Creating the Ultimate Healing Environment

By Herbert, Cheryl L Yoder, Lamont M

Integrating Evidence-Based Design, IT and Patient Safety In early 2004, OhioHealth, a regional Healthcare system headquartered in Columbus, Ohio, began planning a new hospital that would service the needs of a growing community in central Ohio. OhioHealth believed that a guiding principle in the construction effort was basing building design on the best available research to positively impact balanced scorecard measures of quality and safety; patient, family and staff satisfaction; operational efficiency; and financial performance.

Another guiding principle in the design and construction was an investment in cutting-edge information technology (IT) that would assist in improving patient safety while allowing the hospital to be digital, wireless and paperless to the maximum extent possible.

OhioHealth opened its eighth member hospital, Dublin (Ohio) Methodist, on Jan. 8,2008, promising to redefine the delivery of patient care. The 325,000-square-foot hospital provides an ultimate healing and work environment by paying attention to stressreducing design and creating a patient/ family-centered environment that improves safety while respecting privacy and dignity.

INCORPORATING EVIDENCEBASED DESIGN

Evidence-based design, according to The Center for Health Design, Concord, Calif, (see sidebar on page 23), creates environments that are therapeutic, supportive of family involvement, efficient for staff performance and restorative for workers under stress. Evidence- based design should result in demonstrated improvements in an organization’s clinical outcomes, customer satisfaction, productivity, economic performance and cultural measures.

Senior leaders recognized, when designing Dublin Methodist, that while the hospital would open in 2008, it would need to serve the community for decades to come. As a result, Dublin Methodist pushed the envelope and took advantage of the opportunity to start from scratch. Evidence-based design was the roadmap that allowed the hospital to choose design options that would best fit the needs of its patients, families, staff and physicians. Dublin Methodist incorporated as many of those options as was reasonably possible. In addition, process redesign and culture building were important activities necessary to support the healing environment.

One of the many decisions that emerged through evidence-based design research was to make each of Dublin’s 94 patient rooms- expandable to 300 as demand increasesprivate and large enough for patients, families and caregivers. The rooms are acuity adaptable, allowing patients to remain in the same room regardless of level of illness. This virtually eliminates the need for intra-hospital transfers and reduces the likelihood of medical error associated with those transfers. Technology and a highly trained staff help bring this quality care to the patient.

Another feature of the rooms is that they are like-handed (designed exactly the same way): what is on the left in one room is on the left in the next room. Using this concept of maximum standardization has proven to be a successful error-reduction technique in other industries such as the nuclear industry and airline industry. In healthcare, like-handed rooms diminish the need for care providers to search for what they need for patient care. Caregivers can focus more on the patient and hopefully reduce medical errors and staff stress.

During the design phase, Dublin Methodist became part of the Pebble Project, a group of hospitals and healthcare facilities dedicated to using evidence during their design and conducting research after they are open. Given that Dublin has been in operation for six months, most quantifiable results regarding how evidence-based design has impacted its patient safety and other balanced scorecard measures are not yet available. Other facilities in the Pebble Project have seen patient transfers reduced from 80 to 90 percent and falls down by as much as 80 percent.

In addition, Pebble Partners have seen hospital-acquired infections reduced by 4 to 6 patients per month; nurse turnover falling 10 to 14 percent; and drug costs reduced by 5 percent.

In just six months after opening, Dublin Methodist was able to measure the effects of evidence-based design on patient satisfaction. Emergency Department (ED) patient satisfaction scores are in the 99th percentile, and the hospital’s inpatient unit consistently ranks in the 95th percentile and above, according to benchmark surveys by Press Ganey.

Dublin Methodist uses evidence-based design in the following areas:

* Interior courtyards and windows around the entire perimeter of the building allow natural light to reach nearly 90 percent of all occupied spaces. Research has shown that natural light positively impacts rates of medical error, staff satisfaction, patient depression and length of stay.

* Windows in patient rooms partially open to let in fresh air.

* A waterfall and trees in the lobby help to reduce stress among patients, families and hospital staff.

* Decentralized work stations bring caregivers closer to their patients.

* Sound-absorbing ceiling tiles and a noiseless paging system create a quieter environment.

* Standardized rooms for inpatient, ED, and pre- and post-op procedures should help reduce clinical errors.

INTEGRATING IT AND PATIENT SAFETY

One of the most important aspects for Dublin Methodist in creating the ultimate healing environment is weaving evidence-based design with information technology. To gain an understanding of the kind of technology that would best match the hospital’s needs, hospital leaders asked what the best experience would be from a service perspective, from a quality perspective, from a safety perspective and from a staff satisfaction perspective. The answers that emerged guided Dublin Methodist to incorporate technology that would minimize duplicate efforts, whether in communication, documentation or processes.

Every patient’s medical information is stored on the computer network so it can be accessed by those who are authorized to do so using computer terminals throughout the hospital or other equipment such as wireless tablet PCs or handheld devices. This helps reduce the chance for errors because patient information is available in “real time” and to multiple simultaneous users. For example, Dublin Methodist does not have an admitting department but has a group of people who perform the admitting function in the patient’s room upon arrival. Once patients are admitted, all their information can be automatically accessed by any department where care needs to be provided.

Other key IT initiatives include:

* Single sign-on access to multiple computer applications through the use of a biometric fingerprint reader

* Integration of patient call lights, cardiac monitor alarms and bed exit alarms with the wireless communication badge and earpiece worn by each caregiver

* Use of computerized physician order entry

* Implementation of new ED and surgery management systems

* A bed management system that allows proper placement of patients more quickly and sends messages to environmental services when beds need to be cleaned

One of the keys to success for Dublin Methodist’s IT undertaking was its “go live” initiative that saw the implementation of 168 computer applications on opening day. Prior to opening, several mock live events were conducted to test all the IT systems in an integrated, patient care environment. After opening, IT support was provided 24/7 on-site for two months and then went to eight- to 12- hour daily support.

While becoming paperless was a priority, Dublin Methodist was concerned about its feasibility because healthcare facilities are not naturally paperless environments. To overcome this issue, the hospital focused on hiring employees who were willing to use the technology. More than 5,000 people applied for 480 jobs. The hospital chose those who were willing to do whatever it takes to serve patients’ needs. In addition, physicians applying for privileges at Dublin Methodist agree to be trained in and use the available technology.

The learning curve for staff to get up to speed with all the hospital’s technology was steep. Because most healthcare environments have long relied on manual and paper-based processes, Dublin Methodist staff were required to complete up to eight weeks of technology training before the hospital opened to get them comfortable with using paperless processes and technology. The hospital had to operate on opening day as if it had been open for many years.

One important additional note is that a culture that supports the vision and goals of the facility must be built from day one. By picking the right employees-who were supportive of the processes and use of technology-the hospital has created a new model of patient care delivery. Without a good culture, the physical building and the processes used inside will not mean as much.

The best hospital in the world with all the bells and whistles could be built using evidence-based design, but if patients are greeted by someone with a short-tempered attitude or do not get their call light answered, nothing else matters. The culture at Dublin Methodist is the foundation that supports all the work in evidence-based design, IT and patient safety. These core issues require the hardest work and demand the most consistency in order for this new model of care to succeed. In just six months after opening, Dublin Methodist has been able to measure the effects of evidence-based design on patient satisfaction.

One of the many decisions that emerged through evidence-based design research was to make each of Dublin’s 94 patient rooms- expandable to 300 as demand increases-private and large enough for patients, families and caregivers.

EVIDENCE-BASED DESIGN ALLOWS NATURAL LIGHT TO REACH 90 PERCENT OF ALL OCCUPIED SPACES.

A THERAPEUTIC ENVIRONMENT IS A RESULT OF EVIDENCE-BASED DESIGN

Design Partners Critical During Construction

Dublin Methodist executives and staff knew very little about evidence-based design prior to building the hospital. The architectural team introduced senior leaders to The Center for Health Design, Concord, Calif., a leading research and advocacy organization whose mission is to transform healthcare settings- including hospitals, clinics, physician offices and nursing homes- into healing environments that contribute to health and improve outcomes through the creative use of evidence-based design.

Soon after the hospital began working with The Center for Health Design, Dublin Methodist became a partner in the center’s joint research effort, the Pebble Project, which consists of selected healthcare providers who work to create a ripple effect in the healthcare community by providing researched and documented examples of healthcare facilities whose design has made a difference in the quality of care and financial performance of the organization. The Pebble Project currently has 44 active provider partners, seven industry partners and seven alumni.

Working with the Pebble Project had a tremendous impact on the design and construction of the hospital. Prior to meeting with the Pebble Project team, Dublin Methodist senior leaders had design ideas already in mind but came away from its first Pebble Project meeting with new ideas that would incorporate design features to create the best possible experience for everybody who walked through the hospital doors: patients, families and staff.

The Pebble Project gave Dublin Methodist access to other healthcare providers using evidence-based design who were an invaluable resource, providing data in areas of clinical improvement, patient and family satisfaction, organizational change and financial performance.

In its work for Dublin Methodist, design company Big Red Rooster, Columbus, Ohio, completed a cultural report by conducting research about patients and staff perceptions of hospitals and the environment. The research was finished before design and construction of the hospital began so those findings could be incorporated into the design of the building. The research was centered around traditional hospital cultures to help identify areas for improvement such as healthcare quality, patient satisfaction, staff retention, operational efficiency and productivity, and attracting more patients.

By Cheryl L. Herbert, RN, and Lament M. Yoder, RN, FACHE

Cheryl L. Herbert, RN, is president of Dublin Methodist Hospital, and Lamont M. Yoder, RN, FACHE, is vice president and chief nursing officer of Dublin Methodist Hospital.

This article is based on their presentation at the 2008 Congress on Healthcare Leadership titled “Create the Ultimate Healing Environment: Integrate Evidence-Based Design, IT and Patient Safety.” Herbert can be reached at HerbertC@OhioHealth.com, and Yoder can be reached at lyoder@OhioHealth.com.

Copyright Health Administration Press Sep/Oct 2008

(c) 2008 Healthcare Executive. Provided by ProQuest LLC. All rights Reserved.