SummaryGriffin Hospital renovated a 100,000-square-foot inpatient facility and built a new 49,000-square-foot ambulatory pavilion/cancer center which incorporates patient-centered design factors that are intended to create a homelike atmosphere, including a spacious and barrier-free physical environment; natural lighting, plants, and other elements of nature; carpeting, wood, and soft paint colors; music and art; and common areas such as lounges and kitchens that can be used by patients and visitors. Dedicated staff and volunteers within the facilities greet and assist patients and visitors, with the goal of making the inpatient experience as pleasant as possible. Although the hospital has not attempted to quantify a direct relationship between outcomes and facility design, hospital administrators believe the facility design has contributed to low infection rates, fewer calls to nurses, higher patient satisfaction, a reduction in malpractice claims, an increase in patient admissions and financial performance, and recognition of the hospital as an excellent place to work.Moderate: The evidence consists of before-and-after comparisons of key outcomes measures, including patient satisfaction, patient calls to nurses, admissions, malpractice claims, and financial indicators. The evidence also consists of post-implementation Hospital Consumer Assessment of Healthcare Providers and Systems survey scores and infection rates.
Developing OrganizationsGriffin Hospital
Date First Implemented1994
Problem AddressedThe traditional design of hospitals can create a frustrating and somewhat frightening environment in which to receive care, leading to low levels of patient satisfaction and potentially declining market share. A growing body of evidence suggests that patient-centered design can improve patient satisfaction, employee retention, quality, and safety.
- An antiquated facility, leading to patient dissatisfaction: In the early to mid-1980s, Griffin Hospital had the oldest hospital building in the state and was experiencing declining market share and patient satisfaction as a result. A community perception survey highlighted the negative reputation of the hospital, with almost one-third of community residents listing Griffin as the local “hospital to avoid.”
- Many new facilities, creating an opportunity to improve outcomes, satisfaction: The aging condition of Griffin and many other hospitals has led to a "building boom" in recent years. In fact, approximately $100 billion has been spent on new hospital construction in the United States in the last 5 years, and an estimated $250 billion more will be spent in the next 10 years.1 This high level of construction offers an opportunity for hospitals to enhance patient outcomes and satisfaction through better facility design. A literature review identified more than 600 articles in peer-reviewed scientific journals that demonstrate the impact that the hospital environment can have on health status, safety, efficiency, and staff effectiveness and morale.2 For example, one study found that natural lighting can reduce depression, improve sleep, decrease length of stay, lessen agitation, and alleviate pain.3
Description of the Innovative ActivityGriffin Hospital designed its 100,000-square-foot North Wing Patient Care Building to include the following patient-centered design elements: a spacious and barrier-free physical environment; natural lighting, plants, and other elements of nature; carpeting, wood, and soft paint colors; music and art; and common areas such as lounges and kitchens that can be used by patients and visitors. A 49,00-square-foot ambulatory care pavilion and cancer care center with similar design elements opened in October 2008. Dedicated staff and volunteers within the facilities are available to greet and assist patients and visitors, with the goal of ensuring as pleasant an experience as possible. Key patient-centered design and staffing features include the following:
- Easy-to-navigate hospital entry: Entry to the hospital facility is made as nonthreatening as possible through use of the following elements:
- Easy, pleasant parking: Speakers in the hospital parking lots pipe in soft music; free valet parking is available at the entrance for patients who prefer not to park on their own.
- Warm, inviting lobby: The hospital’s front entrance and lobby resemble a hotel, with warm decorative elements, including comfortable chairs and a baby grand piano.
- Welcoming staff: Paid receptionists staff the lobby reception desk, greeting and assisting all who enter. In addition, volunteer ambassadors welcome patients and visitors and offer to escort them to their destinations.
- Library: A health resource library, open to the community, is adjacent to the main lobby; the library includes mainstream “lay” publications as well as a comprehensive medical library with clinical publications.
- Comforting transition to patient units: In contrast to the sterile environment in traditional facilities, the hallways are designed to be warm, with woodwork, soft paint colors, carpeting, artwork, soft lighting, and large windows that allow for natural lighting wherever possible.
- Patient-friendly units: Patient units incorporate the following patient-centered design features:
- Receptionists: Reception desks are located outside elevator doors on every floor so that all patients and visitors are greeted and assisted if necessary.
- Warm design: Patient unit hallways have natural lighting, carpeting, artwork, and soft colors, with soft music piped in as well. Top-floor patient units have skylights. Acoustical ceiling tiles reduce sound levels.
- Decentralized nursing stations: In contrast to the traditional central nursing station, Griffin has decentralized nursing stations into “pods” that allow one nurse to be stationed directly outside of patient rooms, ensuring quick and easy access to patients. Units have one nursing station for every four beds. Nursing stations house medical records and basic medical/surgical supplies.
- (Mostly) private patient rooms: Approximately two-thirds of patient rooms are private, and even semiprivate rooms are designed for maximum privacy via bathroom and cabinetry placement. All beds have a view of the window, while air filtration systems enhance infection control.
- Unit-based resource centers: A satellite health resource center is located on every unit, with Internet access and educational books and materials relevant to the conditions treated on the unit.
- Kitchens, lounges, and entertainment: Each floor has a home-style kitchen, a quiet lounge with comfortable furniture and a fish tank, and an entertainment lounge with a piano where pianists and other musicians come to entertain ambulatory patients and visitors. Some musicians, such as violinists and guitarists, stroll the units.
- Equipment storage: Each unit has an equipment corridor so that equipment normally stored in hallways is tucked away from patient view.
- Open medical record: Signs in patient rooms encourage patients to read and make notations on their medical record. On request, the nurse will review the medical record with the patient.
- Patient- and family-friendly critical care unit: The critical care unit is designed in a unique horseshoe shape, with private rooms forming the horseshoe, an outer ring that serves as the visitor corridor, and a center area for professionals. Patient rooms have doors that access both the visitor and professional areas. Each room also has a private, handicapped-accessible bathroom, which improves infection control. Visitors can stay around the clock; multiple visitor lounges are located around the outside ring, some with sleeping accommodations and shower facilities.
- Ambulatory care/cancer center: The new 49,000-square-foot ambulatory care pavilion and cancer care center incorporates similar design elements; it also has an outside waterfall and reflecting pool, which infusion and chemotherapy patients can view while receiving treatment.
References/Related ArticlesAgency for Healthcare Research and Quality. Transforming hospitals: designing for safety and quality. AHRQ Pub. No. 07-0076-1. September 2007. Available at: http://www.ahrq.gov/qual/transform.pdf (If you don't have the software to open this PDF, download free Adobe Acrobat Reader® software .)
Flower J. Five-star hospitals. Strategy+Business. Issue 42. Available at: http://www.strategy-business.com/article/06108.
Mycek S. Under the spreading planetree. Trustee. 2007 Mar:22-25.
Arneill B, Frasca-Beaulieu K. Healing environments: architecture and design conducive to health. In: Frampton SB et al., editors. Putting patients first: designing and practicing patient-centered care. San Francisco: Jossey-Bass; 2003.
Contact the InnovatorWilliam Powanda
130 Division Street
Derby, CT 06418
Innovator DisclosuresMr. Powanda has not indicated whether he has financial interests or business/professional affiliations relevant to the work described in this profile.
ResultsGriffin Hospital has not attempted to quantify a direct relationship between outcomes and facility design because improvements in outcomes may relate to a variety of other factors as well (e.g., clinician and staff performance, systems of care, and targeted improvement initiatives). Hospital administrators believe, however, that the facility design—particularly the decentralized nursing stations—has contributed to low infection rates, fewer calls to nurses, higher patient satisfaction, a reduction in malpractice claims, an increase in patient admissions, better financial performance, and recognition of the hospital as an excellent place to work. Selected results are as follows (other results are available at http://www.griffinhealth.org):
Moderate: The evidence consists of before-and-after comparisons of key outcomes measures, including patient satisfaction, patient calls to nurses, admissions, malpractice claims, and financial indicators. The evidence also consists of post-implementation Hospital Consumer Assessment of Healthcare Providers and Systems survey scores and infection rates.
- Low infection rates: In 2006 and 2007, Griffin Hospital had no device-associated symptomatic Foley catheter infections and no infections associated with central lines and peripherally inserted central venous catheters. In addition, there were no cases of ventilator-associated pneumonia in the critical care unit in 2006, and the rate in 2007 was 1.43 per 1,000 device days.
- Fewer calls to the nurse: The incidence of patients pressing the nurse call button has been reduced by 40 percent since the nursing stations were decentralized.
- Higher patient satisfaction: In the mid-1990s, the patient satisfaction rate (patients who give Griffin a "very satisfied" or "somewhat satisfied" rating on its patient satisfaction survey) was approximately 80 percent. Since 2000, satisfaction rates have been well above 90 percent. Information provided in August 2010 indicates that from 2004 to 2009, inpatient satisfaction rates have been 97 percent. Outpatient satisfaction rates from 2006 to 2009 have been 97 percent and emergency department satisfaction has averaged 93 percent over the past 5 years. In addition, Griffin's scores on the Hospital Consumer Assessment of Healthcare Providers and Systems survey are in the top 5 percent of hospitals in the United States. Examples of Griffin's high Hospital Consumer Assessment of Healthcare Providers and Systems scores in selected areas include the following:
- Effective nurse communication: Griffin's Hospital Consumer Assessment of Healthcare Providers and Systems scores in this area are 85 percent (meaning that 85 percent of patients answered "always" to all questions in this category), versus a 74-percent state average and a 73 percent national average.
- Responsiveness of nursing services: Griffin scored 71 percent in this area, versus a 58-percent state average and a 60-percent national average.
- Willingness to recommend the hospital: Griffin scored 84 percent, compared with a 69-percent state average and 67-percent national average.
- Reduction in malpractice claims: The number of claims against the hospital dropped from 32 in 1996 to 18 in 2005, a decline of more than 43 percent during a period when annual discharges increased by 40 percent.
- More patients: Information provided in August 2010 indicates that Griffin’s inpatient admissions have increased by approximately 28 percent (from 5,866 in 1997 to 7,533 in 2009), compared with an average increase of about 10 percent for U.S. hospitals. From 1998 to 2009, annual outpatient visits grew from 93,347 to 179,202, an increase of 92 percent.
- Better financial performance: Annual net patient revenue increased from $81.5 million in 2003 to $109.1 million in 2007; information provided in August 2010 indicates that annual net patient revenue increased to $113 million in 2009. Net patient revenue growth has averaged 9 percent annually since 1999. The hospital has also had revenues exceed expenses every year since 1999, with the exception of 2003, when the inpatient psychiatry unit was closed for renovation.
- Recognition for an exceptional patient experience and for quality: Information provided in August 2010 indicates that Griffin Hospital has received national awards from Premier Healthcare Alliance (2010 Award for Quality), HealthGrades (2009 and 2010 Distinguished Hospital for Clinical Excellence, 2009 Outstanding Patient Experience Award, and numerous Clinical Specialty Awards), Data Advantage (2009 and 2010 Hospital Value Index Award), and Cleverly Associates (2008 and 2010 Community Value Index Five Star Hospital).
- Recognition as an excellent work environment: Information provided in August 2010 indicates that Griffin Hospital has been listed on Fortune Magazine’s “100 Best Companies to Work For” 10 times and was ranked fourth in 2006, representing the highest ranking ever achieved by a hospital. In 2009, Griffin Hospital had 8,293 applicants for 242 open positions.
Context of the InnovationGriffin Hospital is a nonprofit community hospital located in Derby, CT, that is licensed for 160 beds and 20 bassinets; the hospital serves a six-town area with a population of 105,000. The patient redesign program was implemented in response to the aforementioned situation facing the hospital in the early to mid-1980s—that is, an aging facility that was leading to declining market share and patient satisfaction. Hospital board members and administrators considered the possibility of closure or merger with one of seven nearby competitors, but ultimately decided to differentiate Griffin by adopting the Planetree patient-centered model of care and design in 1992. Planetree (http://www.planetree.org), founded in 1978, provides education and information about holistic, humanizing models of patient-centered care.
Planning and Development ProcessKey elements of the planning and development process included the following:
- Conducting background research: Administrators planned 12 monthly workforce retreats to discuss their goals and ideals related to creating a patient-centered environment. Administrators also held focus groups and conducted surveys with patients and community residents and visited hospitals across the country to identify key elements of patient-centered care.
- Developing a vision: A consulting firm was hired to assist board members, administrators, and staff in developing a shared vision for patient-centered care.
- Designing the renovation: Architects designed a renovation plan based on hospital site visits (which let them experience the physical plant from the viewpoint of the patient) and suggestions from employees and community residents.
- Getting regulatory approval: Hospital administrators sought and received approval from the state of Connecticut. Approval was granted on the condition that the hospital could renovate the facility at the same cost per square foot as for other facilities being approved at the time.
- Addressing physician resistance: Nurses were generally supportive of the renovation, but physicians resisted certain aspects, such as carpeting the hallways and playing piped-in music overhead. To alleviate these concerns, administrators held informational breakfasts and lunches to tell physicians about their vision for a patient-centered approach to care. Nurses also developed an “Adopt a Doc” program, with each nurse selecting a physician to convince of the value of the renovation.
- Ongoing training: All employees attend a 2-day retreat in which hospital care is simulated from the patient's point of view. During these sessions, staff members are asked for their ideas about service enhancements and design improvements. Refresher training sessions and retreats occur on an ongoing basis.
Resources Used and Skills Needed
- Staffing: The redesign required no new staff; paid receptionists were reassigned from other positions, whereas volunteers serve as patient ambassadors, assisting patients and visitors in navigating the facility.
- Costs: The total cost of the redesign was $31 million.
Funding SourcesGriffin Hospital
Griffin Hospital funded the renovation by borrowing from a quasi-governmental funding agency called the Connecticut Health and Education Facilities, an authority through which tax-exempt bonds are issued. Financing the renovation in this manner allowed the hospital to borrow funds less expensively than through commercial lenders.
Tools and Other ResourcesInformation about Hospital Consumer Assessment of Healthcare Providers and Systems is available at: http://www.hcahpsonline.org.
Resources regarding patient-centered design are available at:
Getting Started with This Innovation
- Develop a shared vision: Hospital leadership, staff, and physicians must develop a consensus around putting the patient first and creating an exceptional patient experience. In particular, hospital leadership must have passion for and be committed to patient-centered care and demonstrate that passion to the entire work force.
- Invest in culture change through training: Changing staff culture is harder than building a facility. Ongoing training is critical to maintaining a focus on the patient experience.
Sustaining This Innovation
- Elicit ongoing feedback: Conduct patient and staff surveys on an ongoing basis and use this feedback to create further improvements in the facility design and patient experience.
Additional Considerations and LessonsApproximately 125 hospitals have been designed according to the Planetree patient-centered model of care.
Service Delivery Innovation Profile
Quality Improvement Goals and Mechanisms:
Original publication: July 20, 2009.
Original publication indicates the date the profile was first posted to the Innovations Exchange.
Last updated: January 03, 2013.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.
Date verified by innovator: July 30, 2010.
Date verified by innovator indicates the most recent date the innovator provided feedback during the annual review process. The innovator is invited to review, update, and verify the profile annually.