There is little doubt that the Affordable Care Act has had a significant impact on the healthcare delivery system. As a result, architects and engineers have to adjust the way they develop responsible design solutions.  The Affordable Care Act (ACA) shifts the antiquated payment reimbursement model based on the volume of care provided to a bundled payment model that is based on value and the quality of care that is delivered.  Under the ACA, one of the bundled payment reimbursement structures will be to financially reward hospitals that improve their patient experience as measured through their HCAHPS scores (Hospital Consumer Assessment of Healthcare Providers and Systems).

HCAHPS scores are now tied to the Centers for Medicare & Medicaid Services (CMS) Hospital Value-Based Purchasing Program.  Hospitals can receive up to a 2% bonus payment based on their ability to reduce patient harm as a result of hospital-acquired conditions.  It is expected that the bonus amount will continue to increase in subsequent years.  By incorporating Evidence-based Design principals, Architects, Engineers, and Interior Designers can create important design solutions to help improve a hospital’s HCAHPS scores and create value for their client by increasing their CMS Value-Based bonus.

There are several strategies which Evidence-Based Design Accreditation and Certification (EDAC) professionals can provide as part of an integrated approach to improving the patient experience.  Noise is one category in the HCAHPS’s inpatient survey that pertains to the environment of care and can be improved with evidence-based design.

Why Does Noise Matter?
We all know that noise can disrupt sleep patterns, which in turn, impedes and delays the healing process. Hospitals with a high level of noise are believed to slow the rate of recovery among patients, as well as delay the development of infants receiving care in neonatal intensive care units.  Medical error rates are also significantly higher in noisier hospital environments. Taken together, these noise-related disruptions can lead to significantly increased healthcare costs.

Generally speaking, inpatients already have their sleep patterns compromised by anxiety, pain, and adjusting to the hospital environment. Incorporating excessive noise only exacerbates these conditions.  Each of these negative environments will now have a significant impact on the HCAHPS survey that each patient will complete upon being discharged from the hospital.  High noise levels will lead to poor reviews, thus having a negative impact on your CMS Value Bonus.

Solutions to Improve the Experience
There is considerable research that suggests that single occupancy patient rooms provide the best solution in reducing noise.  However, many facilities are struggling to make this expensive capital investment.  If this isn’t in your budget, there are affordable options.  For example, research has shown that installing high-performance sound absorbing ceiling tiles and panels will result in reduced noise levels.  Sound absorbing materials and finishes will also change the perception of noise and improves outcomes such as speech intelligibility and reduced staff work pressure.  Other less costly solutions can include replacing the overhead paging systems with wireless technologies and reducing the frequency and intensity of medical device alarms, installing ambient white-noise machines to mask adjacent noises, and incorporating dimming lights in the evening.

The Affordable Care Act has brought a lot of uncertainty and changes. It has also given the hospital, clinic owners, and its employees the opportunity to take a closer look at their facilities. As a result, new benefits are discovered when design changes are initiated. Consider an evidence-based design approach to help increase patient moral, reduce mistakes, and increase HCHAPS scores.

To find the hidden opportunities for your facility, contact Luckett & Farley's credentialed Evidence-Based Design Professionals.

Tom Hammer, AIA, EDAC, LEED AP BD+C (502) 585-4181 thammer@luckett-farley.com.

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