Quality of Healthcare: A Review of the Impact of the Hospital Physical Environment on Improving Quality of Care

Abstract

Quality of healthcareis not merely the technical care and professional performance: it is an integral concept measured by summing up different components. According to Donabedian’s classification, quality can be assessed using three main components: structure, process, and outcomes. Structure is related to the physical environment, including the facility’s design, technology, and equipment, besides the healthcare providers’ credentials and qualifications. Process is the clinical care that considers patient safety, including effective infection control and mitigation of medical errors. Outcomes are assessed by the extent of improved patient health status, combined with patient satisfaction. This chapter generates a new conceptual model using previous evidence of hospital design as an input for quality of care.Objectives(a) to review the main dimensions, metrics, and criteria to assess quality of care at hospitals; (b) to provide evidence of the impact of the physical environment (“hospital design”) on the process, including staff and patient safety; (c) to provide evidence of the impact of the physical environment on the outcomes, including patient health status and patient satisfaction.MethodologyThis paper uses a literature review to introduce a new conceptual model of correlating the physical environment as a structure, impacting the process component including safety aspects of patients and staff, along with assessing the outcome component represented by clinical outcomes and patient satisfaction. Evidence was synthesized, summed up, and interpreted to generate the proposed model. Hospital design includes privacy, noise reduction, lighting, increased square footage of patient rooms, safer design to mitigate falls, well-decorated rooms, well-chosen colors, and visitor-friendly amenities.Key FindingsGood hospital design, such as lighting and following a standardized design of patient rooms, adequate ventilation, better ergonomic design, good maintenance, and less noise, enhances staff and patient safety. This goal will eventually reduce medical errors and improve the efficiency and effectiveness of healthcare delivery. Considering the clinical outcome component of quality, the review supports that rooms with views have a noticeable influence on patient recovery, especially for postsurgical cases, with fewer doses of analgesics and shorter postoperative hospital stays. Colors at healthcare facilities have also an effect on patients and staff. Evidence was generated from different sources that selecting colors should go beyond the aesthetic design and should be more patient- and staff centered for better healing and performance. In regard to patient satisfaction as an outcome component of quality of care, patient satisfaction was correlated to hospital design reflected by privacy, noise reduction, WiFi, lighting, increased square footage of patient rooms, safer design to mitigate falls, well-decorated rooms, and visitor-friendly amenities. Nevertheless, further studies showed only a small effect of hospital re-design on patient satisfaction. Poor patient satisfaction is not related to aging buildings, but rather is more related to the healthcare providers, patient safety, patient-centered design, work flow, and efficiency of healthcare.ConclusionQuality of care can be measured using different metrics: structure, process, and outcomes. Structure or physical environment is essential in impacting the healthcare delivery process and healthcare outcomes. However, it is not only the sophisticated or newly remodeled design that increases healthcare efficiency, effectiveness, and patient satisfaction. The design that meets patient and staff needs will strongly support staff performance and provide a better therapeutic and healing environment that eventually concludes in better quality of care.