Hospitals rethink their overexposing patient gowns

Whether a patient has come to a hospital to have an organ transplant, an appendectomy or a baby, one complaint is common: the gown.

You know the one. It might as well have been stitched together with paper towels and duct tape, and it usually leaves the wearer's behind hanging out.

“They are horrible. They are demeaning. They are belittling. They are disempowering,” said Camilla McRory of Olney, Md., who has had multiple hospital stays.

But if efforts by some health systems are an indicator, the design may be on its way out of style.

The Cleveland Clinic was an early trendsetter. In 2010, it introduced new gowns after being prompted by its chief executive, who often heard patient complaints about the garment when he was a practicing heart surgeon. That feedback led to a search for something new, said Adrienne Boissy, the Cleveland Clinic's chief experience officer.

The prominent academic medical center ultimately sought the help of fashion icon Diane von Furstenberg, settling on a reversible gown with a front and back V-neck, complete derrière coverage and features such as pockets, softer fabric and a new bolder print pattern.

Patients “loved the gowns,” Boissy said. “People felt much more comfortable in the new design, not just physically but emotionally.”

The redesign is part of a trend among hospitals to improve patient reviews and their own bottom lines, fueled in part by such federal initiatives as the Affordable Care Act's focus on quality of care. The Centers for Medicare & Medicaid Services increasingly factors patient satisfaction into its quality measures, which are linked to the Medicare payments that hospitals get.

Sometimes the efforts involve large capital improvement projects. But they can also mean making waiting rooms more comfortable, improving the quality of food served to patients and even updating hospital gowns. Ultimately this focus leads to “a better patient experience,” said John Combes, senior vice president of the American Hospital Association.

The Detroit-based Henry Ford Health System is updating its gowns, an initiative that began when the system's innovation institute challenged students at the city's College for Creative Studies to identify and offer a solution to one hospital problem.

The students responded with a suggestion to redo the uncomfortable, flimsy gown. The process took three years, but last fall the institute unveiled a new and improved version. It's made of warmer fabric — a cotton blend — that wraps around a patient's body like a robe and comes in navy and light blue, the hospital's signature colors.

Patient expectations are also part of the calculus. They “are demanding more privacy and more dignity,” which is sparking hospitals' growing focus on redesigning gowns, said Michael Forbes, a product designer at the institute who developed the gown that the students inspired.

When the institute tested his design in 2013, patient-satisfaction scores increased noticeably in a few days, Forbes said.

The new gown “was emblematic … of an attitude that was conveyed to me at the hospital — that they cared about me as a whole human being, not just the part they were operating on,” said Dale Milford, who received a liver transplant at Henry Ford Hospital while the gown redesign was being tested. “That was the subtext of that whole thing, was that they were caring about me as a person and what it meant for me to be comfortable.”

Replacing the traditional design is more complicated than it might seem. What patients wear needs to be comfortable yet allow health professionals proper access during exams, meaning it needs to open and close easily. The gowns also need to be easily mass-manufactured, as well as efficiently laundered and reused.

New designs, though, can be expensive. After Valley Hospital of Ridgewood, N.J., switched to pajamas and gowns that provide extra coverage, for instance, costs went up $70,000 per year, said Leonard Guglielmo, the facility's chief supply chain officer, because the new garments cost more to buy and maintain.

At the same time, the hospital culture can be slow to change, said Todd Lee, an assistant professor of medicine at McGill University, who co-authored a 2014 study that looked at whether gowns were important and whether patients might be fine wearing their own or hospital-provided pants, instead of or along with gowns.

Often, doctors reported that pants or undergarments beneath gowns would have been OK, but patients said they were never given those options. Traditional gowns make it easier to examine patients quickly, and several doctors Lee spoke to seemed shocked at the idea that patients might wear garments other than the open-backed gown during their stay.

The most common impediment to rethinking the gown, said Dusty Eber, president of PatientStyle, a California-based company that designs alternative gowns, is that hospital decisions are often made by committees, not individuals.

“There's a lot of bureaucratic runaround,” Eber said.