Ambulatory Facility Design and Patients' Perceptions of Healthcare Quality
Becker, Franklin, Sweeney, Bridget, Parsons, Kelley, HERD : Health Environments Research & Design Journal
Objective: This research examines whether the physical attractiveness of an outpatient practice influences patients' perceptions of healthcare quality, including patient and staff perceptions of the quality of staff-patient interaction.
Background: Despite the high and increasing percentage of healthcare dollars for care delivered on an outpatient basis, relatively little research has examined the relationship between the design of ambulatory facilities and patient outcomes. Few studies have examined how patients' perceptions of healthcare quality differ in the same outpatient practice before and after a move to a new facility designed to be patient-centered. This study is the second phase of a study comparing patients' perceived quality of care in ambulatory facilities that differ markedly in physical attractiveness.
Methods: Using both a patient and staff survey, and structured interviews, this study compared staff and patient perceptions of healthcare quality (including staff-patient interactions) before and after a move to a new facility designed to be patient-centered.
Results: Patients' perceived quality of care, and their perceptions of the quality of interaction with staff, was significantly better in the patient-centered facility. Few differences were found in actual patient-staff interaction behaviors.
Conclusions: This study is consistent with other studies that examined the relationship among the physical attractiveness of healthcare settings, patient satisfaction, and perceived quality of care. For this reason, the results are more credible than they would be were they inconsistent with other research or were this the only study examining these issues. These results support the value of investing in the physical attractiveness of patient areas in the ambulatory care setting. Further research is needed to identify specific physical elements that contribute to positive attributions related to quality of care, as well as where the "tipping point" is in investments to improve physical attractiveness.
Key Words: Ambulatory, patient outcomes, care quality, facility design
The 21st century brings a new set of challenges to healthcare organizations, hospitals, and their facilities. Some of these challenges include the rising costs of healthcare, decreased government funding, technological advances, shifting population demographics, nursing shortages, and increased competition among organizations (Cuellar & Gertler, 2005; Grimson, 2001; Guo, 2003; Watson, 2005). These challenges are forcing healthcare institutions to rethink every aspect of their operations from the education of healthcare providers and the patient care delivery system to the environments in which care is provided. More informed patients are demanding higher standards of care and service (Iglehart, 1993, 2005; Institute of Medicine, 2001; Neuberger, 2000). Part of these rising expectations includes concerns about the role of the physical environment in the healthcare experience (Carpman & Grant, 1993; Marberry, 1995, 2006; Nelson, West, & Goodman, 2005; Nesmith, 1995).
In other service industries such as hotels, restaurants, retail stores, professional offices, and banks, it has long been recognized that the physical environment can have an immediate effect on the attitudes and behaviors of customers and employees (Bitner, 1992). Increasingly, healthcare organizations are acknowledging the important role of the healthcare facility in improved patient and staff outcomes (Berry & Bendapudi, 2003; Nelson et al., 2005). Through focus groups and interviews, Stern, MacRae, and Gerteis (2003) found that patients and families want a built environment that facilitates a connection with staff and is conducive to well-being; is convenient and accessible; confidential and private; safe and secure; considerate of impairments; exhibits caring for family; and facilitates connection to the outside world. …