Ambulatory Facility Design and Patients' Perceptions of Healthcare Quality

By Becker, Franklin; Sweeney, Bridget et al. | HERD : Health Environments Research & Design Journal, July 1, 2008 | Go to article overview

Ambulatory Facility Design and Patients' Perceptions of Healthcare Quality


Becker, Franklin, Sweeney, Bridget, Parsons, Kelley, HERD : Health Environments Research & Design Journal


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. In a study of hospital inpatients Douglas and Douglas (2004) found that patients reported the need for personal space, a homey welcoming atmosphere, areas for visitors, access to external areas, and provision of facilities for recreation and leisure.

Much of the research done to date has focused on inpatients (Ulrich & Zimring, 2004). A wide range of design factors has been considered, including single versus multiple-occupancy patient rooms, the design and maintenance of heating and ventilation systems, and the provision of outside views of nature. Outcome measures related to these design factors have ranged from hospital-acquired nosocomial infection, length of stay, and pain medication use to patient satisfaction, stress, and anxiety (Davidson, 1994; Devlin & Arneill, 2003; Nelson et al., 2005; Ulrich & Zimring, 2004; Ulrich, 2000).

Significantly less empirical research has been done on outpatient facilities (Leddy, Kaldenberg, & Becker, 2003; Becker & Douglass, 2008). Yet according to a recent report from the National Center for Health Statistics (2002), 7.8% of the national health expenditure is spent in an ambulatory setting. Given the difference in the nature of the patient experience in ambulatory and inpatient facilities, research that has been done in outpatient settings has shifted the focus from outcome measures such as length of stay and pain medication use to more service-oriented measures such as patients' perceptions of quality and satisfaction (Becker & Douglass, 2008; Edgman-Levitan & Cleary, 1996; Leddy et al., 2003; Stern et al., 2003). In an increasingly competitive market, where healthcare consumers have more options for care, healthcare organizations must work hard to create environments that encourage repeat visits and increase patient satisfaction (Fottler, Ford, Roberts, Ford, & Spears, 2000).

Patient Satisfaction and Quality of Care

Two key components of patients' perceptions of quality of care are their perceptions of the physical environment and their interactions with staff members (Powers & Bendall-Lyon, 2003). Urden (2002) argues that "Patient satisfaction, once considered a 'soft' indicator used primarily by marketing departments, has become an integral component of strategic organization and healthcare quality management" (p. …

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