But hospital leaders differ sharply in how they define the patient experience and how they prioritize their improvement initiatives, leading to a clash within the industry. Should such efforts focus on aesthetics or on clinical processes and communication? Or, should it marry the two? And how should the patient experience balance clinical care—giving a patient the care they need, even if it's unpleasant—with amenities, such as better parking or luxury toiletries?
Dr. Ashish Jha, a professor of health policy at the Harvard School of Public Health, fears that hospitals are too focused on superficial aspects of patient experience. Hospitals are "wasting a lot of resources doing things that are not particularly important," such as artwork and parking, which they think matter for patient experience, Jha said. Yet, "what we know is that patient experience scores are not going up," he added.
The lack of a widely agreed-on definition of patient experience is "one of the most frustrating topics in the entire industry," Merlino said. "I think that hurts our ability to improve."
Many hospitals and health systems treat the patient experience as a matter of improving the customer service experience. Merlino considers that flatly wrong. "The service piece is a component of it, but it's not the primary piece," he said. Instead, he prefers Press Ganey's definition of a good patient experience as safe, high-quality healthcare delivered in a compassionate, empathetic environment.
The Beryl Institute, which focuses on improving the patient experience, defines it as the "sum of all interactions, shaped by an organization's culture, that influence patient perceptions across the continuum of care."
The myriad ways healthcare organizations focus their efforts on the patient experience reflect the range of definitions. Some are renovating and redesigning entire buildings. Others focus on improving communication. And some work on both.
The concept of consumer experience applies differently in healthcare than in other industries. "At the end of the day, it is about having better health outcomes and well-being for people," said Joan Kelly, chief patient experience officer for NYU Langone Health System in New York City. "The reality is, people don't choose this. They only want to use it when something is wrong. It's very different from a purchasing mindset."
The goal in designing Massachusetts General's Lunder Building, which opened in 2011, was to streamline workflow and care delivery for providers while being mindful of the needs of patients and their families, said Joan Saba, a partner at architecture firm NBBJ and the lead architect of the building. Its major design elements reflect that, with use of noise-reducing materials, adjustable lighting, and rooms and doors angled to give patients greater privacy.
Instead of forming a ring of patient rooms around a cluster of workstations, or loading corridors on both sides with patient rooms, Lunder's floor plan resembles two letter Cs facing each other but shifted so their termini don't align, Saba demonstrated with her hands.
Patient rooms are located along the Cs, with service and support rooms stationed in the curve of each, mitigating the issue of staff congregating in a single noisy nursing station. A central diagonal spine shortens travel distances around the floor.
For improving the patient experience, "the private rooms are key," said Susan Cronin-Jenkins, co-director of real estate and facilities at Massachusetts General. "If I have two patients in a room, every time I take care of one, the other patient usually asks for something. So that's more time away from doing what I need to do. It adds staff time and disruption to the patients."
Additionally, a 2016 study in the Journal of Critical Care found that the cost of building private rooms can be offset by reducing hospital-acquired infections. The study, however, only focused on the intensive-care unit.
The feel of Lunder contrasts sharply with that of Ellison in other ways. At Ellison, hallways are cluttered with mobile computer workstations. Nurse desks and supply rooms are located directly across from patient rooms.
"All this stuff makes noise," said Cronin-Jenkins, swiping her ID badge to demonstrate the clicks and pings that accompany opening the supply closet door. "If you're across the hall and you're trying to sleep, it's very disruptive."
The noise level is 10 to 15 decibels lower in Lunder than in Ellison. Higher noise levels in hospital rooms have been linked to disrupted or poor-quality sleep, which can delay a patient's recovery.
The differences between Lunder and other buildings are reflected in patient-satisfaction scores. Patients staying in Lunder consistently respond more positively on the Hospital Consumer Assessment of Healthcare Providers and Systems, or HCAHPS, than do patients who received care in other Massachusetts General buildings.
"By looking at the scores, you can guess where it is. (Lunder) is a better place," said David Hanitchak, vice president for real estate and facilities at Massachusetts General. Employees prefer Lunder too, he added.