The Ecology of the Patient Experience: Physical Environments, Patient-Staff Interactions, and Quality of Care
Healthcare organizations are facing a complex set of challenges in the 21st century. Rising costs of healthcare, decreased government funding, expensive technological advances, shifting population demographics, nursing shortages, and increased competition between organizations are forcing healthcare institutions, especially academic health centers, to rethink every aspect of their operations from the way physicians and nurses are trained to the way care is delivered to the environments in which the care is provided. This study examined how a large scale design intervention that significantly improved the attractiveness of the physical environment affected patients? perceptions of staff behaviors and their interactions with staff members, as well as their perceptions of quality of care. Another aim of this study was to understand how staff perceptions? of their behaviors and their work environment changed in the more attractive environment. The outpatient practice that was selected for this study was previously ranked in an earlier study as being the least attractive out of seven outpatient practices. This practice subsequently moved to a newly constructed ambulatory care center in January 2007, allowing for a pre-move and post-move comparison. The primary data collection methods used were a patient satisfaction survey, a staff retrospective work environment survey, and short focused interviews with both patients and staff members. Results showed that patients perceived a more positive manner in which staff interacted with them, as well as improved quality of care, despite no changes in actual staff behaviors. Findings also indicate that staff members noticed some positive changes in their work environment, which could affect how they interacted with patients. The results also showed an increase in the willingness of patients to recommend the office to others, which signifies increased patient loyalty to the practice. The findings of this study support previous research studies that emphasize the important role of healthcare facility design in influencing patient and staff perceptions of quality and satisfaction. In order to continually improve patient perceptions? of their experience, providers should focus on delivering high quality service in high quality facilities. Based on the findings from this study, future research should explore in greater depth the relationship between employee communication patterns and the effect of these patterns on their interactions with patients. Also, more research is needed to identify specific design elements that improve patient and employee perceptions of quality, as well as satisfaction.
healthcare design, quality of care, outpatient care, patient- staff interactions
dissertation or thesis