In reference to “Changes in patient satisfaction related to hospital renovation: The experience with a new clinical building”

We complement Dr. Siddiqui et al. on their article published in the Journal of Hospital Medicine. Analysis of the role of new physical environments on care and patient satisfaction is sparse and desperately needed for this highcost resource in healthcare delivery. A review of the original article led us to several observations/suggestions. The focus of the study is on perceived patient satisfaction based on 2 survey tools. As noted by the authors, there are multiple factors that must be considered related to facilities—their potential contribution to patient infections and falls, the ability to accommodate new technology and procedures, and the shifting practice models such as the shift from inpatient to ambulatory care. Patient-focused care concepts are only 1 element in the design challenge and costs. The reputation of Johns Hopkins as a major tertiary referral center is well known internationally, and it would seem reasonable to assume that many of the patients were selected or referred to the institution based on its physicians. It does not seem unreasonable to assume that facilities would play a secondary role, and that perceived satisfaction would be high regardless of the physical environment. As noted by the authors, the transferability of this finding to community hospitals and other settings is unknown. Patient satisfaction is an important element in design, but staff satisfaction and efficiency are also significant elements in maintaining a high-quality healthcare system. We need tools to assess the relationship between staff retention, stress levels, and medical errors and the physical environment. The focus of the article is on the transferability of perceived satisfaction with environment to satisfaction with physician care. Previously published studies have shown a correlation with environments and views from patients’ rooms with reduced patient stress levels and shorter lengths of stay. Physical space should not be disregarded as a component of effective patient care. We are committed to seeking designs that are effective, safe, and adaptable to long-term needs. We support additional research in this and other related design issues. We hope that the improvements in patient and family environments labeled as “patient focused” will continue to evolve to respond to real healthcare needs. It would be unfortunate if progress is diverted by misinterpretation of the articles findings.