Letter to the Editor

We thank Mr. Zilm and colleagues for their interest in our work.[1] Certainly, we did not intend to imply that well‐designed buildings have little value in the efficient and patient‐centered delivery of healthcare. Our main goal was to highlight (1) that patients can distinguish between facility features and actual care delivery, and poor facilities alone should not be an excuse for poor patient satisfaction; and (2) that global evaluations are more dependent on perceived quality of care than on facility features. Furthermore, we agree with many of the points raised. Certainly, patient satisfaction is but 1 measure of successful facility design, and the delivery of modern healthcare requires updated facilities. However, based on our results, we think that healthcare administrators and designers should consider the return on investment on the costly features that are incorporated purely to improve patient satisfaction rather than for safety and staff effectiveness.

Referral patterns and patient expectations are likely very different for a tertiary care hospital like ours. A different relationship between facility design and patient satisfaction may indeed exist for community hospitals. However, we would caution against making this assumption without supportive evidence. Furthermore, it is difficult to attribute lack of improvement of physician scores in our study because of a ceiling effect. The baseline scores were certainly not exemplary, and there was plenty of room for improvement.

We agree that there is a need for high‐quality research to better understand the broader impact of healthcare design on meaningful outcomes. However, we are not impressed with the quality of much of the existing research tying physical facilities with patient stress or shorter length of stay, as mentioned by Mr. Zilm and colleagues. Evidence supporting investment in expensive facilities should be evaluated with the same high standards and rigor as for other healthcare decisions.

We thank Mr. Zilm and colleagues for their interest in our work.[1] Certainly, we did not intend to imply that well‐designed buildings have little value in the efficient and patient‐centered delivery of healthcare. Our main goal was to highlight (1) that patients can distinguish between facility features and actual care delivery, and poor facilities alone should not be an excuse for poor patient satisfaction; and (2) that global evaluations are more dependent on perceived quality of care than on facility features. Furthermore, we agree with many of the points raised. Certainly, patient satisfaction is but 1 measure of successful facility design, and the delivery of modern healthcare requires updated facilities. However, based on our results, we think that healthcare administrators and designers should consider the return on investment on the costly features that are incorporated purely to improve patient satisfaction rather than for safety and staff effectiveness.

Referral patterns and patient expectations are likely very different for a tertiary care hospital like ours. A different relationship between facility design and patient satisfaction may indeed exist for community hospitals. However, we would caution against making this assumption without supportive evidence. Furthermore, it is difficult to attribute lack of improvement of physician scores in our study because of a ceiling effect. The baseline scores were certainly not exemplary, and there was plenty of room for improvement.

We agree that there is a need for high‐quality research to better understand the broader impact of healthcare design on meaningful outcomes. However, we are not impressed with the quality of much of the existing research tying physical facilities with patient stress or shorter length of stay, as mentioned by Mr. Zilm and colleagues. Evidence supporting investment in expensive facilities should be evaluated with the same high standards and rigor as for other healthcare decisions.

We thank Mr. Zilm and colleagues for their interest in our work.[1] Certainly, we did not intend to imply that well‐designed buildings have little value in the efficient and patient‐centered delivery of healthcare. Our main goal was to highlight (1) that patients can distinguish between facility features and actual care delivery, and poor facilities alone should not be an excuse for poor patient satisfaction; and (2) that global evaluations are more dependent on perceived quality of care than on facility features. Furthermore, we agree with many of the points raised. Certainly, patient satisfaction is but 1 measure of successful facility design, and the delivery of modern healthcare requires updated facilities. However, based on our results, we think that healthcare administrators and designers should consider the return on investment on the costly features that are incorporated purely to improve patient satisfaction rather than for safety and staff effectiveness.

Referral patterns and patient expectations are likely very different for a tertiary care hospital like ours. A different relationship between facility design and patient satisfaction may indeed exist for community hospitals. However, we would caution against making this assumption without supportive evidence. Furthermore, it is difficult to attribute lack of improvement of physician scores in our study because of a ceiling effect. The baseline scores were certainly not exemplary, and there was plenty of room for improvement.

We agree that there is a need for high‐quality research to better understand the broader impact of healthcare design on meaningful outcomes. However, we are not impressed with the quality of much of the existing research tying physical facilities with patient stress or shorter length of stay, as mentioned by Mr. Zilm and colleagues. Evidence supporting investment in expensive facilities should be evaluated with the same high standards and rigor as for other healthcare decisions.