Evidence-based design for building a world-class heart hospital part two
Last month's article on the use of evidence-based design in building the Richard M. Ross Heart Hospital at The Ohio State University Medical Center (OSUMC) discussed the effect of the facility on patients and families. As noted, the increased patient and family satisfaction led to market share growth, supporting the importance of facility design for hospitals striving to differentiate themselves in the increasingly competitive cardiovascular services market. This month's focus is on creating a work environment that helps retain staff and recruit physicians.
Toward this end, the OSUMC administration involved multiple clinicians in the design process—not just leadership, but also the hands-on staff. It quickly became clear that the benefit of involving staff was more than obtaining their buy-in for the new universal bed care delivery model. Staff was instrumental in providing multiple recommendations that enhanced the design of patient care areas.
The planning team focused on creating a staff- and physician-friendly environment—one that would also support increased efficiency and productivity of care delivery. As mentioned in part one of this article, cardiovascular services had been scattered throughout the OSUMC campus, necessitating travel to multiple floors and patient units (figure 1). Not only were patients inconvenienced, but physician productivity was hampered. In fact, one physician recorded the time he “wasted” while waiting for elevators and walking to and from procedural areas and patient care units, and was astounded to learn that, over the course of a year, he was losing at least one full week of productive time.
The pre- and postconstruction cardiovascular service locations at The Ohio State University Medical Center, Columbus, Ohio.
Overcoming these and other frustrations caused by facility-induced inefficiencies guided the new layout of the Ross Heart Hospital (RHH). Aggregating patient populations by cardiac specialties (e.g., heart surgery, vascular surgery, interventional cardiology, medical cardiology) has reduced the amount of time physicians spend rounding because their patients are located in the same unit during their entire hospitalization. Furthermore, since physicians are interacting with the same staff daily, they are able to develop more collegial and trusting relationships with the nurses, which has resulted in a stronger team approach to patient care.
Moreover, locating the patient care units on the same floor as the procedural areas has made it more convenient for physicians to interact with families and has enhanced physician response time in emergencies by reducing travel time. Consult rooms are situated between the procedural and patient care areas to further encourage physician–family communication (figure 2). To enhance cardiologist productivity specifically, shared physician offices are located near the procedural areas for use between cases. Cardiologists can make follow-up phone calls, answer e-mails, and review patient charts and lab work without leaving the cardiac cath lab vicinity. The result has been higher physician satisfaction scores (95%) in cardiology, as compared to the rest of the OSUMC (82%).
The Ross Heart Hospital second floor patient care and procedural areas.
The design of RHH incorporated flexibility into the nursing stations by providing a mix of centralized and decentralized nursing work space. With decentralization, nursing care is brought closer to the patient, consequently increasing productivity as a result of no longer needing to walk back and forth to a central location to document care, retrieve medications and supplies, or access patient information. Being closer to the bedside, nurses can focus on intense care needs when required, but can also offer more privacy to patients by withdrawing to a nurse substation (figure 3). These substations have computers for documentation, along with space allocated for physicians and visiting staff (figure 4). By providing such substations, RHH continues to foster interdisciplinary communication, enabling staff and physicians to better address patient issues, conduct informal learning, and satisfy nurses' socialization needs.
Decentralized nursing documentation station in a universal bed room.
The multidisciplinary team substation at the Ross Heart Hospital.
These substations are located on both sides of the patient unit so that nurses can meet patient needs quickly on either side of the unit (figure 5). One reception area houses the unit clerk, who directs traffic by assisting families, physicians, and members of ancillary departments to meet their appointments.
Location of nurse substations (S) and one general reception area (R) that houses the unit clerk who coordinates care for the patients.
Also affecting the staff is the outdoors environment, with its campus-like feel and amenities to help reduce the stress they may experience during an average work day. At night, the atrium provides a warm glow and welcoming entry cue. The space is well lit and provides a feeling of safety for the staff (figure 6).
Well-lit space provides feeling of safety at night.
Overall staff satisfaction at RHH (82%) is not only higher than for the rest of the university health system (76%), but virtually matches the “best-in-class” results (83%) ever recorded by the satisfaction survey company used by OSUMC.
Building a Hospital for the Future
To compete and thrive in today's evolving healthcare industry, a hospital must support changing technology, evolving care practices, and increasing utilization, all of which typically demands more space. RHH does this with an adaptable building structure.
Although directly adjacent to the main Medical Center—a 1970s building built with mostly 10'-10″ floor-to-floor heights—the RHH uses a flexible new vertical grid adaptable for future OSUMC buildings; it provides ample floor-to-floor heights, with 17' on the first and second floor and 14' to 16' on the floors above (figure 7).
New floor heights connect Ross Heart Hospital services for greater efficiency and overflow.
The floor construction in portions of the operating rooms, catheterization labs, and outpatient diagnostic areas is reinforced to accept floor-loading for MRI equipment, thus offering tremendous flexibility to accommodate future technology, examples of which are the soon-to-be-installed image-guided magnetic navigation systems for electrophysiology and interventional cardiology. This technology did not exist in the late 1990s when RHH was being planned, but will easily be accommodated today thanks to the facility's flexible floor design.
In addition, strategically placed knock-out panels in the walls allow large, heavy equipment to be easily brought into the building. For example, the MRI equipment in the first floor diagnostic area was purposely bought last to obtain the most current advances in technology. It was installed five months after the hospital opened (figure 8).
The latest MRI technology was installed five months after the Ross Heart Hospital opened with planned building design.
Throughout the planning process, the team kept “tomorrow” in mind, always thinking in progressive terms about what would be needed in the future. The existing three floors (each with 30 patient rooms) can expand vertically with the addition of two floors for another 60 inpatient beds (figure 9). Provisions were incorporated into the fire alarm and HVAC systems to allow the building to meet high-rise code requirements after vertical expansion. Anticipating the need for additional capacity in coming years, mechanical equipment was placed elsewhere in the building, rather than on the roof, allowing for easier vertical expansion when the time comes.
The Ross Heart Hospital received a two-floor vertical expansion.
RHH was designed and built with the goal of elevating patient care and enhancing the work environment for staff and physicians. The hospital has also benefited from a staff-focused environment that has improved efficiencies through the use of the universal bed care delivery model, along with decentralized nurse stations and adjacencies that eliminate multiple transfers. The focus on supporting physician convenience through facility design has facilitated the recruitment of world-class physicians. By combining the latest technology with innovative facility design, the Richard M. Ross Heart Hospital provides a world-class healing environment, offering a patient and staff/physician experience that is second to none. HD
Katherine Kay Brown, RN, MSN, CCRN, is Director of Consulting at Corazon, Inc., in Pittsburgh, Pennsylvania, a consulting and recruitment firm dedicated to providing innovative solutions to create outstanding cardiovascular programs.
Sherm D. Moreland, AIA, LEED AP, is Healthcare Principal at DesignGroup in Columbus, Ohio, a recognized leader in healthcare architecture, planning, and design.