Adapting to family-centered hospital design: changes in providers' attitudes over a two-year period

The United States is currently in the midst of a hospital construction boom. An increasing number of hospitals are being designed using the principles of evidence-based design to improve patient safety and patient satisfaction. Few studies have examined the impact of new hospital design models on providers' attitudes or work performance. The goal of this study was to determine how providers' attitudes at one children's hospital changed over a 2-year period. It was hypothesized that clinicians' attitudes about their work environment would be significantly more positive 2 years after opening.

In 2004 a children's hospital within a hospital was replaced with a free-standing facility, which was designed on the theme of family-centered care. The hospital quality improvement team developed and administered the Environment of Work survey to measure providers' initial impressions of the hospital design on job function, patient safety, and personal well-being. The survey was readministered approximately 2 years later to measure changes in providers' perceptions about the same issues.

A 25-item survey was administered to a convenience sample of clinical staff to measure their attitudes about the effects of family-centered hospital design on providers and patients. Chi-square tests were used to compare subjective ratings collected from the two surveys on pooled samples and on samples stratified by clinical unit.

Surveys were collected from 270 clinicians (a 25% response rate) in 2004 and 544 clinicians (a 51% response rate) in 2006. Nurses accounted for a higher percentage of total respondents (78% versus 57%). Most domain areas garnered improved and overall positive ratings from clinicians in 2006. Providers' ratings of elevated mental fatigue, physical fatigue, and walking burden remained high in 2006 despite improvements. Ratings of noise levels increased on all units except the neonatal intensive care unit. Fewer respondents rated the new hospital "somewhat to much better" than the former hospital.

Moving into a new healthcare facility is a stressful event for healthcare providers and adapting to a new work environment requires a lengthy period of transition. Providers' initial ratings of a new workspace are likely to change over time as they adjust their work practices to the physical environment.