Case Study: Sacred Heart Medical Center

Ten years ago, PeaceHealth, a Catholic health care system comprised of seven hospitals and multiple physician clinics serving Washington, Oregon, and Alaska, embarked on a journey to replace its flagship hospital. Sacred Heart Medical Center, in Eugene, Oregon, was a 432-bed tertiary care facility serving much of western Oregon. Following the development of a new 386-bed facility in Springfield, Oregon, known as Sacred Heart Medical Center at RiverBend, it is now a two-campus hospital with a total of 490 beds. It is the largest medical center between Portland, Oregon, and Sacramento, California.

Our pivotal decision was to engage two architectural firms—one with resort and hospitality experience, and the other, Anshen and Allen, with more than two-thirds of its focus on evidence-based hospital design. A lead Anshen and Allen partner suggested that we join the Pebble Group. We agreed that ours would be an ideal project to contribute to the body of evidence regarding hospital design. While we knew little about this science, we did know that we had one of the most beautiful sites in the country—185 acres on the McKenzie River, known for its spectacular fly fishing. Careful orientation of the new hospital could give virtually all patient rooms a view of the McKenzie River, the nearby Coburg Hills, or the Oregon Coast range.

During the planning process we made a commitment to create a "healing environment," which we defined as maximizing the advantages of the pastoral site along the McKenzie River. As time progressed, we discovered that this also meant the use of evidence-based design features, including comfortable family space and carefully designed single patient rooms. A few community members were skeptical that this was anything more than a justification for building an expensive "Hospital Hilton." The evidence gleaned from our work with the Pebble Group and the overwhelmingly positive response to the early design concepts by the patient review teams converted the skeptics to strong supporters. Roger Ulrich, Texas A&M professor and author of research on evidence-based hospital design, held design sessions with project leaders. Four key elements emerged from Ulrich's research as the most important:

• • Views from patient rooms reduced stress and length of stay by approximately 10 percent.

• • Single-patient rooms helped increase communication between caregivers, patients, and families by 50 percent or more.

• • Single-patient rooms helped reduce infection rates by up to 25 percent.

• • The use of soothing, impressionistic art, muted, warm color, and natural and indirect light had a significant impact in putting patients and families at ease.

Another important influence was a finding from our own research on the benefits of patient lifts. Based on the increasing weight of patients and aging of the nursing workforce, one of our nursing leaders was convinced that the cost of installing lifts—which were rare in U.S. hospitals until recently—would be offset by a reduction in staff injuries. With the average age of our nursing staff pushing fifty, this proposition seemed plausible. To test this hypothesis, we installed lifts in the old hospital in 2003: one of our intensive care units was equipped with lifts, the other was not. Our sixty-month study, published in Health Care Design in 2006, showed an 83 percent reduction in annual work injury costs due to patient lifting. Within the two nursing units in the study, annual staff injuries declined to two from twenty-five, with an associated cost savings of $305,000 during the two-year study period. The lifts actually paid for themselves in fifteen months.

We concluded that every patient room in the new facility must be outfitted with patient lifts. In addition, there must be only single-patient rooms, and art, color, and finish materials must be carefully selected. The comfort and warmth of the facility would belie the sophisticated technology behind the walls. There were risks in designing a patient room that would be replicated hundreds of times. We learned from studying Marriott hotel designers that they build room mock-ups for every hotel and seek customer and staff input prior to construction. The conceptual design often would be changed many...