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Redesigning health care
Hospital begins process by re-examining patient experience
    Of the Post-Dispatch
  • St. Louis Post-Dispatch (MO)
  • May 29, 2005
  • Section: Business
  • Edition: Five Star Lift
  • Page E1

The pre-design process for SSM Health Care's new hospital started in earnest last month with a two-day session at the Knight Center on the Washington University campus. The learning lab brought together 13 national authorities in health care design with members of the SSM design team, patients, physicians and staff. Participants shared stories about health care experiences and imagined ideal healing environments. They burned through a peck of multicolored sticky notes during brainstorming and rapid-design sessions. SSM was hoping to discern general themes, not blueprint specifications. Its goal was to develop touchstones for the design process.

IDEO, an international design consultancy that helps companies innovate, was tapped to lead the meeting by Robert Porter, the SSM executive overseeing the project. He first enlisted IDEO's help in spring 2001 to redesign a medical and surgical unit at SSM DePaul Health Center, where he was then president. The IDE* team shadowed patients and toured the hospital by wheelchair. They dispatched hospital staff with disposable cameras to chronicle the bottlenecks and staff work-arounds. They interviewed patients and learned, not surprisingly, that many view the hospital from a reclining position. More than one patient interviewed had passed time counting ceiling tiles. Designers addressed the visual boredom by putting nature motifs into the ceilings of rooms and corridors.

A super-sized dry erase board replaced a more modest surface used for orienting information such as the names of caregivers and dates. Now, visitors are encouraged to turn the wall into a giant greeting card. IDEO's process led to the creation of nursing pods, or mini-stations, that offer line-of-sight proximity to five or six patient rooms. The old design clustered nurses at two large stations. Another innovation was a pager system carried by the nurses to improve call light response times. Patients relate call-light response to effective pain management and overall care quality. DePaul has since wired the unit's call buttons to portable phones that put nurses in instant voice contact with patients. Peter Coughlan, IDEO's master of ceremonies at the learning lab, said exercises, which included a speed dating warm-up and rapid prototyping, were intended to emotionally engage participants and get their creative juices flowing. A patient's perspective When participants at the learning lab were invited to share stories about patient experiences, Donna Looser, 39, of Mehlville, contrasted her daughter's and son's surgeries at St. Louis Children's Hospital. The procedures corrected congenital finger webbing. Isaac, her infant son, underwent surgery earlier this year. The family got an orientation call telling them where to park and whom to see when they arrived. They met the entire surgical team ahead of the procedure. "They connected with us as people," Looser said. "I could look at the doctor who was going to put him to sleep. When he went to the operating room, he left in someone's arms. I knew he wouldn't be in someone's arms in the OR, but I wanted to feel like he was being cared for as though he was being held, and he was." Every hour Isaac was in surgery, the family got an update from the operating room. Looser contrasted the experience with her angst when her then-infant daughter Callie underwent a similar procedure in 2003. The family went four hours with no information from the operating room. "That made us nuts," Looser said. "Then the same-day surgery department closed down and they left us sitting there in a dark room without knowing where our kid was and we couldn't find anybody to find her. We were afraid she had died." Callie had been admitted because outpatient recovery was shuttered for the night. She shared a room with a 10-year-old boy who was unhappy to have a crying baby keeping him awake, Looser said. Dr. Jeanne Huddleston, medical director of the Mayo Clinic and president of the Society of Hospital Medicine, also shared an experience. When she was 19 and a patient, her doctor made a lasting impact by sitting down next to her bed, taking her hand and looking her in the eye while he discussed her condition, she said. "When I see patients now, and when I'm teaching residents to see patients, I hit the up button on the bed. I bring the patients into the conversation. The patient is a person, not a thing," Huddleston said. Huddleston said most hospitals are not healing environments. Patients are exhausted, disoriented and fearful, she said, with little control over their environment or schedule. She believes facility design must encourage rest, healing and safety. Thoughtful layout can allow nurses and doctors to focus on one task at a time with limited error-promoting distractions, she said. Putting tools and supplies at or near patient beds can free up "touch time" -- the opportunity for caring conversations between staff and patients. De-stressing the staff Mark Renken, an administrator at SSM St. Louis, said most patients relate positive hospital experiences to an employee's act of caring. Realizing this, he assessed the areas SSM sets aside for staff. "The lounges are small, the chairs are plastic. We ask them to provide exceptional care and what do we provide for them?" Renken asked. Comfortable break spaces and walking trails at the new facility can help staff cope with stress, but only if there is time to use them. Porter said SSM wants to make sure its process and facilities design makes the time and creates a variety of spaces where staff can take care of themselves. Some people need quiet to relax, others crave action and distraction. Kurt G. Spiering is a principal architect in the Milwaukee office of Hammel, Green and Abrahamson, the firm working with Mackey Mitchell Associates of St. Louis to design the Fenton medical campus. Spiering said on-site amenities such as gardens, workout rooms and spa services can help staff stay energized. "That is the kind of person I want treating me -- someone as fresh on the fifth day of work as they were on the first," he said. -- Guideposts for SSM's Fenton hospital Themes that emerged from SSM Health Care's learning lab will be guideposts in the design of its Fenton hospital. SSM wants a facility that is: * Organized around the patient's experience and needs. * Conveniently laid out for ease of access. * Supportive of the human dimension of healing by fostering connections between patients and staff and ministering to the needs of families. * Encouraging of the well-being of patient, staff and physician in an environment that supports teamwork and promotes healthy lifestyles.

LOOSER FAMILY PHOT* - Isaac Looser had surgery earlier this year at St. Louis Children's Hospital. His mother, Donna, related the positive experience her family had there during the learning lab for the new SSM facility.

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