title: Optimizing the patient-centered environment: results of guided tours with health care providers and employees.
abstract: OBJECTIVE
  To examine providers' perspectives on the care environment and patient-centered care (PCC) through the eyes of the veteran patient, using guided tours qualitative methodology.
  
  
  BACKGROUND
  Environmental factors, such as attractiveness and function, have the potential to improve patients' experiences. Participatory qualitative methods allow researchers to explore the environment and facilitate discussion.
  
  
  METHODS
  Guided tours were conducted with 25 health care providers/employees at two Veterans Affairs (VA) health care facilities. In guided tours, participants lead the researcher through an environment, commenting on their surroundings, thoughts, and feelings. The researcher walks along with the participant, asking open-ended questions as needed to foster discussion and gain an understanding of the participant's view. Participants were asked to walk through the facility as though they were a veteran. Tours were audio recorded, with participant permission, and transcribed verbatim by research assistants. Three qualitative researchers were responsible for codebook development and coding transcripts and used data-driven coding approaches.
  
  
  RESULTS
  Participants discussed physical appearance of the environment and how that influences perceptions about care. Overall, participants highlighted the need to shed the "institutional" appearance. Differences between VA and non-VA health care facilities were discussed, including availability of private rooms and staff to assist with navigating the facility. They reviewed resources in the facility, such as the information desk to assist patients and families. Finally, they offered suggestions for future improvements, including improvements to waiting areas and quiet areas for patients to relax and "get away" from their rooms.
  
  
  CONCLUSIONS
  Participants highlighted many small changes to the care environment that could enhance the patient experience. Additionally, they examined the environment from the patient's perspective, to identify elements that enhance, or detract from, the patient's care experience.
authors: Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, IL, USA Center for Evaluation of Practices and Experiences of Patient-Centered Care, Edward Hines Jr. Veterans Affairs Hospital, Hines, IL, USA sara.locatelli@va.gov.
authors: Sara M
authors: SM
authors: Locatelli
authors: Center for Evaluation of Practices and Experiences of Patient-Centered Care, Edward Hines Jr. Veterans Affairs Hospital, Hines, IL, USA.
authors: Stephanie
authors: S
authors: Turcios
authors: Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital, Hines, IL, USA Center for Evaluation of Practices and Experiences of Patient-Centered Care, Edward Hines Jr. Veterans Affairs Hospital, Hines, IL, USA Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
authors: Sherri L
authors: SL
authors: LaVela
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D005260:Female; D006282:Health Personnel / Q000523:psychology*; D006787:Hospitals, Veterans / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D007374:Interior Design and Furnishings / Q000592:standards*; D007407:Interviews as Topic; D008123:Location Directories and Signs / Q000592:standards; D008297:Male; D018802:Patient-Centered Care / Q000379:methods / Q000458:organization & administration / Q000592:standards*; D010362:Patients' Rooms / Q000458:organization & administration / Q000592:standards*; D036301:Qualitative Research; D014481:United States
keywords: architecture; design; health care; patient and/or family; patient-centered care