Architecture

A New Model for Hospital Design Rises in an Ohio Cornfield

By Randy Edwards

Dublin Methodist merges beauty and brains to create a high-quality, patient-friendly facility

In the mid-1990s, Bessie Garten spent nine miserable days and nights in a large Columbus, Ohio, hospital at her husband’s bedside. Howard, a traffic cop, had been struck by a car. “When they said he had life-threatening injuries I could not leave his side,” she recalls. “I sat next to his bed and slept in the chair with my head leaning over on the bed.”

As the days went by and flowers poured in from the police fraternity and concerned strangers, Garten’s extended bedside vigil began to grate on the nursing staff. “One of them actually yelled at me. She said, ‘Why don’t you go home and take half these flowers with you?’ ”

Howard Garten recovered from his injuries and retired from the force. A dozen years later, when he needed abdominal surgery, he and Bessie chose a nearby hospital that, while still only 3 months old, already was earning a reputation for its technological advances—and for its hospitality. Dublin Methodist Hospital was about 10 miles from their home in one of Columbus’ fastest-growing suburbs.

For six nights, Bessie Garten again stayed at her husband’s side, this time as a welcome guest in a sleeper sofa and with the warm support of the nurses and hospital administrators. The spacious, private patient room was large enough for plenty of extended family, and there were no limits to when they could visit.

“I came with my own blanket and pillow,” she recalls. “When they said I could spend the night, and they’re going to actually have a place for me to sleep, I said, ‘Woo-hoo!’ ”

Oversized rooms with overnight berths for family members are among the many amenities patients notice while receiving treatment at Dublin Methodist Hospital, a full-service, 94-bed hospital opened in January by OhioHealth, a system of not-for-profit hospitals based in Ohio’s capital city.

Patients know there is something different about the hospital the moment they enter the airy, open atrium and see the live ficus trees and a waterfall towering more than three stories above the coffee shop. As they’re escorted to their destination by cheerful greeters (the hospital has no admitting department), they notice natural light streaming into every corner of the building, polished blond wood, walls painted in soothing earth colors and decorative bamboo accents.

What they might not notice as quickly—because it’s not there—is the paperwork. The new, $130 million hospital is nearly paper-free, using digital medical records for just about every facet of the patient’s visit. Doctors and nurses alike carry laptop computers that keep them a few clicks away from a patient’s vital signs, lab results and physicians’ orders.

The Future of Health Care

Yes, it looks like a fine hotel and functions like the command center on “24,” but these amenities are more than cosmetic or trendy. Dublin Methodist is the most recent partner in the Pebble Project, a research venture pursued jointly by the California-based Center for Health Design and a consortium of more than 50 health care providers committed to evidence-based design—a concept that links the quality of the hospital environment to patient healing. From the expansive windows to the furniture to the sculpture in the rooftop gardens, the purpose in every aspect of Dublin Methodist’s design is to provide a comforting and calming atmosphere for patients, their families and the hospital staff—and be cost-effective at the same time.

“Evidence-based design is the future of health care,” says Xiabo Quan, a research assistant for the Center for Health Design. “We need to improve the physical environment for patients and staff in order to improve health care quality.”

Many hospitals are adopting elements of evidence-based design in remodelings or expansions, but because Dublin Methodist was built in what had been a cornfield, OhioHealth was able to incorporate the latest concepts and state-of-the-art technology from the ground up.

“The administration at the Dublin hospital has paid great attention to evidence-based design from the very early phases of design,” Quan says.

Cheryl Herbert, the hospital’s president, says the chance to design and build a hospital from scratch is a once-in-a-lifetime opportunity for a hospital administrator. “And that opportunity carries with it the obligation to make it the best that it can be,” she says.

Herbert acknowledges that many of the high-tech innovations are in use elsewhere, but says Dublin Methodist has wed technology with design to fundamentally change patient care in novel ways. “What makes us unique is the coordination of everything, with everything being together in one place,” Herbert says. “We believe we’ve pushed the envelope.”

Although evidence-based design sounds a little like advanced feng shui, published research supports every element of Dublin Methodist’s design, Herbert says. She cites some examples: The private rooms prevent infection and medical errors; patients recovering in rooms with natural sunlight use half as much pain medication as patients who are in an interior room. The Vocera wireless communication system and sound-muffling ceiling tiles help keep the hospital quiet, which has been shown to benefit the emotional well-being of both patients and staff.

Planning the hospital involved traveling throughout the country to look at other examples of evidence-based design. Mock-ups of rooms in a nearby warehouse were created so that doctors and nurses could offer critiques.

“It was great to have the opportunity to build a room once and tweak it to find out what works before we went out and built it 94 more times,” Herbert says.

All rooms, even those in the emergency department, are acuity adaptable, so patients can maintain the same room and the same staff throughout their stages of recovery. They’re also all same-handed, which means if the oxygen is on the left side in one room, it’s on the left side in every room.

Competence is Not Optional

The paperless records system also is intended to improve patient care by increasing the speed of information transfer and reducing errors. Dublin has virtually eliminated paper, creating a patient record database that can be accessed through a secure, Web-based interface from anywhere a caregiver might be found.

“Let’s say we have a person come in with chest pain,” explains Dave Boehmer, medical director for Dublin Methodist’s emergency department. “I need to call his cardiologist and brief him on the patient’s condition. If the cardiologist is in his office, or even at home, he can go online and pull up the chart. While I am talking to him, he can be looking at all the lab tests, maybe even the EKG. And while you’re getting that information, sometimes it prompts additional questions. He’ll say, ‘Hey, what’s up with that blood pressure?’ ”

Multiple firewalls and backup power systems are in place to avoid system failure, and the staff has been trained in an alternate system (i.e., good, old-fashioned paper charts) in the event there is a crash.

Competence in the new system is not optional, says William Schirmer, M.D., who performed Howard Garten’s surgery. “They made it clear when I applied for credentials that they want doctors who come here to understand that they’ll need to have a comfort level with computers and be able to use technology to streamline procedures,” he says. “And if that seems too much for us, well, you should know that going in.”

It was overwhelming at first for Schirmer, despite a three-hour orientation and the dedication of the hospital’s IT professionals, who met Schirmer at the door and did everything but scrub on his first day. “I’m pretty comfortable with computers,” says Schirmer, who made his own practice paperless three years ago. “But on my first day, it took me 45 minutes to do something that usually takes me five. And it was frustrating.

“As frustrating as my first day was, though, I can already see where this system is going to be a time-saver, and cut down on errors,” Schirmer says. Orders are immediately transferred to the lab or the pharmacy, and can be called up by nurses even before the patient arrives on the floor. Vital signs, test results and other patient records are available instantly. If a patient has a drug allergy and a physician tries to prescribe that drug, it sets off a warning.

Getting Personal

But the impact of the technology goes beyond speed and accuracy, Herbert says; it affects the way work gets done. “When you introduce as much technology as we have, it’s not just automating existing procedures,” she says. A totally digital medical records system, for example, eliminates the need for a central records repository in the patient care unit, and that has allowed the hospital to do away with the traditional nurses’ station entirely. Instead, the staff for each unit is distributed across six ministations, which the staff refer to as “nursing perches,” says Connie Eltringham, R.N., a 16-year veteran of the OhioHealth system. These are polished counters with attractive overhead lighting, and when a couple of nurses are perched there over their laptops, it resembles a Starbucks at midday more than the hub of a busy hospital. But it’s all part of what Dublin Methodist calls its “high-tech, high-touch” philosophy.

“We’re closer to the patient and the room. We’re able to look in without having to walk over there. And we’re able to come to them immediately, and that’s especially important in an emergent situation,” she explains. The larger rooms are laid out in such a way that a family can easily move to one area when a patient needs a nurse’s care, without being asked to leave the room.

Eltringham admits that the nurses are more exposed, with family around 24/7 and without the option of retreating to the traditional, fortresslike nurses’ station. “It’s definitely different, but that’s part of being a nurse. You’re going to be accessible to both the patient and family,” she says. “There are areas they call ‘patient staging areas’ where we can have those private conversations with doctors or family about patients without running into HIPAA problems.”

Is It Too Much?

The private rooms, flat-screen TVs and other apparent luxuries at Dublin Methodist naturally have drawn fire from advocates of affordable health care. From the time OhioHealth announced plans for the hospital, critics suggested that the facility was unnecessary and would draw business away from central city hospitals, which already were suffering from low occupancy rates.

Cathy Levine, executive director of the Universal Health Care Action Network of Ohio, says she supports the use of advanced technology to improve health care efficiency and reduce medical errors. She questions, however, the need for a new full-service hospital with spacious private rooms and posh appointments in Columbus’ affluent suburbs when “there is a shortage of crisis proportions of access to primary medical care elsewhere in the community.”

Ohio no longer requires a certificate of need for hospitals, and a system of regional health-planning agencies was phased out nearly a decade ago when the state legislature cut funding. As a result, Levine says, there are no objective criteria to determine whether the Dublin area needed a new hospital.

“But do I suspect that this particular hospital got built because it’s in an affluent community with a high percentage of insured people? Yes, I do,” she adds.

In response, Herbert says the Dublin area is one of the fastest-growing regions in Ohio and that the immediate area was underserved with hospital beds close to patients’ homes. As the area grows, so does the travel time between the outlying suburbs and places like Riverside Methodist Hospital, an OhioHealth property in Columbus, she says.

As a not-for-profit community hospital, Herbert adds, Dublin Methodist accepts all patients, regardless of ability to pay, and receives the same reimbursement from Medicare and insurance companies as the other OhioHealth hospitals. And as the technological systems at this hospital prove themselves, they’ll be expanded to other OhioHealth hospitals, including those that serve less-affluent populations.

The hospital staff is working with the Center for Health Design to test the business case for evidence-based design. “In the end, we’re convinced that there is going to be a payback for all the technology in terms of clinical quality, patient safety and patient satisfaction, as well as cost effectiveness,” Herbert says.

Researchers hope to report preliminary results by the spring of 2009, but 100 days after opening its doors, Dublin Methodist Hospital already was experiencing shorter than average stays (about three days) with daily admissions running between 25 to 30 patients.

For his part, Schirmer believes more and more hospitals will be looking to Dublin Methodist and others like it as models for health care. “It’ll be driven by results and value, and Dublin may be on the cutting edge, but this is the wave of the future,” he says.—Randy Edwards is a freelance writer in Columbus, Ohio

This article 1st appeared in the July 2008 issue of HHN Magazine.

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