In the healthcare world, results are defined by outcomes and patient satisfaction. Healthcare executives across the country are facing questions on how their organization can improve patient satisfaction and, as a result, scores on the Hospital Consumer Assessment of Health Care Providers and Systems (HCAHPS) survey. The importance of patient satisfaction results have evolved since the introduction of healthcare reform—which affects hospitals’ reimbursement partly based on scores they receive on the HCAHPS. Healthcare facility planners and designers have the responsibility to create a physical environment that enables improved results. After all, creating an atmosphere in hospitals that is safe, clean and quiet makes patients more comfortable and more likely to heal. The ability to identify the design elements that contribute to a healthy and positive patient experience allows hospitals to institute operational plans and design solutions that improve healing. In this presentation, planning and design experts from BSA LifeStructures will discuss the impact a hospitals’ environment can have on patients and then present design recommendations that have been proven to improve satisfaction scores and value for the hospital. BSA LifeStructures has developed methods to track the impact of design solutions in hospitals. And, in doing so, have given healthcare organizations a valuable tool to determine the value and effectiveness of their healing environment. The epicenter of patient experience is generally focused on the patient room. The different human interactions within the patient room create the paradigm for defining the patient experience…the people, the process and the place. People—the physical space of the patient room can contribute to engaging the caregiver by providing plenty of natural light, giving caregivers adequate space to work, and planning spaces that combine multiple functions. Process—Lean design principles should be used to improve the caregiver’s workflow and limit the number of value-wasted movements. By making their job more efficient they can save energy and leverage opportunities for rest and respite. Place—the physical space needs to be quiet and clean. Using easy-to-clean flooring materials and designing patient rooms to limit room-to-room and corridor-to-room noise transfer enables the space to address typical areas for satisfaction shortfalls. These three interactions need to work well collaboratively in order to yield a satisfactory patient experience and quality HCAHPS scores. It is the cause and effect flow to HCAHPS scores.

1. THE RELATIONSHIP BETWEEN HCAHPS
AND FACILITIES: HOW TO IMPROVE
SCORES IN NEW AND EXISTING
HEALTHCARE FACILITIES
NOVEMBER 7, 2013
The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
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2. Learning Objectives
• Understand Patient Satisfaction (HCAHPS) questions and
scores and their relationship to the built environment.
• Learn how Facilities can respond to improve results in HCAHPS
scores.
• Identify specific ways that Facilities can impact scores on:
– Cleanliness
– Noise
– Courtesy, Listening and Respect
• Understand the relationship between hospital acquired
conditions (infections and patient falls), patient satisfaction and
the built environment.
• Identify specific facility strategies to improve outcome measures
through use of a value and cost relationship improvement tool.
The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
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3. Presenters
Terry Thurston, RN, BSN, MBA
Director of Healthcare Operations Planning,
BSA LifeStructures
Joe Mynhier, AIA, ACHA, NCARB
Principal, BSA LifeStructures
The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
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4. What are HCAHPS?
HCAHPS
Hospital Consumer Assessment of
Health Care Providers and Systems
Hospital’s reimbursement is partly
based on scores they receive on the
HCAHPS
CMS LINK:
http://www.medicare.gov/hospitalcompare/compare.html#cmprTab=1&cmprID=150024%2C150056%2C150074&loc=INDIANAPOLIS%2C%20IN&lat=3 9.7685155&lng=-86.1580736
The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
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5. Comparative Analysis by State
The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
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6. Comparative Analysis by State
The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
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7. Interpreting the HCAHPS Scores
The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
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8. Interpreting the HCAHPS Scores
The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
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9. The Patient Experience Paradigm
The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
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10. Operational & Facility Planning
Driven Design
The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
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11. Value Based Purchasing – Aligned
Goals
(-)
SAFE
Hospital
Acquired
Condition
Measures
25% (+/-)
Outcome
Measure
(2014)
EFFECTIVE
PATIENT CENTERED
EFFICIENT
TIMELY
30% (+/-)
EQUITABLE
Patient
Experience
Measures
(HCAHPS)
AFFORDABLE
(+/-)
45%
Core
Measures
The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
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12. Relationship Between HCAHPS
& The Built Environment
HOSPITAL ENVIRONMENT
HOSPITAL ENVIRONMENT
QUESTIONS
QUESTIONS
Accelerators
CARE COMPOSITE
QUESTIONS
(QUESTIONS 8 & 9)
(QUESTIONS 1-3, 5-7)
During this hospital stay, how often
were your room and bathroom kept
clean?
Courtesy
During this hospital stay, how often
was the area around your room
quiet at night?
Listen
Respect
Explain
The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
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13. Built Environment Response To Care
Composites
Questions 1-3, 5-7
Respect, Courtesy,
Listen, and Explain
(The Engaged
Employee)
Built
Environment Impact
1
Adequate caregiver space at
the bedside
2
Off-stage collaboration areas
to facilitate manager rounding
& team communication
3
Caregiver Support Spaces
The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
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14. Built Environment Response To Care
Composites
Adequate Caregiver Space At Bedside
•
•
•
•
BSA LifeStructures
•
BSA LifeStructures
Computer
orientation
Staff Seating
Supplies at bedside
(80/80/80
Guideline)
Clear of Family
Zone and path of
travel to bathroom
Collaborative areas
at patient bedside
The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
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15. Built Environment Response To Care
Composites
Caregiver Support Spaces
•
•
•
•
•
Staff Lounges
Entrance
Respite Areas
Natural Light
Ergonomics
Photo © John Durant | www.johndurant.com
The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
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16. Hospital Acquired Conditions: Patient
Falls
Condition
Built
Environment Impact
1
Travel path to and from the
patient bathroom are the most
frequent contributors to falls
2
Unobstructed Pathways
3
Patient falls in room
& bathroom
contribute to
increased patient
morbidity, mortality,
LOS, & cost of care
Lighting and Finishes
The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
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17. Preventing Patient Falls
Environmental Recommendations
•
•
•
•
•
•
•
Unobstructed path from bed to
bathroom in few steps
Leafed double bathroom door
Handrails to bathroom and vertically
outside bathroom door
Non-slip flooring
Lighted pathway from bed to
bathroom
Visibility from corridor to bed or foot
of bed
Toilet in center of bathroom (2
caregiver assist)
Clemson University Patient Room of the Future
The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
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18. Hospital Acquired Conditions:
Infection Prevention
Condition
Hospital Acquired
Infections
Built
Environment Impact
1
Location of sink and hand
sanitizers
2
Personal protective
equipment (PPE) location
3
Cleanability and surfaces
The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
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19. Hospital Acquired Conditions:
Infection Prevention
Environmental Recommendations
•
Sink located at entry to patient
room
– Features: height, depth, faucets,
splash, visibility to patients
Dublin Methodist Hospital
© John Durant | www.johndurant.com
© The Chester County Hospital
http://www.cchosp.com/images/Tower/P_PatientRoom_lrg.jpg
•
•
•
Cubicle curtains: cleanable, hand
guards
Enclosed toilet in ICU
Personal Protective Equipment
Location
The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
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20. Private Rooms – Still Not There
PERCENTAGE OF MEDICARE PATIENT STAYS IN SINGLE
OCCUPANCY ROOMS 2002-2010
31.1%
30.2%
30.0%
29.7%
29.0%
28.5%
28.2%
27.5%
2002
27.7%
2003
2004
2005
2006
2007
2008
2009
2010
SOURCE: “HEALTH CARE CONSTRUCTION OUTLOOK FOR 2012 AND BEYOND” © 2012 THE
ADVISORY BOARD COMPANY
The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
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21. The Hospital Environment: Patient
Room Cleanability And Finishes
Question #8
Built
Environment Impact
1
A clean room contributes to
higher patient satisfaction
2
Due to surfaces and
products selected, a clean
room may not look clean
3
During this hospital
stay, how often was
your room and
bathroom kept
clean?
Contaminated environment
contributes to hospital
acquired infections
The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
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22. Keeping The Patient Room Clean:
Cleanability
Design Considerations For Furniture, Casework, & Built-ins
•
•
•
•
•
Floor plan layouts
Furniture locations
Built-in casework locations
Areas to collect dust
Difficult areas to clean
The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
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23. Keeping The Patient Room Clean:
Furniture Location & Design
BSA LifeStructures
BSA LifeStructures
• Fixed vs. Moveable
• Snug Fit vs. Awkward
Voids
• Appropriate Cleaning
Products
BSA LifeStructures
The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
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24. Keeping The Patient Room
Clean: Floor Plan Design
Environmental Recommendations
• Floor plan configuration
– Avoid acute angles and corners
• Furniture location and placement
– Avoid tight and compact areas which will be difficult to clean
– Anticipate where furniture can be moved
• Areas that collect dust and dirt
– provide soffits above upper cabinets
– provide soffits for task down lighting
– provide sloped tops as an alternative to soffits
The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
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25. Keeping The Patient Room
Clean: Finishes And Products
The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
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26. Keeping The Patient Room Clean:
Finishes
Environmental Recommendations
Flooring, Walls, & Ceiling
•
•
•
The Mohawk Group
Armstrong
easy to clean
products
products that look
clean
simple cleaning
instructions
MDO Wall
The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
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27. The Hospital Environment: Patient
Room Internal & External Noise
Question #9
Built
Environment Impact
1
Noise contributes to lower
patient satisfaction
2
Noise contributes to slower
recovery of the patient
3
During this hospital
stay, how often was
the area around your
room quiet at night?
Noise contributes to longer
lengths of stay
The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
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28. Sound Levels In Decibels
• JACKHAMMER
130
• COMMERCIAL JET
120
• LEAF BLOWER
110
• BABY CRYING
110
• FLUSHING TOILET
80
• NORMAL CONVERSATION
60
• ARCHITECT-LATE PAYMENTS
200
The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
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29. Preventing External Noise
Noise From Corridor To Patient Room
Noise From Other Sources To Patient Room
• From staff/physicians near
patient room door
• From caregivers/visitors in
corridor
• From equipment in corridor
alcoves & storage
• From decentralized nurse work
stations
• From mechanical and HVAC
systems
The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
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30. Preventing External Noise
Decentralized Nurse Work Stations
BSA LifeStructures
•
•
•
Collaboration adds noise to corridor
Work station adds noise at patient room entry
Corridors remain same width despite function change
The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
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31. Preventing External Noise
Environmental Recommendations
• Implement sound attenuation techniques
– Sound masking at door
– Sound insulation along corridor wall
• Implement caregivers/visitors “reduce voice volume” program
– Quiet zones
– Provide sound recording devices in key locations (green,
yellow, red light)
• Implement mitigation of external noise
– Remove moveable items, carts & equipment
– Sound insulation added at external sources
– Study door locations to avoid door alignment
The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
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32. Preventing Internal Noise
Noise Within The Patient Room
Noise From Patient Room To Patient Room
• From toilet in adjacent patient
room
• From television in adjacent
patient room
• From adjacent mechanical rooms
• From caregivers/visitors in
adjacent patient room
• From equipment in patient room
• From caregivers/visitors in patient
room
The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
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33. Preventing Internal Noise
The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
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34. Information Overload?
•
This year, 5 million times the
information included in all the books
ever written, will be created
•
A majority of people say that less
than half of the information they
receive is valuable
•
A majority of people wish they could
spend more time working with the
information they have versus trying
to manage it
So how do you use the information we have given you?.......
The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
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35. HCAHPS Improvement Grid
The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
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36. HCAHPS Improvement Grid
The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
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37. HCAHPS Improvement Grid
The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
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38. HCAHPS Improvement Grid
The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
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39. THE RELATIONSHIP BETWEEN HCAHPS
AND FACILITIES: HOW TO IMPROVE
SCORES IN NEW AND EXISTING
HEALTHCARE FACILITIES
NOVEMBER 7, 2013
The Relationship Between HCAHPS and Facilities: How To Improve Scores In New And Existing Healthcare Facilities
39