When a patient is admitted to a hospital, the hope is that the patient will improve and go home in short order. Those of us who work in healthcare know about hospital-borne infections and other potential complications of an inpatient stay, and improving a patient's chances of a successful hospitalization is a prudent goal.

For all the intentions of hospitals to be healing environments, why do they more often than not feel exactly the opposite? And if we are intent on improved patient outcomes, happy staff, worker retention and decreased costs, why are we not paying more attention to the environments where care is delivered?

Identifying the problem

According to the Robert Wood Johnson Foundation (RWJF), the hospital environment can be a cause of problems for both staff and patients:

"Poor air quality and ventilation, together with two or more patients in the same room, are major causes of nosocomial infection. Inadequate lighting is linked to patient depression as well as to staff's medication errors. Lack of a strong nursing presence can result in patient falls. Staff members often have to do their charting and fill medication orders in crowded, busy makeshift areas, which can lead to errors and increase staff burnout.

"Hospitals produce stress in a variety of ways. Excessive noise from paging systems, alarms, machines and voices upset patients and distract staff. Poorly designed hospitals where people can get lost easily or that force bedridden patients to stare directly at glaring ceiling lights can cause anxiety and a sense of helplessness. Double-occupancy rooms that impinge on patients' right to privacy and rest can impede their recovery. There are few places where patients can talk quietly with their families or with staff."

Noise, lack of privacy, limited access to sunlight and other factors can make a hospital stay unpleasant, if not unhealthy. Studies and articles all elucidate the fact that hospital design matters, and that it impacts not only patient well-being, but also the experience of family visitors and the staff who provide patient care.

The problems could not be more apparent. So what are the solutions?

Evidence-based design

A seminal paper by Roger Ulrich, et al, is frequently cited as a source of inspiration and ideas for the improvement of hospital design. Other studies and papers have reached similar conclusions.

Ulrich identified a number of interventions and design features that can produce significant improvements and positive changes for both staff and patients. These include, but are not limited to:

  • Changes in unit design that decrease staff fatigue and honor established work-flow patterns
  • Improved lighting for both patients and staff
  • Interventions to decrease noise pollution (removal of intercoms, soft rubber wheels on equipment, noise-absorbing ceiling tiles, etc.)
  • Establishment of healing gardens for enjoyment of staff, visitors and patients
  • Improved airflow and ventilation
  • Single-bed patient rooms for privacy, decreased risk of infection and decreased patient stress
  • Hospital design that simplifies navigation and decreases visitor and patient stress and confusion
  • The use of music, aromatherapy and artwork specifically designed for healing and stress relief

These types of design interventions can be both expensive and relatively affordable. While considering cost, administrators and executive decision-makers should also consider potential outcomes that speak to longer-term savings. Decreased rates of infection, increased staff retention, faster healing time and improved patient satisfaction are four important outcomes worthy of consideration in this regard.

Healthy 21st-century environments

21st-century healthcare consumers are savvy and discerning. Patient satisfaction is now a key measure of organizational success (including reimbursement), and patients can no longer be satisfied by generic bargain-basement artwork and racks of informative health pamphlets. Patients want and deserve more.

At the same time, hospital organizations cannot afford high rates of attrition of nurses and other key staff members due to unsafe, stressful and unhealthy work environments. Worker attrition is exponentially more costly than worker retention, and forward-thinking healthcare leaders should equally consider the well-being of staff and patients.

Healthcare environments are meant to promote health and healing, and the research now supports thoughtful investment in amenities and design that promote wellness. Therefore, hospital administrators and key healthcare decision-makers should take note of the small and large changes that can reap significant rewards, benefits and savings for all parties concerned.