Facilities and patient choice

With Choose and Book providing patients with a firm way of choosing which hospital they wish to be referred to for their treatment it is clear that the environment of the hospital can influence these choices. So what can the estates and facilities teams do to enhance the view of their premises to the local populous?

Patient experience
Having worked in and alongside the NHS since 1979, starting in Wolverhampton, it has been interesting over recent years to attend the same hospital with various family members. Having looked at hospital premises the country over with my ‘professional’ eye I have found it most revealing to undergo the patient experience first hand. While my observations may be specific to one hospital I know from my travels throughout the UK NHS that this is not a unique situation and I use the examples noted below to highlight some of the generic issues that could do with a second look where you work.
    
Patient choice is a good idea in theory and definitely provides the opportunity for people who wish to do so to vote with their feet between hospitals – but what influences their decisions? Typically we are told that it is mortality and success rates for different consultants but recent surveys show that it is actually the facilities that are top of the public’s agenda.
    
The first thing about choice is time to make it and when the GP calls for an ambulance you go where the ambulance takes you, normally your local Acute NHS Hospital. Arrival in the A&E Department or an Emergency Assessment Unit assaults the senses and an efficient greeting and initial paperwork filling must be well handled.
    
Nowadays this is normally accompanied by an MRSA swab – a positive and necessary measure so that we can really see what comes into the hospital and what might have been picked up while inside. However, a six hour trolley wait from then to see a doctor can be a little off-putting and one non facilities improvement that would really help is feedback into the bed bays or waiting areas so that people can understand any expected wait time. No information can cause problems for diabetics and the elderly for whom meal times and related medicine taking can be a real difficulty.
    
We all know that car parking is a pain and the hospital that can make this easy makes the very first element of the patient experience a positive instead of negative experience. Simple things like good and clearly visible signage and an indication of where there are spaces is a great help and multiple access points rather than single entrances helps avoid queues that can often block emergency vehicle access at visiting times.

Signage & posters
Within hospitals general signage can always be improved and nowadays there seems to be a proliferation of ad hoc signs appearing near entrances to buildings and areas. These can be distracting to the visitor who has enough with their concerns for their relative on their mind.
    
Similarly the placement of ward or department naming signs then becomes even more important. One example of ‘bad practice’ is to have the name sign suspended part way down the entry corridor so that it is obscured by the lintel of the entrance door – from the main corridor this may not be clearly visible and the name sign over the entry door is much more effective.
    
At my local hospital they have launched an information campaign on cross infection with posters and a pull up in the main entrances reminding visitors that they should not enter the hospital if they have suffered from sickness or diarrhoea in the preceding 72 hours. Alongside advice to clean hands with alcohol gel, not to sit on patient beds, observe visiting times and use litter bins this is a very positive way of reminding the public entering hospital premises that they are as much a part of the patient environment as the staff.
    
The placement of adequate alcohol gel dispensers with signs is also a very positive step but it can be difficult to use these when carrying in a patient’s effects and often the top swivels round just as you press and the gel ends up on your shoe or the floor where is becomes a slip risk. Perhaps the suppliers can come up with a more usable solution?

Cleaning schedules
On cleanliness it was disappointing in November to see that the Heath Care Commission released the results from their January and February 2008 spot visits. This was after the news from the Department of Health in September 2008 that the June HCAI target had been met. The media interest in this just goes to reinforce the fact that the public perception is driven not only by what they see when entering our premises but also what is in the media at the time. Timely news is important and out of date news is often damaging.
    
As part of their reviews HCC has apparently been asking Trusts to display cleaning schedules in public places. Whilst as a visitor I am not sure that I am going to make time to read such things it is an interesting point and as this kind of information can be a direct output from management systems like the Credits for Cleaning application commissioned by the Department of Health for the NHS this reinforces the importance of using such systems.
    
Security of wards and other departments is also a difficult area and we do need to bear in mind that as visitors arrive in our premises they have other things on their minds and so call buttons to gain access through secured doors need to be clearly visible and well placed.
    
On arrival at the ward or other department the facilities have been 100 per cent of the visitor’s experience.
    
Having talked these items through with neighbours, the staff team at HFC and some of our colleagues at hospitals around the country our combined experience of UK hospitals shows that these are common problems wherever we go, albeit to differing degrees. These types of difficulty can be alleviated by entering the site and taking a walk through as a patient or visitor and using their eyes rather than our own mind set as an employee. This could of course be done using volunteers from the local community, which would provide a positive and affirming level of community involvement.
    
My local acute hospital is run by The Royal Wolverhampton Hospitals NHS Trust and they have made significant improvements including the opening of the new £70m heart and lung centre and ward refurbishments at around £200,000 each, which have definitely improved the in-patient experience and the Trust is to be congratulated on the steps taken. However, as with the whole of the NHS there is still room for improvement provided the Trust can justify the expenditure and this is always going to be the balancing act. To close let me quote David Loughton, chief executive of the Trust, from his recent key note address at the Healthcare Estates Conference in Harrogate: “We could not have achieved any of this without the estates department’s very considerable input.”
    
So, does the estates and facilities team have any impact on patient choice? I believe so and would encourage my colleagues around the country to have a look and see how a little additional care and forethought can do a great deal to do in influencing patient choice.