What a hospital can do to be more comfortable for patients

Although filled to the brim with patients, hospitals were created to support doctors, not us patients. Historically, their organizational structure focused on doctors’ needs and doctors’ requirements. The concept of centering hospital care on patient needs and requirements is a relatively recent development.

How can a hospital switch from being provider-centered to patient-centered? Shifting such a complicated and cumbersome behemoth a full 180 degrees is a huge undertaking.

I believe it can be done. I’ve put much thought into this and feel my 5 steps are do-able and (relatively) easy to implement without interfering with the changes already in evidence organizationally and technologically.

My 5 steps were born of an epiphany. Without us patients there would be no hospitals. Without us patients, there’d be no place for:

  • practical teaching
  • developing best practices
  • solving health puzzles patients often present.

Patients are hospitals’ raison d’être. Here’s how you can make us feel more like the VIPs we are.

1. Be quiet. Quiet. Shhhh. We need a library environment. I don’t want to hear staff shrieking to one another down halls and across nursing stations. You have other options. You can get up and walk over to the person you are addressing or send a text (SMS, IM etc.), a Twitter message or an email. Silence the doors, drawers, cabinets, carts. No more slamming, ramming or bashing. We VIPs have sensitive ears and nerves. I know this quiet can be done. On hospital’s office floors for example, it’s dead quiet.

2. Paint. Hospital colours are depressing. We need something comforting and peaceful, colours that create a warm and welcoming atmosphere. Colour can also help us VIPs find our way in the hallway labyrinths. Mazes befuddle and confuse.

3. Change the linens. Hospital bedding is just awful. Please learn from hotels. They also grapple with high volumes of laundry and infection-control requirements. Yet, their sheets have a thread count of more than 100.

4. Turn curtains into art. The privacy curtains. Honestly! They’re utterly useless. Privacy’s a joke and the colour makes us VIPs feel we’re already dead. Instead, use them as a canvas and showcase Canadian art. Use the same industrial strength material as scrubs.

5. Let us dress with dignity. Even if you can’t do the first 4 steps right away, there’s one I hope you’ll consider changing — the hospital gown! The hospital gown is the single most important thing that demoralizes even the most understanding VIP. They’re embarrassing for all. They de-humanize, demean and really make us VIPs feel like we’re an afterthought — and a tiresome one at that.  Please change the design of the hospital gowns. Grown-ups need grown-up gowns.

Bonus: Change the floors. Changing the floors may be too expensive. But wouldn’t it be great for every foot that ever walked on a hospital floor to have a nicer surface like bamboo or cork, providing they met with infection prevention and other necessary codes.

Perhaps, compared to the issues of patient safety, medication errors and technology inequities, what I propose may seem frivolous: nice to have, rather than need to have. But ask any one of us VIPs. For us, it’s the often the common sense, meeting-human-needs components that gives meaning to patient centred.

Kathy Kastner is Founder and President of Ability for Life.

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  • Boutdrz

    Interesting points, but it isn’t that simple.
    Hotels don’t have to contend with feces, blood, or other bodily fluids. Their linens are not subjected to the same infection control standards that hospitals are: I don’t ever recall the feds crawling around the Sheraton.
    He gowns are functional. Thy can be put on and removed while patients are comatose. Next chance you get, try to change your partner’s clothes while they are asleep and have tubes and lines attached to thier limbs.
    Bamboo and other floor surfaces are porous. This creates a breeding ground for germs, and is much more costly to repair/replace/maintain.
    As for the noise? I agree. Most wards can be quieter.

    • http://mcghealth.org Mparrish

      Georgia Health Sciences Medical Center (formerly MCG Health) in Augusta is a pioneer in PFCC – Patient Family Centered Care. We have hundreds of patient advisors providing direct input into not only the plan of care, but in the design of all our facilities.

  • jsmithfan

    And while they’re at it, maybe they could quiet all of those alarm dings and get rid of the call button and just have a nurse by the bedside 24/7.  Scratch that, the doctor should be there 24/7- I mean if it weren’t for us patients, they wouldn’t even have a job!

    The American public’s disconnect with the costs of healthcare are increasingly astounding.

  • http://www.facebook.com/profile.php?id=1035766343 Dorothy Myers

    I just spent a day and a night in hospital this week because of a kidney stone.  The five recommendations listed above would be nice, but they have been recommended for OVER 30 YEARS, as long as I have worked in the health care industry, and NOTHING to speak of has been done.  A patient can’t sleep in the hospital.  I was so glad when I got out.  It was like prison, bad rough sheets and all.  The night staff were run off their feet with work.  Doors were slammed, people talked loudly, lab tech came to collect blood at 3 a.m. and the housekeepers cleaned the room at 4 a.m. It’s like there’s no night.  It took me a full day to recover from one day and night in there.  Horrible.

  • http://www.facebook.com/audrey.mcgill.looman Audrey M Looman

     Re: Kevin MD….His ideas for the VIP patient are fine but above would be good personal pt. care. As a nurse, I see people discharged from the hospital who need a bath and shampoo. Not services they are getting. When a bedbound pt is refused having her hair washed because no one knows what a shampoo board is or if they have one available is pretty poor basic nursing. Pt care is not what I was taught 30 years ago.
    Audrey Looman LPN, CHPLN   

  • Laura Sessum

    I’ve been a patient and I’ve also been an ICU nurse.  From an ICU perspective there is very little that could be done to decrease the noise or change patient gowns.  Alarms and machines are noisy.  Staff have to communicate with other members of the healthcare team, phone calls have to be made, labs have to be done, procedures performed, etc.  And of course codes occur.  A hospital isn’t a hotel–people are there because they have life-threatening conditions.  Hospitals don’t just require gowns because they think it’s humorous…gowns are needed so that quick access can be made.  Sure I agree with limiting staff from just sitting around chatting, or scheduling procedures or services to a more appropriate time when possible.  But I don’t recall any lab, xray, or procedure being performed in the middle of the night because it was just when someone felt like doing it.  It was always because it was absolutely needed at that time.

    I guess as a patient I was more understanding to these issues because I’ve been on the other side. A hospital exists to save your life.  That’s worth dealing with a few inconveniences.

  • http://www.facebook.com/people/Natalie-A-Sera/743004321 Natalie A. Sera

    Trivial, trivial, trivial. I don’t give one ounce of thought to the colors of the walls or curtains. What I want is quality of care that will keep me alive — I wouldn’t be in a hospital if I weren’t seriously ill. Being diabetic, I want the correct insulin regimen and insulin given at the proper time, so I don’t go low before meals, and sit for hours with blood glucose in the 400′s because the nurse doesn’t think it’s time for insulin. (Have experienced both). I’d like a private room, so my sleep isn’t disturbed by the family visiting my roommate, and by nurses coming in and out to care for her. I’d like a nurse to check on me more than once every 12 hours, so I’m not lying on a pad soaked and dripping in my own urine. (That happened to me, too). Yes, there ARE changes that could be made to improve patient comfort, but let’s deal with the serious and necessary ones.

  • Maryann Long

    How about fixing the food?  Shouldn’t food for people who are ill, recovering from illness, or whatever be fresh, appealing, prepared so as to retain nutrients, and served at reasonable hours at the appropriate temperature?  I mean really, apart from clear liquid diets, why should gelatin desserts exist in hospitals?

  • http://twitter.com/LifeWithJoAnne Here’s a story

    I’m a Registered Nurse, I’m also a burn survivor who has clocked a lot of time as a patient. I admit, there’s a lot hospitals can do to improve the patient experience, but you are not staying in a hotel. You’re staying in a hospital. There ARE hospitals that provide a more “luxurious” patient experience, BUT, you’re going to pay more money for those. I saw nowhere in your blog where you offered to pay additionally to have this experience. So if you’re not willing to do that, you’re going to continue to have the same experience. The government is cutting the payments hospitals receive at least yearly. So if a hospital is going to chose between state of the art equipment and art in the rooms, or fine linens, the choice is relatively easy.

    I work for a non profit, public hospital, and honestly, your blog was hurtful. I often change linens on my patients up to 8 to 10 times a day. Sometimes more. Not the CNA, me, your nurse. So all of those linens should be high quality? If you’re hearing shrieking, yelling, and carts, you’re probably hearing an emergency taking place while someone fights for their life. I like to joke that I do more by 7 AM than the Marines do by 9. It’s not really a joke. By an hour and a half into my shift, I have probably bathed, medicated, charted, and started discharging the 5 people whose lives are in my hands. Or if I don’t have discharges, I’m doing wound care, teaching, and charting, charting, charting.

    My hospital did make big changes several years ago. We added room service style dining, which has improved how my patients eat. This was huge, and involved a lot of hiring by my hospital. Again. Public. Charity. Hospital. I’m so glad my patients can eat when they feel like it, but hospitals don’t get increased reimbursements by increasing how “nice” the hospital stay was. We also work hard to prepare patients for discharge from admission onward, which helps to discharge people when they, and their families are ready. We’ve placed noise cancelling tiles in the ceilings to help contain noise from the nurse’s station. We also changed our art. Every piece of art in my hospital was donated by the employees of the hospital. It saved our hospital a ton of money, and showcases the abilities of our employees.

    Please remember, this is our JOB. You don’t want to hear a nurse laugh at the nurse’s station? You don’t laugh at work? Are you the same patient who is going to complain that your nurse wasn’t friendly enough? We understand that these are some of the hardest days of your life, but I also expect that you and your fellow patients do NOT create a hostile work environment for myself by causing me physical or emotional harm. As a nurse, I’ve been punched, I’ve hurt myself catching a fainting patient who ignored my request to use his call light. I’ll have pain the rest of my life. This is the job. I’m not going to stop laughing when a brief moment of joy comes by, and if I need help because someone might be dying, I’m going to hit alarms and yell until I get enough people in the room.

    A good hospital stay? At my hospital? Getting your surgery, getting in and out without added infection. Always being on dry, clean, linen, even if it isn’t the best quality. Not getting a pressure sore because your nurse had time to make sure you were changing your position when you were too groggy or ill to do so. Getting discharged early in the day so you have plenty of time to get home and get settled, and not discharge during rush hour. Frequent purposeful rounding to make sure you don’t have to hit the call light to go to the bathroom, get pain meds, getting your water refilled.

    Forget what you’ve heard about bringing candy to your bedside. I don’t eat anything that comes out of a patient room, and I round on my patients hourly regardless of how friendly or unfriendly they are. I push myself to check on unpleasant patients MORE frequently because they tend to be the people who crash, which requires a lot of shrieking and running and clamor. Evidence based practice is encouraging frequent rounding so patients KNOW a healthcare provider will be in each hour to check on them.

    I will give my list of suggestions to people who go to the hospital for an elective procedure.

    1) If you have to pay for a private room, try to save and do it. Bring your own pillow, and don’t let anyone take the pillow case.

    2)Ask your nurse or CNA to use bacteria killing wipes on your bath basin before giving you a bath.

    3)If you have someone who can stay with you and encourage you, have them there. (make sure your hospital allows this ahead of time)

    4)DO limit the number of visitors you’re going to get. If you’re not walking, not doing your breathing exercises, or blocking the nurse from assessing you because you have 5+ people in the room who refuse to leave, your stay WILL be extended. You WILL be worn out from attempting to play hostess to a parade of people. They can come see you AT HOME.

    5) Don’t hand out the nurse’s station phone number to everyone you know. Don’t hand out your privacy code to everyone you know. Select one or two people and have them disseminate information among your family and friends. I’ve gotten more than 20 family phone calls in a 12 hour shift. If each phone call is only 5 minutes long, well, you do the math.

    6) My last request. If you see your doctor or nurse, coat on, bag in hand, don’t ask that person to go get you items. Use your call light. They are leaving because the next shift is there.  When we put on our coats, when we walk out of the hospital, that’s when we pull ourselves out of the hospital headspace and try to shake off the day as we head home to make dinner, do laundry, make beds, and see our families. Please don’t stop us. Let us go. Most of us have less than twelve hours to get home, rest, and come back to caring for you and your loved ones.