“Logical, not lavish” characterized the entire approach to Froedtert Hospital's first inpatient expansion project since it opened in 1980. An aggressive effort to seek staff and patient input was crucial to our success. By methodically implementing the planning process described in this article, we ensured that the new addition, called the North Tower, met staff and patient expectations and was completed ahead of schedule and under budget.

As with most facility development, the driving force was growth-in Froedtert's case, a substantial and sustained increase in the number of admissions. Simply put, we were running out of space and forced all too often to divert patients to other hospitals.

One early and essential step in planning was to create a team. It was imperative that the team develop, guide, and implement this project. The team consisted of representatives from Froedtert's staff, the architectural firm Ham-mel, Green and Abrahamson (HGA), and Mortenson Construction. Team members had worked together on previous Froedtert projects, which was an invaluable asset. They were familiar with each other and with the facility and its procedures and processes. They understood the needs of the organization and how they fit into Froedtert's strategic goals. The team's first assignment: to list common goals in order to produce a facility that worked as intended.

To begin with, because of the urgency of this project, the team segregated the bidding process into seven packages. This saved time by allowing us to overlap different processes and stages of construction. We were able to proceed with site work, foundations, and structural steel work while finalizing the last stages of the project, which dealt with interior spaces. It worked: Froedtert broke ground for the North Tower in July 2001, and beds in the new addition were occupied by September 2002.

As for the planning process, the project program called for construction of 100,000 square feet at a projected total cost of $30 million. Of that amount, approximately 35% went to soft costs, such as design fees for furniture, art-work, plants, site surveys, materials testing, air- quality monitoring, signage, landscaping, and so forth. The North Tower was to include a 12-bed neurosciences intensive care unit, 12 special bone marrow transplant rooms, and 94 acute care rooms, as well as family and staff support spaces.
Nursing station was enclosed in glass for patient and staff privacy, and to allow diffusion of natural light from exterior windows

Nursing station was enclosed in glass for patient and staff privacy, and to allow diffusion of natural light from exterior windows

In developing its goals and mission statement, the Froedtert Facility Planning and Development Group focused on multiple user groups, including patients, families, nurses, physicians, housekeepers, transporters, materials distribution staff, maintenance, and security staff. With all these groups in mind, the team wanted to:

  • provide a foundation allowing for the flexibility needed for future change and expansion;

  • embrace an ongoing philosophy of customer service and a positive work environment for staff;

  • identify, project, and meet current facility needs for each department;

  • create opportunities for operational efficiencies that would affect cost and quality of services provided;

  • establish a workable timetable to meet facility needs; and

  • develop a feasible cash flow supporting capital improvement costs within the projected budgeted financial resources.

Although a traditional design process solicits needs from various constituents, we did not want a “traditional” project. The challenge was to obtain meaningful input from user groups in a much broader way than the typical “meetings with the architects” provide. The effort to obtain staff input began well before construction and continued throughout the project. For example, recognizing the many demands on constituents' time, Froedtert offered incentives to encourage staff involvement in the project. The hospital's public relations staff was an integral aspect of this phase. Focus groups were formed, articles published in the hospital newsletters, public forums and open houses held, feedback postcards provided, and posters displayed.

The use of a 1:1 mock-up of a patient room proved invaluable. Staff were lured to the mock-up room with food certificates, refreshments, and raffles. Cookies, popcorn, and soda were on hand for those perusing the latest iteration of design. If staff members filled out and returned a feedback card, they were automatically entered in a raffle for prizes, such as a portable TV. Returning a short questionnaire earned staff a certificate redeemable at the hospital delicatessen. The costs of these incentives were built into the construction budget early on, with the specific intent of investing now so we would have fewer change-order costs later.

This proved to be a fruitful investment. For example, having nursing staff move actual equipment in and out of the mock-up room, we found that the angle of the doorways made passage difficult. Although the size of the doorways was fine, we had to redesign the doorway frames to ease the staff's work. We changed the shower areas into a more rectangular shape, to allow more space for staff to assist patients, and we reoriented the airflow ducts to eliminate a draft problem that staff had noticed. All of this would have cost a great deal more at the change-order stage. Also, this planning process resulted in a feeling of ownership for all.

Innovative medication/supply cabinet with convenient dual access from corridor and patient room doorway

Innovative medication/supply cabinet with convenient dual access from corridor and patient room doorway

While it is easy to “throw a lot of money” at the physical environment, I needed to be assured that value was there before authorizing an expenditure. Froedtert, being an academic medical center, has even greater demands on its limited capital than most healthcare organizations. This need to conserve capital, added to the very basic issues of providing affordable healthcare, drove my urgency to ensure that every penny we spent resulted in added value. Through the value-engineering effort and detailed costing methodologies of our construction manager, Mortenson, the understanding of our design team at HGA, and my firm belief in a logical approach versus a lavish one, we delivered a project that incorporates:

  • patient rooms that are by no means the largest in our market, but big enough to accommodate overnight stays by family members;

  • laptop hook-ups in each room;

  • patient “living rooms” in a corner of each floor, with full-length windows visible from the far ends of the patient room corridors, as well as recliners, TVs, and other comfortable furnishings;

  • supply and medication cabinets for each room, with access from both inside the doorway and outside the room for staff convenience and minimal patient disruption;

  • consultation rooms that double as “hotel rooms” on each floor to allow staff caregivers to communicate with and educate family members on patient status-equipped with flexible furnishings, such as seating that easily converts to beds, and whiteboards to help illustrate discussion points;

  • staff lounges with windows;

  • staff charting and workrooms with windows; and

  • a garden courtyard with water features.
    Central courtyard

    Central courtyard

All of these spaces were finished in “simple” ways that produced high-end results at low cost-for example:

  • lots of variety in paint versus use of wall-coverings;

  • lots of poster art versus “originals”;

  • placement of items based on staff needs rather than “standard” locations (for example, rather than placing electrical outlets at 18 inches AFF (above finished floor), we adhered to our staff's suggestion to place many of them higher to minimize bending and trip hazards); and

  • incorporation of lighting flexibility (i.e., we tried many lighting combinations in actual patient rooms over several months and asked for staff and patient feedback; the result was a customized lighting fixture, developed with the manufacturer, that provided procedure lighting, reading lighting, and ambient up-lighting, all controlled from the patient's nurse-call panel).

While much of today's focus is on the patient environment, we wanted to ensure that staff members' interests were considered equally. Their input kept us on a logical level; most of their recommendations were drawn either directly from the patients they had cared for or from their own work environment disappointments.

Satisfaction Results

We can talk and write all we want about the physical results of our “logical, not lavish” facility development process, but it means nothing unless it produces outcomes that enhance our mission. To investigate whether we had achieved these goals, Froedtert used the Press Ganey Customer Satisfaction Survey, a highly detailed statistical measurement tool. As it happened, the quarterly Press Ganey surveys provided us with an excellent controlled study: The third quarter survey was conducted before the move, and the fourth quarter survey after the move, with the only differentiating factor being the new physical environment. The results confirmed our perceived successes. In fact, they showed a huge improvement: an 8.6% increase in patient satisfaction. According to Press Ganey, an improvement of 1% from quarter to quarter is considered statistically significant.

This proved to me that we could significantly improve our care environment without having to be lavish. By proceeding in a logical fashion, we had created a facility that met all of our program and strategic goals. HD

John Balzer is vice-president of facility planning and development, Froedtert Hospital, Milwaukee, Wisconsin.

For further information, phone (414) 805-2649, e-mail jbalzer@fmlh.edu, or visit http://www.froedtert.com.

Healthcare Design 2003 May;3(2):63-66