Putting it together
For more than 20 years, the Minneapolis Heart Institute had grown as most hospitals do: by accretion, adding services and units in space as it became available about the hospital. So it wasn't surprising that, after years of this process, patient services that should have been delivered contiguously and collaboratively were instead scattered about the hospital campus, with patients having to walk as much as two blocks through the hospital campus to complete a proper sequence of care. Six years ago, a group of cardiovascular physicians, nurses, and hospital administrators sat down to reevaluate how the hospital would look and operate if it were designed to provide a top-quality experience from the patient's perspective. In April 2005, the answer emerged—a radically reoriented new structure incorporating the latest concepts in patient convenience, comfort, and coordinated care. Recently, architect Jeff Stouffer of HKS, Inc.; Daryl Schroeder, vice-president of operations; and Julianne Lapensky, director of cardiovascular patient services, offered a virtual tour of Abbott Northwestern Heart Hospital and its “patients first” design.
Daryl Schroeder: It was really a challenge finding an architect to develop this new model in what was a fixed urban footprint, with little or no flexibility in size or shape of the building. We chose HKS because of the experience they had demonstrated developing healthcare projects under similar circumstances.
Jeff Stouffer: We went through a model-of-care study with staff, evaluating in detail how patient flow would change and staff would work with this, and then we designed the building around it. Nurses were accustomed to being based in the center of a circular unit, where all patient rooms were easily visualized. But from a patient perspective, the circular unit was inadequate because of noise and constrained space for families or storage. However, the staff were committed to the patient-centered approach, and the result offered a combination of decentralized work spaces between rooms, still with good visibility, and convenient central work spaces for nurses, as well.
Stouffer: This is an excellent visual symbol of how challenging this building was architecturally. It's built on top of an existing ICU unit and connected with a new lobby, and it provides what we intend as an interesting transition for patients and families from the existing garage to the hospital. The stairwell (heated in winter) winds around the curved façade with large windows providing excellent views of the park. This leads directly to a bridge connector to the new lobby. The lobby is spacious and has a large fountain and a grand piano.
Julie Lapensky: We thought we could reorganize patient traffic patterns and staff work flows to be more efficient for patients and staff. For example, we put all outpatient services adjacent to the entry lobby and the parking ramp and colocated the cardiology clinic next to cardiovascular diagnostic services (stress testing, echocardiography, nuclear medicine, CT angiography, and cardiovascular MRI). It was felt that the adjacencies would provide more convenient access, one-stop registration for patients, and better communication between outpatient departments.
Stouffer: These services are also adjacent to a business center, an education center, and a bistro with heart-healthy food, so the whole area is clearly more than a reception/waiting area.
Lapensky: We also colocated cardiovascular prep and recovery services in one space, rather than four spaces as before, making wayfinding easier for patients and families. In addition, providing care is more efficient for staff and physicians because prep/recovery is directly adjacent to the CV/EP labs and CV ORs.
Schroeder: From a utilities perspective, reorganizing the adjacencies led us to install all new utilities. All the existing ones were either at capacity or old enough to raise reliability questions, so we viewed this as an opportunity to create a complete new building and all new systems from scratch. This has given us an opportunity to evaluate just how building design affects utility costs by comparing the old and the new. We've never been able to disentangle utility costs from building operations before or have a standard of comparison. But as we gain experience with the new building and shut down portions of the old one, we'll be able to get a much clearer perspective on this. One thing we know already is that the new utilities are more efficient per square foot.
Acuity-Adaptable Versus Universal
Stouffer: We sized the medical gas system to convert an entire floor to critical care, if necessary. The rooms are all the same size and have been designed for easy adaptation according to acuity. Universal rooms were given some consideration at first, but they meant having to equip all the rooms with the necessary monitors and other equipment, plus cross-training the staff appropriately—altogether, a very costly proposition.
Lapensky: Especially with a heart hospital of this size—128 inpatient beds and 32 prep/recovery beds. With the high- acuity of our ICU patients and how quickly their conditions can change, our nursing staff thought it would be safer to have critical care nurses immediately available to assist one another with these cases rather than rely on a universal approach.
Lapensky: We thought it was important to provide the nurses with pleasant spaces on the units for staff meetings, education, and breaks. Nurses indicated that this would be more convenient for them than traveling to other parts of the hospital.
Stouffer: This was a high-priority consideration. We wanted to make the nurses' jobs easier and their environment more pleasant, especially with nurse retention being such a generalized challenge these days.
Lapensky: A lot of our thoughts on patient-centered design came from our experience with developing an integrative therapies program for CV patients. Therapies such as guided imagery, massage, and music are employed to enhance pain management and relaxation. We surveyed the literature and asked patients, families, and staff, “What creates a healing environment?” Ideas included an emphasis on nature, water features, gardens, soft colors, art, and plenty of daylighting. We allocated family space in each patient room, including a pullout sleeper and high-speed Internet access. We also have terraces on each floor, including one just outside the surgical waiting area, allowing patients and families to walk about or visit in pleasant outdoor surroundings.
Stouffer: We were interested in creating “places of escape” for families and patients. Aside from the outside balconies or terraces on each floor overlooking the central garden area, we have a large waiting room on each floor with a separate play area for children, and solaria with great views of downtown Minneapolis for people to visit during the winter months. These have operable windows for people to use in warmer weather. Giving families more freedom was one of our central themes from the start.
OR of the Future
Stouffer: We've shelled in an extra-large operating room—abut 900 sq. ft.—because there is a lot of talk these days about combining MRI and other radiology procedures with surgery to the point that these ORs might serve as multifunction rooms, or what I call “fusion rooms.”
Schroeder: I have the responsibility of overseeing radiology, among other departments, and I know there is a lot of interest in collaborative possibilities with surgery. The shelled-in OR gives us the opportunity to explore these possibilities over time.
Schroeder: I think our hospital safety director was as pleased as anyone with the new design because it freed us of the clutter of wheeled equipment lining the hallways. We gave a lot of thought to providing adequate space to conveniently locate new technologies—for example, providing nooks for computers in hallways.
Lapensky: Our physicians and nurses were consulted in depth on all aspects of design, including space needs. A nurse manager even measured all the existing equipment so that we could plan the space appropriately and in detail to accommodate technology.
Stouffer: I'd add, as a general observation, that the medical and nursing staff at Abbott Northwestern were terrific to work with. I think the key to this was that they were involved in developing the model-of-care studies from the start. They started with a patient focus, and they stayed committed to that throughout. HD