Check in to any hotel (from a Holiday Inn Express to a Mandarin Oriental), and you will know instantly that you are important. The enterprise and the industry exist to maximize your positive experience(s).
Register at a New York hospital or Emergency Room, and you promptly are aware that you are not important. You are viewed as an insurance or credit card, a package of symptoms, and hopefully, a heartbeat.
Evidence-Based Design (EBD)
There are rumors that patient-centered care in the hospital environment is emerging and there is (or will be) a new generation of healthcare facilities that will be significantly different from the current familiar institutional models.
The research that underlies these “supposedly” new developments, known as Evidence-Based Design (EBD) draws from a number of areas of study including neuroscience, evolutionary biology, psychoneuroimmunology, and environmental psychology with an emphasis on the idea that the design of the built environment can enhance the quality of healthcare.
Research demonstrates that well-designed physical settings play an important role in making hospitals safer and more healing for patients and better places for staff to work. The research also supports the idea that the creation of healing environments through the effective design of the physical environment, makes hospitals less stressful and promotes faster healing for patients and improved well-being for families.
Viewing the hospital environment from a fiscal viewpoint, hospital leaders and boards are increasingly required to include cost-effective evidence-based design (EBD) interventions in their strategic plan and investment portfolio or risk suffering the economic consequences of an increasingly competitive and transparent environment.
Pay to Play
In the last few years, there has been a growing new concept in the reimbursement to hospitals and physicians, “value-based purchasing” or “pay for performance.” This requires mandated reporting of patient experiences in hospitals through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. It is predicted that hospitals that have more comfortable, safe, and patient-centered environments will be rated higher by patients in the HCAHPS survey and this could have a significant influence on a patient’s choice of a hospital with a resulting impact on its market share and financial bottom line.
Research finds that environmental satisfaction with a hospital obtained through various sources such as interior design, architecture, housekeeping, privacy and the ambient environment was a significant predictor of patients’ overall satisfaction with the hospital experience. A study of pneumonia patients found that a one standard deviation increases in a hospital’s hotel-like amenities increased its demand by 38.5 percent on average; whereas demand is substantially less responsive to various measures of clinical quality.
Emergence of Hospitality
Changes in employer health coverage and a new competitive environment are giving people more choices in the doctors and hospitals they can use, shaping a new look and feel for hospitals that are now starting to create settings that offer patients a sense of hospitality. Some hospitals are taking healthcare to a new level of luxury, competing for wealthy customers who are willing to pay extra and can go just about anywhere. These patients are pampered with everything from high thread count Italian bed linens and marble baths to restaurant-like menus and private concierge services. This changes the healthcare landscape and makes a strong business case for intelligent EBD decisions.
The increasingly competitive health market and growing patient consumerism plus higher service expectations have placed the patient experience at the top of the healthcare providers’ agendas. There is a greater appreciation of the marketing role for the tangible environment in healthcare experiences in order to satisfy and exceed patients’ needs and wants.
There is a fundamental recognition of the “patient as customer,” resulting in healthcare facilities offering patient-centered care that employs a range of research approaches from a marketing and more specifically a service quality and service design perspective. This recognizes that people’s purchasing decisions include the total product with the atmospherics (physical and controllable environmental components), of the product affecting the buyer’s propensity to consummate a marketing exchange.
HealthScapes
To enable healthcare researchers and providers to understand the dynamics of the total product from a marketing perspective a theoretical model has been designed: HEALTHSCAPES. The focus on the patient experience has resulted in healthcare providers looking at the service as it is delivered in other industries where the importance of the setting to the service experience is most thoroughly understood such as restaurants and hotels.
What the Patient Wants
Beyond implementing strategies used in guest services industries, another aspect of the focus on patient-centered care is the emphasis on consumers and their experiences which is also the core value of service design. Managers need to understand the communicative power of the environmental cues from the customer’s point of view rather than the architect’s or the manager’s point of view.
The HealthScapes Model
The idea that the physical environment can play an important role in the healthcare experience is not new. The earliest known western hospitals (Greek Asklepieion, 480 BC) were grand temples with marble, soaring atriums, statues, and other works of art. Hospital design was also one of Florence Nightingales’ key ingredients in her therapeutic milieu (Notes on Nursing, 1859). The healing environment constituted by the “hospitality healthcare design” of the 1980s – the notion of guest-focused care that represents the new approach to the concept of hospitality meets healthcare affects not just the design of the facility but also operations, combined with efficient and staff interactions.
There is an increasing acceptance of the idea that success in both healthcare and hospitality depends on the core principle of creating a culture of respectful treatment and valuing all stakeholders. Healthcare providers are not only leveraging design ideas from the hospitality industry but also a hospitality-style approach that focuses on a service culture. A guest-centric culture is the mystery ingredient in the delivery of high-quality service across industries (including healthcare) and is a factor that transcends but encompasses important customer service skills such as empathy.
The creation of hospitable hospitals through an infusion of hotel-like attributes along with both product (design) and service-related dimensions is appealing. Patients who stayed in hotel-like rooms had higher evaluations of physicians, nurses, and overall service performance. Creating more visually and physically appealing environments had a ripple effect on patient perceptions, during and long after their hospital stays in terms of customer satisfaction, loyalty, favorable word of mouth, recommendations, and service quality perceptions.
From a service perspective, a patient evaluation of the hotel function of hospitals found that those who perceived better customer service delivery, in terms of factors such as courtesy, promptness, and cleanliness, indicated significantly higher satisfaction levels.
Perception of Products and Services
Patients perceive their hospital room as an entire experience, as a bundle of attributes, and do not assess each element individually. Recognizing and accepting this reality, hospital architects. designers and comptrollers should consider:
- · Design renovations focused on the patient experience in the hospital room as opposed to the hospital facility at large. This shift in focus may not involve extensive capital investment and large-scale physical renovation. Spa services with spa-quality bath amenities (i.e., spa-quality towels, soaps, shampoos, and bathrobes) and in-room spa/salon services may not add large expenditures to the bottom-line profitability of the hospital.
- · Food and beverage services (kitchenette including refrigerator and coffee maker) and on-demand room service can improve the attitude of the patient.
- · Wall décor: artwork on the walls and colorful wall schemes add to the ambiance and not to costs, especially when local artists and art students are engaged in the planning and space design.
- · While luxury bed linens may not meet all healthcare necessities, as the wellness of the patient, improves, changes in the physical environment can reinforce the fact that the patient is, in fact, getting better.
- · Designer-inspired furniture and high-end material finishes can enhance the visual experience of the patient tethered to a bed for long periods of time.
- · Hi-resolution flat-screen TVs (that actually work and have user-friendly remotes) aid in passing the endless hours of being in a bed, waiting for doctors, nurses and test results.
- · Smart room technology including patient health tracking and a personal entertainment tablet may temper patient anxieties as to their current medical condition.
- · Concierge services for patients enable flexibility and a sense of control when deciding on food, beverages, and activities.
- · Certification of healthcare staff in hospitality service delivery. Not everyone is born with “nice” as part of their DNA. Healthcare personnel trained by hospitality industry professionals can instruct how to be pleasant and reassuring to their patients in a variety of situations and environments.
- · Presence of aroma/fragrances and mood lighting. The opportunity to control some part of a hospital environment can be reassuring suggesting that recovery is possible.
Show Me the Money
Willingness to pay higher out-of-pocket expenses has valuable and serious implications for healthcare providers. Studies suggest that the less healthy patients are likely to pay on average 13 percent higher out-of-pocket expenses for a hospital room with hotel-like features than those who are healthier. Wealthier patients who are hospitalized more often and for longer durations and are more financially secure are more likely to request hotel-like hospital rooms, representing an opportunity for hospitals to utilize hotel-like “upsell” techniques for this group of patients.
Hospitals can benefit from the provision of hotel-like attributes not only in terms of competitive advantage but can also provide a way to improve the patient experience and satisfaction score while also enhancing revenue through a hotel-like pricing strategy.
Opposing Viewpoint
Not everyone agrees that hospitals should borrow ideas, systems, and procedures from hotels. Dr. Benjamin Levin (www.kevinmd.com) finds that “hospitals are places no right-minded person ever wants to be.” He points out that hotels operate in a free-market environment where costs can be relatively controlled and a budget based on fixed costs. On the other hand, healthcare and hospitals are subject to strict regulatory oversight and dependent on numerous income streams. There are no clear links between what the patient or the insurance company will pay and what the hospital actually receives.
It is understood that everyone engaged in healthcare wants to see their patients cured; however, Dr. Levin reminds us that what patients think is good for them (i.e., increased number of tests, more meds), may not be in their best interest.
Asking the Right Questions
Selecting medical care? Queries are different for selecting a hospital rather than selecting the best hotel. When searching for a hotel, location, price, a kosher kitchen or vegan menu, plus amenities and star ratings may top the Wish List. When selecting a hospital, the Wish List changes.
At the top of the hospital list are such questions as:
1. Which hospital has the best medical team for the job to be done?
2. Which hospital is most experienced based on the available diagnosis?
3. Who has performed the most surgeries in the field?
4. Are the facilities (i.e., toilets, radiology labs) clean and sterile (out of concern for infection)?
Realistic Expectations
The US ranks #22 out of 27 high-income countries when analyzed for efficiency in turning dollars spent into extending lives (UCLA Fielding School of Public Health and McGill University in Montreal, 2013). The findings shed light on several questions: How is it possible for the United States to have one of the most advanced economies yet one of the most inefficient health care systems? In addition, the US health care system performs poorly for men, but even worse for women (https://www.news-medical.net).
Regardless of positioning, making sick care environments less scary and more nurturing is an important part of the health process. It is not unreasonable to agree that the guiding principle should be the safety and wellbeing of the patient although some experts believe that the current trend to turning patients into “customers” or “consumers” is misguided and there is a disconnect between what really matters in providing and receiving excellent care. Unfortunately, American healthcare executives are slow to accept change and this may be because they have heavily invested in the status quo.
Healthcare Goes Global
Americans are taking their health care needs to other countries and making decisions based on costs, medical teams, ambiance, etc. Unless or until the American healthcare industry takes the time and makes the effort to see what hospitals and medical teams are doing in the United Kingdom, Germany, Thailand, and the Middle East, a person needing medical care can take their business elsewhere creating an even larger gap between patients’ expectations and the ability of the US system to deliver quality medical and wellness experiences within a hospitality environment.
