[Case studies] Addressing HCAHPS challenges with design

Wednesday, March 6, 2019
Image: surgeons running through a hallway

Improving HCAHPS survey scores is of great importance to health care systems to ensure adequate funding. While only two of the HCAHPS survey questions specifically reference the physical environment, every aspect of a patient’s experience is indirectly influenced by a variety of design factors that inform all survey questions.

ASHE recently surveyed members and asked “Which HCAHPS area is the biggest challenge for your organization?” The top three answers included “quiet at night,” “doctor communication,” and “staff responsiveness.” Health care planners and designers have an opportunity to incorporate features into the physical environment that help to mitigate these challenges.

Read on to learn about two hospital case studies demonstrating a boost in HCAHPS scores in these categories

Quiet at night
Of ASHE members surveyed, 27 percent responded that “quiet at night” is the biggest HCAHPS challenge for their facility.

Patients spend the majority of their time in a health care facility in their room, which should be a tranquil, healing haven, especially at night. Inadequate sleep can lead to issues with pain management, prolonged healing, increased anxiety and blood pressure, and more.

Noise can be effectively reduced with simple changes such as disabling TV audio at night, turning pagers and phones to vibrate mode, scheduling housekeeping services during the day, and encouraging staff to use softer voices. Other enhancements may include upgrading to equipment that incorporates sound reducing technology, investing in quieter carts, and installing white noise machines.

Case study: Christiana Care
For eight years, the staff at Christiana Care, a hospital based in Wilmington, Delaware, has worked to reduce noise at night. As part of their long-standing Quiet at Night Challenge, patient care units can receive incentives when they effectively decrease nighttime noise.

As part of the challenge, at 9 p.m. the lights are dimmed and a soothing voice announces that the nine-hour quiet time is beginning. During quiet times, patients are asked to watch TV using headphones, cellphones and pagers are turned to silent or vibrate mode, and health care facility staff members speak softly. Other changes that have been made include adjusting pneumatic tubes to eliminate noise, updating carts with smooth-gliding wheels so that contents don’t rattle, adding soft-close lids to linen carts, and ensuring doors are made of materials that allow them to close softly.

After the first six months HCAHPS scores improved on average by 3 percent, and on one floor scores improved by 23 percent. “Quiet at night” scores have improved steadily with each subsequent challenge.

Doctor communication and staff responsiveness
Of the surveyed ASHE members, 14 percent responded that “doctor communication” or “staff responsiveness” is the biggest HCAHPS challenge for their facility.

Staff responsiveness and communication can be affected by the layout and design of a unit. Planners and designers can allow for better communication by selecting furniture that enables proper eye contact between staff members and patients, placing nursing stations close to patient rooms, and improving access and visibility of patients with interior windows. Patient rooms should be designed in a way that promotes communication, and remote quiet spaces should be accessible so that doctors and staff can speak with patients and family members privately if needed.

Case study: South Shore Hospital
HCAHPS scores relating to “staff responsiveness” were low at South Shore Hospital based in South Weymouth, Massachusetts. The facility decided to add a new orthopedics wing that replaced one built in the 1970s. The old wing had crowded double rooms, a central nurse station that made communication difficult, and minimal natural light.

The new wing was designed in a way that fosters patient and caregiver interaction. Two nurse stations allow staff to remain closer to their patients and monitor them more frequently. Single, open room layouts create a clear and easy path for staff to approach the patient’s bedside. Comfortable visitor seating and windows that let in natural light were added.

After adding the new wing, HCAHPS scores for responsiveness jumped from 52 percent to 90 percent. On average, patients are being discharged one day earlier and the “definitely recommends” score increased from 64 to 88 percent, indicating that patients are more satisfied with the facility overall.

HCAHPS scores, and more importantly, the patient experience, can be significantly improved with the right design features. The 2019 PDC Summit will allow you to further explore planning and design as it relates to the patient experience. Relevant sessions include:


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