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The Third Party Role Of The Environment
By Susan E. Mazer, B.A., M.A.

What is at stake in the hospital environment? From the extensive use of optional pain medication to the experience of extreme anxiety unrelated to the diagnosis; concern for privacy and confidentiality; staff stress; medical errors; and risk of miscommunication and misunderstanding between family members and caregivers, the environment plays a continuous, if not insidious, third-party role.

For example, patient satisfaction surveys have shown that noise remains an unsolved dilemma and clutter threatens the safety and cleanliness of hospital corridors. Overhearing the suffering or trauma of others becomes the context in which patients and families undergo their own experience. The challenges in delivering quality healthcare are impacted by the quality of the place in which services are provided which, in turn, become a determinant in patient outcomes and staff satisfaction.

The sound environment is the least controllable and most pervasive, if not invasive factor in how patients and families respond to healthcare crisis. It is also the major determinant in how we interpret communications -- how critical a miscommunication may be when information is heard and transmitted. Whether trying to control breakthrough pain for a cancer patient or calm an agitated patient, the sounds around the patient play a role in how effective caregivers are.

Noise abatement, a myth at best, has been healthcare policy, but without success. The intentional design of this first major portion of the invisible space well begins the process of redesigning the culture of an organization, as it contains the substance of how relationships are experienced. Factors such as use of restraints, requested pain medication, nursing assistant calls, staff stress, and so many other critical healthcare indicators are affected by the auditory environment alone. Therefore, the risk of leaving it to chance or assuming it to be a necessary side-effect of institutional care is missing an opportunity to dramatically improve the quality of care.

If you think any or all of this to be insignificant or trivial, consider the cost of medical errors, sick leave, work related injuries, staff grievances, and malpractice suits. It would hardly be a stretch to consider the current clinical environment a risk factor in all cases, with each incident levying a major expense in both money and reputation. Thus, a healing environment by its very nature can have real bottom-line benefits.

For example, in the current climate of overworked and stressed out staff, the environment is a critical factor in recruiting and retaining good people. The business world has long known this and used it to its advantage. It is not unreasonable to expect that over time, an investment in a healing environment can far outweigh the average costs of $30,000-50,000 to replace and retrain a single nurse.

What is the ultimate goal of creating a healing environment? While the hospital is organized in pods of specialization, one patient potentially may experience and move through every department. Whether as patient, visitor, family member, or staff, the hospital becomes a maze through which people can monitor their own health status and be aware of their prognosis. The experience of care is almost as important as the treatment protocol.

Therefore, it is important that the culture of the hospital and the space in which healthcare services are delivered be consistent in quality, intention, personal caring, and standard of concern. While the clinical environment has necessarily become biased to medical technology and scientific protocol, the patient experience is more comprehensive, including an acute sensitivity to perception and implied prognosis drawn from non-clinical factors.

From the front lobby to the admitting area, cafeteria, ICU waiting area, radiology, and PACU...needs for human caring and evidence of concern cross all boundaries. The environment becomes the proxy, if not the actual caregiver, and therefore represents the level of professionalism of each individual and of the organization as a whole. A healing environment births a healing culture. We often ask the rhetorical, if not literal, question: If the environment is not itself healing, what is it doing?

Susan E. Mazer is president of HealingHealthCare Systems (www.healinghealth.com), a Reno, NV, company whose mission is to develop media products and educational programs to assist healthcare organizations in providing clinical environments that are directly supportive of recovery. She can be reached at healinghealth@aol.com.