Beyond the architecture Lesson 5: Build it on the inside
It always starts this way—with great hope, unbridled enthusiasm, and imaginative artists' renderings. All of the input sessions and planning meetings, developed and discarded design concepts, conventional wisdom, and new-to-the-world thinking have come to this moment of anticipation when “what it could look like” is ceremonially unveiled and symbolically explained. It's a moment of pure possibility that occurs in every major design project in which the architect's interpretation of the client's hopes and dreams is put majestically and vulnerably on display.
Is this interpretation “spot on” or does it “miss the boat”? Does it courageously expand the vision or sheepishly confine it? Will it work? Can we afford it? Will people be inspired by it? And then, in the blink of an eye, that magical moment is gone and the fledgling concept is left to fend for itself and learn its fate. Many of these concepts don't make it off the drawing board, condemned to spend the rest of their days in that vast chasm between “totally impractical” and “hopelessly uninspired.”
But that's not the worst fate, not by a long shot. The worst fate belongs to the once-inspired concepts that get built but are dissected and value-engineered to such a degree that their souls are excised. What's left may be a monument to efficiency, but it is also a slap in the face of differentiation.
I still remember the first major facilities project I was involved in after graduate school in 1979 (I'm really dating myself, aren't I?). It started with a wonderfully distinct “health village”-on-a-lake design aspiration but ended up being a square-box-medical-office-building-in-a-strip-mall reality. But even this project and other similarly fated ones don't represent the worst of their kind, because at least an offering has been made on the altar of “practicality.” The worst, in my view, are those wonderfully inspired design concepts that get built but concentrate all the inspiration on the structure and none on the people who inhabit it.
It is understandable why architects, designers, and engineers don't see this lack of focus on people as their responsibility. But it is also understandable why this lack of involvement in designing the experience, and the culture needed to perform it, is the single biggest threat to the longevity of the healing environment movement. Because without the “we did the best we could with the resources we had” excuse to fall back on, if these new and more elaborate stages don't produce tangibly different outcomes, they will become extravagances that the healthcare industry thinks it simply can't afford. The architects who designed the buildings and the healthcare leaders who approved them will be ridiculed as hopelessly out of touch with reality. And one of the most important developments in the history of healthcare facilities will come to a screeching halt, all because no one took responsibility for building the design concept inside each person, not just inside each building.
The Next 50 Years
Gary Brewer, CEO of the 80-bed Valley View Hospital in Glenwood Springs, Colorado, had some dreams of his own as he began an ambitious six-stage hospital replacement project, some of which were grounded in the past.
“Fifty years ago, so many people in our valley committed so much of what they had to build this hospital,” says Brewer. “I felt like we needed to build a new place that would last another 50 years and honor the character of this community.
“We visited many other hospitals prior to design. And while there were a lot of nice hospitals out there, to a great degree they still felt like hospitals. We wanted something new, something uniquely different, and we knew that wasn't going to be easy to do. That's why we spent triple the amount of time on planning as we did on actual construction.”
So with the help of Hart Freeland Roberts, Inc.; I.C. Thomasson Associates, Inc.; and general contractor R.J. Griffin & Company, a journey of establishing a new standard—not copying an old one—was begun. Valley View had adopted the Planetree philosophy of care, which encourages patients and family members to become actively involved in the actual healing process. The importance of “connecting” patients, family, and staff was essential to the character of the new facility.
“What began to emerge from these design elements was more of a ‘health hotel’ than a hospital,” says Sam DiCarlo, lead architect for the project. “The environment became more akin to that of the hospitality industry—one that was more relaxing, engaging, and involving to the patient and family.” And so the artist's rendering (page 24) was created, which shows a facility more reminiscent of a mountain retreat than a clinical intervention site. But the process didn't stop there.
As a matter of fact, many of the lessons from The Experience Economy that have been detailed in this series are on display at Valley View. Everything is driven by Valley View's three-word operating theme: Personalize. Humanize. Demystify (PHD) (see Lesson 1: Harness the power of a theme, HEALTHCARE DESIGN, March 2005, p. 20). Impressions that support this theme are harmonized throughout the project, and cues that run counter to the theme are eliminated.
For example, think about a traditional nurses' station desk with a chest-high countertop. While it provides the nurse with ample hidden storage, the countertop creates a tangible communication barrier from the patient's and family's perspective. Valley View is replacing the typical desks with furniture that eliminates the visual barrier and provides a space that's much more conducive to discussing important concerns.
On each patient unit, kitchenettes allow family members to prepare a favorite meal as a means of encouraging patients' healing process. A dining room and family room complete with a cozy fireplace allow the patient and family to get together outside the confines of the bedroom. (Notice the new terminology used to describe these “places within the place.”) Natural exterior light, plantings, low ambient interior lighting, and selected wood finishes are used to create a warm, soothing environment and interest in each space.
Bedrooms are designed to allow patients to customize their environment and use computer technology (see Lesson 2: Make the experience personal, HEALTHCARE DESIGN, May 2005, p. 22). Interior and exterior landscaping helps screen out the normal, intrusive clinical activities necessary in a healthcare environment (see Lesson 3: Design onstage and offstage, HEALTHCARE DESIGN, July 2005, p. 19). Even the lobby's ceiling lights reflect the idea of stars in a clear Colorado night sky. In other words, no detail has been overlooked in creating an intentional, sensory-engaging environment. But while the work was truly extraordinary, the Valley View team realized it wasn't really enough.
Building It on the Inside
“You have to remember,” says Brewer, “we have accomplished many great things in our old buildings. So it's not the new building itself that will make the biggest difference. It's the people inside and the relationships we build with one another that will matter most.”
And with this observation by Brewer, another design project was begun—this one focused on creating a work experience as intentional, vibrant, and genuine as the new building housing it. In collaboration with Mid-Columbia Medical Center in The Dalles, Oregon—the first hospital in the country to implement the Planetree philosophy hospital-wide—Valley View's team looked at the PHD theme from a new perspective. Together, both organizations sought new insights and asked soul-searching questions such as: (1) How will our people know that our commitment to the Planetree philosophy of healing is real, genuine, and authentic? (Answer: They'll know because we'll go beyond advocating it for our patients, to living it for ourselves); (2) What would it mean to PHD our work experience, not just our patients' care experience? (3) Do we believe in the Planetree philosophy enough to apply it to ourselves? (4) What would be unearthed if we did apply it to ourselves? and (5) What would be lost if we didn't?
As you can imagine with this type of deep introspection, a groundbreaking design has emerged for the “Valley View Way.” A few examples of this culture development effort include:
The development of a strategy and context story entitled “The Lost Book of Yampah” (see Lesson 4: Give the actors a story line, HEALTHCARE DESIGN, Sept. 2005, p. 14), outlining the history of the Glenwood Springs area and the new application of the PHD theme to the work experience of each healer;
The development of new roles in Human Resources that customize each person's work experience based on his or her personal goals and aspirations;
The creation of an institute that teaches the Valley View Way to all employees (see sidebar, “Key Principles of Lesson 5,”); and
The development of a Relationship Center that helps Human Resources attract employees, not repel them.
(While we're at it, maybe the “R” in HR could come to stand for “Relationships” instead of “Resources.” And if that concept were brought to life, perhaps there would be fewer articles like the recent cover story in Fast Company entitled, “Why We Hate HR.”)
You can bet that recruitment, orientation, and performance appraisal are being redone at Valley View, too. In fact, an interlocking set of 34 distinct employee experience initiatives has been designed and is being readied for implementation. You may ask, “Why go to all this trouble? Why not be satisfied with a building that is sure to win its fair share of design awards?” Daniel Biggs, director of HR at Valley View Hospital, puts it this way: “Exactly 50 years ago, Valley View Hospital and Disneyland opened at about the same time. And while they seemed like very different businesses back then, their future success was based on the same thing—everything must ‘walk the talk.’ No detail is too small or insignificant. In a way, we're both in the transformation business, and if Disney can touch people's lives through a vibrant culture and inspired architecture in an amusement park setting, imagine what we should be able to do in a hospital.”
What a great fate has befallen Valley View's artist's rendering! HD