"Hospitals Build A Better 'Healing Environment' - Outdated Facilities Redesign Patient Areas To Lift Quality Of Care", (c)  Laura Landro, The Wall St. Journal, March 21, 2007"

At Northwest Community Hospital in Arlington Heights, Ill., the neonatal intensive-care unit's open-plan nursery is being transformed into a series of private "pods," with glass walls that allow staff to observe infants, but privacy curtains and reclining chairs for moms to be alone with their babies. The aim: to sharply reduce noise, harsh lighting, and other environmental stresses that can spike blood pressure, interfere with breathing and heart rate, and worsen sleep for newborns.

Amid a $200 billion construction boom to replace or rebuild aging and outdated hospitals over the next decade, health-care architects and designers are creating a new blueprint for a "healing environment," based on a growing body of evidence showing that the quality of a hospital's patient rooms, corridors and public spaces directly influences both the health outcomes of patients and the stress levels and efficiency of hospital staff. In addition to private patient rooms and "social spaces" for family members, new designs include decentralized nursing stations to reduce staff chatter, acoustical tiles and carpet to reduce equipment noise, special filtration systems to improve air quality and neutralize odors, and access to gardens and natural light to reduce stress and combat depression that can be exacerbated by noisy, chaotic and harshly lit hospitals.

Just as doctors practice medicine based on evidence of effective treatments, hospitals are turning to "evidence-based design," as studies show "the built environment has an important impact on outcomes in health care," says Debra Levin, president of the nonprofit Center for Health Design, a leading research group that is working with about 40 hospitals on a program known as the Pebble Project to document examples of health-care facilities whose design has made a difference in the quality of care and improved financial performance.

The federal Agency for Healthcare Research and Quality is developing a video for hospital officials that ties evidence-based design to patient and staff safety and increased savings over time. And the military health system, under mounting scrutiny after revelations of poor conditions at outpatient facilities at Walter Reed Army Medical Center, is also turning to evidence-based design as it begins to replace outmoded medical facilities at Walter Reed, elsewhere in the Washington, D.C., area and in San Antonio, Texas. In January, Assistant Secretary of Defense William Winkenwerder Jr. issued a memo instructing design teams to apply "evidence-based design" principles for all new medical construction projects. The department is relying in part on research by an internal effort dubbed the Epidaurus Project -- named for the sanctuary that was the healing center of the ancient Greeks -- which has studied the benefits of "advanced healing interiors," therapeutic gardens and spiritual spaces.

"We have a once-in-a-lifetime opportunity to reshape some of our most important facilities, and bring research-based design to help enhance the patient environment and support the families of those who have served our country in uniform," says Clay Boenecke, chief of capital planning for the military health system. While some of the new designs may add 2% to 5% in upfront capital costs, "we have to balance that against the costs of injuries and adverse outcomes from a bad hospital environment," Mr. Boenecke adds.

The notion that physical surroundings can affect patient outcomes first gained traction in the late 1970s, when a number of pioneering hospitals adopted a model developed by the nonprofit group Planetree to build hospitals that feel less cold and institutional, and encourage family participation in care. But the effort had little impact on existing hospitals with no new construction or renovation plans. Now, with the boom in new construction, there is a clear economic incentive to adopt better designs, says Planetree president Susan Frampton, as more studies show patients actually heal faster, require less medication, and spend less time in the hospital when their physical environment is pleasant, quiet, naturally lit and aesthetically pleasing. Planetree, which has 120 member hospitals in the U.S. and Canada, is also working with health officials in India, Iceland and Japan about using evidence-based design in hospitals.

More hospital plans are incorporating natural spaces to help patients and families escape the hospital setting. Banner Good Samaritan Medical Center in Phoenix converted an outdoor smoking area to a "healing garden" with desert plants more than a decade ago, and added additional outdoor corridors with benches bordered by exotic plants in a renovation and expansion completed in 2004. Colleen Hallberg, chief nursing officer, says cardiac patients can be monitored from the outdoor spaces via wireless telemetry devices, while chemotherapy patients can turn their chairs to face outdoors during infusion sessions.

With about two dozen construction projects under way at medical centers in several regions, Oakland, Calif.-based health-care giant Kaiser Permanente is also turning to evidence-based design, conducting research on thousands of patients to determine how light, color, noise and other factors affect care, including a grant from the American Institute of Architects to study how hospital design affects recovery and healing for people of different cultures. "Every patient takes a journey that starts with fear and stress and in many cases pain and discomfort," says John Kouletsis, director of planning, strategy and design for Kaiser's national facilities services department. "We are trying to determine what we can do along that journey to improve the experience."

For example, Kaiser is studying the impact of natural light, after finding that patients with rooms facing the sunniest exposures have shorter hospital stays and use less medication, and have higher satisfaction with their experience. It is also experimenting with lowering lighting in hospitals periodically over the day because studies show noise levels from staff and visitors drop when lights are lowered, and spreading out nursing stations to reduce staff chitchat.

"Noise reduction has historically been one of the most overlooked components to creating the complete healing environment" says Randy Guillot, a health-care architect at Chicago-based design firm OWP/P. To reduce noise at an expansion project for OSF/St. Francis Medical Center and Children's Hospital in Peoria, Ill., his firm designed a "third corridor" to handle all service and delivery carts, leaving patient-room corridors free of cart traffic and the accompanying clatter. Sue Wozniak, the hospital's chief operating officer, says that putting smaller individual workstations outside patient rooms will help cut noise and reduce travel time, distance and fatigue for nurses and other staff.

Sometimes the new designs have to balance the needs of convenience for staff with the comfort and safety of patients. In neonatal units, for example, while open plans make it easier for staff to move from baby to baby, "the evidence says that noise and lights and the hustle and bustle of staff are detrimental experiences for fragile populations like premature infants," says Kathy Ferket, director of children's services at Northwest Community Hospital, which is also building a new adult inpatient tower incorporating designs aimed at reducing noise and artificial light, including 80% private rooms.

At Montefiore Medical Center in Bronx, N.Y., a program instituted last year, Silent Hospitals Help Healing, has sharply reduced the decibel level by monitoring and discouraging hallway conversations, lowering intercom volumes, and asking staffers to adjust their pagers to vibrate.

Sandra Ganey, a 58-year-old patient hospitalized at Montefiore recently for chest pains, learned of the policy when a nurse came in and, to her great relief, asked the other patient in her shared room to put headphones on to listen to her television set. "When you are trying to get well, the last thing you need is a lot of noise," says Ms. Ganey.