IMAGES PROVIDED BY HKS, INC.

Use of nature is a great way of creating a campus that is more than just healthcare. Walking trails can provide a respite for families with children or relatives in the hospital.

Hospitality design intertwined with healthcare architecture is not, in itself, new. For the last 10 years, healthcare architects have been focused on destination healthcare-type settings that connect with their communities while appealing to the patients.

This movement started by adding hospitality-like finishes, such as bedspreads and warm wood flooring. The next movement incorporated front-of-house and back-of-house activities. But, at the end of the day, the facility was still a hospital.

Today, a new wave of facilities is coming online that takes this a step further by thinking about the patient experience beyond just the rooms.

The new method: guest-focused care. This design approach views the patient as a guest first-creating a new, implied personal contract. While patients are something to be processed, guests are to be treated and are with you a short while. As a result, the idea of guest-focused care is about getting to the DNA of design and introducing design attitudes that focus on the guest experience, which affects not just finishes but operations, efficiency, and staff interaction. The result is a renewed approach to the concept of “hospitality meets healthcare design” that goes further than what has been done in the past. It shapes everything from check in to check out and is the basis of experiential design.

Times are changing

When discussing the integration of hospitality and healthcare, it is hard to ignore medical tourism as a key segment of the market. This is a vastly growing business, both online and overseas, as patients seek to lower costs by traveling abroad. From hotel entities to overseas health centers, there is increasing competition for medical tourism. It evolves from lifestyle marketing in the hospitality industry and from elective, private-pay clients-many of whom are uninsured or underinsured and need to reduce costs.

While one would think that a down economy would negatively affect this industry, the reality is that it is as strong as it has ever been. Consumers on tight budgets use the Internet to shop for bargains, at times yielding as much as a 66% savings on some procedures.

The irony

The irony is that this idea isn’t new. Hospitals and hotels have the same etymology. The word “hospital” comes from the Latin word “hospes” (host), which also is the root for the English words “hospice,” “hotel,” “hostel”, and “hospitality.”

The healthcare and hospitality mix is happening through initiatives such as creating healing environments and patient-focused care. However, these trends and methods stop short of reaching their full potential, as they are almost always about dressing up the facility to be more hospitable instead of focusing on the cultural change required to truly reach this goal.

One of the first lessons of hospitality design is that 90% of what establishes the difference between a two-star hotel and a five-star hotel is service. This is the reason that we must move beyond finishes and toward operations, service, and process. A deeper shift is required to truly integrate hospitality and healthcare.

Market share

Surveys such as those by Hospital Consumer Assessment of Health Care Providers and Systems (HCAHPS) have shown that hospitals that incorporate extra features and amenities score higher on satisfaction surveys.

This integration is more than a feel-good thing to do. There is also a sound business case for why integration makes sense: It’s called market share. As many healthcare facilities know, the driver today is patient satisfaction. Satisfied patients lead to improved market share since most consumers choose their providers, even within managed networks. They are also more likely to recommend a facility to friends or family.

Meditation areas and gardens located inside and outside of health pavilions provide a range of spaces for different types of social activity, from peaceful meditation to staff respite.

Guest-focused care is about designing around the experience-a mindset instead of a mandate on finish qualities or amenities.

Surveys such as those conducted by Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) have shown that hospitals that incorporate extra features and amenities score higher on satisfaction surveys. This is especially true for facilities wanting to attract private-pay patients with higher reimbursement rates.

Just as hotels can be rated, healthcare facilities are being rated as well. Now more than ever hospitals and businesses are creating hospital scorecards that rank items from patient satisfaction to hospital outcomes and performance. Many of these are now being made public and are tracked in public forums. While this is controversial in the healthcare industry, it is indicative of increased accountability to the consumer.

This may not only potentially impact hospitals, but extended-stay, assisted-living, and retirement centers as well. With the aging baby boomer population, all of these markets are growing, and an approach to how hospitality is brought into the fold is critical.

A facility primarily will be remembered based on the total experience. How were patients greeted? How long did they wait? How was their quality of care? How was the food? All of these things dictate the experience, and all of them, when considered in totality, can influence design beyond what is strictly required by healthcare codes.

A case study

Although it is still in its early stages, HKS is working with a client in Lancaster, Pennsylvania, to master plan a facility on a 70-acre site that follows the client’s mission: “To create an extraordinary experience every time.”

HKS, known for its healthcare and hospitality design, leveraged its depth of experience in both areas to work with the client to undergo a first-time design approach that is really just a pebble in the pond for this sort of shift in thinking. By shaping a new philosophy around “guest-focused care,” the firm was able to move beyond finishes and use design principles from hospitality, where the focus is on guest and staff experiences. With an increased emphasis on patient satisfaction, and research showing that patients with lower stress levels heal up to 40% faster, implementation of this idea is timely.

At Lancaster Hospital, hospitality design is incorporated into every aspect of the project. The goal is to have a 150-bed hospital with no patient rooms. When designing the campus, the owner and design team visualized a guest room with health amenities, instead of a patient room with hospitality finishes. The firm envisioned waiting rooms as living rooms; the cafeteria as a restaurant-style dining area; a kitchen that could provide tasty, diet-friendly menus; and a farmers market to introduce fresh produce to the campus.

When master planning the facility, HKS researched benchmark comparisons at healthcare and hospitality destinations in terms of distance a guest must walk from the door to the greeter, from the door to check-in, from the door to parking, from the door to the elevator, from the elevator to the farthest room, and from the service elevator to the farthest room. This allowed the client to compare the hospitality versus healthcare facilities’ walking distances, developing a more hospitality-like approach to customer care.

Defining the healthcare experience

Similar to how the hospitality industry uses a star system to rate hotels, the team created a range of amenities and allows clients to pick and choose to create their desired experience, resulting in a “healthcare rating system” customized to the particular needs of each client.

HKS outlined amenities in three categories to create the system. The team organized all available amenities, from service-oriented to architectural, ranking them (1) certain, (2) viable, and (3) extraordinary. For example, pedestrian paths, meditation space, and fitness rooms in the health lodge were “certain” amenities, while valet services, walking trails with benches, and a doorman were “viable” options. The “extraordinary” list included paths with water features and a signature dining area where consultants would work with guests to create diet-appropriate meals.

The point wasn’t to dictate what should be provided but to map the realm of possibilities for the client and facility to be served. This approach allowed HKS to tailor the facility using a hospitality approach to amenities, and to prioritize both the operational and architectural requirements that such amenities would require.

Cost implications

The best part is that most of the amenities don’t cost extra. For example, all facilities have an operator that answers the phone. However, it’s what the operator says when a guest presses “0” that can make a difference. It is about a shift in culture that promotes the view that patients needing treatment are rather guests in need of care.

Many will argue that in light of the current economy, this is a luxury for the few who can afford it. The reality is that healthcare facilities will continue to compete for market share. Boomers are aging and will continue to choose more elective procedures, as well as select facilities that cater to them. This, combined with research showing the effects of the environment on healing, suggests that thinking about hospitality isn’t an “if you can afford it” luxury, but rather a “must consider what applies to you” essential. This is a way of looking at design, not a mandate on quality. And, it is not about cost. Guest-focused care is about designing around the experience; it is a mindset instead of an order on finish qualities or amenities. It is, in fact, primarily about thinking through adjacencies, touch points, and efficiencies.

A simple shift in perspective, complemented by an understanding of both markets, can have a dramatic impact on design solutions. This isn’t just about elective procedures and spa-like environments. While that is certainly one application, this movement is also about revamping routine care with ideas and solutions that don’t have to add costs.

One of the central themes to the whole life campus is that this is a place where people will come when they are healthy. As such, entrances can be designed where guests don’t enter through a hospital, but through a pavilion that connects to nature and that is much more inviting.

Integrating with the natural environment is a great way of creating a hospitality-like campus, giving opportunities for outdoor dining, walking paths, and healing gardens to staff and guests/patients.

Guest-focused care has an impact throughout the design. Rather than designing the ideal patient room with hospitality amenities, the design could begin with a hospitality chassis and integrate necessary health amenities.

The goal is to go beyond decorations and into the actual shaping of the architecture, the operations, and the philosophy of care being delivered. It is only then that integration can occur, and the patient experience can be redefined from patient-focused care to guest-focused care, raising the bar for both design and healthcare delivery. Shannon Kraus, AIA, ACHA, LEED AP, vice president and practice leader-Washington, D.C., can be reached by e-mail at

skraus@hksinc.com or phone at 202.682.6289. Jeff Jensen, AIA, principal and design leadership, can be reached by e-mail at

jjensen@hksinc.com or phone at 214.969.5599. Healthcare Design 2010 November;10(11):100-106