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Staff perspectives on patient experience

Clinical and support services staff share their opinions on what makes safe and comfortable healing environment
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All hospitals want to provide a safe and comfortable environment for staff to work, loved ones to visit and patients to heal.

Image by Getty Images

Patient experience is the obvious answer to nearly every question posed about health care facility priorities. All hospitals and health care facilities want to provide a safe and comfortable environment for staff to work, loved ones to visit and patients to heal.

Guidance documents, work plans, tools and key performance indicators (KPIs) associated with patient experience are used by hospital organizations for continuous improvement. Teams follow standards, guidelines and protocols and can still manage to fall short, particularly with HCAHPS scores.

The daily reality of achieving compliance and excellence is that patient experience is personal and relative. One bad experience can change the mood and attitude of a patient for their entire stay.

While staying diligent in measurable KPIs is important, the more intangible efforts and seemingly unrelated actions of staff make a difference. They will take an organization from good to great when it comes to patient satisfaction.

Doing great work and going above and beyond in service to others comes naturally to many in the health care field. Others need coaching and empowerment to develop the soft skills necessary to take their “on-stage” performance to another level. Feedback loops and celebrations of success help to reinforce positive actions and allow employees to see the value of their jobs and be rewarded for doing them well.

Defining patient experience

Ask 10 individual health care staff members about what is important for providing a great patient experience, and there will be 10 different answers with several interesting overlapping themes.

A patient will say their experience needs to be accessible, accommodating and affordable, but this is becoming increasingly more difficult in the United States. A contractor should be focused on minimizing disruption and mess, but construction is loud and messy by nature. Architects and planners take responsibility for designing a building that is easy to navigate, but this can become challenging when hospitals tend to grow organically over time into complex mazes. An environmental services (EVS) professional needs to be focused on keeping health care spaces clean and healthy, but this is a job that is never truly done. Interior designers want patients to feel comfortable from the time they walk in the door until they are walking to their car, but this work can be seen as frivolous and costly when broken down into individual materials.

In terms of patient experience, executive leaders are generally concerned about the clean and orderly nature of their facilities, but this can be put on the back burner when revenues are suffering. Engineers and facilities managers are diligently concerned about minimizing disruption to patient services and maintaining full infrastructure functionality, but this can be difficult when teams are continuously putting out fires and are unable to step back and see the full impact of systems.

Many health care staff members entered the field because they or a family member had either an awful or a great experience in a health care space that impacted their life dramatically and transformed their career trajectory. The definition of patient experience is personal and yet universal.

Patient experience is heavily tied to patient safety. A robust patient safety program should include broader efforts to improve patient experience because many efforts to keep patients and visitors safe and healthy have a direct impact on patient experience. This includes early and empathetic communication to patients and their families when disruptions or changes occur.

Teams focused on systemic improvement of patient satisfaction can reference the three-pronged approach outlined in the American Society for Health Care Engineering’s (ASHE’s) monograph, “Hospitals in Pursuit of Excellence (HPOE) Guide: Improving the Patient Experience Through the Health Care Physical Environment”.

While the monograph is almost 10 years old, the content is still relevant to achieving excellence today. It notes that patient satisfaction teams and other hospital leaders can use the people, process and place model to address specific areas for improvement. These elements can be described as:

  • People — Creating a culture of caring.
  • Process — Policies and procedures that support patients and staff.
  • Place — The physical environment, equipment, technology and furniture.

Health care staff members have the greatest impact on a patient’s experience, regardless of how compliant and exceptional a policy is. While standards and policies are important and following them ensures a certain level of excellence, true excellence involves staff who go above and beyond the call of duty and outside of their daily task list.

Patients and their families remember small acts of kindness. They remember someone helping them navigate hospital hallways. They remember seeing an EVS staff member cleaning their room with meticulous detail and a friendly conversation. Patients and visitors also remember service and maintenance failures. They remember outages and noisy construction.

Both good and bad experiences create lasting impressions. The bad experiences of a patient can destroy the reputation of a campus or hospital system overnight. This can be difficult and expensive to overcome.

Physical environment influences

As most health care staff members have been patients themselves or presented with a family member who was a patient, there are noticeable day-to-day influences that are observed repeatedly for their positive and negative contributions to the patient experience.

Some of the most-noticed positive areas of high impact are cleanliness, quiet, fresh air quality, connection to nature and views to the outdoors, and visually interesting and calming ceilings. Inversely, areas that are the most noticed as negatively impacting the patient experience are dirtiness (either perceived or real), disrepair, materials failures, drab ceilings with harsh and direct lighting (especially at nighttime), noisy conditions, stale or foul-smelling air and lack of views to the outside.

When it comes to identifying challenges, health care staff members consistently report budget constraints as the biggest barrier to patient experience improvements. Other commonly identified challenges include the need to complete a careful and thorough future-forward planning process with an integrated team to create realistic budgets, and growing thoughtfully and strategically to keep wayfinding simple.

Care is becoming increasingly more expensive, and dollars are not stretching nearly as far as before, leading teams to make difficult decisions about priorities. It is essential to adjust thinking to a long-term view of cost. This strategy requires changing the budgeting equation to compare short-term value versus long-term value and return on investment, prioritizing the direct value of a given expense or budget allocation to patients and consistently asking, “How does this budget decision impact our patient experience?”

Coupling materials, products and designs that improve aesthetics, comfort and access to nature with an extension of project and building life by lengthening the time until replacement can be a winning strategy.

In the design phase of a hospital project, careful planning, design exploration and collaboration among diverse teams of experts are essential to patient experience and project success. Additionally, meaningful early collaboration and strategic thinking about future needs makes change and growth easier.

One example of this is planning for change so that spaces can be utilized in different ways during a growth phase and allocating extra space in planning to allow for new or different equipment needs. The default move is to squeeze as much program as possible into the smallest amount of space possible to reduce first costs. This sets hospitals up for painful future growth and difficulty maintaining resiliency and redundancy needs. It can be avoided with strategic planning and investment in future opportunities.

One of the largest sources of immediate stress and anxiety for patients and visitors to health care facilities is wayfinding. Great wayfinding is seamless, almost unnoticeable and makes a building easy to navigate, while poor or complicated wayfinding creates confusion, delays and an unnecessary burden to all who walk the halls. The design of exceptional wayfinding parallels the system of the four laws of “how to create a good habit” from the book Atomic Habits by author James Clear. They include:

  • Make it obvious — Nobody should have to stop and squint to figure it out.
  • Make it attractive — It should be eye-catching.
  • Make it easy — Use a system that includes symbols and colors to cater to different needs.
  • Make it satisfying — Good wayfinding gives people a sense of accomplishment.

Inspiration and resources

There are endless examples of everyday health care staff members receiving inspiration from their own health experiences and those of colleagues who set a high bar for others to follow, as noted in the related article below. It is culturally important to any organization to document, acknowledge and celebrate outstanding acts of service.

Some additional ASHE monographs that may prove helpful in ensuring compliance and excellence in patient experience and satisfaction include the following:

Future thinking

Looking into the future, there are bright spots emerging that will alleviate the current challenges.

For example, artificial intelligence (AI) will continue to change the way everyone works. Wearable technology will change the ambience of patient rooms, making them feel more hospitality-like. Personalized digital interfaces will continue to transform health care delivery. Population health management will keep patients at home, healthy and out of hospitals.

AI can improve every aspect of the patient and staff experience. It is allowing staff to free up valuable time that can be given back to direct patient care and engagement. AI also helps prevent outages by detecting problems early, using the same technology that can help find tumors earlier and increase the likelihood of positive patient outcomes. AI will help everyone in the health care field do their jobs better. It is important to pay attention and seize these opportunities.

Wearable technology will help eliminate much of the bulky and expensive equipment that gets attached to patients from their arrival to their discharge. This will increase comfort, mobility and safety. Patients will be able to navigate their rooms with more ease and independence. Clinical staff will have better real-time and historical patient data to make more informed decisions about treatment.

Personalized digital interactions and interfaces will help transform wayfinding. Consider how Google Maps has transformed navigation. Patients will be able to get real-time updates and education. Self-driving vehicles will be able to drive patients and visitors home after a long night or some bad news.

It’s not a new concept or trend, but continuing to transition to population health management, health care at home, and an increased focus on mental health and disease prevention are ways that the health care field will be able to reduce the overall cost of health care. The impacts of a robust system that treats the whole patient should not be ignored when planning future growth, expansion and changes to services, including a trend toward wellness and hospitality-like environments.

Wonderful experience

The combined specialized health care staff member values of patient experience work together to cover the full spectrum of a wonderful hospital experience.

The health care workforce needs to collaborate to minimize triggers and stress while patients and their families are in a fragile state.

The health care field needs to ensure that the patient population gets attention and care; that patients can find where they are going and receive help when they need it; and that the hospital environment makes patients, families and staff feel better.

In the end, patients in health care facilities should feel safe and that they are in good hands.

Related article // Patient experience stories of excellence from the field

Contributors to this article who were interviewed had memorable stories of patient experience successes from different perspectives. Some of them include:

  • Stepping outside of their role. A facilities manager at a hospital had a reputation for being a perfectionist and focused on tasks at hand, but he would always stop and help patients or families with navigational challenges with a friendly attitude, stopping what he was doing and walking them to where they needed to go. This demonstrates the soft skills needed to work in hospital environments and deliver patient experience excellence.
  • Access to outdoor space on a patient floor. A health care staff member experienced firsthand the calming and healing effects of a hospital’s dedicated outdoor space for patients on a patient floor and has a unique appreciation for this often overlooked amenity that is sometimes value-engineered out of a project.
  • Ensuring a great first impression. A hospital experienced complaints about the cleanliness of the public restrooms in its main lobby. The environmental services team increased the number of times the restroom was cleaned and repeated this increase as necessary until complaints were eliminated, which led the team to increase the number of cleanings from once a day to every two hours.
  • Future-proof design. A well-planned hospital created an “empty chair” concept — an additional empty room designed intentionally to allow for future mechanical equipment replacements to occur seamlessly by always having an empty space allocated for future needs, eliminating downtime in operating rooms.
  • Staff resiliency rooms. A hospital created resiliency rooms for clinical staff on a patient floor to provide them with a dedicated space to decompress or exercise to relieve stress as a response to the impacts of the COVID-19 pandemic. 

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Ashley Mulhall, AIA, LEED AP BD+C, WELL AP, EDAC, LFA, is sustainability director in Arizona for Grace Design Studios. She can be reached at amulhall@grace-design.com. Assisting her with this article were Lynn Kenney Koffel, EDAC, SASHE, a business development and marketing consultant; Brittany Burbes, project executive at DPR Construction; Thomas Chasty, partner and registered architect at Grace Design Studios; Rosi Fowler, retired executive at Banner Health; Zach Goldsworthy, PE, principal and electrical engineer at DHE; Nate Jones, PE, principal and mechanical engineer at DHE; Tiana Lemons, IIDA, NCIDQ, EDAC, partner and interior designer at Grace Design Studios; Susan Romano, MHA, a patient experience consultant; Shari Solomon, president at CleanHealth Environmental; and Jennifer Wilcynski, IIDA, NCIDQ, LEED AP, EDAC, interior designer at Grace Design Studios.

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