Given the chance to develop a brand-new hospital from the ground up, Cheryl Herbert wanted to make the most of it. “To have that opportunity and not take it as far as you can in terms of making things new and improved, would be to squander what really is a once-in-a-lifetime opportunity,” says Herbert, president of recently constructed Dublin Methodist Hospital.

The hospital, which opened this January, was built on a greenfield site in the Columbus, Ohio, suburb of Dublin. It is the latest member of the OhioHealth system, a family of not-for-profit, faith-based hospitals and health care organizations headquartered in Columbus.

The hospital was designed by Columbus architecture firm Karlsberger, with associate architects Andrews Architects of Dublin. To make sure the new health care facility embodied the latest thinking in quality care, the project team looked to the burgeoning field of evidence-based health care design.

“There’s just a lot of information out there” about which design strategies are most effective for health care environments, says Jane Peters, AIA, ACHA, LEED AP, vice president and senior architectural designer for Karlsberger. “There’s a lot of research being done.”

She points to the health care design specialties at major universities like Clemson and Texas A&M, as well as the work of the Center for Health Design, a research and advocacy group based in Concord, Calif., that seeks to improve health care through evidence-based health care facility design.

The hospital itself will be measuring several areas of patient care as a partner in the Center for Health Design’s Pebble Project, a research program in which participating hospitals share data about evidence-based design efforts.

“Because we had a big emphasis on patient safety when we designed the building, we’ll measure a lot of things related to patient safety,” says Herbert. This will include the incidence of falls, medical errors and health care-associated infections at the facility.

Using the best data available, the Dublin Methodist project team set out to create a “revolutionary health care setting,” Peters says.

Inside and Out

One of the most important features of the new facility is the transparency between the interior of the hospital and the outside world, says Peters. The building’s design emphasizes a connection to nature, which has been shown to promote healing and reduce stress. For instance, the stained concrete floor in the entrance lobby provides a natural look and eases the transition into the hospital by bringing in exterior materials.

The multistory lobby atrium features plentiful natural light, trees, stone and a waterfall that cascades down three-and-a-half floors. Additionally, the concrete flooring includes a wavy pattern suggesting the natural contours of a stream; this design leads visitors intuitively to the elevator lobby.

The main lobby atrium and a second, smaller atrium near the emergency department help fill the hospital with natural light. The building is fairly narrow, which allows light to penetrate to the interior. According to Herbert, 90 percent of occupied spaces in the facility have access to daylight. In fact, the building does not even have a basement. Services like the pharmacy and laboratory, which are often located in hospital basements, are on the ground floor of Dublin Methodist.

“The lab and pharmacy folks love it,” says Herbert. “They’re typically stuck in windowless environments. They’re pretty happy with the spaces they work in.”

Access to nature helps create a calm atmosphere throughout the building. On the whole, the building offers 13 different spaces where people can enjoy the outdoors, including a labyrinth, a Zen garden, courtyards and rooftop plantings.

The emphasis on nature is furthered by the work of photographer Henry Domke, a former Jefferson City, Mo., physician who specializes in natural art for health care.  Domke produced 150 pieces for the facility. Close-up nature images printed on unframed canvas are displayed throughout the hospital’s public spaces; patient rooms feature scenic landscapes.  Susan E. Long, IFMA, Karlsberger vice president and director of interior design, says, “[Domke’s] work and the perspective he brings is very appropriate to this project, since it is evidence-based and trying to push the envelope of the hospital.”

The vibrant colors of the photographs are set off by darker, yet natural-toned finishes designed to give the hospital a spalike, noninstitutional feel.

The attention to daylight and views extends beyond the main public spaces of the hospital. On the patient units, walls were lowered where feasible or punched through with openings to allow light to flow as freely as possible through the patient floors. Many workspaces and most waiting areas on the units overlook outdoor gardens.

These small waiting areas are designed to give family members quiet, comfortable places to relax or hold private conversations. Sound-absorbing floors and ceilings add to the peaceful environment of these spaces.

Decentralized Areas

There are six caregiver “perches,” or decentralized staff work areas, distributed along each 20-bed unit. The perches give nurses, physicians and ancillary caregivers transient workspaces near patients. Medical staff do not require a large desktop to maintain patients’ charts, because records at the hospital are stored electronically to help decrease medical errors and give the multiple providers on a patient’s care team immediate access to his or her medical information.

The perches are designed around structural columns, turning potentially negative interruptions of the space into positive design elements.  Their curved shape softens the interior architecture in a way that did not significantly impact the project’s bottom line. “You want to maintain a smart building, and if you add too many curves, that gets costly,” says Long. The circular perches and the curvy flooring pattern around each one, which evokes the look of ripples in a pool of water, take some rigidity out the building and give it a more dynamic appeal, she says.

Extending to Rooms

The stream motif that begins on the lobby floor continues on the patient units. The entrance to each patient room is marked by a silk flower by the door and a blue stripe in the hallway carpet. The stripe, representing water, continues in the sheet vinyl flooring of the room itself, extending across the caregiver section of the room and up the wall behind the handwashing sink. 

Above the sink, the stripe is rendered in glass tile covered with a dicrylic film that sparkles with opalescent color as it reflects light. “One of the biggest problems in health care, obviously, is nosocomial infections. What we wanted to do is celebrate handwashing,” says Long.

The blue stripe provides caregivers with a visual cue to wash their hands when they enter the room; it also highlights the sink area so the patient can be assured that they have done so.

A thin blue stripe in the tiled floor of the patient bathroom extends up behind the bathroom sink, reinforcing the idea of a calm, cleansing stream.

Forty-eight square feet of windows in each patient room provide natural light, views and even a bit of fresh air.  The windows are divided into several panels, one of which can be opened a few inches—enough to freshen a room without interfering with the hospital’s heating and ventilation system, says Herbert.

The 340-square-foot universal patient rooms are designed to accommodate patients of any acuity level, so most patients will not have to be moved if their condition changes during their hospital stay. By maintaining a continuity of care, the hospital hopes to prevent the errors that can occur when patients are transferred from one medical team to another.

The patient rooms are also like-handed; everything is in the same place in each room so medical staff can locate items quickly. “Regardless of what room, they’re going to go in and know exactly where the outlet is, where the gasses are, and so it just becomes easier for them,” says Long. Even the flooring pattern is the same, to prevent optical confusion.

Peters says designing for like-handed rooms raised some interesting concerns.  For example, beds could not be repositioned to control the view out of the patient window. “I think you always end up with some rooms with better views than others, but it was an interesting exercise to see how that played itself out,” she says.

Also, patient room doors are separated by about 16 feet, instead of being paired closer together as in a typical mirror-image layout. The decentralized perches are positioned to allow nurses to monitor and access any cohort of rooms easily.

Although headwalls are not shared between rooms as they are in a mirror-image layout, some bathroom plumbing is shared and the handwashing sink in one room shares a chase with the headwall in the neighboring room. “There is still an efficiency there, it’s just not the traditional way that it’s done,” Peters says.

A handrail leads from the bedside to the patient bathroom, which is located along the headwall of the patient room. This design is intended to reduce the number of patient falls; it is easier for patients to walk to the bathroom by themselves if they do not have to cross the room unaided by a handrail. “People want to have their independence,” Long explains. The door to the bathroom is 4-feet-wide, providing plenty of room for medical equipment like IV poles and wheelchairs, and for nurses or family members to walk beside patients who require assistance.

Visitors are welcome any time at the hospital, which has no set visiting hours because family involvement is known to assist in patient care. The patient rooms include a family zone with a sleeper sofa, desk, Internet connection and mini-refrigerator. A second cubicle curtain can be drawn between the patient bed and the family zone to allow visitors to remain in the room during quick procedures or read or work without disturbing a resting patient.

A smooth curve marks a flooring change to wood-look vinyl in the family zone, to give the room a softer, warmer look. Likewise, there is a gentle curve at the bottom of a soffit placed midway through the room, where the ceiling height raises from 8-feet to 9-feet high.

Attention to Detail

The hospital’s labor-delivery-recovery rooms have a slightly different layout than the typical patient rooms, but look and feel similar. “A lot of times you go to a hospital and the LDRs are these great, magnificent spaces. And then you get put in a regular room and it’s like you’re going to the Motel 6,” Long notes. The design team made a conscious effort to use consistent materials and finishes throughout the hospital.

Patient rooms throughout the buildings boast several extra design details meant to make patient stays more comfortable. For example, a frosted glass panel helps minimize the broad expanse of the wide, wooden bathroom doors. The room number is prominently displayed on the patient footwall, so patients can easily relay their room number to friends and family members. The rooms even have colorful bedspreads.

“I really try not to use the phrase ‘homelike’ because I think that those of us in the hospital world are kidding ourselves if we actually think we’re going to create something that’s homelike,” says Herbert. “But the whole building and everything about it is designed to be less stressful. Those small kinds of details are things we feel contribute to producing a less stressful environment that people will be a little more comfortable in.”

By All Measures

Early indications suggest the approach is working. Less than three months after opening, the hospital’s inpatient satisfaction scores, as measured by South Bend, Ind.-based Press Ganey Associates Inc., were in the 85th percentile.

Given its Pebble Project status, it’s no surprise that many more measurements are on the way. In addition to falls, medical errors and health care-associated infections, the hospital is also planning to examine the impact of its like-handed rooms, as there is not a lot of research in this area to date. The impact of the distributed perch workstations on the patient floors is another likely target of post-occupancy study.