Competition in the health service community has never been more fierce than it is today. Whether trying to recruit top-notch medical staff or be recognized as the health care institution of choice in your marketplace, hospital executives are required to be increasingly creative in their efforts to gain that competitive edge. Some hospital pioneers are discovering that an improved hospital environment—from hospital ward configuration to its general atmosphere and ambience—can be a significant distinction among medical professionals and consumers.

Certainly, the health care industry is facing numerous challenges, ranging from insurance issues to a growing public concern over hospital safety. Changing the market perception is a constant struggle many hospital executives are facing. Stories appear in public periodicals raising the health care credibility stakes, offering examples of slipping standards of care, staff shortages and overstress, and overall low patient satisfaction. Rethinking the hospital environment can go a long way in starting to address these issues. In fact, studies suggest the hospital environment itself drastically affects a patient’s attitude and, subsequently, the length of stay, recovery period, and clinical outcome.

In the war between consumer expectations and efficient operations, the force of consumer choice can’t be ignored. Due to patients’ perceptions of depth and credibility, small and rural hospitals are losing many of the less complex diagnostic and treatment services to tertiary centers. Meanwhile, in metropolitan areas, where hospitals compete for the same market share and universal insurance coverage nominalizes care choices, consumer choice governs the dynamic and patients vote with their feet.

Most hospitals built within the last half of the 20th century approached inpatient treatment in a walled ward type of arrangement, compartmentalizing patients in clear geometric order. The driver for this model was space efficiency to reduce initial construction costs—but not necessarily to increase patient satisfaction or operational efficiency. Recently, other inpatient unit planning models have been developed, successfully merging top-flight clinical practice with the heightened expectations of fine hotels. These models, however, while interesting and instructive, aren’t the norm for most hospitals, which aren’t in a position to completely reinvent their inpatient care infrastructure nor have the luxury of sufficient capital to risk a new idea.

In fact, the opposite case is the norm. Most inpatient units are arranged in such a manner that a reduced staff can’t effectively administer care at all levels to their patients. While a fortunate few institutions are in the process of reinventing their care delivery and environmental models, most hospitals are too financially constrained to embrace this trend.

While hospital executives continuously grapple with these issues, they continue to face the question, “How can a hospital with limited resources begin to respond to this demand?”

There’s hope for managing this challenge, and it begins with planning and design. There are a variety of cost-efficient, effective approaches that can be taken to begin to transform a 20th century hospital into a patient care facility for the new millennium.

• Reconfigure unused inpatient rooms to create new public spaces. These are very different than public waiting areas of the past with access to natural light, Internet, and private decompression areas.

• Decompress double-occupancy rooms into private rooms.

• Provide rooms for an attending family member to spend the night, or allow family caregivers an opportunity to spend the night in the patient’s room to learn the care required upon discharge.

• Decentralize storage, utility, and equipment spaces into the space currently occupied by unused patient rooms. Since these rooms may require special fire ratings and are probably already used for some storage, address the issue and make them code compliant.

• Decentralize nurse stations to bring nurses closer to their patients.

• Focus on acoustical control of noise from staff, both for confidentiality and to reduce the distracting noise that interferes with a patient’s recuperation.

• Introduce lively forms, colors, and textures into the finishes to awaken the general stark, neutral, and monotonous palette in most inpatient environments. However, this shouldn’t be considered a “decorating exercise,” and care must be taken to engage professionals who understand color, texture theory, and application along with their effects on curative outcomes.

It’s no secret that the built environment affects people’s enjoyment of a space. Just the way a space has been built and decorated can cause people to feel good or bad. The positive sensory perceptions can bring peacefulness, while others have to do with creating a feeling of confidence in a space—confidence that this is a safe place to be.

What are the risks of not progressing, of not being ahead of the curve? The court of public opinion generally rules in these matters, and various published claims present a very compelling case to a wary public whose clinical demands and consumeristic expectations are growing. IBI