.5% of their Medicare payments based on their score.¹ Centers for Medicare and Medicaid Services (CMS) increased this incentive to approximately 2% of Medicare payments in 2017.¹

For hospitals that are underperforming, how can they improve?

A model that healthcare and health system leaders use, supported by the American Society for Healthcare Engineering (ASHE), in order to evaluate and address patient satisfaction is the “people, process, place” model. This model assists leaders in developing specific patient-centered ways to improve the patient experience through:

1. culture changes,
2. process improvements that support patients and staff, and
3. making enhancements to the hospital physical environment.

People: Teamwork makes the dream work

The key in addressing the “people” portion of this model is to involve all staff in the patient experience. Hospitals and health systems that are actively engaging their staff members in efforts to improve the patient experience are trying diverse and comprehensive approaches. ASHE conducted a survey of facility managers in 2015, and found that roughly half were part of their respective hospital’s patient satisfaction committee.²

Some hospitals have gone so far as to create “No Pass” zones, which require all nonclinical staff to respond to call lights instead of walking by a room with a patient call light on.¹ It continues to be a struggle for many institutions to establish a pervasive culture of caring, especially among those staff who have traditionally not had much interaction with patients.

Process: Each Step Matters

Due to the vast complexity of hospitals and health systems, policies and processes for the clinical and non-clinical staff can end up directly and indirectly affecting the patient experience.

One example of a ‘process’ question, proposed by Eileen Malone at Mercury Healthcare Consulting, would be: “How often was the area around your room quiet at night?”

One of the most common, and sometimes unavoidable, complaints that hospitals receive deals with the amount of noise that patients experience during their stay. Hospital noise is a major cause of loss of sleep for patients. Because of the impact that noise has on a patient’s ability to rest and relax, it interferes with the healing process and can negatively impact the patient experience.³ Data shows that the question about noise is the one for which hospitals consistently receive the lowest score on the HCAHPS survey.¹

Some ways to improve night-time noise include introducing practices for staff such as guidelines for night-time care, quiet voices, and procedures for resupply and equipment movement. Possible patient behaviors to address noise include wearing earplugs and using TV and radio headphones. Lastly, some visitor actions include awareness of the need for noise reduction, and reduced cell phone usage.

In order to obtain the best outcome for patient satisfaction, every department should participate. Many hospitals have also been known to invite members of the community to provide input, including creating a patient-family advisory council.

Place: Impact of the physical environment

Research on how the physical environment affects health outcomes began in the 1980s. The research has examined the effects of architecture, interior design, furniture placement, art, lighting, building materials, building systems, maintenance programs, and other elements of the physical environment that may affect the patient experience. More than 600 studies have linked the hospital built environment to effects such as patient satisfaction, stress, health outcomes, and overall health care quality.⁴

Studies have found that patients who have their own private rooms are more likely to give positive evaluations of the care they receive compared with those who stay in the more traditional double-occupancy rooms.⁵ Patients in more enjoyable living quarters also rate their doctors, housekeepers, environmental staff, and even the food higher than those in typical rooms. It was also determined that patients and their families were more likely to recommend the hospital to others.³ Several analyses have indicated that patients who have a view of nature, including a mural or portrait of a landscape scene, require fewer doses of pain medication than control groups with views of abstract art, brick walls, or plain walls.⁶ Reports have revealed that exposure to nature through multi-sensory immersion can reduce perceived pain even more, and some patients and staff members feel less stressed when exposed to areas like healing gardens.⁷

Studies have also found that spaces that allow better communication with caregivers make it easier to provide effective healthcare.  For example, private rooms are beneficial because they provide a more private, quiet, and intimate setting for communication on sensitive health care topics.³ It is also important to consider using furniture that allows eye-to-eye contact between caregivers, patients, and family members. Facilities managers should also position white boards so the patient and family members can easily see them, and make sure all the information that staff and patients need is communicated on them. Lastly, not only should thought be given to the design of individual rooms but to the entire unit so that the physical space and technology can best allow a precise, detailed, and seamless flow of communication between all healthcare providers.

Conclusion

Patient satisfaction is an important outcome for hospitals and health systems across America. Achieving it comes with the potential for big rewards, and failing to do so can result in major penalties and loss of reimbursement payments. It is imperative that healthcare leaders measure patient satisfaction thoughtfully, and include staff, patient advocates, and members of the community in this endeavor.  By evaluating the people, process, and place that forms part of the patient experience, hospital and health system executives can achieve their patient satisfaction goals.

References:

1. Kenney, L. (2015). HCAHPS scores, the patient experience, and the Affordable Care Act from the facility perspective. ASHE monograph.
2. The survey was sent to 1,000 facility managers who were members of the American Society for Healthcare Engineering—200 facility managers randomly chosen from each of ASHE’s 10 regions. A total of 105 surveys were completed between April 24 and May 4, 2015, for a response rate of 10.5 percent.
3. Dube, J. A., Barth, M. M. and Cmiel, C. A. (2008). Environmental noise sources and interventions to minimize them. Journal of Nursing Care Quality, 23(3), 216-224. doi: 10.1097/01. NCQ.0000324585.68966.51.
4. Ulrich, R. and Zimring, C. Report to the Center for Health Design, (2004). The role of the physical environment in the hospital of the 21st century: A once-in-a-lifetime opportunity.
5. Swan, J. E., Richardson, L. D. and Hutton, J. D. (2003). Do appealing hospital rooms increase patient evaluations of physicians, nurses, and hospital services? Health Care Management Review,28(3), 254-264.
6. Malenbaum, S., Keefe, F. J., Williams, A., Ulrich, R. and Somers, T. J. (2008). Pain in its environmental context: Implications for designing environments to enhance pain control. Pain,134(3), 241-244. doi: 10.1016/j.pain.2007.12.002.
7. Therapeutic Landscapes: An Evidence-Based Approach to Designing Healing Gardens and Restorative Outdoor Spaces. (2013) (1st edition). Hoboken, NJ: Wiley.

Kevin Anderson is a graduating medical student at Duke University School of Medicine and will be starting at LEK Consulting later this year. He’s most passionate about healthcare redesign, patient engagement, and the life sciences. His free moments are spent traveling  and enjoying sporting events with his wife and daughter.

Image: Pexels

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