Published in the August 2015 issue of Today’s Hospitalist
DOES WORKING IN A NEWER HOSPITAL give you an edge when it comes to patient satisfaction scores?
You may think that shiny new buildings packed with amenities definitely help hospitals bump up their results. But according to a new study led by a hospitalist, that’s not the case: Patients can distinguish their satisfaction with a hospital’s physical environment from their satisfaction with clinicians.
The study, which was published in the March 2015 Journal of Hospital Medicine, compared patient satisfaction scores reported in both an older and a brand new facility at the Johns Hopkins School of Medicine in Baltimore.
The study did find that scores in the new facility were higher in areas like satisfaction with patient rooms and staff attitudes toward visitors. But when it came to overall patient satisfaction, scores rose in only one area.
The data show that patients can separate their experiences with a hospital environment from their experiences with physicians and nurses. The results also call into question the assumptions that many hospitals use when justifying expensive renovations.
Artwork and light
According to lead author Zishan K. Siddiqui, MD, the idea that patient satisfaction can be linked to a hospital’s environment has deep roots that go beyond anecdotal evidence. Several small studies have claimed to show that newer facilities produce a so-called halo effect in terms of patient satisfaction.
“One study said that in the absence of data proving otherwise, if you’re in a pleasing environment, everything will look better, including physicians and nurses,” explains Dr. Siddiqui, a hospitalist who is assistant professor of medicine at Johns Hopkins School of Medicine.
When Hopkins opened its new facility in May 2012, many physicians and administrators assumed that satisfaction scores would jump. The new building featured a long list of amenities, from healing gardens with a large water feature to soaring lobbies, more than 500 works of art, light-filled private patient rooms with sleeping accommodations for family members, and a television menu with movies, games and Internet.
“People automatically assume that certain units in certain hospitals are not a good comparison for other units or hospitals because they’ve been renovated recently,” Dr. Siddiqui says. “I’ve heard colleagues working in older hospitals say they believe they could not improve satisfaction scores unless they moved to new facilities. The feeling is that satisfaction is obviously going to be higher in a newer facility, so it’s unfair to compare older hospitals to newer ones.”
Using data from Press Ganey and HCAHPS surveys, researchers found that there was some truth to that view. The study, for example, found that patients admitted to the new facility gave higher scores on questions related to the hospital environment.
The highest score for pleasantness of dÃ©cor was 34% in the old facility compared to 64% in the new one. The top score in the category of visitor accommodation/ comfort was 50% in the old facility vs. 70% in the new.
But on questions that had less to do with hospital environment and more to do with overall satisfaction, the gains were less impressive. Scores in areas like nursing communication, physician communication and a broad “other” category didn’t change between the two facilities.
In fact, Dr. Siddiqui points out that on four measures of overall satisfaction, only one “hospital rating “showed a significant improvement. While 75% of patients gave the older facility a top score on hospital rating, 83% of patients gave the new facility a top score. He describes that change as “moderate,” given that some of the units in the old building (which remained in service) also saw score increases as well.
Dr. Siddiqui is quick to add that some changes may be due to overall improvement in satisfaction that occurred in all categories. “That is driven to some extent by the fact that we continue to improve at all times,” he says.
That was the case even in the old facility. (Researchers continued to survey patients in the older facility before and after the new one opened.) An example: While overall hospital ratings jumped for patients in the new building, they also climbed almost two percentage points for patients in the old.
What does it mean?
Dr. Siddiqui, who regularly studies patient satisfaction, notes that it may be tricky to figure out what these data mean. It’s encouraging that scores went up in both buildings, but it’s a challenge to determine the source of those changes.
“Overall satisfaction with a tertiary care center may be more resilient to changes because patients go there for clinical expertise,” he says. “So even if physician communication is not perceived to be great, patients could still think they’re getting a higher quality of care that is not necessarily captured in the survey.”
What’s the bottom line? If patients can separate their satisfaction with a building from satisfaction with providers, you can’t blame flagging patient satisfaction scores on older facilities.
And if that seems a little bleak, Dr. Siddiqui says there’s a positive side to study results: They put renewed attention on the impact that human factors play in patient satisfaction. “I’ve talked to several health care leaders,” he explains, “and some do believe that buildings have little to do with satisfaction. They feel vindicated because all along they’ve maintained that people, not shiny new buildings, are the key to patient satisfaction scores.”
He’s not saying that renovations have no place in modern health care. “Renovations will need to occur because our infrastructure is aging,” he says. “Many hospital systems were built 100 years ago.”
But the study may inform some decisions made during renovations. “The question is, what features do we put into these buildings?” Dr. Siddiqui says. “And what is the return on investment on some of the priciest features that are supposed to enhance patient experience but don’t necessarily have any other impact on safety or quality? As we look at amenities like a huge water feature, everyone needs to think about return on investment.”
Edward Doyle is Editor of Today’s Hospitalist.