Methodist Hospital rethinks the gap-in-the-back hospital gown

Hospitals want to cover your backside.

This summer, Methodist Hospital in St. Louis Park will join a select group of medical centers that are trying to close the dreaded gluteal gap patients get with most hospital gowns.

Beyond complaints about flimsy materials and faded colors, patients in focus groups have told the hospital they feel exposed with current gowns — in ways that promote an unnecessarily hierarchical relationship with caregivers.

"Everyone hated the patient gown," said Christa Getchell, president of the Park Nicollet Foundation, which is related to the hospital. "There's a lack of dignity. … So, it was really to create an equalizer for patient care."

Methodist Hospital hasn't decided whether to switch to new gowns. Instead, the medical center will be part of a six-month study to compare current gowns and linens vs. premium products in terms of cost and patient satisfaction.

Hospitals are being pushed to improve the experience of care for patients, with the federal Medicare program in April unveiling a new five-star rating system for hospitals based on patient surveys.

The public scores will factor everything from the responsiveness of staff to the cleanliness of facilities, so some hospital officials believe they can't afford any ill will from an ill-fitting gown.

The hospital gown market currently generates sales of about $85 million per year, according to Premier Inc., a North Carolina-based company that contracts for a wide variety of hospital supplies. Change doesn't come easy, hospital officials say, and isn't cheap at the outset.

Premium products can cost twice the price of a standard gown, which industry sources say can cost between $4 and $7. Change can be complicated because many hospitals don't actually own the gowns their patients wear — instead, the garments are rented from laundries that also clean and replace gowns as they wear out.

Finally, new gowns must still be functional and not create headaches for nurses and support staff.

"Hospitals are running on pretty tight margins, so if they're adding to fixed costs, they'll have to justify them," says Stephen Parente, a health policy expert at the University of Minnesota. Noting that current gowns are "never flattering," Parente adds: "As far as I can tell, it looks like the technology hasn't changed in maybe 80 years."

The style for current hospital gowns dates back to 1910 and was designed with at least one clear function in mind. The opening in back made it easy to use bedpans, said A. Blanton Godfrey, a professor in the college of textiles at North Carolina State University.

In 2006, Godfrey and colleagues were the recipients of a $230,056 grant from the Robert Wood Johnson Foundation to develop possible new designs for patient gowns. As part of the project, researchers found that 60 percent of former hospital patients surveyed said they "disliked" or "disliked very much" wearing the traditional hospital gown.

Even so, a 2009 summary of the work acknowledged "the patient gown has qualities that account for its widespread use: it is simple, low in cost and maintenance, and provides health care providers easy access to the patient's body for monitoring and procedures."

Making the switch

If Methodist Hospital switches to a new design, it won't be the first medical center to do so.

Maple Grove Hospital opened at the end of 2009 with premium patient gowns in hopes of differentiating the medical center from the competition, said spokeswoman Jennifer Krippner.

The hospital's gowns tie in the back and on the side and are made from a jersey knit fabric, she said. Patients also have the option of wearing hospital-issued pants. At the launch, there was only one hitch.

"I didn't buy enough," said Jennifer Perkins, the hospital's manager of environmental services and materials management.

Figuring out how many gowns to buy was an important part of a 2013 switch at the Cleveland Clinic. The hospital worked with designer Diane von Furstenberg to develop a wrapping garment that features lightweight, durable fabric and can be worn as a gown or a robe.

The first phase of the transition involved just a subset of the clinic's 10-hospital network, and officials determined they had to buy about 155,000 gowns.

The unit cost jumped from about $4 to $14, but the increase wasn't a concern given patient benefits, said Jeanne Murphy, a nurse and executive liaison who worked on the project. Plus, the clinic doesn't need to replace the new gowns as often.

Valley Hospital in Ridgewood, N.J., switched to new gowns in 2012, and patients and hospital officials have been pleased with the change, said Leonard Guglielmo, the chief supply chain officer. But annual replacement costs are about $100,000, he said, rather than about $65,000 with standard gowns.

Noting that hospitals don't bill patients or insurers directly for gowns, Guglielmo said: "You need to go into this — call it 'eyes open.' "

In April, Henry Ford Health System started to introduce 35,000 new patient gowns across its network of four hospitals in the Detroit area. Beyond helping its own patients, the health system also hopes to license its design to a garment manufacturer.

"It's a big market," said Michael Forbes, a product designer at the Henry Ford Innovation Institute. "At every single hospital, what's the number one thing that you're handed when you walk in? What does every single patient use?"

The arguments make sense to officials at Park Nicollet. In 2011, the health system launched a contest for design students to reinvent the hospital gown.

Linsey Griffin, a graduate student at the University of Minnesota's College of Design, was co-designer of the winning prototype. Bed pans are just one of the functional considerations that made the project challenging.

"It is the ultimate, tension-filled article of clothing," Griffin said. "The patients have very different wants and needs as users than the nurses and doctors."

Once the prize was awarded, the process of developing and introducing a new gown slowed considerably, said Getchell.

Laundry list

Methodist Hospital rents patient gowns from Health Systems Cooperative Laundries, so any change has to take into account the impact at the laundry — a massive facility in the east side of St. Paul, where the square footage exceeds that of a football field.

Standing on the floor of the laundry last week, general manager Larry Hilton said he was excited to be part of the forthcoming study on the new gowns. If they work well for Methodist Hospital, he said, the garments might be a good option for other medical centers.

Currently, 21 hospitals and 350 affiliated clinics use the cooperative laundry. With about 240 employees, the facility launders more than 34 million pounds of linen in a year with an automated system of washers and dryers for everything from hospital gowns and scrub wear to bed linens and towels.

Standardization is key to the process, Hilton said. The laundry will clean items that are unique to hospitals, he said, but the process is most efficient when medical centers use the same garments.

Hilton wants to see how well the new gowns work with the complex system of conveyor belts, press machines and folding equipment currently used to process hospital gowns. Special handling would add costs, but the new gowns could boost efficiency if they dry quicker or last longer, he pointed out.

A hospital gown typically lasts for 40 to 45 washes, Hilton said, so increased longevity would mean "we won't have to buy as many," he said.

The new gowns were developed by Medline Industries, an Illinois-based supplier that's part of the study. For the first three months of the project, the hospital will get baseline satisfaction scores from patients on two hospital floors. Then, the hospital will collect satisfaction scores from patients on the same floors who use the premium gowns and linens.

Documenting the return-on-investment will be key, said Getchell.

"We're going to watch and see," she said, "if the patient scores go up."

Christopher Snowbeck • 612-673-4744

Twitter: @chrissnowbeck