Healthcare Design - March 2016 - 28

C THE CENTER | 03.16
Teaching to the test
The unintended negative consequences of teaching primary school students
to perform well on tests may serve as a warning to designers creating spaces
to achieve high HCAHPS scores By Debra Levin
A group of well-meaning politicians crafted the federal No Child Left Behind Act of 2001 (NCLB), in an
effort to make schools accountable for improving
student performance. The law required all schools
to test the reading and math skills of second
through 12th graders. How well the students progressed year after year toward proficiency in these
subjects was directly tied to the federal funding
the schools received, with other punitive actions
potentially coming into play if schools continued to
underperform.

not only by involving a multidisciplinary team in
the design process, but also by looking at the
culture of the organization and how that culture
can be harnessed to work symbiotically with the
facility design.

Critics of the law said that by focusing on reading and math, other subjects like social studies,
the arts, and physical education became less
important and resources to create diverse educational opportunities dried up. Some schools even
cut back on recess in order to provide more time
in the classroom, something that seems counterintuitive for a generation that already spends more
time with electronic devices than outside playing
with friends.
There have been positive outcomes from the
law, though, such as younger students testing at a higher level in basic reading and math.
But when these same students reached middle
school and high school, they struggled more with
critical thinking skills as the tests got more complex. Since NCLB's implementation in 2002, we
seem to have educated a generation of good test
takers but not a generation of great thinkers.
It's hard not to draw a connection between
these efforts in education and their correlation
to federal funding with the current push toward
improving HCAHPS scores and their correlation to
Centers for Medicare and Medicaid Services reimbursements to healthcare institutions. HCAHPS
scores have caused providers to focus more of
their efforts on the items being measured in the
survey, in an attempt to improve outcomes and
maximize their reimbursements.
So how can we learn from the unintended
negative consequences of "teaching to the test"
in education? How can we avoid designing
environments myopically, creating spaces that
are designed solely to improve survey scores
leading to reimbursement at the expense of other
outcomes? Healthcare facilities require us to continue to take a holistic approach to their design,

With all of this said, it's still important to
continue to focus on how we can improve
HCAHPS scores through the built environment.
As a community, we all have to rally around
creating healthcare environments that produce
the best possible health outcomes, at the most
reasonable cost of care, and to support a
healthcare institution in its success. The topics
the HCAHPS survey tool measures do directly
tie back to health outcomes and the experience
the patient and their family members have during treatment.
The key is also to learn from other industries
and make sure we don't start designing exclusively to the survey. NCLB had its successes in
education, as has measuring patient satisfaction through the HCAHPS survey allowed for
improvements in the healthcare experience. It's
our role as stewards of the healthcare environment to continue to keep a holistic eye on the
total value the environment can have on healthcare and not become hyper-focused on only
what is measured. HCD

HCDmagazine.com 03.16

HCAHPS scores have caused providers to
focus more of their efforts on the items being
measured in the survey.

Debra Levin is president and CEO of The Center
for Health Design. She can be reached at dlevin@
healthdesign.org.

Debra Levin

http://www.HCDmagazine.com

Table of Contents for the Digital Edition of Healthcare Design - March 2016