Don't Blame Your Dingy Hospital for Low HCAHPS Scores

Patient satisfaction scores only modestly improve after hospitals are remodeled, research shows. What matters more is communication between providers and patients.

Picture yourself walking into a glitzy, gorgeous hotel that was designed entirely with beauty and comfort in mind. Everything—from the lobby, to the beds, to the food, to the view—is simply beautiful, looking like a spread in a glossy high-end travel magazine.

But what if, after a couple of days, you discover that the service at this gorgeous, dream locale is just mediocre? What if it's downright bad? Would you give the hotel a glowing online review and recommend it to all of your friends?

I'm guessing that the answer is probably no. As it turns out, the same is true for hospitals, too.

According to a new study led by Johns Hopkins researchers, patient satisfaction scores only modestly improve based on the effects of a remodeled/redesigned hospital.

The bottom line?

"Healthcare leaders should not blame suboptimal environments for poor satisfaction scores," says the study's lead author, Zishan Siddiqui, MD, assistant professor of medicine at the Johns Hopkins University School of Medicine. He also believes that nurses and other frontline caregivers will emerge as the research leaders in this area.

Compassionate Nursing Care Linked to Higher HCAHPS Scores

Patient-centered hospital design has gotten a lot of attention over the past few years, being touted as a way to improve patient satisfaction scores. In 2011, for instance, I wrote about a hospital that took cues from Disney World and health resorts with the design of its brand-new, $211 million facility.

Siddiqui agrees that the hospital/hospitality analogy might be an apt one—to a point. He concedes that "a fantastically clean room and a great view" at a hotel might somewhat make up for bad service.

But that "halo effect" doesn't seem to apply in the healthcare setting.

"Very few things, if anything at all, can make up for poor communication from a healthcare provider," he says. "The kind of care that [patients] get is so much more supremely important."

Siddiqui and colleagues found themselves living within a "very interesting natural experiment" in which some of the care at Johns Hopkins Hospital was moving to a gorgeous new building, while some care stayed in an older facility. This allowed researchers to compare results of HCAHPS and Press Ganey patient satisfaction surveys between the new and old facilities.

Although there was a significant improvement in facility-related satisfaction scores, there wasn't a significant change in care-related satisfaction, or even overall satisfaction.

"I was surprised," Siddiqui says. "We looked at the data and we said, 'We have to write this up.'"

There are certainly hospital design elements that can help improve patient care. For instance, one hospital undergoing a redesign got advice from its nursing staff about the functionality of showers and how patients would flow through the facility.

But Siddiqui says he imagines that his research will inform leaders' decision-making about how much they really want to invest in lovely—and likely expensive—design elements that might not actually provide a return on investment.

Siddiqui adds that his team's research spotlights two additional aspects of patient satisfaction research in general. First, he notes that patient satisfaction surveys don't capture every patient's experience.

"Only 20–25% of our patients respond to our surveys," he says. Therefore hospital leaders could be making decisions based on an unrepresentative sample.

"We have to figure out a way of getting these non-responders to tell us what they think," Siddiqui says.

He also believes that there is a big opportunity for bedside nurses and other frontline caregivers to lead the way in patient satisfaction research, especially since funding is limited. Doing so can help leaders discover evidence-driven, local solutions for what will work in their own hospitals, and then share that knowledge more broadly.

"I think healthcare leaders need to find out a way of supporting researchers within their hospitals," he says. "I think they will be the critical players in advancing research in this area."