Operations and Facility Management

The Looking Back column is part of Healthcare Design’s 25th anniversary coverage in 2025. If you’re interested in contributing, contact Editor-in-chief Anne DiNardo at [email protected].

Looking back

One of the greatest impacts on healthcare design over the past two decades came from the recognition and importance of patient and family experience. For years, designers sought to convince healthcare clients that improving their physical environments was good for business.

Sheila F. Cahnman (Image: Courtesy of JumpGarden Consulting, LLC)

The industry promoted the competitive marketing advantage of having the most up-to-date amenities and hospitality or homelike environments to attract healthcare providers and satisfy consumers. Because so many factors affected healthcare choices, including physician practice patterns and insurance coverage, this strategy was successful to a point, but not readily quantifiable.

Patients’ perception of the hospital experience become a more important issue for U.S. health systems when the Centers for Medicare & Medicaid Services (CMS) instituted the Inpatient Prospective Payment System (IPPS) to pay hospitals a predetermined rate for each inpatient stay, rather than the actual cost of treating each individual patient.

Under these provisions, participating healthcare systems were required to report quality measures, or annual payment updates would be reduced.

CMS-required quality measures

One CMS-required quality measure was the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), a standardized and publicly reported survey of inpatient hospital experiences that was instituted in 2012. The survey’s data collection methodology enabled valid comparisons of patient experience across hospitals.

Questions regarding provider/patient communication, cleanliness, and quietness could be directly or indirectly impacted by the physical environment.

Research also indicated that patients rated their healthcare experience higher in updated facilities. Patient experience became a top priority for the hospital C-suite due to market recognition and financial incentives.

Introduction of chief experience officers

Simultaneous with these governmental actions was a movement toward creating a culture of patient-centered care, which promoted empathy, communication, and respect for patient preferences.

Hospitals, such as the Cleveland Clinic, created chief experience officer positions focused on improving the level of service and general well-being of patients during their stay.

Healthcare design adopted new strategies including the Disney concept of onstage/offstage, intending to hide staff and support services to create a more “hotel-like” environment.

Refining patient, staff experience

Today, we recognize that providers, nurses, and support staff are under increased pressure and sometimes threats of violence that impact their interactions with patients.

Healthy, supportive communication between staff and patients and families may be the most important factor in promoting the best experience with the physical environment playing a supportive role.

There is also more emphasis on spaces that enhance staff members’ physical and mental well-being, such as tranquility/respite rooms and providing more access to natural light and outdoor areas.

With ready access to information from many sources, patients today are more informed and have higher expectations for their healthcare interactions. The ideal of the patient experience has matured, building on the lessons of the past 25 years.

Sheila F. Cahnman is president of JumpGarden Consulting LLC.