Improving Hospital and ER Services? Hospitality Industry Offers Roadmap

Dr. Elinor Garely has researched, written, and taught the multiple aspects and dynamics of the hotel, travel, and tourism industry for many years as a reporter /editor with eTurboNews.com and WorldTourismNetwork (wtn.travel) and a Professor at the City University of New York, BMCC campus.

She has gotten sick in Mexico, parts of Africa, Italy, and the Caribbean - and survived!

Having recently experienced ER departments and in-patient medical services in Manhattan, she was not sure if she would live to tell the tales of her medical experiences in two New York hospitals.

Drawing on her knowledge and experience, she offers her suggestions on how hospitals can improve patient services and outcomes by using hotels as templates.

• Hospitals Look to Hotels for Improving Services

Hospital administrators, architects, interior designers, and IT executives should laser focus on the hospitality industry if they have an interest in improving the availability and deliverability of services to patients and increasing medical and support staff morale.

Not Easy Peasy

Complexity is the hallmark of a hospital where challenges include the navigation of large multi-floored interconnected buildings combined with communication and logistics of managing staff, visitors, and equipment while meeting the goals and objectives of helping sick patients become healthy.

Hospitals hold a huge amount of high value inventory ranging from fixed and mobile equipment to medicines of every shape and color plus healthcare providers and support staff. The demand for the correct assets to be at the right place at the right time can be daunting. Research suggests that there is a huge amount of time wasted by staff looking for equipment (from 10-30 percent of their work time).

There is also time lost looking for patient supplies and medical equipment that is moved from patient-to-patient and building-to-building. In addition, healthcare personnel are overburdened with patient and family demands that could be addressed by other resources (i.e., technology, support personnel). All these “time wasters” add stress to doctors and supporting hospital staff who, in reality, have as their primary purpose - to look after patients and not infrastructure.

Patient Journey

The first step toward improving the ER/hospital experience is to develop and analyze the critical path taken by the patient from the time he/she enters the facility to the time they search for the exit.

Hospitality Focus

To determine the healthcare services in need of improvement the patient experience begins with a walk through the “customer” journey, looking at the points of interactions and series of exchanges across time-periods with service providers. The outcome of the interactions can be analyzed and used to design medicalized wellness and hospital service features desired by both out-patients seeking medical attention through Urgent Care and/or hospital ER rooms and/or patients requiring in-hospital attention.

The touch point steps can be improved and expedited to enhance and improve the ER/hospital experience through technology, and trained personnel, freeing up healthcare professionals and staff to focus on the patient and not on administrative details. In addition to the efficiency of technology and enhanced employee training, robots and multilingual/trained personnel can address patients in their preferred language or, for hearing or sight impaired individuals, communicate with them based on their personal needs and preferences while being culturally sensitive to patients regardless of age, ethnicity, financial status, etc.

Having recently spent too much time at ER departments and in-hospital beds, it is obvious (to me) that the touch points begin at check-in where robotics and trained personnel could efficiently query the patient as to name, age, residence, pain level, and quickly and efficiently obtain and/or retrieve from existing databases, other medically routine information. The one robot and skilled staffer could access the facilities database and validate and/or add information and print out an ID bracelet and present it to the patient, replacing at least three staff members. Currently, bureaucrat focused employees’ staff assigned to intake procedures, make some of these individuals more suitable for a prison hospital experience than a public/private hospital environment.

The next in-take step has a medical focus and this step can also be effectively administered by a robot. Some healthcare facilities have introduced RFID solutions (i.e., RFID tags, readers, software and networks) and there are opportunities to expand the use of this technology and range from passive, non-powered small sticker type labels attached to individuals’ items to active powered tags. RFID technology does not need a line of sight to record a code and automatically records movements of items and reports anomalies.

Not Once but Multiple Times

Because of my post-Covid vaccine response, an overaggressive GI physician and the consumption of pre-MRE chemicals (that were not explained or described), I developed a cyclone IBS attack, lasting many months leading to serious damage to my health. The blow to my well-being was hindered (rather than helped) as a result of ill-informed, over-worked and under-staffed healthcare professionals and administrators at two of New York City’s major hospital complexes (namely Mount Sinai and NYU Langone).

Improvement Cannot Wait

If hospitals administrators are looking to build loyalty among patients along with recommendations from these “consumers,” it is in their best interest to consider a long list of improvements that will impact positively on people who, because of doctor referrals or the absence of other medial choices, end up at an ER complex – urgently in need of medical attention. Loyalty is an important concept when considering availability of health services. Patient perception is frequently determined by the level of satisfaction experienced and is likely to determine continued selection of a particular provider. Loyal customers are important to health services as attracting new customers tends to be more expensive than keeping existing ones because of the marketing costs associated with doing business are reduced.

Hospitality Industry Offers Insight

Loyalty in ER and hospital settings increases with reliable services and professional employees. As patient demands move beyond clinical care and they assess personal satisfaction as part of an outcome analysis, hospitals are looking to elements of hospitality to increase patient satisfaction, loyalty and overall patient experiences. Hospitals with a hospitality-centric philosophy – offering hospitality to patients on par with hospitality experiences offered to hotel guests, creates a higher distinction of service excellence and is achieved by integrating hospitality features.

In the 1950s, Alfred P. Sloan stated, “the hospital in certain respects is a very specialized hotel.” Sloan believed that executives could learn a great deal from the management approaches used in the hospitality industry. Over time, innovations and practices from hotels have been incorporated into the healthcare workplace. This is not surprising given that the two industries share the goal of achieving high customer satisfaction. Services of hotels and hospitals share a number of elements – primarily people, processes and place-related items – to effect positive outcomes.

Hospitals have used hotel-type imagery and physical design to appeal to and reassure prospective patients. However, starting in the 1930s, as healthcare providers became increasingly focused on the technological aspects of medicine, hospitals shifted to an institutional appearance and mode of operation. Many hospitals were constructed following minimum standards developed under the 1946 Hill-Burton Act, which tended to reflect an institutional rather than a hospitality orientation.

Currently, increasing healthcare expenditures have led hospital administrators to implement cost-containment measures because of competition among providers which has increased to a level never before experienced. To address this issue, providers are reviewing design and other hospitality elements as a way to gain competitive advantage. Some hospitals are unable to afford to be primarily or exclusively medical-focused and therefore the emphasis in hospital design is shifting once again to hospitality-type amenities that are patient and family centered enabling hospitals to compete for patients and donor dollars.

Technology

Hospital administrators are finally reaching the conclusion that the introduction of new technology will bring the system one step closer to solving the multiple complex challenges associated with the healthcare industry. There is pressure from patients, governments, politicians, medical and healthcare services, as well as donors and financial institutions to improve the healthcare system. As budgets are cut and quality is demanded, the challenge of running a patient focused operation can be discouraging. The multiple-layer challenges include a growing concern that the future ageing population will need attention with fewer human resources. Embracing technology is increasingly seen as the pathway to improved services. While it is important to focus on improved health practices and encourage increased education in order to prevent diseases and illnesses, hospitals are the key establishment where caregivers and equipment often make the difference between life and death.

Physical Environment

The physical environment is one of seven key indicators for the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), the first national, standardized, publicly reported survey of patient’s perspectives on and satisfaction with hospital care with the results carrying significant financial impact in areas that hospitals need to address.

As patients are increasingly responsible for more of their healthcare expenses as a result of changes in insurance coverage, and healthcare decisions are significantly influenced by physician recommendations as well as other medical and non-medical factors, patients and their families expectations for hospital services and environments have approached levels similar to those of other service providers and retail merchants, leading hospitals to consult with and assess findings of various survey research and hospitality-related firms. In the face of intense competition, rising consumer expectations, and the movement toward holistic therapies, hospitals are pressed to differentiate themselves on the basis of factors beyond traditional clinical outcomes and services.

As hospital administrators lose sight of the reality they are working with sick patients and not stacks of computer chips, the loss of the “human touch,” is decreasing the quality of services that could transform a sick patient into a well person. Consumers frequently look to the physical environment for cues about the firm’s capabilities and quality before making purchasing decisions and these signals are especially important in hospital settings where the clinical outcomes may be intangible and difficult for non-clinicians to measure, so consumers rely on design cues to form opinions about the quality of care. Research performed in waiting rooms found that patients surveyed in physically attractive areas gave higher ratings on quality of care and patient-staff interactions and were more willing to recommend the facility to others than those surveyed in comparatively unattractive waiting areas.

Hospitals with more hospitality-oriented environments were also found to retain staff and increase staff satisfaction levels at a higher rate than those with environments that were less attractive. Amenities such as numerous and attentive staff and pleasant surroundings, hotel – quality food, are all basic requirements in the hospitality industry, were found to play an important role in generating hospital demand and patients perceived value of their medical experience.

Outsource or In-house

Some hospitals have borrowed a people processes place framework, frequently used in the hospitality industry to improve service quality. Some hospitals have outsourced their dining services, maintenance, facilities management, engineering, biomedical equipment management and housekeeping functions to hospitality service providers such as ARAMARK Healthcare and Sodexo, while others have worked with hotel operating companies or hospitality-related firms such as the Ritz-Carton Hotel Company, Four Seasons Hotels and Resorts and the Walt Disney Company for training in-service processes and management. Unfortunately, many ER and hospital administrators continue to offer services that fit an earlier decade and a different target market.

Out-patient and in-Hospital Facilities Single patient rooms have been shown to help reduce medical error rates, lessen patient stress and depression, and shorten length of stay while increasing overall satisfaction with the hospital. Newly designed hospitals even offer private single in-room stay-over facilities for family members. Clinicians value patients’ families as important partners in care through social and psychological support which can speed recovery. Family members may even monitor the patient when the nursing staff cannot be present. Some hospitals have begun to offer the comfort of luxury suites to compete for customers who are willing to pay additional out-of-pocket costs that are typically not covered by insurance.

Priorities

Luxurious public spaces may be attractive; however, health facility planners should accept the reality that patients typically do not experience the hospital lobby for an extended period, so substantial investment in lobbies have limited viability. In addition, the design and use of resources for expansive lobby spaces to justify additional construction and operating expenses is unnecessary.

Signage and Way-Finding

Hotels are usually designed to facilitate direction finding through signage and landmarks. However, hospitals may have expanded in multiple phases on limited land parcels, making them extremely difficult to navigate for patients and families. Hotel style way-finding can save hospitals significant amounts of money. One study (1990), found a savings of approximately $450 per bed when accounting for the hidden costs of hospital staff providing directions when their responsibilities were elsewhere.

Patient room signage is unique to hospitals and difficult for visitors/patients to interpret. Hospitals would be smart to use hotel-style sequential room numbering that is intuitive and familiar. Other options include clocks, and fountains as-way finding devices. Whatever the process, way-finding should be approached as a complete system and sending directions to consumers before the visit, including external building cues, unique building names, maps and signs that are coordinated among the hospital departments and made simple, accurate, intuitive and available in multiple languages. For people with sight and hearing impairment, other technology should be included as part of a complete multi-purpose system.

ER Bays and Hospital Rooms: Basics

ER and hospital rooms should include furniture that is comfortable, easily disinfected, and adapted to the needs of the patients as well as the hospital staff. Easily accessible electrical outlets for cell phones, laptops and chargers along with complimentary WIFI are basic necessities. Because of long waits for medical and healthcare personnel, self-service food/beverage outlets and vending machines should be easily accessible, regardless of mobility agility or budget.

HVAC systems that enable patient control of the room temperature should be among the most basic amenities, along with the opportunity to control light and sound. Another basic patient need is the technology to directly reach nurses and doctors. At this moment, in some NY hospitals, there is no system available to contact professional or administrative staff and regardless of need (i.e., pain, access to toilets); patients are left to fend for themselves.

Innovation

Hotels and hospitals share the challenge of designing facilities that are functional, cost-effective and promote the organization’s mission. While the consumer’s selection of hotel facilities maybe discretionary, hospitals need to attract revenue, meet HCAHPS standards and promote positive, patient-centered outcomes is increasingly leading hospitals to consider incorporating hospitality elements in their designs. It is not easy to introduce hospitality design elements in a complex hospital system as it requires careful planning, systematic thinking and consideration of many factors including the healthcare system, needs of the stakeholders, unique attributes of organizational and/or community cultures, improvement efforts in the planning stages, and financial constraints of the hospital. Integrating hotel features will require an innovation team composed of interdisciplinary professionals and former patients who are able to recognize the importance of integrating modernization into the organization’s strategic facility plan and getting a buy-in from stakeholders.

Benefits

Benefits of integrating hotel amenities into a hospital environment can create a healing environment and promote patient satisfaction with the potential to increase the financial bottom-line for the institutions. Patients are likely to pay more for improved/enhanced services and leave their medical experience more satisfied resulting in generating positive word of mouth feedback and a higher rate of return, should the patient require future medical services.

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