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 28 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