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Hospitals have made vast improvements since the days of the overcrowded wards of the 1950s and 1960s. In the 1970s and 1980s, hospitals began to identify the need for more privacy, with semi-private rooms. This was a vast improvement but still did not meet the needs of most families. Gradually, as the nursing model of care changed, family-centered care (FCC) became the standard. We all know the importance of family bonding, patient education, and lactation support in a healing environment, but few obstetrical services have had the facilities or the resources to fully operationalize this concept. In the 21st century, while building on FCC and responding to consumer needs, hospitals have begun to build hotel-like services into maternity care. In my opinion, this enables hospitals to enhance the family's experience during childbearing.

Although nursing care and patient education are the heart of postpartum care, both are complemented by the use of hotel and concierge services in a maternity program. In two programs that I implemented, hospital architects worked with staff in all departments to use design, soothing colors, and art to create a healing environment. Programs such as this also offer amenities such as room service 24/7 from a restaurant-type menu, with food delivered within 30 minutes. The usual institutional linens are replaced by higher quality linens, fluffy towels, designer pajamas and gowns, and signature bathrobes. Families can sleep on a pull-out sofa or roll-away bed and join the patient for meals as guest trays are provided. Internet access and a concierge service assist with any other desired programs such as massage, hairdressing, and manicures and pedicures (paid for as fee-for-service).

Do amenities make a difference in patients' and families' perceptions of care? Yes!! A study of 67 obstetric patients found that satisfaction with maternity services is strongly related to the aesthetics of the hospital's physical environment, comfort for themselves and their partner, cleanliness, variety/quality of food, valuing of their individual preferences, and incorporation of the family into care (Howell & Concato, 2004). In a Norwegian study (Caspari, Naden, & Eriksson, 2007), patients cared for in an aesthetically pleasing environment reported greater general well-being, and the authors suggested that aesthetics, often ignored in hospitals, should be considered an important aspect of quality patient care. Ulrich's (2001) Theory of Supportive Design links healthcare environments to increasing coping and decreasing stress for patients, families, and staff.

In my own institution, the "likelihood to recommend" on the patient satisfaction survey increased from 84.2% to 90.6% when a patient care unit was moved into a new space with an amenity program, although the staffing and nurse manager remained the same. Amenities included guest service managers, room service dining, and a hotel-type room. The guest service managers, educated in both hospital and hotel operational (not clinical) service, coordinate the hotel amenities and are additive to the nursing staff, not used as substitutes for nursing in any way. Thus, the nurse continues to attend to essential clinical care, patient and family education, breastfeeding instruction, skin-to-skin support, and partnering with the new families. Enabling nurses to provide nursing care while others provide the guest services is a major nurse satisfier.

Hotel-like units can also generate incremental revenue for an institution; one unit generates more than $3 million annually in revenue through the amenities program, which includes a holistic nursing spa-located in the hospital-to provide massage, aromatherapy, and reflexology (for a fee) to staff and families. Revenue from the spa supports holistic nurses who provide complementary therapeutic massages to staff on duty to mitigate stress. A doctoral nursing student/nursing leader at our hospital is now studying the reduction of nurses' stress through the use of therapeutic massage.

Patient satisfaction surveys clearly show a need for privacy, cleanness, a quiet environment, appetizing food, and personal attention. Hotel services add to FCC, enhancing the experience for parents, families, and staff. This healing environment should be available to all patients.

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