Patient Perceptions of the Environment of Care in Which Their Healthcare is Delivered.

Abstract

To measure patients' perceptions of the environment of care (EOC), with a focus on the physical environment, in which healthcare is delivered. The EOC may impact patient experiences, care perceptions, and health outcomes. EOC may be improved through redesign of existing physical structures or spaces or by adding nurturing amenities. Demographics, health status, hospital use, and data on the environment (physical, comfort, orientation, and privacy) were collected via a mailed cross-sectional survey sent to patients seen at four hospital Centers of Innovation (COIs; that implemented many modifications to the healthcare environment to address physical, comfort, orientation, and privacy factors) and four matched controls, supplemented with checklist and VA administrative data. A modified Perceived Hospital Environment Quality Indicators instrument was used to measure patients' EOC perceptions. Respondents (3,321/5,117; 65% response) rated, [mean (SD)], exterior space highest, 3.09 (0.73), followed by interior space, 2.96 (0.74), and privacy, 2.44 (1.01). COIs had significantly higher ratings than controls on interior space (2.99 vs. 2.96, p = .02) and privacy (2.48 vs. 2.38, p = .005) but no differences for exterior space. Subscales with significantly higher ratings in COIs (vs. controls) in interior space were "spatial-physical comfort" and "orientation," for example, clean, good signage, spacious rooms, and for privacy included "not too crowded" and "able to talk without being overheard." Checklist findings confirmed the presence of EOC innovations rated highly by patients. Patients identified cleanliness, good signs/information points, adequate seating, nonovercrowding, and privacy for conversations as important. Hospital design modifications, with particular attention to the physical environment, can improve patient EOC perceptions.