Sita Ananth and Mary Hassett's H&HN Daily column last week, on the rise of hospital amenities as a factor in driving competitive edge relative to quality performance, elicited several responses from our readers. The quality vs. amenities debate is heated, I think, because it carries the implicit suggestion that clinical excellence isn't as important as the quality of the food or the view out the hospital room window.

Deirdre Mylod commented that amenities do, indeed, play a role in quality, noting "we need to be careful about trivializing healing attributes of the care environment as merely amenities that are separate from quality. We also need to allow for more layers of 'quality assessment' that patients can and do make beyond just hospital level metrics of quality performance such as safety or mortality issues."

And reader Monte Fulton also chimed in: "As healthcare grows more competitive and cost conscious, most organizations will gain a competitive edge by improving amenities. The hospitality industry learned this a long time ago!"

Personally, though, there's a third factor that overrides overall quality outcomes and aesthetics when I informally rate a facility—my informal read of staff competence and communication acumen. I'm much more likely to judge a hospital experience on the communication skills of the nursing staff and physicians, the relative order or chaos of the visit and my admittedly nonclinical take on the overall decision-making process. Thankfully, I haven't had the misfortune to end up in a hospital bed since I was 8, but I've visited enough folks in the last few years to form opinions about the type of place I would want to end up in.

The ED visit a few years back where my octogenarian grandmother was left for 45 minutes before boarding a few feet from a young, apparently overmedicated man as he screamed and lunged at his family? It may be an unfair judgment, but it's not an experience I'm yearning to revisit, although members of my family have gone to that facility for decades. The hospital where a cousin spent a few weeks where protocols and procedures were posted everywhere, the staff was friendly and decisions were explained clearly? Unfortunately, it's out of state, but otherwise I'd go there for my own care in a heartbeat.

I've definitely also noticed the wide variance in amenities that exists today—from Spartan accommodations with views of brick walls and old TVs to private rooms with spectacular panoramas. But while aesthetics definitely contribute to the overall experience, my recollections of hospital visits invariably return to recollections of staff behavior and institutional order—or lack thereof.  And while I've occasionally researched quality outcomes on a specific procedure to try to figure out whether a specific hospital is up to snuff on say, cardiac care, my personal satisfaction as a visitor or concerned family member ultimately returns to my observations on order and care.

Did the nursing staff clearly communicate with everyone in a respectful manner? Were clinical decisions, accounting for the built-in chaos of any hospital experience, explained in a manner that suggested high-quality decision-making? It's these factors, and not the number of flat screen TVs or even a high HCAHPS score, that ultimately would play the greatest role on which hospital I would want to spend time in. And I don't think I'm alone.