Healthcare and the Patient Experience: Harmonizing Care and Environment

Abstract

Beginning in the 1970s, sensitivity to the patient's perspective on the healthcare experience and the elements underlying patientcentric approaches to care began to emerge as a radical concept, challenging an entrenched status quo. Three decades later, this previously disruptive technology has moved firmly into the mainstream; the most notable progress is found in the built environment. Early pioneers included Planetree (www.planetree.org), established by a patient in 1978 (Martin et al., 1998), and The Center for Health Design (www.healthdesign. org), the 1980s brainchild of progressive design professionals. Their vision and commitment helped move the field toward an appreciation of both the experience and evidence underlying the need to transform environments from institutional to healing places to meet patient needs better.Simply put, the healthcare experience should be organized, first and foremost, around the needs of patients (Agency for Healthcare Research and Quality, 2006). To understand these needs, Planetree has always turned to the source. Thousands of focus groups, interviews, and surveys with patients, long-term care residents, families, and professional caregivers across the country and around the globe have reinforced the need for a more personalized, humane, and demystified patient experience (Frampton & Charmel, 2008b; Frampton et al., 2008).Over the last several years, I have had the opportunity to participate in a growing number of international forums focused on the patient experience in healthcare settings. It has been fascinating to observe both the unique cultural elements that influence our views of the care received in diverse settings and the similarities in the human experience of illness. I often ask people whether they have ever been a patient in a hospital setting or had a loved one who needed treatment for an illness or injury. Have you? Think for a moment about that time and that experience and the memories that stand out in your mind. What do they center on? What do you see in your mind's eye?The answers I often hear, regardless of continent, country, or region, focus on two primary areas: (1) human interactions-the communication and coordination or lack thereof between patients and their families, and the nurses, doctors, therapists, and case managers responsible for their care (Frampton, 2009; Spatz & Frampton, 2009); and (2) place-the alien environment, increasingly complex technologies, and loss of control that too often come from being in such an environment. Technology continues to revolutionize the practice and delivery of medicine, from smart phone apps to electronic health records, remote specialty care to robotic surgery. At the same time, patients are experiencing increasing dissonance between their appreciation for these advances and unease with the deterioration of their relationship with care providers that often accompanies these advances.Such challenges are both supported and complicated by efforts toward national healthcare reform and their impact on finances, both current and anticipated. Efforts to empower and activate patients, improve relationships with physicians, and deliver personalized and effective care coordination have never been more relevant. National policies shaping healthcare delivery and reimbursement include provisions that promote patient-centered quality (Centers for Medicare & Medicaid Services, 2006; Cleary et al., 1991). The Health and Human Services National Healthcare Quality Strategy has identified a triple aim: to reduce costs, improve experiences/access, and improve population health. The National Quality Forum has proposed a set of related priorities to implement these goals, including the engagement of patients and families in managing their health and making decisions about their care. Collectively, these provisions hold providers accountable for improving outcomes, enhancing care coordination, and reducing avoidable readmissions. …