The expectation that the hospital built environment may affect the health and satisfaction of patients and their families continues to interest health care providers and hospital administrators as they differentiate and distinguish the quality and health outcomes of their services. In preparation for the design, construction, and postoccupancy evaluation of a new Children’s Convalescent Hospital, focus groups were conducted and measurement instruments were developed to quantify and characterize parent and staff satisfaction with the built environment of an existing pediatric health care facility, a 30-year-old, 59-bed, long-term, skilled nursing facility dedicated to the care of medically fragile children with complex chronic conditions. The measurement instruments were designed in close collaboration with parents, staff, and senior management involved with the existing and planned facility.
The objectives of the study were to develop pediatric measurement instruments that measured the following: (1) parent and staff satisfaction with the built environment of the existing pediatric health care facility, (2) parent satisfaction with the health care services provided to their child, and (3) staff satisfaction with their coworker relationships.
The modules developed for this study followed the Pediatric Quality of Life Inventory (PedsQL) instrument development methodology previously used, which consists of a review of the existing literature, focus groups and individual focus interviews, item generation, cognitive interviewing, pretesting, and subsequent field testing of the new measurement instrument in the target population. A convenience sample of 11 parents and 26 staff members participated in focus groups of semi-structured interviews. The focus groups were used to develop the scale items. Items were generated from a review of the existing literature, the focus groups’ coded qualitative information, and discussions with both health care providers and senior management. The 5-point Likert-scale instrument consisted of several modules: a built environment module (e.g. the structure, aesthetics, and for staff, the work environment); a healthcare satisfaction module (r.g. information, inclusion of family, technical skill, services communication, overall satisfaction); and for staff, a staff satisfaction scale–coworkers module. The mailed surveys resulted in 40 parents completing the parent survey (68% response rate) and 72 staff completing the staff survey (73% response rate), both considered adequate to represent the population surveyed. The 5-point Likert-type scales for the response categories were linearly transformed into a 0 to 100 scale to facilitate interpretation of the results, with higher scores indicating greater satisfaction. Initial scale validity was determined in two ways, and computing the intercorrelations among scales provides initial information on the construct validity of an instrument.
The Pediatric Quality of Life Inventory (TM) scales demonstrated internal consistency reliability (average a = 0.92 parent report, 0.93 staff report) and initial construct validity. As anticipated, parents and staff were not satisfied with the existing facility, providing detailed qualitative and quantitative data input to the design of the planned facility and a baseline for postoccupancy evaluation of the new facility. Consistent with the a priori hypotheses, higher parent satisfaction with the built environment structure and aesthetics was associated with higher parent satisfaction with health care services. Higher staff satisfaction with the built environment structure and aesthetics was associated with higher coworker relationship satisfaction.
The authors identified several potential limitations.
- The mail survey methodology limits generalizability of the findings to other pediatric health care facilities.
- Because the mail survey was anonymous, investigators were unable to test any differences between participants and nonparticipants that may limit representativeness of the findings.
- The sample size precluded the use of factor analysis to empirically derive the subscale structure, which was drawn intsead from the existing literature.
- Given the complexity of their health condition, pediatric patients were not included in the evaluation process.
- Although investigators hypothesized that parents with higher satisfaction with the built environment would also be more satsfied satisfaction with health care, the direction of this relationship cannot be fully validated; it may be that parents who perceive good care are more likely to feel positively about the built environment .
Additionally, the usrvey was developed in the context of a pediatric long-term care facility, where concerns may differ from other types of pediatric facilities.