By Anne Federwisch, OTR
February 10, 2000
Photo: Courtesy of Saint John's Hospital & Health Center

When designing a multimillion-dollar healthcare center, the placement of a sink may seem like a trivial detail. But put that sink in the wrong place and the efficiency of an entire unit could suffer, possibly causing unsafe conditions and decreasing staff and patient satisfaction. Involving nurses and other health professionals in the initial design phase of the project will likely improve the facility and avoid costly corrections after construction, experts say.

"The architects' priorities were aesthetics and utilization of space," said certified operating room nurse Rebecca M. Patton, MSN, RN, director of ambulatory operations for the University Hospitals Health System in Cleveland. She wore a hard hat as the on-site administrator for the design of the 108,000-square-foot medical office/ambulatory surgery center that opened in September. Her priorities included ease of work flow, patient privacy, and efficiency for patients and staff.

"The architects knew they needed to have sinks, but they were placing them inside storage rooms, inside dirty utility rooms," she said. By linking standards of care for operating room nurses with the necessity of handwashing, Patton was able to get the plans changed early in the design process.

Denise Orthen, MSN, RN, director of critical care at Saint John's Hospital & Health Center in Santa Monica, Calif., needed to convince architects that the initial plan for the center's seismic redesign after the 1994 Northridge earthquake wouldn't work. "The architects initially had tunnel vision when they looked at the historical use of a critical care unit," she said. "The nurses had to walk too many places to get what they needed to provide patient care." She and other nurses also are contributing ideas for the center's new $270 million facility, scheduled for completion in 2005.

Proximity issues also were key for Bobbie McCaffrey, MA, RN, chief operating officer/chief nursing officer of MountainView Hospital in Las Vegas. "You have to look at the nitty-gritty essence of what takes nurses' time and what makes a better experience for the patient," she said. McCaffrey and other nurses made sure that work flow issues, patient and visitor access, and privacy were adequately addressed in the architecture of their facility, which opened in 1996. She currently is advising designers on nursing concerns for a planned $34 million expansion.

A growing trend

These designing nurses are part of a growing trend. "More and more facilities are recognizing that if they want to have a facility that is responsive to their patients and the people providing care, they absolutely need to include the input of people who are going to be working in that space," said Paula Smith, MN, RN, vice president of patient care services for Saint John's. "It's less expensive than to do change orders."

Innovators have been using health professionals' advice for at least 10 years, said Sara Marberry, director of communications for the Center for Health Design, a nonprofit organization in Lafayette, Calif., whose mission is to be an industry facilitator of the development of health-enhancing environments. The practice has become more common in recent years, Marberry said. "The better-designed facilities do involve nurse, patient, and other health professionals' input."

George Peters, MD, wouldn't have it any other way. The executive director of the Uuniversity Texas Southwestern Center for Breast Care synthesized advice from staff, patients, and volunteers to make his dream of a one-stop breast cancer treatment center-which includes mammography, surgery, radiation, psychology, and other related services all under one roof-a reality. The fruition of his dream-the Seay Biomedical Building in Dallas-opens in March. "Whether it was a patient, physician, nurse, or receptionist, the feedback and the input we were getting helped us make this a very effective way to see patients," he said.

Patient and staff preferences

By listening to patient and health professionals' feedback, designers were better able to provide features of necessity and comfort. "The most surprising thing that came from patients was, 'Would you please put temperature controls in the rooms?' " Peters said. "Here we're talking about a facility that is state of the art, and that's the detail we were missing."

Using focus groups and phone surveys, designers were able to gather detailed feedback. Carolyn Walker, a freelance writer, breast cancer survivor, and volunteer breast cancer peer counselor, voiced her opinion on the design of the Seay building. Walker helped decide where to place snack machines, what to have in them (decaffeinated coffee, for example), what colors to use (pastels), and what artwork to place on the walls (photographs, for universal appeal). "I've seen all the fabrics, the carpets, the paint chips," she said. "I'm prejudiced, but to me, it's an incomparable facility."

Such sentiments of pride are common among patients and staff of facilities that are redesigned with their needs in mind. "We have very high patient and employee satisfaction ratings," said McCaffrey.

And while patient and staff satisfaction is a laudable goal, there's another benefit of soliciting nurses' input when building new facilities, Smith said. "The message you send by the inclusion of people like nurses in the process is that we value their input and expertise."