Building for Exceptional Care

It’s not news that things are changing on the Washington University Medical Center campus, where Washington University School of Medicine, Alvin J. Siteman Cancer Center, Barnes-Jewish Hospital, St. Louis Children’s Hospital and other patient-care facilities are situated. If you drive along Kingshighway Boulevard, just east of Forest Park in St. Louis, the changes are obvious: cranes, steel girders and a transformed skyline offer more than a hint that renovation is underway.

What’s not so obvious is the nature of the planning process that helped bring a vision to fruition, well before an old brick came down or new beam was hoisted. Honoring the mission of the medical campus—to take exceptional care of people—the architects, designers and engineers worked with several BJC HealthCare advisory groups to arrive at a plan for the 780,000-square-foot-expansion.

Patient Room Rendering

Rendering of a labor and delivery room.

“We pioneered a new, innovative design process,” says Nancy Coleman, BJC HealthCare’s director of planning and design. BJC HealthCare is the parent health system for Barnes-Jewish and St. Louis Children’s hospitals. In addition to the patient-satisfaction data that BJC HealthCare collects through the national Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, it also gathers its own data based on feedback from its employees, and patients and their families.

“Traditionally, hospital-design decisions are made without reference to HCAHPS performance scores, safety information, or employee-satisfaction data,” Coleman says. But in designing the new buildings, she notes, “we used all these things to help determine design solutions that ultimately will improve patient outcomes and satisfaction. Former patients and their family members served on three different advisory councils, along with more than 350 physicians, clinicians and non-clinical staff.

The goal is to build buildings designed to help doctors, nurses and technicians meet the mission. “We feel confident that the new buildings will help us deliver the highest level of patient-centered care,” Coleman says.

Little changes, big impact

Peter Grandine, vice president and senior medical planner of the health care division of HOK, the architecture and engineering firm for the project, offers an illustration of the mission-influenced design: “In a traditional hospital room, the patient has to cross the room to get to the bathroom. In the new patient rooms, these facilities are located on the headwall, where the head of the bed is positioned. That means there’s a shorter, safer walk for the patient and a reduced risk of falling.”

The proximity of bathroom to bed is just one element of a new, standardized room layout. As staff members enter one of the new rooms from the hallway, the bed is always on the left, in one of three distinct areas called zones by the planning and design teams. In each room, there’s a zone in the center of the room for the patient and bed; a zone near the window and bed for visitors to gather; and a zone nearest the hallway for caregivers, oriented so that caregivers face patients and family when they enter.

The benefit of standardizing the room design—hundreds of rooms, all the same—is that it helps staff react quickly when necessary; no one has to pause to study the room and locate emergency equipment—it’s always in the same place. This kind of consistency also means that staff can be more efficient, with more time to spend with their patients.

Stephanie Kroener, BSN, RN, project manager for St. Louis Children’s Hospital, offers this example of patient-centered design: “Traditionally, computers are placed on the sidewalls of patient rooms. In one of our advisory council meetings, a teenager mentioned that staff always had their backs to patients when they turned to enter information in the computerized medical chart. So we moved the computer from the sidewall to the headwall. Now staff members face patients and families while they are charting.”

Color and light

Garden Rendering

A rendering of the garden intended for women and their families postpartum.

The new buildings are designed to take advantage of as much outdoor light as possible. Because natural light promotes healing, every patient room has one wall that is almost entirely window; nearly 85 percent of these rooms look out onto Forest Park. Many of the other rooms offer views of one or more of five outdoor gardens. Windows placed at the end of each corridor are there to help visitors orient themselves within the building, helpful when trying to navigate a complex campus.

Color, too, is important and plentiful, employed for three primary purposes: to help visitors find their way through the buildings, to distinguish staff work areas from patient-care areas and, most important, to promote healing.

In the new buildings, colors were chosen for their abilities to generate emotional and physical responses. Kroener says, “Research tells us that different colors elicit different responses. So we’ve asked, ‘Are we trying to motivate patients? To help them stay calm?’” By way of example, Kroener notes, the orthopedic unit has incorporated brightly colored stripes into the flooring that serve as distance markers. “It’s more fun for children if you can say, ‘You made it to the green stripe yesterday. Let’s go for blue today.’” Similar striping in the labor and delivery unit helps women and their partners mark their progress as they walk the corridors, preparing for delivery.

Shhhhh

Noise is a major stressor. According to Jon Bettale, BSN, MBA, project manager for the Barnes-Jewish Hospital expansion, “Stress can lead to elevated blood pressure in our patients and raise their heart rates, ultimately affecting the body’s ability to heal. And research tells us that staff members working in calm, quiet environments are better able to focus.”

Accordingly, one of the top design priorities was banishment of as much noise as possible. This has been accomplished in a number of ways, including: use of sound-absorbing flooring and ceiling materials, and placing the doors leading to busy supply and utility rooms in ways that reduce noise levels in public corridors.

And, Bettale says, “walls in patient rooms are thicker, reducing the transmission of noise and vibrations.” Additionally, the new room configuration places the headwall of one patient room directly opposite the footwall of the room on the other side of the wall. When beds are placed headwall to headwall, Bettale says, bedside activity is transmitted through the shared wall, disturbing neighboring patients and distracting medical caregivers.

Offering respite

Honoring the requests of former patients, families, physicians and nurses, every floor in both buildings has separate respite areas for families and for staff, and every floor in St. Louis Children’s Hospital has what’s called a child life room, where therapists and children can “play” through the challenges of hospitalization. “We’ll have respite areas at the end of each corridor, where patients and their families can be together. For patients with extended hospitalization, these areas are a welcome change from the hospital room,” Bettale says.

Other accommodations designed for families include kitchen and dining areas, showers, laundry facilities, private computer stations and lounges with comfortable, living-room style furniture.

Bettale describes the staff respite areas this way: “It’s more of a lounge, small and quiet, with soft seating and dimmer switches on the wall for lighting.” Grandine adds, “The requests for this space actually came from patients and families who understand the intense emotions associated with caring for patients. They wanted physicians and nurses to have a place where they can take a few quiet moments for themselves.”

Offering comfort and healing for patients and their families, and efficiency and calm for staff, the new patient-care spaces make healing more pleasant for everyone.

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Barnes-Jewish Hospital at Washington University Medical Center is the largest hospital in Missouri and the largest private employer in the St. Louis region. An affiliated teaching hospital of Washington University School of Medicine, Barnes-Jewish Hospital has a 1,800 member medical staff with many who are recognized as "Best Doctors in America." They are supported by residents, interns and fellows, in addition to nurses, technicians and other health-care professionals.

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