IMAGES COURTESY OF ENGBERG ANDERSON, INC.

“I can tell you from experience that the personal touch really does matter. As with many people who have to deal with aging parents, my family was no exception. Last July and August my father spent the last weeks of his life, for the most part, conscious, but unable to speak due to a ventilator. We spent countless hours in the ICU. At no point was my dad ever denied the respect and dignity that all of us deserve, but, more importantly, our family had complete access to him, whenever we wanted. Those last days and hours were difficult for all of us, but the hospital staff was stellar. While my job does not involve direct patient contact, I am nevertheless proud to be part of an organization that demonstrated the utmost compassion to my dad and our family when it was needed most. While time does soften the pain, the loss is something you work through. During those times when things are the darkest, you tend to remember an instance or situation that stays with you forever. One of those moments was with Dr. Smith (not his real name) in the ICU. His ability to connect the clinical status of my dad with his own spiritual beliefs was unforgettable.”

This is the story of Waukesha Memorial Hospital. It is a real-life example of the daily interaction, connection, and feeling between caregiver and patient on the campus. The structure that embodies this feeling is a hospital based on creating a culture of compassion and the Optimal Healing Community (OHC). Pebble Partner, Waukesha Memorial Hospital (WMH), is the flagship hospital of ProHealth Care (PHC) in Waukesha, Wisconsin. Established in 1914, the hospital campus has expanded from approximately 60,000 square feet to nearly one million square feet over the past 96 years.

As a system, PHC has adopted the cultural brand commitment of creating the OHC as a way of expanding its mission to promote health and provide extraordinary healthcare to the communities it serves. The five essential elements of the OHC provide touchstones that remind clinical and nonclinical staff of the organization's core values and how each person can make a difference through the daily delivery of optimal care.

• Patient centered: making an optimal patient experience the primary purpose of one's efforts.

• Healing: interacting in ways that support mind, body, and spirit.

• Excellence: being the best you can be.

• Relationship: being an instrument of healing through empathetic person-to person interactions.

• Self-awareness: knowing who you are and what you bring.

Space challenges impacting the optimal healing experience

The collaborative and supportive approach of the OHC facilitates the advancement of patient-centric medical care and the achievement of best practice clinical outcomes. Delivering this brand promise requires an environment that empowers staff to embrace the emotional and spiritual needs of the patients and each other. To establish alignment between the OHC essential elements and the WMH Strategic Campus Master Plan, WMH leadership assembled an interdisciplinary team to address the challenges.

Wayfinding. Located on top of a hill and surrounded by developed neighborhoods, WMH has experienced the typical 90-year hospital growth pattern of bed towers, a new main entrance, and an attached professional office building. The result is a landlocked campus with multiple entry points on different floor levels and a complex wayfinding experience.

Diagnostics and procedures. Continued growth of key specialty centers of excellence, new integrative technologies, and trauma-level two emergency status are putting pressure on the already congested diagnostics and procedure departments. The Day Surgery, Cardiac Cath, and Diagnostic Imaging Departments are left with limited possibilities for future expansion and a less than optimal patient arrival and waiting experience.

Decentralized centers of excellence. Supporting the growing operational and space needs of the Regional Cancer Center and Neurosciences Institute resulted in fragmented placement of both programs across the hospital and professional office building.

Public and patient circulation. The majority of primary corridors throughout the hospital continue to serve both “front-stage” and “back-stage” traffic. The open corridor structure causes lost and confused patients to find their way into department areas designated for staff only.

The Pebble Project creates a ripple effect in the healthcare community by providing researched and documented examples of healthcare facilities where design has made a difference in the quality of care and financial performance of the institution. Launched in 2000, the Pebble Project is a joint research effort between The Center for Health Design and selected healthcare providers that has grown from one provider to more than 45. For a complete prospectus and application, contact Mark Goodman at mgoodman@healthdesign.org.

Pebble Partnership and strategic facility design principles

One of the first steps to implementing the OHC culture was WMH becoming a member of The Center for Health Design's (CHD) Pebble Project research initiative in 2008. Applying an evidence-based design (EBD) approach through best practice evaluation, operational innovation, team collaboration, and research advancement, strategists from CHD worked with service leaders to develop key design principles. The new Strategic Facility Design Principles (see sidebar) have been rolled-out at the PHC system level, and require an “integrated” approach to planning-involving patients, community members, clinicians, operational planners, and researchers as part of the process.

Fresh Eyes Initiative and Interior Master Plan

As the WMH campus advances towards its 100-year anniversary, senior leadership recognized that several areas of the hospital looked, a bit “tired.” Early in 2009, a multidiscipline “Fresh-Eyes Committee” was assembled to evaluate, photograph, and rank every room, corridor, and exterior space on the campus. The committee utilized a color-coded evaluation matrix to consistently evaluate each space and establish a level of “acuity.”

To address the Fresh-Eyes priorities and create a consistent look and feel across a combination of capital projects, a new Interior Master Plan was commissioned. Engaging community members, patients, and staff in the visioning process, resulted in design concepts reflective of the WMH community-natural stone quarries, Les Paul's burl wood guitars, and the Fox River. A palette of refreshing design concepts and finishes, visually nurturing artwork, and a wayfinding technique that enables a consistent, welcoming, and comfortable transition from front door to point of care are being applied in all future facility projects.

Projects transforming the care experience

The following projects are the first to be planned using the new OHC elements, Strategic Facility Design Principles, and interdisciplinary project team approach. Planned concurrently, each project addresses individual patient, clinical, and project goals, while delivering a consistent healing experience across two buildings, three entrances, and five floors of the hospital.

Advanced Healing Center. The new Advanced Healing Center is a three-story, 140,000-square-foot facility dedicated to the advancement of the PHC Centers of Excellence and improving patient access to outpatient diagnostic/testing services. Located on the west edge of the WMH campus and connected to the main hospital through public and service connectors, this new building has been planned and designed to embrace the patient and connect care providers in a collaborative, supportive, and
healing environment.

Phase 1 of the new building, scheduled to open in 2012, includes the Regional Cancer Center, Center for Breast Care, Outpatient Medical Imaging/Lab Testing Center, and Neurosciences Center. Future expansion strategies include the addition of the Cardiovascular Center of Excellence, Women's Health Services, and the Outpatient Rehabilitation Gym.

PROHEALTH CARE STRATEGIC FACILITY DESIGN PRINCIPLES

Accessible – Create space that is easy to find, easy to get to, and easy to use.

Welcoming, Comfortable – Create a welcoming environment that promotes the comfort and wellbeing of patients, families and staff.

Individualized – Create an environment that supports an individualized experience.

Sustainable Design – Build to green design principles.

Safe – Ensure a safe environment for patients, visitor, and care providers.

Regulatory Compliance – Design will meet all applicable regulatory statutes.

Relationship Focused – Create an environment that promotes relationship-centered care.

Efficient – Streamline patient care experience while balancing staff efficiency and organizational investment.

Flexible and Adaptable – Design spaces that promote flexibility of use as well as future technology and utilization.

Branded – Design to reflect the ProHealth Care brand of the Optimal Healing Community.

Respectful of All Stakeholders – Meet the needs of those we serve while respectful use of our community's resources.

East Entry and retail experience. Last updated in 1994, the East Entry continues to serve as the main entrance for the professional office building and as a primary entrance for many long-time WMH patients and visitors. Updated finishes, improved reception, circulation to the main public elevators, and a visual connection to the new main entry/atrium are goals of the renovation. The new East Entry and retail experience was created through community, patient, and staff visioning sessions. The result is a nonclinical respite area, offering a variety of getaway spaces ranging from a quiet “living room” to lively café seating located in the coffee kiosk, along the connecting “river” corridor, and into the adjacent outdoor garden. The new retail amenities include an enlarged gift shop with integrated retail pharmacy and wellness store, plus an expanded Garden Grille Café catering to visitors.

Centralized reception and patient wayfinding. The first floor Main Entry to the hospital is the primary point of access for all procedure services, including Day Surgery, Cardiac Cath Lab, and the GI Center. It also serves as the point of reception and registration for patients being seen in the Cardiovascular Center, Respiratory Therapy, and Outpatient Clinic Department supporting wound care and non-oncology infusions.

Based on Strategic Design Principle #1 (easy to find, easy to get to, and easy to use), the new Registration and Admitting Center is clearly visible from the front door, 15 steps across the main lobby, and offers a single point of service using a combination of personalized service and electronic kiosks to quickly register and admit patients. Flexibility in functionality and design was important when planning this new area. During later phases of the master plan, challenging wayfinding to Day Surgery and Cardiac Cath Lab will be solved when reception and waiting are pulled closer to the main lobby. In the meantime, a new wayfinding strategy is being implemented, helping to guide patients from entry to point of care. Mapped from the patient perspective, this new strategy is more than signs. It utilizes floor details to map circulation pathways (river), color cues at main intersections and destinations, and artwork for landmark identification and decision making.

Patient unit improvements: 4 East Fresh Eyes. The 4 East – Neurology Unit is the only remaining inpatient area in the 1930s wing of the hospital. During the Fresh Eyes evaluation, it was quickly identified as the highest priority. Renovation is being done in phases with minimal to moderate construction. The unit is receiving a “fresh-eyes” makeover, including new wall and floor finishes, plus lighting, furniture, and artwork.

Overall, the Optimal Healing journey has taught the WMH team to “walk a mile in the patient's shoes” and to ask the big questions around what gets in the way of the ideal patient experience. Driven by a common vision, and encouraged through the Pebble Project external review process, the interdisciplinary team has developed new processes, design strategies, and wayfinding experiences that support patients, visitors, and staff from first point of contact to final point of care. Over the next three years, implementation of the Campus Master Plan will prepare the WMH Campus for another 100 years of delivering optimal healthcare. Pamela Kleba is a design coordinator with ProHealth Care. Julie Kent is Senior Healthcare Planner at Blue Cottage Consulting. For more information, visit www.prohealthcare.org. Healthcare Design 2010 September;10(9):18-22