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I'm not sure what I think of the current hospital star ratings on the U.S. government's Hospital Compare website.

Because they're based on HCAHPS scores -- 32 multiple choice questions that patients answer after they've left the hospital. They may or may not remember exactly what happened during their stay.  They may only remember the bad things. Or the good things.

Orchestrating memorable events is what becomes the patient experience. And the design of the physical environment is definitely part of the patient experience.

Yet, only two HCAHPS questions directly address the physical environment:

  1. During this hospital stay, how often were your room and bathroom kept clean?
  2. During this hospital stay, how often was the area around your room quiet at night?

I could also argue that the design of the physical environment affects communication between staff and patients/families and possibly even pain management. But it's a little more of a stretch.

Does it matter to healthcare executives?  86% of those surveyed by Health Facilities Management/American College of Healthcare Engineers recently said patient satisfaction is “very important” in driving design changes. And 54% who responded to Healthcare Design's A/E/C survey reported that improved patient satisfaction/HCAHPS scores was a common client goal.

Hospital Star Ratings System Too Harsh?

There has been criticism of the hospital star rating system because it is too harsh. Only 251 received a five-star rating in April when CMS rolled out the first part of a broader ratings initiative.

The release of an overall quality hospital star ratings system has been delayed because of complaints that the data didn’t take into account hospitals that treat patients with low socioeconomic status or multiple complex chronic conditions. That seems reasonable, but the reality is that no measurement system is perfect.

And like I said in the beginning, relying on patients to remember what they experienced is tricky. But here's an interesting fact:  Many patients are also sharing their experiences in real time on social media.

According to researchers at Boston Children's Hospital, who analyzed 400,000 tweets, 9% of them were about food, money, pain, room condition, wait time, communication with staff, discharge, medication instructions, side effects, or general satisfaction. Not all the comments were negative, either.

So, between the data and chatter, patients should be able to make informed decisions about where they get their healthcare. Hospitals with poor star ratings better be ready to up their game -- looking at everything they can do to improve the patient experience, including the design of the physical environment.

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Michael Walsh

8 years ago

Interesting and relevant I think ... from both business and social perspectives. Business because shining a light on the issue presents and opportunity for hospitals to 'up their game' and from a social perspective in that WE the public can hold hospitals to account.

Marjorie Serrano

8 years ago

As a healthcare and design professional I have always been skeptical of both the value and validity of HCAHPS data. Like you Sara, I have also been disappointed that more questions related to environment are not included.
Nevertheless, I looked forward to sharing my responses after a brief hospitalization at a large medical center 3 years ago. I was surprised that I did not receive the survey until 2 months later. Still, I remembered vividly my experiences. I answered all questions carefully and wrote in details filling most of the blank space on the forms. Included were exceptionally positive and negative contacts with multiple departments. I added some simple suggestions for improvements and names of staff who provided stellar care. I asked to be contacted but never received any response. I imagine that my survey went into a machine to be tallied and was never seen by a human. Very disappointing!

7 Things in the News That Could Affect Healthcare Design - Sara Marberry Sara Marberry

8 years ago

[…] Hospital Star Ratings Don’t Tell The Whole Story of the Patient Experience […]

Dale Anderson

8 years ago

Sara: I'm willing to bet the survey of patients, when it is conducted, already has the questions leaning in such a way that the responses avoid the actual areas of contention. As you note, patients don't typically remember much of their stay when they are ready to leave. To participate in a survey is likely a burden to them anyway and they are probably in a hurry to get it completed. By answering the posed questions pre-supplied, the surveys may totally avoid the problem issues or real feelings of the patient experience.
Thanks for your article.

Sara Marberry_013-Retouched-New copy

What's my story? I'm a healthcare and senior living design knowledge expert who writes and speaks frequently about trends and issues affecting these two industries. I'm also a strategic marketing consultant and content creator, working with companies and organizations who want to improve the quality of healthcare and senior living through the design of the physical environment. You can reach me at .

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