5 ways to improve the healing environment of hospitals

The very basic definition of a hospital is a place of healing and recovery. Health care is in a tumultuous state of flux at the moment, with the universal drive for quality improvement and the need to reign in costs. These issues, along with the desire to enhance our patients’ satisfaction and overall health care experience, were barely even talked about a decade ago. Now, they are all the buzz around every hospital administration table across the country. The problem that we have however is that the whole topic of making hospitals better places to be has become a bit of a bumper sticker — with lots of convoluted and complex ideas being put forward, that often border on being nothing more than expensive gimmicks.

At the same time, most hospitals are missing a lot of the common sense measures that really make hospitals places where people can actually comfortably get better. In terms of going back to these fundamental basics, here are 5 of the most straightforward ways to achieve this:

1. Make hospitals as quiet as possible. This should go without saying, but is so commonly overlooked. If patients cannot get a decent rest, especially at night, how can they possibly feel better? It’s often the first complaint I hear in the morning when I enter a patients’ room — either due to a noisy neighbor or activity outside the room. While it may be impossible to eliminate all nocturnal noise in a busy environment, we can do so much better. I call this the “rough and tumble” atmosphere in most hospitals.

2. Single-bed rooms. This also links to the noise problem, but is just as much an issue with hygiene and infection control. The trend over the last few decades is for fewer and fewer patients to be grouped together in rooms. Although the United States is ahead of the curve compared to most other countries, there’s little doubt that in the not too distant future, sharing a room with another patient will be viewed as just as unacceptable as finding out you are sharing a hotel room with a random stranger when you check-in.

3. Staffing ratios. We need to ensure that all frontline health care staff, especially doctors and nurses, have adequate time with patients and their families. The more rushed and frantic the atmosphere is, the less a hospital becomes a place of healing and instead more like a factory floor. So many of our problems in healthcare, whether they are to do with improving patient safety or enhancing patient satisfaction, would be solved with the right numbers of frontline clinical staff. Think it’s expensive to have more doctors and nurses? Imagine the cost benefits in terms of reduced medical errors and the organization gaining a better reputation with patients and their families.

4. Hospital design. As new hospitals are being built, and those that are already here add to their campuses with new building wings, let’s put maximum thought into the right internal (and for that matter external) design for a hospital. Utilize an open plan design as much as possible, minimize the old-fashioned style long corridors, and pay attention to other important design aspects such as the flooring. You know when you’re in a nice and classy restaurant, hotel or airport, and you feel good about it. The same rules apply to hospitals.

5. Ambulate patients and take them outside the room. One clinical aspect of medical care that we don’t address enough is the need to ambulate patients as much as possible during their recovery. It’s the worst thing for patients to be stuck in bed for most of the day, barely sitting up. Not only does this increase the risk for deep vein thrombosis (a blood clot in the leg), but also leads to a higher risk of infection and generally prolonged recovery. The inpatient medicine world can actually learn a lot from orthopedics in this respect, because orthopedic surgical floors are among the best at ambulating their patients post-operatively. All hospital units need to be stricter about protocols for making patients get up out bed, ambulating them whenever they can, and even taking them around the hospital — in a wheelchair if necessary. This can increase patients’ motivation and give them a welcome change of scene. The most positive feedback I’ve heard has been in hospitals with beautiful external areas, where patients can be taken outside on nice days, often to garden-like areas.

These are just five ways that we can make hospitals into the “healing temples” that they are supposed to be. We all know from our experiences of even having a simple cold or viral infection, that nothing helps us more than a comfortable and quiet environment. Until we get this most basic requirement right of what a hospital should be like, it’s really futile to be discussing a lot of other things. The world of health care needs to remember that aside from good medicine, a nice environment can be just as sweet a pill.

Suneel Dhand is an internal medicine physician and author of Thomas Jefferson: Lessons from a Secret Buddha and High Percentage Wellness Steps: Natural, Proven, Everyday Steps to Improve Your Health & Well-being.  He blogs at his self-titled site, Suneel Dhand.

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  • Steven Reznick

    Excellent suggestions with ratio of patients to nurses critical. The inpatients are older and sicker than in years past. Nursing is the glue that holds inpatient care together. Once you get above 4 patients to one on non critical care floors the time available per patient dwindles .
    During a recent hospitalization of a colleague in her midsixties she was critical of hospital services and even referred back to a reality TV show about quality travel and hotel service and how many of the principles of cleaning hotel rooms ( different colored clothes and devices for different areas of the room) could be applied to hospital rooms to cut down infection and improve cleanliness
    Communication person to person is the key today because the introduction of computers and high tech equipment is fraught with learning curve errors. Unless doctors talk to patients, staff and each other the hospitals will continue to be error prone places.

    • Margaret Fleming

      Thank you Steven Reznick. Computer learning curve errors accounted for some of my most scary and painful moments in acute rehab after lumbar fusion. (Although the fact that nobody knew the foot rest on my wheelchair could be raised – that’s really not high-tech equipment. . .)

  • RenegadeRN

    I agree with ALL your suggestions. Common sense and basic humanity have pretty much been replaced with understaffing, redundant charting, and the needs/ requirements of administration- instead of the patients!

    Additionally, what about the plain old filth? The large NICU I used to work in was a dust bunny hell! It seemed all that ever got cleaned was the floor- run a finger over cabinets or inside them and it was appalling. Nurses no longer have the time to remedy such issues-nor should be required to.

    I used to occasionally indulge in a little fantasy- If if was able to start my own hospital, how would I make it the ideal place to get wonderful competent care and BETTER than merely sufficient staffing- with people who were paid well enough to be happy to be there? I told you this was a fantasy… It was fun to really plan out.

    Healing is truly more than being infection free.

  • rational2012

    The cost of a hopital stay is entirely out of proportion to the value of it. It is utter insanity and in fact, criminal.