Does Swanky Equal Satisfied?

Expensive hospital renovations have little impact on how patients rate their care.

By Zishan Siddiqui

Our study challenges the conventional wisdom and shows that patients are reliably able to distinguish between creature comforts and improved care.

Over the past decade in the United States, an estimated $200 billion has been spent on hospital renovation and construction projects, and many more projects are in the works. The trend has been toward patient-centered design, which includes incorporating such features as well-lit private suites, sound-reduction panels, appealing art, healing gardens, water features and sleeping accommodations for family members.

Some hospital leaders have assumed that improving facilities with patient-centered design will automatically improve overall patient satisfaction scores—scores that are more important than ever now that hospital payments are linked to performance on the Medicare-mandated Hospital Consumer Assessment of Healthcare Providers and Systems patient satisfaction survey. What’s more, many physicians and nurses assume they can’t improve their patient satisfaction scores while providing care in aging, outdated facilities.

Studies have shown that satisfied patients are more likely to return for and recommend health care services, maintain a relationship with their providers, and adhere to physician recommendations.

Despite the importance of patient satisfaction, there is a lack of in-depth understanding of how various factors influence this measure, and not many evidence-driven strategies are known. So my team and I set out to explore a timely question: Are swanky new hospitals important in boosting patient satisfaction scores?

Fortunately, we found ourselves amid a natural experiment right here at Johns Hopkins that allowed us to explore this issue—the opening of the Sheikh Zayed Tower in 2012. The tower boasts well-decorated and light-filled rooms, sleeping accommodations for visitors, use of sound-absorbing material and more than 500 works of art. At the same time, the clinical teams of nurses, physicians and ancillary staff members that served these units remained essentially unchanged after the move. Some of these units had moved from buildings that were constructed in the 1930s. Would physicians and nurses receive a boost on their scores with this move?

Our team analyzed 12 months of pre-move patient satisfaction survey results and 7.5 months of post-move patient survey results, totaling some 5,663 patients from both the baseline and control groups.

To our surprise, patient opinions about their physicians and nurses did not change significantly. The satisfaction with cleanliness, quietness and comfort for visitors soared—but the overall satisfaction improved only modestly.

Our study challenges the conventional wisdom and shows that patients are reliably able to distinguish between creature comforts and improved care. These results also challenge the widespread belief that facility renovation and expansion are vital parts of patient satisfaction improvement strategies.

The findings have sparked a debate on patient-centered design in the health care design community. Hospital leaders will need to think carefully about return on investment as they choose to incorporate some of the priciest design features. And these leaders should stop blaming poor patient satisfaction scores on aging buildings and units.

Our study, published in the March 2014 issue of the Journal of Hospital Medicine, was admittedly limited in its study of 5,600-plus patients at a single urban teaching hospital. It is also important to note that the impact of new clinical buildings goes beyond improving patient satisfaction, since some features could improve patient safety, workflow, efficiency, provider satisfaction, stress and productivity. There are many more important questions that remain unanswered, and we plan to investigate several of them in the near future.

At a time when hospitals are analyzing every expenditure to stay in the black, it should be instructive and reassuring for hospital leaders to know that some of the most expensive aspects of a renovation project—soaring glass atriums, multistory waterfalls—may have little impact on how patients rate their care. n

Zishan Siddiqui is an assistant professor of medicine at Johns Hopkins.