It was one of those “Ah-hah!” moments. A moment typically reserved for an early morning shower after you’ve been up all night pondering an issue you can’t resolve.

A group of people was standing in the bathroom inside a full-scale, plywood mock-up of a patient room for the new Sacred Heart Medical Center at RiverBend. It was a standard-sized bathroom and much smaller than the bathroom in the mock-up room next door (with an Americans with Disabilities Act [ADA] compliant bathroom).

After looking at both, one team member, a community volunteer, asked, “Why do you have smaller bathrooms? Why aren’t they all bigger?” The question got hospital leaders thinking.

“Larger bathrooms are safer,” says Lola Fritz, RN, Sacred Heart’s director of operational facilities planning. “Caregivers had complained for years about getting patients into the bathroom.” But it took a community member asking a simple question to make a significant change to the design of the hospital. Now, all patient rooms in the new facility are designed with larger, ADA-compliant bathrooms, eliminating needless transfers when a patient who does not need an ADA-approved bathroom must be moved for one who does.

That experience illustrates just one small example of the process hospital leaders have followed throughout the design and construction of the new, 362-bed regional medical center, Sacred Heart Medical Center at RiverBend, part of the PeaceHealth system. Extensive involvement from all levels of administration and staff, coupled with input from the community and evidence-guided hospital design principles, have steered the development of a facility to safely and efficiently deliver quality patient care to the community.

“We had more than 500 nurses, physicians, colleagues, and patients who worked together in the functional and schematic planning of this building,” explains Fritz. “Coupled with that, the design was driven by interviews with patients and their families. Patients reviewed the process of care and shared what they wanted and needed in a healing environment.”

Patient rooms ensure privacy and safety

One of Sacred Heart at RiverBend’s most noticeable differences is that all patient rooms are private and larger than before, inviting family members to stay closer to the patient or stay overnight, if desired. Research shows that patients not only prefer private rooms, but also that privacy encourages them to share sensitive health information with providers. Private rooms prevent the spread of infection, as well.

The hospital looked carefully at research throughout the design process as an active partner in the Pebble Project—a joint research effort between The Center for Health Design and selected healthcare providers. Project members identify, promote, and incorporate design elements that make a difference in a hospital’s quality of care and operational efficiency.

An example of patient safe design at Sacred Heart at RiverBend is medication at the bedside. To ensure that patients receive the correct medication and dosage, medications at Sacred Heart at RiverBend will be delivered and stored inside the private patient rooms in a locked drawer. Nurses will have a computer, the medication (in the locked drawer), and the patient all in one place. Hospital leaders believe this design will greatly reduce medication errors due to distraction, which can occur when nurses have to leave the room to retrieve medication.

Sacred Heart’s current efforts as a Pebble Partner have already produced documented results and affected change in the design of Sacred Heart at RiverBend. The majority of the private patient rooms at Sacred Heart at RiverBend will be equipped with patient lifts due to research performed at Sacred Heart’s existing hospital campus in Eugene. After examining data from the intensive care and neurology units at that facility—where there are lifts in each room—the team found that staff injuries from patient handling were almost eliminated. The staff greatly appreciated this new tool and Sacred Heart saw a cost savings on treating employee injuries, yielding a return on investment within two years. Installing lifts in patient rooms has caught on with other hospitals in the country that have followed Sacred Heart’s lead, particularly those involved with the Pebble Project.

At the RiverBend campus, which is due to open in October of this year, Sacred Heart plans to study how its new design features are providing caregivers with more time at the bedside. The facility will also measure rates of medication errors and hospital-acquired infections, length of stay, staff retention, patient satisfaction, and employee satisfaction to ensure the facility is continually improving.

Efficiency: Where form follows function

With the development of a new facility, the hospital’s administration is taking every opportunity to review clinical processes and make changes focused on patient safety. The planning teams considered areas they could address in the hospital’s design that would allow for greater efficiencies.

“The challenge was to make sure we take full advantage of the building for the effective and efficient performance of a number of processes,” says Steve Gordon, MD, regional vice-president and chief quality officer for PeaceHealth’s Oregon Region. “We wanted to make sure the building was designed to complement the work.”

When redesigning clinical processes, teams took apart each step and considered if the process could result in harm to a patient or if it represented an efficient use of resources. The Emergency Department represents a clear example of how rethinking clinical processes influenced design to create efficiencies for patients and staff.

Based on feedback, patients told the hospital they disliked waits in the emergency room—“Figure out a way we don’t have to wait.” The planning team took on the challenge and began looking at current patient volumes. They determined how many rooms the hospital would need to easily triage patients and get them back for treatment.

The result was an Emergency Department with a much larger square footage. When patients come to the new Emergency Department, they will be ushered into a private room where staff will assess their needs and determine whether they need immediate physician care.

Creating an Emergency Department with only private rooms resolved the waiting problem, but created a new challenge: how to create an efficient design for an Emergency Department with more rooms. The team was determined not to produce “one big race track with rooms around it.” The solution came after looking at hospitals across the country.

When it opens in the fall of 2008, the new Emergency Department will include five pods of eight to 10 patient rooms each. The decentralized rooms eliminate the central nurses’ station and instead locate staff just outside patient rooms. The department will continue to use a wireless electronic tracking system, as is in place at the hospital’s current campus, to track patients through a streamlined care giving process, thus reducing wait times.

Putting the full benefits of nature to work

The hospital takes full advantage of the natural beauty of its 181-acre site on the banks of the McKenzie River, and boasts scenic views from nearly every patient room.

“Research shows that views of nature reduce length of stay, reduce perception of pain, and reduce the amount of time on IV narcotics,” says Fritz. “If a patient’s length of stay is less and their healing is faster, it’s better for everyone.”

Todd Tierney, principal with architectural firm Anshen+Allen, said the hospital’s physical location had a significant influence on its design.

“The site is extremely beautiful with views of the river and hillside,” Tierney said. “We wanted to minimize the hospital’s footprint as opposed to creating something sprawling. We choose this site so it wasn’t imposing on the rest of the community.”

The hospital interior has a Northwest feel that includes many fireplaces and natural surfaces. Patients, families, and staff are encouraged to enjoy the environment with outside paths leading to the river and extensive bike paths. Even the stairways have huge windows with expansive views—a strategy designed to encourage people to take stairs.

“We wanted to create a healing environment, a noninstitutional healthcare facility,” said Tierney. “We hope to change the perception of what healthcare is and challenge the traditional care model.”

The new hospital’s development has been an opportunity to create a building based on feedback from patients and their families. More importantly, it represents a transformation in healthcare. “We’re not just building a building, we’re increasing the reliability and safety of care; we’re providing more compassionate care,” says Fritz.

From the perspective of the caregivers at Sacred Heart, this project is a life’s work and a rare opportunity to rethink all of the elements that go into healthcare. HD