MJ Medical

Quiet please!

Some thoughts on patient (un)friendly environments


By Nathaniel Hobbs, MJ Medical Director

As the parent of a young child who suffers from a severe chronic condition, I have spent a lot of time over the last three years in hospital. My stays have been long and short, at district generals and at tertiary paediatric centres, in the UK and abroad, and, on the whole, seen an overwhelmingly high quality of care and caring from staff.

This experience has given me some significant insights into how healthcare systems, facilities, and organisations are working for patients. The most obvious of these is the confirmation that whilst many NHS hospitals do still operate systems that are grossly inefficient, it is certain they increasingly lack the funds to do the job we are asking them to do. The kicker is that, rather than act as an incentive to become more efficient, underfunding more often than not just stymies the investment required to improve.

However, as well as spending a lot of time awake in the middle of the night, on a fold-away bed, next to my daughter, thinking about this ‘big issue’ stuff, it is the smaller, more proximate experiences that literally keep me, and the rest of the ward, awake. The unnecessary stress of the patient unfriendly environment never fails to amaze and annoy me. Issues such excessive bedside noise and light, or poor ward configuration, are not new to anyone involved in the healthcare design industry, and there is a serious focus on them. However, the array of hospitals where I have seen these continue to be a major problem, be they newly built or Victorian, globally renown or in special measures, containing single bed or multi-bed wards, makes me think that many healthcare providers at least may not be taking them seriously.

Now this is not just about me getting my beauty sleep, as important as that it is; a good amount of quality research shows well rested, calm patients not only have a better experience, they get better quicker, are discharged faster, and have better clinical outcomes. Many of the reasons for this are obvious, for example calm and well rested patients are less stressed and tired, improving their psychological well-being and morale and aiding the healing process. However, some are less so – well-rested patients communicate better with clinicians, aiding the diagnosis and treatment planning process, and improving compliance. Convincing a tired child to undergo basic procedures such as cannulation usually ends up being much more traumatic and clinically challenging than for one who is well rested and happy in their environment.

The causes of patient unfriendly environments stem from organisational culture, operational approach and facility design. A sample from my personal list includes, in no particular order; hospital staff paying no regard to the noise they make during the night; beds on wards located next to equipment stores; beds on paediatric wards located next to non-sound-proof treatment rooms; binary lighting (a term I invented referring to a lighting system which is either retina burning bright, or “500-meters-down-a-mine” dark, with absolutely no in between); nurses turning the binary lighting system to the ‘retina burning’ position when doing night obs; emergency alarms set off repeatedly and continually by toasters; and last but not least infusion pump alarms, infusion pump alarms, infusion pump alarms.

Solutions to all of these issues and more exist, however all too often they are met with resistance to cultural or operational change, capital cost constraints or, most depressingly, they are ‘value engineered’ out during the course of the design process. It is time for healthcare providers to get serious about putting the creation of a patient friendly environment at the heart of their approach – the solutions exist and the benefits are clear. If not the result is tired, stressed, unhappy patients who take longer to get better.


To read more about this issue see here: