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 APPresident, 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…

Patient and Family

Experience of Care

People

Process

Place

Survey of Patient Experienceshttp://www.medicare.gov/hospitalcompare

Expansion of CAHPS Survey Program

• Hospital Consumer Assessment of Healthcare Providersand 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

• 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-freecommunication•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 hands-free 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 WestCincinnati, Ohio

HCAHPS SCORESNational Average

Patients who reported YES, they would definitely recommend the hospital.

70%

ST JOSEPH'S HOSPITALSaint Paul, MNSAINT JOSEPH REGIONAL MEDICAL CENTERMishawaka, INCOLUMBIA ST MARYS HOSPITALMilwaukee, WI

OUR LADY OF LOURDES REGIONAL MEDICAL CENTER

Lafayette, LAPROGRESS WEST HEALTHCARE CENTERO Fallon, MO(HCA) METHODIST STONE OAK HOSPITALSan Antonio, TX

75%

74%

81%

73%

77%

83%

New facilities = high scores

Key elements for improving the patient experience

The Beryl Institute

“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 effectsUlrich et al., 2008.

Reduced noise levels improved sleep and mood, better pain tolerance Janssen et al., 2000

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100

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Emergency Department Overall Scores

Pre

PostNorth Ottawa Community Hospital Grand Haven, Michigan

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 NichesGalter Pavilion, Northwestern Memorial Hospital, Chicago, IL

Surgery Status Board

Family & patient communication

Family communicationKaiser Permanente Westside Medical CenterHillsboro, 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 responsivenessSanford Health, Heart Hospital, Sioux Falls, SD

Decentralized Patient SuppliesSoin Medical Center, Beavercreek, Ohio

Kaiser Permanente WestsideHillsboro, Oregon

Scripps HospitalSan Diego, CA

Activating Fitness

Lee Memorial Health System Cape Coral, FL

Respite for StaffMary 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?

Pain in its Environmental Context: Implications for Designing Environments to Enhance Pain Control, Pain, February 2008Malenbaum, Keefe, Williams, Ulrich, and Somers

Natural lightViews of natureVirtual reality

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 HospitalGrand Rapids, MI

Natural scenes reduce stress Stone Psychiatric Unit, Northwestern Memorial Hospital, Chicago, Illinois

Virtual reality

Philips Ambient Experience

Wayfinding

Wayfinding: Reducing Anxiety

Sheila Cahnman

Kaiser Permanente Westside Medical CenterHillsboro, Oregon

Northwestern Memorial HospitalChicago, Illinois

Concierge desks and self-service kiosks

Mary Free Bed Rehabilitation HospitalGrand Rapids, MI

Concierge desks and self-service kiosksRegions Hospital, Expansion, St. Paul, MN

Work SessionPeople Process Place

COMMUNICATION

CLEANLINESS

NOISE

RESPONSIVENESS

Next…

Exhibitor Reception

5:00-6:30 PMFoyers