“Run until apprehended”. These were the three words Cheryl Herbert, president of OhioHealth's new Dublin Methodist Hospital (DMH), instilled in every member of the project team as we began the challenging endeavor of designing a hospital to be better than any that had ever before existed. With a client offering us the freedom to use our imaginations and creativity, we realized the tremendous opportunity ahead of the team of designers and the OhioHealth organization.

Firmly committed to evidence-based design, Karlsberger partnered with Rosalyn Cama, FASID, president of CAMA, Incorporated, and board chair of The Center for Health Design. She served as the interior design and healing environment consultant. The team recognized the opportunity to incorporate research and data into the project's development and encouraged the client to make this a Pebble Project; it was accepted.

Dudley Fleming for Karlsberger

 

Areas of interest to the client and project team included how innovative design could improve the quality of healthcare in terms of safety and recovery times, attract patients, enhance operational efficiency, recruit and retain staff, and increase philanthropic, community, and corporate support. Furthermore, the project team shared a belief that evidence-based design could improve the emotional and spiritual well-being of users as much as it could improve operational efficiency, the quality of clinical care, and productivity. Our goal was to apply research in a sensitive and thoughtful manner that considered elements of healing environments and every user's individual experience.

OhioHealth and DMH

Dublin Methodist Hospital is part of OhioHealth, a not-for-profit, faith-based health system headquartered in Columbus, Ohio. Serving a 46-county region with 14 hospitals, 14 ambulatory sites, home care, hospice, and employer health services, OhioHealth is Central Ohio's largest health system. The new hospital will include 94 inpatient beds (34 maternity/nursery beds and 60 identical, acuity-adaptable medical/surgical/ICU beds), as well as 32 emergency department beds, 4 surgical and 2 endoscopic suites, a full complement of imaging technology (including two CT scanners and one MRI scanner), 25,000 square feet of shelled space, and a central energy plant, for a total of 325,000 square feet
Dudley Fleming for Karlsberger
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The guiding principles for the project included creating a healing environment with a stress-reducing design; designing for maximum standardization; including a wide representation of stakeholders in the design process; creating a patient/family-centered environment that respects privacy and dignity; providing clear wayfinding and accessibility; and designing to support a digital, wireless, and “paper-light” system.

Commitment to Culture

From the beginning, Herbert was driven by a cultural mission to create a hospital that would revolutionize healthcare delivery. Encouraging the design team to think outside the box and take measured risks, we identified and reacted to the specific needs, identity, and culture of the people seeking treatment, visiting, or working in the hospital. With this awareness, advisory groups composed of leaders in their respective areas of expertise, were created from within the OhioHealth system to reexamine clinical and support functions.

Engaging an experience and consumer-research firm to assist in culture creation, the team embarked on a study of the culture of healing environments. The integrated team collaborated to understand perceptions of the existing healthcare culture within Central Ohio and how facility design could positively affect it. Perceptions were collected through individual and group interviews, questionnaires, and anecdotal recollections of personal experiences. Desired experiences were then identified and described in terms of the behavioral norms, language systems, ceremonies/rituals, and physical surroundings necessary to create and support those experiences.

Identifying and Achieving Core Values

OhioHealth is a faith-based organization with a mission “to improve the health of those we serve”. Core values identified in establishing a new culture were to:
Courtesy of Karlsberger

  • Care for patients medically, spiritually, and emotionally
  • Respect the family of our patients and staff
  • Encourage and promote education for our staff, patients, and community
  • Promote a close-knit team approach to care

Evaluating each core value, we identified design solutions that would foster the core value in question. For example, in addressing the issue of facilitating a close-knit team approach to care, we decided to provide conference/team rooms, informal/semiprivate teaming areas, places to meet with families, staff break rooms with multiple zones, extensive views to outside/nature, and outside roof terraces/gardens to reduce stress and foster interaction and team building. Our design solutions sought to create balance between the patient and family experience, while also embracing the staff
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Creating extensive opportunities for daylight, the hospital is “pulled apart”. Patient pavilions are connected to the diagnostic and treatment areas by glass-enclosed corridors and include an open core located around a courtyard, providing views to nature from within patient units. Shared support spaces are ringed by circulation to allow for daylight and functional movement through the facility.

Nurses' stations have been replaced by decentralized informal areas stocked with supplies, defined as “perches” by the project team, where staff can meet with one another or with family members to discuss treatment details outside the patient room. Similarly, there are decentralized multipurpose alcoves spread throughout patient units, open nourishment areas, and private consultation rooms. This layout cultivates a culture in which staff members spend more time with patients.

To facilitate family as part of the team, we aimed to remove barriers between caregivers and family members, create collaborative support areas and opportunities for impromptu/informal communication, and keep work areas as open as possible. In addition, we provided a family area in the patient bedroom, family-physician consultation rooms, and an education center.

Patient rooms are private, acuity-adaptable, like-handed, and standardized, with everything in the same place from one room to another. This should reduce the risk of medical errors as caregivers need not rely on short-term memory of where things might be as they try to treat patients in differing room layouts.
Courtesy of Karlsberger

Explaining this decision over the option of mirrored rooms, Herbert says, “It intuitively makes sense to us that standardization will decrease medical errors. This is based on the experience of other industries where standardization is the norm–the airline industry and the nuclear industry, for example. Those are the industries I think healthcare now is comparing itself to, and that is how we justified the identical nature of the rooms”.

Improving on the trend of distinct patient, family, and caregiver zones, each patient room has potential areas of overlap where the three user groups have space for interaction. Physicians are trained to work on the patient&#
39;s right side. Therefore, the room design enables physicians to be in a central spot between the patient and family zone, fostering their interaction and communication with both patient and family, while nurses, who make more trips in and out of the patient room, are able to enter a room and go directly to a patient's left side without obstacles
Courtesy of Karlsberger
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Research has shown that many falls by patients occur while they are trying to get to the bathroom. Therefore, to further the commitment to improving patient safety, the team placed bathrooms along the headwall, with handrails supporting patients from bed to bathroom.

Family zones include a full foldout bed for overnight stays and counter space for family use, with wireless Internet connectivity and a television. The Patient Station is an interactive touch-screen unit where patients can access a variety of services, such as the Internet, menus, and patient educational resources, providing a positive distraction and empowering patients with a greater sense of control over their experience. Portions of the window in each patient room are operable, giving patients access to nature and fresh air, again returning some autonomy to them.

At the End of the Race

As each decision was made, the team examined the status quo of healthcare delivery, areas for improvement, data already available, and their individual perspectives and experiences. Nothing was taken for granted, nor was anything ruled out before it was shared and considered by the entire team working together. Recalling a stay at the Ritz Carlton, Cama described the experience of checking into the hotel through a personal greeter at the front door, who directed her to the right floor so that she didn't have to wait in line at the front desk. Describing how the hotel applied technology and staff placement to improve its customer service, efficiency, and customer satisfaction, Cama presented this concept as a consideration for DMH.

Cama describes Herbert's reaction: “Our trailblazing leader said, 'Okay, so take the reception desk away!'”

Now affectionately deemed the “Ritz handoff” by the project team, reception desks will not exist in DMH. The “Ritz handoff” involves an individual that greets patients and visitors when they arrive at the front door and directs them to their next destination. As patients and visitors approach this destination, another person greets them as if they were expected (through the use of electronic headsets or handheld computers) and escorts them to the next destination and introduces them to their caregiver. Removing the stress of having to navigate to information desks and wait in lines, this new method of checking in patients and directing visitors meets users' increasing service expectations.

Final Thoughts

Reflecting back on this project, which began with the order to “run until apprehended,” we can say with great confidence that this team ran very far, through many uncharted territories. We developed news ways of running and new ways of navigating our running path. We discovered new ways of looking at healthcare and its delivery, and we celebrated new ways to use the design of its facilities to achieve positive change in the culture, the quality of care, and the user experience through the tactical application of research and data. We have run far and have come out stronger for it.

In the words of Cheryl Herbert, who is proving herself to be a pioneer in the revolution to improve the delivery of healthcare: “We have a once-in-a-lifetime opportunity to build better buildings for all the people who come into them”.

Imploring the audience at the HEALTHCARE DESIGN.06 Conference in Chicago to take advantage of evidence-based design in their work as architects and clients, Herbert said, “We have an opportunity to reinvent the hospital. Do not equate evidence-based design with pretty hospitals. Equate evidence-based design with building buildings that are going to be better for your patients, your families, your staff, and your physicians. To the architects in the crowd, you have an obligation to design buildings this way. To the owners in the crowd, you have an obligation to demand that your architects design buildings this way. If we know that we have an antibiotic available to us that will treat people's infections, shame on us if we don't use it. If we know we have evidence available to us about how to build a better building, shame on us if we don't use it”. HD

Based on “Dublin Methodist Hospital Lecture Series–Evidence-Based Design in Action,” a presentation at HEALTHCARE DESIGN.06, November 6, 2006, in Chicago by Rosalyn Cama, Principal Designer, CAMA, Inc., New Haven, Conn.; Cheryl L. Herbert, RN, MBA, CHE, President, Dublin Methodist Hospital, Dublin, Ohio; Gregory C. Mare, AIA, Senior Vice-President and Director of Planning, Karlsberger, Columbus, Ohio; and Craig Zimring, PhD, Professor, College of Architecture, Georgia Institute of Technology, Atlanta