Last weekend, I had the chance to go to the Georgia Aquarium in Atlanta with my cousin and her grandson. I have always loved going to the aquarium. The vibrant colors in nature, like the intense yellow of the angel fish, amaze me. I enjoy watching the sea otters as they play together and swim through the water. My favorite habitat at the aquarium, though, is that of the penguins. I always laugh at their silly waddle and the way they flop forward onto their belly and then slide right into the water—they’re comical on land, but such fast and graceful swimmers.
As I watched my cousin’s grandson, Cole, observe these sea animals for the first time, I felt almost like it was my first visit. I watched him as he scrutinized each creature’s movements; he laughed as the otters swirled and glided through the water, and he eagerly pointed out a whale shark as it passed over us in the glass tunnel. I have no doubt there will be many more visits in his future!
Watching Cole carefully examine each creature and point out every detail about them made me realize something—as we become more familiar with our surroundings and activities, we often miss the small details. We end up taking what is in front of us for granted, because it becomes a common experience to us.
This is an actual phenomenon, which psychologists refer to as “habituation”. Simply put, it is a decrease in response to something after repeated presentations—the more often we see something, the less we notice it.
This made me think about health care settings, and the fact that as caregivers and employees, we eventually become accustomed to our patient care environments. We become so used to seeing the same setting every day, we may hardly notice when something is out of place, something has collected a little dust, or that a new, unsightly blemish has appeared on a wall, a piece of equipment or furniture.
Because providers and staff are busy focused on patient care, these small details might be easily overlooked; however, patients are looking. I know from my own experience as a patient, when I’m waiting in an exam room, I usually have enough time to give it a thorough inspection. Small details and first impressions have the potential to create a powerful set of assumptions. If patients see something askew or neglected, it may plant seeds of doubt in their minds about quality of care. As an inpatient, one has even more time to examine the details of a room. If something is not working or doesn’t look clean, it may signal to the patient that we don’t care, which is certainly not the case.
Perception is reality to our patients and their families. That’s why as providers and employees we have to practice seeing every aspect of our interaction with patients from their perspective—it’s more important than most of us think.
In fact, a number of studies link a range of aspects of the physical environment to patient safety, patient and family stress and healing, improved overall health care quality and cost, and even staff stress and effectiveness. The physical environment shapes every patient experience and all health care delivery, including those episodes of care that result in patient harm, according to the Agency for Healthcare Research and Quality (AHRQ). According to the NIH, various studies conducted at ambulatory care centers also show the physical environment has been associated with favorable patient outcomes.
The lists of physical features in care environments that are associated with positive patient experiences can be quite comprehensive, but some of the principle demands are an environment that:
- Promotes safe behavior by patients, staff and visitors – for example plentiful, visible hand washing and hand disinfection stations.
- Prevents accidents – for example ensuring spills are promptly cleaned up to prevent slips and falls.
- Encourages patients and staff to feel reassured – through adequate interior and exterior lighting, visibility of security personnel, and, in the case of inpatient care, secure storage for personal items such as glasses, keys and money.
- Reduces stress, anxiety and aggression – through the provision of pleasant, comfortable waiting spaces, feedback and communication on waiting times and priorities, attention to ambient temperature, light and noise, etc.
These aspects can be further supported by robust monitoring and reporting, demonstrating a Culture of Trust, and having a sense of personal responsibility and willingness to admit safety concerns and report mistakes, should they occur.
On a regular basis, take an unbiased look at your patient care or service environment. Try seeing it from the patient’s perspective. What would be your first impression of the waiting area? Does furniture or equipment need repair? Is it dirty or scuffed? What does the front desk look like? Is there excessive or old signage? Are patients and family members warmly greeted on arrival? What do the exam rooms and/or inpatient rooms look like? Are ceiling tiles damaged? Is the work area cluttered? Is paint peeling or scuffed?
These are just some examples of things of which we should remain aware. I believe we do a wonderful job at UTMB of providing an excellent care environment, but we should always be vigilant. We need everyone’s help!
- Report facilities issues that need maintenance; if the problem does not get fixed or you don’t have a response within a week, escalate it to your supervisor
- Keep clutter out of the hallways
- Assure all supplies are not expired and that they’re properly stored
- Check for expired supplies and medications
- Ensure refrigerator temperature monitoring, proper food labeling, and cleanliness
- Make sure linens are covered
- Eliminate dirty, cluttered work areas
It’s very easy to quickly resolve issues that impact patient care by dialing one number: 2-4040. Requests may also be made with each area’s designated Zone Mechanic. Calls will be routed to the UTMB Service Response Center, which has expanded its service to act as the single point of contact for all clinical support services in the following areas: Environmental Service, Pest Control, Food and Nutrition, Clinical Equipment, Nursing Unit Support, Maintenance, Utilities, and In-house Construction.
More information on these topics can also be found on UTMB’s internal web site, The Joint Commission: http://intranet.utmb.edu/qhs/TheJointCommission/default.asp
Thank you for the part you play in keeping UTMB hospitals and clinics beautiful and safe for our patients and our staff!