The Application of Hospitality

Elements in Hospitals
Ziqi Wu, strategic facilities planner, Hoag Health System, Orange County, California;
Stephani Robson, PhD, senior lecturer, School of Hotel Administration, Cornell
University, Ithaca, New York; and Brooke Hollis, executive director and lecturer, Sloan
Program in Health Administration, Cornell University

E X E C U TI V E S U M M AR Y
In the last decade, many hospital designs have taken inspiration from hotels, spurred
by factors such as increased patient and family expectations and regulatory or finan-
cial incentives. Increasingly, research evidence suggests the value of enhancing the
physical environment to foster healing and drive consumer decisions and percep-
tions of service quality. Although interest is increasing in the broader applicability
of numerous hospitality concepts to the healthcare field, the focus of this article is
design innovations, and the services that such innovations support, from the hospi-
tality industry.
To identify physical hotel design elements and associated operational features
that have been used in the healthcare arena, a series of interviews with hospital and
hotel design experts were conducted. Current examples and suggestions for future
hospitality elements were also sought from the experts, academic journals, and
news articles.
Hospitality elements applied in existing hospitals that are addressed in this
article include hotel-like rooms and decor; actual hotels incorporated into medical
centers; hotel-quality food, room service, and dining facilities for families; welcom-
ing lobbies and common spaces; hospitality-oriented customer service training;
enhanced service offerings, including concierges; spas or therapy centers; hotel-style
signage and way-finding tools; and entertainment features. Selected elements that
have potential for future incorporation include executive lounges and/or communal
lobbies with complimentary wireless Internet and refreshments, centralized controls
for patients, and flexible furniture.
Although the findings from this study underscore the need for more hospitality-
like environments in hospitals, the investment decisions made by healthcare
executives must be balanced with cost-effectiveness and the assurance that clinical
excellence remains the top priority.

For more information on the concepts in this article, please contact Mr. Wu at
zig.wu.ziqi@gmail.com.

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Journal of H e althcar e M anag eme nt 58:1 J anuary /F ebruary 2013
I N TROD U C TIO N
When considering whether to fund a
new program to train future hospital
executives in the early 1950s, Alfred
P. Sloan stated, “the hospital in cer-
tain respects is a very specialized hotel”
(Malott, 1959–1961). Sloan believed
that executives could learn a great deal
from the management approaches used
in the hospitality industry. Over time,
innovations and practices from hotels
have been incorporated into the health-
care workplace in a variety of ways. This
development is not surprising, given
that the two industries share the goal
of achieving high customer satisfaction.
Services of all types combine a number
of elements—primarily people, pro-
cesses, and place-related items—to effect
positive outcomes. This article focuses
on design and other place-related ele-
ments borrowed from the hospitality
industry (which we term hospitality
elements) that have been successfully
incorporated in hospitals designed and
built primarily over the past decade. It
also provides a detailed review of the
academic and applied design literature
and outlines additional hospitality
design innovations with the potential
for successful implementation in hos-
pitals, which were developed through
interviews with hospital and hotel
design experts.
Hospitals have long used hotel-type
imagery and physical design to appeal
to and reassure prospective patients
(Adams, 2008). But starting in the
1930s, as healthcare providers became
increasingly focused on the technologi-
cal aspects of medicine, hospitals shifted
to an institutional appearance and
mode of operation (Forty, 1980). Many
48
hospitals were constructed following
minimum standards developed under
the 1946 Hill-Burton Act, which tended
to reflect an institutional rather than a
hospitality orientation (White, 1982).
Today, skyrocketing healthcare expendi-
tures have led hospital administrators to
implement cost-containment measures
(Verderber & Fine, 2000) while competi-
tion among providers has increased to a
level never before experienced. Accord-
ingly, providers are revisiting design and
other hospitality elements as a way to
gain a competitive advantage. Hospitals
can no longer afford to be solely medical
focused; the emphasis in hospital design
has shifted once more to hospitality-
type amenities and patient- and family-
centered care as hospitals compete for
patients and donor dollars.
Furthermore, high patient satisfac-
tion is no longer just a “good to have”
for hospitals. The physical environ-
ment is one of seven key indicators for
the Hospital Consumer Assessment
of Healthcare Providers and Systems
(HCAHPS), the first national, stan-
dardized, publicly reported survey of
patients’ perspectives on and satisfac-
tion with hospital care (CMS, 2010), the
results of which now carry significant
financial impact in areas that hospitals
need to address (Studer, Robinson, &
Cook, 2012). At the same time, patients
are increasingly responsible for more of
their healthcare expenses as a result of
changes in insurance coverage. While
healthcare decisions are still significantly
influenced by physician recommenda-
tions and other medical factors, patients’
and their families’ expectations for
hospital services and environments have
approached levels similar to those for
 T he A pp li cati on
other service providers and retail mer-
chants, leading hospitals to consult with
and assess findings of various survey
research and hospitality-related firms
(Press, 2002; Lee, 2004). In the face of
intense competition, rising consumer
expectations, and the movement toward
holistic therapies, hospitals are pressed
to differentiate themselves on the basis
of factors beyond traditional clinical
outcomes and services. One indicator of
this trend noted in Modern Healthcare’s
design awards is that healthcare archi-
tects frequently consult with hotel or
resort designers to improve the patient
experience (Robeznieks, 2010).
W H Y DO E S D E S I G N M ATT E R ?
Research on hotels, restaurants, profes-
sional offices, banks, and retail stores
demonstrates that facility design influ-
ences customer behaviors and brand
perceptions (Baker, 1987; Bitner, 1990,
1992; Kotler, 1973; Shostack, 1977).
Consumers commonly look to the
physical environment for cues about
the firm’s capabilities and quality before
making purchasing decisions (Berry &
Clark, 1986; Shostack, 1977). These
cues are especially important in hospital
settings, where the clinical outcomes
are often intangible and difficult for
nonclinicians to measure, so consumers
sometimes rely on design cues to form
opinions about the quality of care (Hut-
ton & Richardson, 1995).
Furthermore, evidence shows that
patients’ perceptions of healthcare
outcomes can be influenced by the
design of the hospital facilities. Research
performed in waiting rooms found that
patients surveyed in physically attractive
areas gave higher ratings on quality of
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of H ospitality E l ements in H ospi tals
care and patient–staff interactions and
were more willing to recommend the
facility to others than those surveyed
in comparatively unattractive waiting
areas (Arneill & Devlin, 2002; Becker,
Sweeney, & Parsons, 2008). Hospitals
with more hospitality-oriented environ-
ments were also found to retain staff
and increase staff satisfaction levels at
a higher rate than those with environ-
ments that were less attractive (Becker
et al., 2008). Amenities such as good
food, attentive staff, and pleasant sur-
roundings, all basic requirements in
the hospitality industry, were found to
play an important role in generating
hospital demand, and patients value
hotel-like features such as private and
family-friendly rooms, views, room
service meals, and massage therapy
twice as much as they value the clini-
cal reputation when making hospital
choices (Goldman & Romley, 2008).
Evidence-based design (EBD) research
has provided additional documenta-
tion of the impacts of design on patient
safety; clinical outcomes; treatment
effectiveness; and the overall experi-
ence for patients, families, and staff (see
Table 1). One simulated model hos-
pital designed using EBD findings not
only appeared to improve the patient
experience and quality of care but also
demonstrated the potential to generate a
positive return on the additional invest-
ment (Berry, Parker, Hamilton, O’Neill,
& Sadler, 2004).
H O S P ITALIT Y D E S I G N
E L E M E N T S I N H E ALT H C AR E
Many hospitals have borrowed a
people–processes–place framework,
which is frequently used by the
Journal of H e althcar e M anag eme nt 58:1 J anuary /F ebruary 2013
TA B L E 1
Relationships Between Design Factors and Healthcare Outcomes
Healthcare Outcomes
Reduced hospital-acquired
 infections
Reduced medical errors
Reduced patient falls
Reduced pain
Improved patient sleep
Reduced patient stress
Reduced depression
Reduced length of stay
Improved patient privacy/
 confidentiality
Improved patient/family
 communication
Improved social support
Increased patient
 satisfaction
Decreased staff injuries
Decreased staff stress
Increased staff effectiveness
Increased staff satisfaction
Key: •• Especially strong evidence—multiple rigorous studies indicated improved outcome via design intervention
• Relationship indicated between specific design factor and outcome—directly or indirectly by studies reviewed
Note. Adapted from Ulrich et al. (2008).
Design strategies on environmental interventions
Acuity-adaptable rooms
Noise-reducing finishes
Decentralized supplies
Family zone in patient
Appropriate lighting
Nursing floor layout
Single-patient rooms
Ceiling patient lifts
Access to daylight
Views of nature
Carpeting
rooms
••
• • • •
• • • • • •
• • •• •
•• • •
• • • •• • ••
•• •• • •
• • •
•• • •
•• • •
• • •
•• • • • • • •
•• •
• • • • •
• • • • • •
• • • •
50
 T he A pp li cati on
hospitality industry to improve service
quality. For example, some hospitals
have outsourced their dining services,
maintenance, facilities management,
engineering, biomedical equipment
management, and housekeeping func-
tions to hospitality service providers such
as ARAMARK Healthcare and Sodexo,
while others have worked with hotel
operating companies or hospitality-
related firms such as the Ritz-Carlton
Hotel Company, Four Seasons Hotels
and Resorts, and the Walt Disney Com-
pany for training in service processes
and management.
Healthcare providers can learn
additional lessons directly from hospi-
tality design practice or from innovative
hospitals that have adopted elements
of hotel design and operations such as
those that follow.
Hospitals with Hotel-Like Patient
Rooms
Single-patient rooms have been shown
to help reduce medical error rates,
lessen patient stress and depression, and
shorten length of stay while increas-
ing overall satisfaction with the hospi-
tal (Ulrich et al., 2008). Many newly
designed hospitals have private single
rooms that offer in-room “stay over”
facilities for family members, thereby
serving the role of a hotel to nonpatient
guests, who interact with staff and the
environment in new, distinctive ways.
Clinicians increasingly value patients’
families as important partners in care
through social and psychological sup-
port, which can speed recovery (Happ
et al., 2007). Family members may even
help monitor the patient when the
nursing staff cannot be present. This
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of H ospitality E l ements in H ospi tals
contribution to care may become more
important in the future given forecasts
of clinical staff shortages.
Some hospitals have moved beyond
offering the comfort of private, single-
patient rooms to providing luxury suites
to compete for customers who are will-
ing to pay additional out-of-pocket costs
that are typically not covered by insur-
ance companies.
The Medical Hotel
Three categories of medical hotels cur-
rently exist, each catering to the special-
ized needs of health facility users. The
first type is simply a standard hotel
located proximate to a medical cen-
ter; the second type is a hotel that has
tailored facilities or services to serve the
healthcare segment but may not neces-
sarily be owned by the hospital organi-
zation; and the third type is a hotel that
is physically integrated into a medical
facility, may provide on-site medical ser-
vices to hotel guests, and is likely owned
by the hospital organization.
Medical hotels accommodate a
growing need in the healthcare mar-
ketplace, as the trend toward shorter
inpatient stays increases the demand for
convenient, comfortable, and afford-
able lodging or step-down facilities near
the treatment facility. The advantages
to owners of medical hotels over those
of other hotel property types are their
strong occupancies, lack of seasonality,
and relatively low marketing costs given
the strong demand generated by the
hospital.
The Kahler Grand Hotel, in Roch-
ester, Minnesota, belongs to the first
category of medical hotels, providing
hotel accommodations for patients and
Journal of H e althcar e M anag eme nt 58:1 J anuary /F ebruary 2013
their families at the highly regarded
Mayo Clinic (Rutes, Penner, & Adams,
2001). A variation on this model is
the step-down hotel approach,
whereby specially trained hospital
support staff can establish a formal
relationship and help support patients
at a nearby hotel as a kind of post-
acute hotel, such as the arrangement
between Penn Medicine and Ritz-
Carlton in Philadelphia (Abramson, as
cited in Hollis & Verma, 2012).
The Jesse H. Jones Rotary House
International at MD Anderson Cancer
Center, in Houston, Texas, is an exam-
ple of a medical hotel of the second
category. Owned by MD Anderson and
managed by Marriott International, the
full-service hotel was developed exclu-
sively to serve the needs of MD Ander-
son patients and their families (Rutes et
al., 2001). The hotel features oversized
elevators, hallways, and guest rooms
to accommodate stretchers and wheel-
chairs, and it houses special consulta-
tion and meeting spaces for group and
individual counseling. Some rooms
are equipped with a kitchenette to
support long-term stays; these are
located in a dedicated part of the build-
ing to minimize noise from traditional
hotel guests.
The third type of medical hotel is
exemplified by the hospitel, a term coined
by the management of the Farrer Park
Medical Centre in Singapore. A unique
feature of Farrer Park is the colocation of
the hospital and hotel, called Connex-
ion at Farrer Park. The hospitel provides
accommodations that are more afford-
able than a traditional hotel to patients
with non-life-threatening illnesses, those
requiring long convalescent care, or
52
those who are relatively stable post-
surgery. The hospitel room is a hotel/
hospital room hybrid, featuring basic
medical equipment to provide some
level of medical support and services
and space to accommodate family care-
givers. International patients who travel
to Farrer Park for care can stay in the
hospitel while family and friends have
the option of staying in either the same
hospitel room or in an adjacent hotel
room. With strong physical and opera-
tional integration between hospital
rooms, hotel rooms, and medical suites,
patients are able to stay in a hotel-like
guest room while maintaining access
to medical facilities and clinical staff as
needed.
Hospital Spas, Therapy Programs,
and Wellness Centers
Spas and wellness centers or programs
address the social, psychological, spiri-
tual, physical, and behavioral compo-
nents of health and well-being. They
have been a key driver of hotel guest
satisfaction for the past 20 years and
are increasingly serving as profit centers
(O’Fallon & Rutherford, 2011).
Spas and wellness facilities located
in hospitals can potentially offer ben-
efits to a variety of organizations and
their employees in the community,
not just the hospital itself (Nicholson
et al., 2005; Murray, Nicholson, Pauly,
& Berger, 2006). They can help the
clinical staff capitalize on all possible
avenues of healing for the patients’
benefit and provide patients with
complementary and alternative medical
(CAM) services not always offered in
traditional hospital settings. Apart from
the clinical benefits, spas are becoming
 T he A pp li cati on
recognized as a compatible supple-
mental revenue stream that can offer
competitive advantages.
Indiana University Health North
Hospital, in Carmel, and Henry Ford
West Bloomfield (Michigan) Hospital
have achieved substantial success in
improving patients’ perceptions, profit
margins, and patient referrals after these
hospitals incorporated spas that pro-
vided treatments specifically designed for
patients (Osborn, 2005; Ology Spa, n.d.;
Fierce Healthcare, 2008; Taylor, 2011). In
some cases, health systems such as Cleve-
land Clinic have affiliated with well-
established spas to provide certain health
programs in conjunction with the spa.
The success of hospital spa services may
be partly attributed to obtaining buy-in
from physicians and partly to careful
planning of health centers as purpose-
built facilities that incorporate the spa
and wellness center with the rest of the
hospital from the beginning.
Despite the benefits that can be
derived from having a spa within the
hospital, some issues and challenges
remain. Trade-offs in space need to be
considered, and staff—especially physi-
cians—must be educated to develop
acceptance of spa or CAM services.
Hospitals considering spas should
also explore marketing to a client base
outside the hospital and integrating the
spa’s offerings with existing hospital ser-
vices. For example, the Cayuga Medical
Center, in Ithaca, New York, developed
a freestanding fitness center with on-site
physical therapy space and a spa off of
its campus, closer to the city center, to
serve not only its patients but also the
broader community in an effort to pro-
mote wellness and increase revenue.
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of H ospitality E l ements in H ospi tals
Hotel-Quality Food and Family Dining
Five-star hotels employ trained chefs
who use the finest ingredients and tech-
niques to delight patrons. In contrast,
hospitals have historically served food
that is limited in depth beyond its nutri-
tional purpose. Simple changes such as
serving a freshly baked basket of bread,
as is standard practice in fine-­dining
restaurants, or offering guests warm
chocolate chip cookies at turndown,
a signature amenity of the Doubletree
Hotel chain, can help make guests feel
welcome and pampered. Some progres-
sive healthcare facilities now offer hotel-
style on-site dining and room service for
their patients and visitors to enhance
the facility’s patient and family orienta-
tion, improve patient satisfaction, and
gain a niche in a very competitive mar-
ket (Sheehan-Smith, 2006).
Henry Ford West Bloomfield part-
nered with a Detroit restaurateur, a
college culinary department, and an
organic farm to improve food service at
the hospital (Fierce Healthcare, 2008).
The new food program allows patients
to order nutritious, restaurant-quality
meals 24 hours a day and is combined
with a 90-seat culinary education
facility, a “healthy” café, and a newly
opened teaching greenhouse, all of
which serve the larger community (van
Grinsven, cited in Hollis & Verma,
2012). Griffin Hospital, in Derby, Con-
necticut, part of the Planetree Member
Network, created residential kitchens
in all patient care units, where family
members may prepare meals and dine
with the patient. Moreover, each kitchen
is stocked with beverages and snacks,
and volunteers bake cookies in the after-
noon, creating a distinctly nonhospital
Journal of H e althcar e M anag eme nt 58:1 J anuary /F ebruary 2013
aroma and providing a treat for patients
and families.
Sheehan-Smith’s (2006) study
on hospitals that have incorporated
hotel-style room service showed that
the benefit of offering patients con-
trol over their food choices and meal
times increased patient satisfaction.
One hospital increased from a 25th
percentile ranking in its peer group to
a 99th percentile ranking in the Press
Ganey surveys just one year after room
service was implemented. Other ben-
efits included better use of staff time,
reduced food cost, less food wastage,
enhanced pride among food service
employees, and increased time available
for nursing staff who no longer were
required to deliver meals.
Welcoming Lobby Spaces
In the hospitality industry, the lobby is a
focal point for the hotel. It directs guests
and visitors to the front desk, food and
beverage outlets, elevators, and other
public areas and serves as an informal
gathering space and security control
point for the building. Moreover, the
lobby sets the tone for the entire hotel
or resort experience (Rutes et al., 2001).
The most successful hotel lobby designs
carefully balance their visual impact
with optimum functionality.
Many hospitals built or remodeled
since the 1990s have been inspired by
hotel design, in particular the idea of
grand lobbies that incorporate atriums
and other dramatic design elements.
Henry Ford West Bloomfield Hospital
features a multipurpose atrium—but
rather than being situated at the entry,
it is located near the patient rooms and
includes live trees, a meditation garden,
54
and an organic food and tea kiosk. A
measure of the space’s success is the fact
that the hospital has been asked to host
multiple weddings in the atrium.
While grand public spaces are attrac-
tive and may be appealing to hospital
visitors, health facility planners should
recognize that patients typically do not
experience the hospital lobby for an
extended period, so substantial invest-
ment in lobbies may have limited
benefit for HCAHPS scores. Further, one
must be careful in the design and use of
resources for expansive lobby spaces to
justify the additional construction and
operating expenses these areas require.
Some innovative designs, such as Singa-
pore’s Khoo Teck Puat Hospital’s use of
natural ventilation in its atrium lobby,
may reduce operating costs.
Hospital Concierge, Special Guest
Services, and Service Training
Programs
While design and specialized programs
can be important in their own right,
many hospitals have recognized that
hospitality training and hiring tools and
techniques can be extremely valuable
in promoting high levels of service and
a positive patient/family experience.
Examples adopted by some community
hospitals and members of the Academic
Medical Center Consortium include
concierge or special services for employ-
ees, seamless clinical referral programs
for patients, and personalized services
for staff and guests. In addition to help-
ing patients cope with issues beyond
their immediate hospitalization, these
programs help keep staff on the prop-
erty and free up their time from running
personal errands (Hines, 2009).
 T he A pp li cati on
Although some hospitals have
reported great success in adopting
concierge and similar programs (Hines,
2009), other organizations have not
achieved the positive outcomes they
had expected. The implementation of
any such program must be carefully
conceived.
Hotel-Style Signage and Way Finding
Traditionally, hotels have been designed
to facilitate direction finding through
proper signage and landmarks. Many
hospitals, on the other hand, have been
expanded in multiple phases on limited
parcels of land, making them extremely
difficult to navigate for patients and
families. Hotel-style way-finding strat-
egies can save hospitals significant
amounts of money: One study iden-
tifies savings of about $450 per bed
when accounting for the hidden costs
of hospital staff providing directions
when their responsibilities lie elsewhere
(Zimring, 1990).
Patient room signage often uses
cryptic numbering or follows patterns
that are difficult for newcomers to inter-
pret. A better approach may be hotel-
style sequential room numbering that
is intuitive and familiar. Some hospitals
have also used landmarks such as ponds
and art pieces to help patients and visi-
tors orient themselves in the building,
following the examples of hotels using
lobby elements such as clocks and foun-
tains as way-finding devices. Others,
such as Brigham and Women’s Hospital,
in Boston, have referenced the nearby
Massachusetts Turnpike in creating a
major organizing route through the
hospital called “The Pike.” No matter
the approach, way finding should be
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of H ospitality E l ements in H ospi tals
tackled as a complete system. Printed
directions sent to consumers before
the visit, external building cues, unique
building names, maps, and signs should
all be coordinated among the hospital
departments and made simple, accurate,
and intuitive.
Entertainment and Positive-Distraction
Features
Illness and treatment often generate
tremendous stress and negative emo-
tions for patients and their families. Just
as hotels offer a variety of artwork and
entertainment options to contribute to
a relaxing atmosphere, hospitals with
art galleries, entertainment facilities,
and resource centers can offer what
Pati (2010) calls “positive distractions.”
Research has shown benefits from
positive distraction for both adults and
children, including the reduction of
pain and anxiety, improved energy, and
other desirable physiological and psy-
chological outcomes (Pati, 2010). Given
that pain control is one area measured
by HCAHPS, a combination of hospital-
ity training and physical features that
reduce perceptions of pain may have
potentially positive impacts on evalua-
tions (see Table 1).
In 2009, Miami Children’s Hospi-
tal, with the support of philanthropy,
created the Michael Fux Family Center,
which houses family-friendly ameni-
ties ranging from gaming centers to a
movie theater and performing arts center
(Miami Children’s Hospital, 2012). In its
Children’s Art and Video Center, young
patients and visitors can play video
games, create scrapbooks, and work on
art projects while parents can use the
family library for research or as a quiet
Journal of H e althcar e M anag eme nt 58:1 J anuary /F ebruary 2013
space to work or relax. Children also
have their own library, with storytelling
events and other educational activities.
The center is staffed seven days a week
by hospital personnel and volunteers.
ADDITIO N AL H O S P ITALIT Y
C O N C E P T S W IT H P OT E N TIAL
F OR H E ALT H C AR E
The hospitality industry continues to
develop innovative amenities and design
elements to attract and retain demanding
travelers. While clearly most appropriate
in hotel settings, several of these elements
might represent new opportunities for
hospitals and other healthcare facilities.
Social and Communal Spaces
Limited-service hotel brands, such as
Courtyard by Marriott, Holiday Inn
Express, and Aloft, are designing lob-
bies that serve as a social hub to cater to
a market that is increasingly feeling the
need to stay connected. These lobbies
include comfortable furniture, outlets
for laptop chargers, informal seating
areas, complimentary WiFi, and self-
service food and beverages. Hospitals
might consider creating similar lob-
bies that are functional and comfort-
able rather than merely opulent spaces,
which patients rarely use. These might
also serve as respite areas for families
staying with patients for extended stays.
Executive lounges on specific hotel
floors provide complimentary food
and beverages and highly personalized
service—often with a concierge—as a
perquisite to recognize important guests
and encourage loyalty. While certainly
not appropriate in all cases, hospitals
can incorporate some form of semipri-
vate, upscale lounge on specific inpatient
56
floors, as has been done at New York-
Presbyterian/Weill Cornell Medical
Center’s Greenberg 14 South wing (New
York-Presbyterian Hospital, n.d.).
Libraries
Borrowing an idea from bed-and-
breakfast inns, hospitals can offer small
libraries from which patients may
borrow their favorite reading material
or learn about managing their condi-
tion. Additionally, the library could
rent e-readers or tablet computers for
patients to download media at their
own cost, a successful practice at most
Planetree hospitals and at Henry Ford
West Bloomfield Hospital.
Room Management Technologies
Room management technologies, such
as room key cards, help the hotel save
energy costs by adjusting the room’s
temperature when use of the key card
indicates the guest is not in the room
(Sachs, Nadel, Amann, Tuazon, &
Mendelsohn, 2004). Bedside controls
that regulate temperature and lighting
can enhance guests’ satisfaction in their
in-room experience. Some hotels even
have intelligent ambient control systems
that intuit guests’ intentions (e.g., floor
sensors that activate lighting when the
hotel guests get out of bed). A common
patient frustration is a lack of con-
trol of their environment, particularly
temperature. While patients’ unique
needs require hospitals to treat them
differently than hotel guests and given
that hospitals operate sophisticated
physical plant management systems,
healthcare organizations may be able to
reduce energy costs and/or increase their
patients’ sense of control over the room
 T he A pp li cati on
environment by using a variant of some
of these room management technolo-
gies. Providing touch-screen monitors or
tablets to patients by which to control
the room environment, access entertain-
ment, and place service requests might
also increase the user’s span of control
and may reduce demands on staff time
currently spent responding to requests.
Themed Bathrooms
Some hotels, such as the Westin New
York at Times Square, have designed their
bathrooms to be peaceful and spa-like,
offering opportunities for relaxation and
restoration. Although perhaps appropri-
ate only for medical hotels or lower acute
care settings, this concept might help
to increase perceived value for stay-over
family members who experience stress
from their loved one’s hospitalization.
Expandable or Flexible Room Design
Innovations to increase flexibility in
spaces help hotels accommodate fluctu-
ating demand for suites. These innova-
tions include foldable walls, foldout sofa
beds, and vertically stacked guestrooms
linked by an exterior staircase. By incor-
porating some of these features, a hospi-
tal could potentially expand a regularly
sized hospital room into a VIP suite on
demand. This approach is related to the
hospital concept of “universal” rooms,
which are set up for multiple levels of
acuity but might add a hospitality com-
ponent with revenue potential.
Other Technology Applications
Many hospitality innovations address
the increasing demand for technology
for both utilitarian and entertainment
purposes, such as sophisticated bedside
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of H ospitality E l ements in H ospi tals
controls that provide convenience and
customization or digital lending librar-
ies to reflect many people’s preferences
for taking in media. While some of
these features might be more suitable
for a hotel that is attached to a medical
center than being incorporated directly
into the healthcare setting, they might
yet hold possibilities for increasing satis-
faction for all users, supporting positive
outcomes, and in some cases generating
revenue. Other service providers along
the continuum of care might also adopt
some of these strategies.
I M P LI C ATIO N S A N D
C O N C L U S IO N
Hotels and hospitals share the challenge
of designing facilities that are func-
tional, are cost-effective, and promote
their organizations’ missions. While the
consumer’s selection of hotel facilities
is much more discretionary than that of
hospitals, the need to attract revenue;
meet HCAHPS standards; and promote
positive, patient-centered outcomes
is increasingly leading hospitals to
consider incorporating hospitality
elements in their designs. The hospi-
tal must not lose sight of its primary
goal of providing quality clinical care
when it considers allocating resources
to hospitality-oriented enhancements.
And although improving the experience
without a systematic approach to deliv-
ering value is not sustainable in the long
run, many of these approaches could be
incorporated in a wide variety of hospi-
tal settings, and in some cases with only
limited additional cost (see Table 2).
As the number of examples of hos-
pitality applications in hospitals grows,
policy makers, healthcare executives,
Journal of H e althcar e M anag eme nt 58:1 J anuary /F ebruary 2013
TA B L E 2
Comparing Relative Value of Hospitality Elements
Perceived
Feature Cost Perceived Effect/Outcomes
Hotel-like rooms $$ • Improve patient
satisfaction; allow use of
family as caregiver resource • Require single-patient
• Create new revenue stream
for hospital
Medical hotels $$$ • Provide spaces for families
• Create new revenue stream
for hospital
Hospital spas/ $–$$ • Establish branding for
wellness programs hospital
• Improve patient
satisfaction
• Perpetuate preventive
healthcare
Hotel-quality food $$ • Improve patient • Require changes in food
and family dining satisfaction
• Improve family satisfaction
• Provide patient and family • Require hiring of personnel
dietary education
• Reduce food waste
• Free up time for caregivers
Welcoming lobbies/ $$– • Improve patient
green spaces $$$ satisfaction
• Improve visitor satisfaction
Hospital concierge/ $ • Improve employee
special guest ser- satisfaction
vices/service train- • Improve patient
ing programs satisfaction
• Improve visitor satisfaction
Hotel-style signage $ • Improve patient and
and way-finding visitor satisfaction
tools • Cause fewer patients/
visitors to become lost and
be late for appointments
• Reduce staff time needed
to provide directions
58
Main Challenges in
Implementation
• Create disruption to
existing operations
rooms
• Impose higher cost on
patients
• Require space for expansion
or land to develop
• Require physician buy-in
• May trigger competition
for spaces with other
services in hospital that
may be perceived as more
important
delivery system and related
facilities
for in-room services
• Result in high operating
costs (e.g., energy, cleaning)
• Require training and
program development
• Increase operating costs
• Require educating users
of new room-numbering
system
• Require integration with
other way-finding elements
(e.g., website)
 T he A pp li cati on of H ospitality E l ements in H ospi tals

TA B L E 2 continued

Entertainment and $$– • Improve patient • Cost may be prohibitive if

positive distraction $$$ satisfaction not funded by donors
• Improve family satisfaction
Social and commu- $ • Improve family/visitor • May lead to competition
nal spaces satisfaction for existing spaces within
• Improve patient hospitals
satisfaction
Libraries $$ • Improve family/visitor • May lead to competition
satisfaction for existing spaces within
• Improve patient hospitals
satisfaction
Room management $ • Reduce operating costs • Existing infrastructure
technologies • Increase patient may limit extent of
satisfaction and comfort incorporation of room
management technology
Themed bathrooms $–$$ • Improve patient/visitor • Require accommodation
satisfaction to plumbing equipment
limitations
Expandable patient $$ • Improve patient • Must work around existing
rooms satisfaction structural walls
• Allow adaptability for
multiple uses
• Generate revenue

Note. $ = low perceived cost; $$ = medium perceived cost; $$$ = high perceived cost. The ideas listed in this table are
generalized summaries. The actual cost ranges vary depending on the type of implementation and particular organizational/
facility conditions.

and EBD researchers will have opportu- Implementing hospitality design

nities to more fully assess best practices
and add to the body of research (see Fig-
ure 1). One possible direction for future
research is to examine which hospitality
elements deliver the greatest value in
terms of improving consumer percep-
tions, health outcomes, and employee
productivity, or which elements offer
competitive advantages in the most cost-
effective way.
elements within the hospital is a
complex process. It requires careful
planning; systematic thinking; and con-
sideration of a variety of factors, includ-
ing the healthcare system, needs of
different stakeholders, unique attributes
of organizational or community cul-
tures, other improvement efforts under
way, and financial constraints of the
hospital. Hospitality facility planners

59
Journal of H e althcar e M anag eme nt 58:1 J anuary /F ebruary 2013

FIGURE 1
Selected Additional Organizational Resources

American Academy of Healthcare Interior Designers, http://www.aahid.org/

American College of Healthcare Architects, http://www.healtharchitects.org
American College of Healthcare Executives, http://www.ache.org:
• “Managing Healthcare Facility Design and Construction Programs” [seminar], http://
www.ache.org/seminars/seminar.cfm?pc=DESCO
• Selected sessions at the 2012 Congress on Healthcare Leadership, http://www.ache.org/
Congress/pdf/CongressBrochure2012.pdf
American Institute of Architects, http://www.aia.org
American Society for Healthcare Engineering of the American Hospital Association, http://
 www.ashe.org
Center for Health Design, http://www.healthdesign.org/chd
Cornell University Center for Hospitality Research, http://www.hotelschool.cornell.edu/
 research/chr
Facility Guidelines Institute, http://www.fgiguidelines.org
Planetree, http://www.planetree.org

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PRAC TITIONER A P P L I C AT I O N

Laureen K. Tanner, RN, FACHE, president and CEO, Ranken Jordan—A Pediatric
Specialty Hospital, Maryland Heights, Missouri

W hen we at Ranken Jordan—A Pediatric Specialty Hospital began the design

process for our current facility 10 years ago, we knew we wanted to create a place
where even the sickest kids could be just kids and where the whole family felt wel-
come. Our goal was to make sure no one felt like an uninvited guest.
As we worked with the architect, we incorporated several of the hospitality ele-
ments described in Wu et al.’s article into the design. This was not a marketing deci-
sion but rather a choice made to recognize the value that design brings to a healing
environment. Certainly, our aging facility discouraged some parents from bringing
their children to Ranken Jordan for care, but the more important issue was the need
to provide an environment that facilitates the kind of care that our team was devel-
oping. We believed that the hospitality features we chose would make a genuine
difference in outcomes for the children and their families. With the new design, our
facility became almost a member of our care team.

62