Pebble Partners routinely state that the greatest benefits of being a healthcare executive involved in a hospital design and construction project is the wealth and accumulation of information and lessons learned over the course of the life of the project. Recently two Pebble Partners came together to share this wealth: Laguna Honda Hospital and Rehabilitation Center in San Francisco hosted members of the Royal Jubilee Hospital Patient Care Center team from Victoria, British Columbia (BC) for a short, intense, two-day visit. The Patient Care Centre (PCC) is a 500-bed inpatient replacement facility currently under construction in Victoria, British Columbia, Canada, for the Vancouver Island Health Authority (VIHA). It is located on the Royal Jubilee Hospital campus, a 24-acre site, founded in 1889. The PCC will provide modern inpatient care to this tertiary referral center. Scheduled to open to patients in early 2011, the PCC is a $300-million, fully equipped facility which will be an eight-story, 400,000-sq.- ft. building designed to accommodate medical, surgical, and mental healthcare.

At the PCC, people aged 75 years and older accounted for 41% of inpatient days in 2006/07; by 2011 this population is expected to increase to 50% of inpatient days. Over the next 40 years, the population of adults aged 85 years and older is projected to quadruple in Canada, thus VIHA has made becoming a Centre for Excellence in Elder Care a strategic objective. Creating an elder-friendly physical space within the PCC is a key enabler of this goal.
Royal Jubilee Hospital Patient Care Center, Victoria, British Columbia, Canada

Royal Jubilee Hospital Patient Care Center, Victoria, British Columbia, Canada

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

Laguna Honda is a skilled nursing and rehabilitation center owned and operated by the San Francisco Department of Public Health. Located on a 62-acre campus in the heart of the city, Laguna Honda is one of the largest skilled nursing facilities in the United States and represents one of the most extensive commitments by any city or county to therapeutic care for seniors and adults with disabilities. It was founded in 1866 to care for one of the first generations of San Franciscans, the Gold Rush pioneers. A century and a half later, it remains a civic icon representing San Francisco's tradition of service to the underserved.

Chief Project Officer Rudi Van Den Broek from the PCC and Larry Funk, Associate Administrator from Laguna Honda Hospital, share in their own words what the visit and exchange of ideas was like for them.

Rudi Van Den Broek: “Despite the recent boom of new hospital construction underway in both the United States and Canada in recent years, it remains a truth that most clinicians and hospital administrators are lucky if they are involved in one new hospital project during their career. We are happy to report that we are one of those lucky few. For those involved the opportunity to leverage our clinical knowledge, together with our past experiences, to ensure patient-centered environments are created is both an honor and an immense responsibility. It is a responsibility to our patients, the public, and all care providers and staff working within our facilities.

“So how can we rise to the occasion to ensure that the new healthcare facility that results from our efforts will be as good as it can be? How do we ensure that the process-staff engagement, design collaboration, program transition, and the actual move into our new facility-will be as smooth as possible? The same way we have within other dimensions of medicine, by sharing knowledge, by using evidence, and by sharing best practices within like communities of interest. The PCC team had considered that there would be significant benefits from the visit to Laguna Honda, but the actual return on the investment of everyone's time and travel exceeded expectations. We came away with much more than examples of best practices and a growing to-do list. The PCC team was offered the unique opportunity to observe a hospital that is living its own transition. In other words, the raw world, where problem solving and priority setting was occurring within the context of the urgency of continuing to deliver high-quality care. From our perspective, an unpredicted benefit for the Laguna Honda team was the motivational effect that our interest in their work had for the clinical and operational team, a Hawthorne effect if you will.

“At first glance these two projects might not seem similar, one being a rehab and skilled nursing facility, and the other a tertiary medical surgical and mental health tower, one located within the United States and the other in Canada, there are many facets that are the same. Both projects have leveraged the knowledge within evidence-based design to create a patient-centered, therapeutic, healing environment. Both have included elements within their design that honor the heritage of the sites, both teams realize a transition into a new building creates an opportunity to influence workplace culture, and both are going live within an environment where operating budgets will remain challenged more than ever before.”
Laguna Honda Hospital and Rehabilitation Center, San Francisco

Laguna Honda Hospital and Rehabilitation Center, San Francisco

Larry Funk: “It was a privilege for the staff at Laguna Honda Hospital to share some of our lessons learned in designing and building a new 780-bed hospital complete with a variety of Evidenced-Based Design (EBD) principles with our Pebble colleagues from Victoria, BC.

“Over the course of the two-day visit we attempted to provide the broadest possible overview of our project to our guests, and gave them an opportunity to become totally immersed in the planning process. Included in the whirlwind two-day visit was an opportunity to show our guests the 90-year-old existing facility with open “Nightingale” units, and describe the challenges of operating an aged facility. We then toured our three new buildings totaling over 500,000 square feet and described the many EBD features, all of which are intended to improve safety for residents and staff, improve clinical outcomes, improve satisfaction scores, and enhance operational efficiency. As each of these design elements was shown and discussed, the mutual learning opportunities were enriched. Examples of some of these EBD features included:

  • an emphasis on nature, sunlight, and therapeutic gardens;

  • animal farm, greenhouse, and planting beds;

  • specially designed bariatric care rooms;

  • ceiling lifts for patient lifting and transfer that travel from bed to bathroom;

  • a social dining program with family-style meals;

  • a “great room” for socialization and activities;

  • seven different room types for choice and variety;

  • a wellness center with swimming and therapeutic pools;

  • patient rooms each with view windows with operable sashes;

  • designs resulting in supply chain efficiency; LEED Green Building features; and

  • emphasis on accessibility throughout the campus.

“In addition to sharing programming and design issues we invited guests to participate in the transition planning activities. These activities included attendance of our monthly Fit Up/Commissioning Committee, Patient Care Committee, Support/Ancillary Committee, Orientation and Training Committee, and Executive Committee that guides and supports the entire process. One fascinating aspect of our guests' participation in the meeting was identification of the different management styles and organizational cultures between the two organizations. Another was the obvious pride demonstrated by our staff who felt honored and flattered that their work and the new facility was so significant that it attracted international interest from our visitors.

“We also introduced guests to our consultants who perform FFE/Procurement services, and others who guide the Transition Planning process. These introductions were instant networking opportunities where our guests learned new means and methods of performing planning work, and exchanged contact information for potential future collaboration.

“Even though both hospitals are distinctly different, in separate countries, and each having a unique culture and financial approach, we uncovered many commonalities. These included a commitment to creating safe and efficient healthcare environments, providing a high quality of life for patients and staff, and striving to improve clinical outcomes. To that end both Pebble Partners are conducting rigorous research to prove their hypotheses regarding EBD, as every Pebble Partner is committed to doing. All of us involved in healthcare design and construction projects have unique features and areas of expertise. We hope to have more visits, like the one the leaders of Royal Jubilee Hospital of Victoria, BC, made to Laguna Honda in San Francisco.”

These visits accelerate and facilitate the dissemination of innovative design features and EBD results to the healthcare and design communities. This information sharing has a beneficial effect on the quality of future healthcare facilities, which benefits society at large. Take a cue from Pebble Partners and do your part. Invite others to share your success and lessons learned, and listen and learn from others-healthcare will be that much better for it. HD

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Healthcare Design 2009 November;9(11):20-23