Food for Thought: The Impact of a Hospital’s Cafeteria Renovation on Patient Care Experiences

Patient experience is an intrinsically important dimension of care that is increasingly rewarded by pay-for-performance models and reflected in public reporting efforts. In addition to technical care quality, however, practice amenities may influence patients' experiences, with implications for provider payment. In this study, we examine the causal impact of the extensive renovation of a hospital’s cafeteria on patients’ experiences with ambulatory care and subsequent patient demand for care.

Using data from electronic health records linked to patient experience surveys administered to a random sample of ambulatory visits at two large Boston-area hospitals, we conduct difference-in-differences and event study analyses to compare how patient experience ratings evolved between December 2015 and 2017 in one hospital that renovated its cafeteria (treatment) compared to a nearby hospital within the same system that did not (control). This approach produces unbiased estimates of the impact of the renovation at the treatment hospital assuming differences in experiences would have remained constant in the absence of the renovation. To test the plausibility of this assumption, we perform falsification analyses.

Our study included 56,730 ambulatory visits of 37,061 patients treated by 910 attending physicians over the 9 quarters before and after the renovation of the treatment hospital’s main cafeteria in 2016–2017. Patient and practice characteristics, including patient age, sex, race, education, insurance status, and comorbidities, were balanced across groups. The treatment hospital’s cafeteria renovation was associated with a statistically significant 3.4 percentage point (11.5%) differential average increase in patient experience ratings overall. The increase occurred immediately after renovation and persisted thereafter. Falsification tests showed no significant ratings changes in the control hospital or off-campus practices affiliated with the treatment hospital (and thus far from the cafeteria).

A hospital’s cafeteria renovation improved patients’ overall experiences with hospital ambulatory care and may attract additional patients. Our findings have implications for hospital quality measurement and payment policy, which should consider that hospitals may strategically compete on non-technical aspects of care.