Design Is Still Essential to Patient Satisfaction

Fancy Flourishes at Hospitals Don’t Impress Patients, Study Finds — Or Does It?

March 11, 2015

Healthcare Partner, NBBJ

Kaiser Health, in reporting on a Johns Hopkins study recently published in the Journal of Hospital Medicine, claimed that design features had little effect on patient satisfaction in one specific building, the Sheikh Zayed Tower on Johns Hopkins’ Baltimore campus. Quite to the contrary, however, the Hopkins study indicates that design does cause patient satisfaction to rise.

For example, the study found that satisfaction with noise reduction rose almost 20%. This is important, as reduced noise has a scientifically proven correlation to a patient’s ability to heal — we know from neuroscientist Dr. John Medina that stress hormone levels go up when sound levels exceed 55 dBA, which can not only slow the healing process, but can also lead to mistakes and lack of concentration on the part of care providers. The study also found that visitors’ satisfaction in their accommodations and comfort rose 20%, which is important in light of research demonstrating that family has a profound impact on their loved one’s healing.

Looking deeper, the study shows patient satisfaction rose in 32 of 33 indicators, including satisfaction with nurses’ attitudes, the time physicians spend with patients and the friendliness of staff (all up 2-3%), as well as overall rating of care (up 6.2%) and the likelihood that patients will recommend the hospital (up 5%). But these increases should be greater. Such minor gains reinforce the need for further study into why the design of this building did not have a greater impact on patient’s satisfaction with providers.


Sheik Zayed Tower, on the Baltimore campus of Johns Hopkins. (Courtesy SEAPCI)

More importantly, the reaction to the Hopkins report reveals a cognitive bias toward binary thinking: between what I call “wretched excess” on the one hand and “austere functionalism” on the other. The former assumes that design consists merely of “fancy flourishes” (to borrow Kaiser’s language), which excite people at first, but which cost a great deal yet provide no lasting value. The latter assumes that a just-the-basics approach is sufficient for healing, while ignoring our very real human needs for nature, socialization and beauty.

What often remains ignored is an essential aspect of design: behavior. That is, how can design positively affect behavior in ways that improve clinician performance and satisfaction, as well as patient satisfaction? This ability does exist, through rigorous, experientially-focused process improvements. But are those processes fully integrated into the design; are they experientially focused; and is there follow-through prior to moving in, so all staff are trained in the processes the built environment was designed to support?

As architects and environmental designers, we evaluate the success of our built environments using both quantitative metrics and qualitative professional judgment. We quantitatively know that designing for exposure to natural light, ease of movement and regulation of sound has a profound positive effect on the healing process. We also qualitatively know that design — by providing access to nature and fresh air, and by balancing places of quiet reflection and restoration with places for social connection — can also affect the way a patient, family or staff member feels. The beauty of good design is that it applies the best of science insights to the environments in which we work and live.

Ultimately, design must strike a dynamic balance of function, experience and expression. In an era of reform, every dollar we spend must provide value. We do not want our environments to wallow in wretched excess nor do we want the austere functionalism of old: the former suggests a lack of responsibility and accountability; the later dehumanizes us. Design, however, provides a powerful, quantitative, qualitative tool for a healthcare system renewing its focus on health and well-being.

Image courtesy of Sean Airhart/NBBJ.

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