The Case for Including Friends and Family in the Healing Process

Key Insights

  • Evidence shows that welcoming families into the patient room is good for patients, family members, caregivers, and healthcare organizations.
  • Having a support person in the room appears to improve patient safety – reducing overall costs.
  • The patient’s guests can improve communication and understanding between the patient and caregivers.
  • Family support during treatment is linked to higher patient satisfaction scores.
  • Creating family zones in patient rooms encourages guests to be part of the healing process around the clock. 

Not so long ago, the friends and family of hospital patients had to abide by strict visiting hours. Today, many healthcare organizations are taking a different approach, welcoming guests to stay around the clock as a key part of the patient care team.

This about-face is being driven by mounting evidence that shows the support of guests can help healthcare organizations meet their goals. From improving patient outcomes to reducing costs, the most valuable thing a healthcare organization can add to a patient room may be a “welcome mat” for family and friends.

For starters, having a familiar face and hand to hold night and day is simply what many patients want. Susan Frampton, president of the nonprofit patient-centered organization Planetree, says, “Across regions, cultures, generations and other demographics, certain hallmark patient-centered practices... consistently surface as the way patients want their healthcare delivered. They don’t want to be needlessly (and somewhat arbitrarily) separated from their loved ones....They want their loved ones to be supported to take on aspects of their care and care management.”1

Recent studies show many other compelling reasons to give families a place in the healing process—and the patient’s room. 

Patient Safety

While every healthcare organization strives for a perfect safety record, the statistics for serious-injury falls are sobering.
A recent study at three Midwestern hospitals found they increased the length of inpatient stays by 6.9 days and hospital charges by $13,806.2

However, researchers have identified a surprisingly effective way to prevent these falls. In a 2012 study, data showed there are roughly half as many falls in patient rooms with a designated family area as there are in rooms with no designated family area.3

In another study, following a renovation to create large, single- bed rooms at Methodist Hospital in Indianapolis, families spent more time with the patients, and falls were cut by two-thirds.4 5 In fact, the Fable Hospital 2.0 analysis, which envisioned an ideal environment for patient care, revealed that adding space to accommodate families adds an estimated $1,000,000 to construction costs—but those same family/social spaces contribute to a savings of $1,534,166 in reduced patient falls.6

The evidence is so strong that in 2011, the American Association of Critical Care Nurses added the following statement to its PracticeAlertTM: “The unrestricted presence and participation of a support person can enhance patient and family satisfaction because it improves the safety of care.”7

In addition to preventing falls, family presence has been linked to reducing the patient’s anxiety, decreasing the chance of medical error, relieving staff by providing non-clinical patient assistance, and providing an added layer of security.8 Numerous studies also demonstrate the value of family to patients’ engagement in medical decision-making,9 treatment adherence,10 quality of healthcare processes11,12, physical and mental health,13 and mortality.14 

Enhanced Communication

Having family members in the patient room may also improve communication between the patient and caregivers, particularly if the patient is a child or unable to speak or think clearly. Often, the family can share information about the patient’s history or typical behavior, helping caregivers understand how the patient’s mental or physical status may be changing. The Institute for Patient-Centered Design backs up this idea, saying, “Unrestricted presence of a support person can improve communication, facilitate a better understanding of the patient, advance patient- and family-centered care, and enhance staff satisfaction.”8

Another study suggests that family companions can influence the quality of patients’ healthcare in several ways, including:

Facilitating information transfer and coherent service use across time and healthcare settings, motivating patients to adhere to treatment regimens on a daily basis, initiating contact with health professionals to report on emerging conditions or symptom exacerbation, and advocating on behalf of patients for services, benefits, and provider attentiveness to patients’ preferences and needs.15

Higher Patient Satisfaction

While patient satisfaction has always been an important factor in the competitive healthcare market, it’s now more crucial than ever to an organization’s success. With the passage of the Affordable Care Act, Medicare and Medicaid reimbursement is now linked to patient satisfaction scores, and raising these HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) scores can help boost an organization’s bottom line.

One effective way to do so may be to invite the family into the patient room. According to a 2008 report,16 numerous studies demonstrate the relevance of family presence to satisfaction with physician care. The Fable Hospital 2.0 analysis supports this idea by suggesting, “Family support and involvement in patient care can enhance clinical outcomes and increase satisfaction with the hospital experience.”6 

Creating a Welcoming Space

Given all of this evidence, the case for welcoming families into the healing process is clear. But what exactly does a “welcoming space” look like, and how can an organization make use of evidence-based design to create a space that encourages families to stay nearby?

According to the Fable Hospital 2.0 analysis, “Hospitals can foster these benefits by incorporating family gathering spaces, such as dining and kitchen spaces, business centers, and sleeping rooms.6” An increasing number of critical care units are cultivating a more patient- and family-centered culture by providing comfortable family zones in patient rooms and family areas in public areas that encourage family presence and involvement.17, 18, 19, 20, 21

With new construction, extra space can be incorporated to accommodate family members. The 2010 Guidelines for the Design and Construction of Healthcare Facilities now provide specific design provisions for patient- and family-centered rooms, including an additional minimum of 30 square feet per family member, and a home-like atmosphere22. The Fable Hospital 2.0 analysis suggests even more space for guests, citing a study that says, “Increasing room size by 100 square feet allows family members to stay overnight with the patient, increasing their satisfaction and involvement in care.”23

In existing spaces, organizations need to look for other ways to welcome families within the limited footprint of the patient room. One study suggests that a designated family area with recliners, sofa beds, and sofa bed drawers may increase the perception that family members are welcome and encouraged to remain close to their loved one and to stay longer.24

Evidence-based design has also led healthcare furniture designers to develop more complete family-centered solutions. What began with recliners and convertible sleep sofas has grown into more activity-based planning to address the needs of guests around the clock. Today’s patient rooms might include tables and integrated power and data that let guests work, eat, and entertain themselves, dedicated storage to keep personal items out of the way of caregivers, and seating options that let guests adjust their proximity to the patient.

“Increasing room size by 100 square feet allows family members to stay overnight with the patient, increasing their ” satisfaction and involvement in care.

– The Fable Hospital 2.0 Analysis

The importance of families in the healing process is becoming more widely recognized around the world, with research showing their presence can be an effective tool for improving patient outcomes, communication, and satisfaction, and reducing costs. As more organizations open the door to family involvement, expect a continuing evolution of solutions that make them feel welcome in the patient room and encourage them to stay around the clock. 

1. Frampton, S. Don’t let lack of evidence delay patient-centered changes. Modern Healthcare. January 6, 2014.

2. Wong CA, Recktenwald AJ, Jones ML, et al. The cost of serious fall-related injuries at three Midwestern hospitals. Jt Comm J Qual Patient Saf 2011;37(2):81-7.

3. Calkins, Margaret; Biddle, Stacy; Biesan, Orion. Contribution of the Designed Environment to Fall Risk in Hospitals. Ideas Institute. 2012.

4. Hendrich A.; Fay, J.; & Sorrells, A. Courage to heal: Comprehensive cardiac critical care. Healthcare Design, 11-13. 2002.

5. Hendrich A.; Fay, J.; & Sorrells, A. Effects of acuity-adaptable rooms on flow of patients and delivery of care. American Journal of Critical Care, 13(1), 35-45. 2004.

6. Sadler, Blair L.; Berry, Leonard L.; Guenther, Robin; Hamilton, D. Kirk; Hessler, Frederick Al; Merritt, Clayton; and Parker, Derek. The Hastings Center –
Fable Hospital 2.0: The Business Case for Building Better Health Care Facilities. <http://thehastingscenter.org/Publications/HCR/Detail.aspx?id=5006>

7. Bell, Linda. American Association of Critical Care Nurses AACN PracticeAlertTM. Family Presence Visitation in the Adult ICU. November 2011.

8. Institute for Patient-Centered Design, Inc., 2011. “10 Principles of Patient- Centered Design.” 2011

9. Clayman, M.; Roter, D.; Wissow, L.; Bandeen-Roche, K. Autonomy-related behaviors of patient companions and their effect on decision-making activity in geriatric primary care visits. Soc Sci Med. 2005; 60(7): 1583-1591. [PubMed: 15652689].

10. DiMatteo, M. Social support and patient adherence to medical treatment:
a meta-analysis. Health Psychol. 2004; 23(2): 207-218). [PubMed 15008666].

11. Glynn, S.; Cohen, A.; Dixon, L.; Niv, N. The potential impact of the recovery movement on family interventions for schizophrenia: opportunities and obstacles. Schizophr Bull. 2006; 32(3): 4511-463. [PubMed 16525087]

12. Vickrey, B.; Mittman, B.; Connor, K.; Pearson, M.; Della Penna, R.; Ganiats, T.
et al. The effect of a disease management intervention on quality and outcomes of dementia care: a randomized, controlled trial. Ann Intern Med. 2006; 145(10): 713-726. [PubMed 1711916].

13. Seeman, T. Health promoting effects of friends and family on health outcomes
in older adults. Am J Health Promot. 2000; 14(6):362-370. [PubMed: 11067571]

14. Christakis, N.; Allison, P. Mortality after the hospitalization of a spouse. N. Engl J Med. 2006; 354(7): 719-730. [PubMed: 16481639]

15. Berwick, DM. What ‘patient-centered’ should mean: confessions of an extremist. Health Aff (Millwood). 2009; 28(4): w555-565. [PubMed: 19454528]

16. Wolff, J; Roter, D. Hidden in plain sight: Medical visit companions as a quality of care resource for vulnerable older adults. Arch Intern Med. 2008; 168(13):1409-1415. [PubMed: 18625921]

17. Douglas CH, Douglas MR. Patient-friendly hospital environments: Exploring the patients’ perspective. Health Expect. 7(1):61-73. 2004.

18. Douglas CH, Douglas MR. Patient-centered improvements in health-care built environments: Perspectives and design indicators. Health Expect. 8(3):264-276. 2005.

19. France, D.; Throop, P.; Walczyk, B.; Allen, L.; Parekh, A.D.; Parsons, A.;
et al. Does patient-centered design guarantee patient safety? Using human factors engineering to find a balance between provider and patient needs. Journal of Patient Safety, 1(3), 145-153. 2005.

20. Rashid, M. A decade of adult intensive care unit design: A study of physical design features of best-practice examples. Critical Care Nursing Quarterly, 29(4), 282-311. 2006.

21. Seo, H.; Choi, Y.; Zimring, C. Impact of hospital unit design for patient-centered care on nurses’ behavior. Environment and Behavior, 43(4), 443-468. 2011.

22. The Facility Guidelines Institute, P. 91. 2010.

23. M. Rashid, “A Decade of Adult Intensive Care Unit Design: A Study of the
Physical Design Features of the Best-Practice Examples,” Critical Care Nursing Quarterly 29, no. 4 (2006): 282-311; D. Harris et al., “The Impact of Single Family Room Design on Patients and Caregivers: Executive Summary,” Journal of Perinatology 26, suppl. 3 (2006): S38-S48; C.H. Douglas and M.R. Douglas, “Patient-Centered Improvements in Health-Care Built Environments: Perspectives and Design Indicators,” Health Expectations: An International Journal of Public Participation in Health Care and Health Policy 8, no. 3 (2005): 264-76; H. Chaudhury, A. Mahmood, and M. Valente, “Advantages and Disadvantages of Single- versus Multiple-Occupancy Rooms in Acute Care Environments—a Review and Analysis of the Literature,” Environment and Behavior 37, no. 6 (2005): 760-86.

24. Choi, Y.-S., & Bosch, S. J. (2013). Environmental affordances: Designing for family presence and involvement in patient care. Health Environments Research & Design Journal, 6(4), 53-75.