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          Beyond resource efficiencies, green buildings aim to create healthy indoor environments for building occupants. In terms of improving occupant well-being, a unique case emerges for healthcare facilities, whose patients may be at a vulnerable state. In the U.S., the Leadership in Energy and Environmental Design (LEED) rating system has become the most widely recognized certification system for green buildings, including green healthcare facilities and buildings. Hospitals with high total scores in the LEED rating system are green buildings but may not necessarily be the optimal green healthcare environment from a patient’s wellbeing perspective. Certified health-care facilities were analyzed in terms of their credit valuation to assess whether health-care facilities prioritize specific criteria that influence patient wellbeing and recovery time. Analysis of results indicate hospitals may be valuing the level of certification more than those credits that were deemed relevant for patient wellbeing and rate of recovery, either due to lack of information or due to economic constraints. To consolidate the previous results and to compare the performance of LEED certified green hospitals to the national average, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey was analyzed for patients’ perspectives on the healthcare facility. Results indicate higher satisfaction in green hospitals’ overall patient care performance as well as a greater tendency to recommend green hospitals to others compared to the national average. No statistical significance was found for hospital cleanliness and quietness between green hospitals and the national average.

          • Hospital LEED scores not directly aligned with credits that affect patient wellbeing

          • HCAHPS survey results compared green hospitals to the national average

          • Overall patient satisfaction 3.6% higher in green hospitals versus non-green hospitals

          • Patients self-reported 5.6% more likeliness to recommend green hospitals to others

          • No statistical difference observed for hospital cleanliness or quietness

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          Most cited references 37

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          Development, implementation, and public reporting of the HCAHPS survey.

          The authors describe the history and development of the CAHPS Hospital Survey (also known as HCAHPS) and its associated protocols. The randomized mode experiment, vendor training, and "dry runs" that set the stage for initial public reporting are described. The rapid linkage of HCAHPS data to annual payment updates ("pay for reporting") is noted, which in turn led to the participation of approximately 3,900 general acute care hospitals (about 90% of all such United States hospitals). The authors highlight the opportunities afforded by this publicly reported data on hospital inpatients' experiences and perceptions of care. These data, reported on www.hospitalcompare.hhs. gov, facilitate the national comparison of patients' perspectives of hospital care and can be used alone or in conjunction with other clinical and outcome measures. Potential benefits include increased transparency, improved consumer decision making, and increased incentives for the delivery of high-quality health care.
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            Measuring hospital care from the patients' perspective: an overview of the CAHPS Hospital Survey development process.

            To describe the developmental process for the CAHPS Hospital Survey. A pilot was conducted in three states with 19,720 hospital discharges. A rigorous, multi-step process was used to develop the CAHPS Hospital Survey. It included a public call for measures, multiple Federal Register notices soliciting public input, a review of the relevant literature, meetings with hospitals, consumers and survey vendors, cognitive interviews with consumer, a large-scale pilot test in three states and consumer testing and numerous small-scale field tests. The current version of the CAHPS Hospital Survey has survey items in seven domains, two overall ratings of the hospital and five items used for adjusting for the mix of patients across hospitals and for analytical purposes. The CAHPS Hospital Survey is a core set of questions that can be administered as a stand-alone questionnaire or combined with a broader set of hospital specific items.
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              Morning sunlight reduces length of hospitalization in bipolar depression.

              Bright artificial light improves non-seasonal depression. Preliminary observations suggest that sunlight could share this effect. Length of hospitalization was recorded for a sample of 415 unipolar and 187 bipolar depressed inpatients, assigned to rooms with eastern (E) or western (W) windows. Bipolar inpatients in E rooms (exposed to direct sunlight in the morning) had a mean 3.67-day shorter hospital stay than patients in W rooms. No effect was found in unipolar inpatients. Natural sunlight can be an underestimated and uncontrolled light therapy for bipolar depression. This is a naturalistic retrospective observation, which needs to be confirmed by prospective studies.

                Author and article information

                Journal of Green Building
                College Publishing
                Fall 2020
                9 December 2020
                : 15
                : 4
                : 3-18
                Author notes

                1. University of Delaware, College of Earth, Ocean and Environment, 111 Robinson Hall, Newark, DE 19716, USA

                2. TED University, Department of Civil Engineering, Ziya Gökalp Cad. No:48, Kolej 06420, Ankara, Turkey

                * Corresponding Author

                Volumes 1-10 of JOGB are open access and do not require permission for use, though proper citation should be given. To view the licenses, visit

                Page count
                Pages: 18
                RESEARCH ARTICLES


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