TV sitcom writers have delighted in the creative possibilities of those shadowy figures lurking behind the curtained dividers between hospital beds. In real life, though, they’re a threat to privacy, leading esteemed organizations like the American Institute of Architects to back a current mandate to replace semi-private rooms with single ones in all new hospital construction. At issue is not only privacy and patient-doctor confidentiality, but everything from staff turnover to patient recovery times.
Enter Paoli Hospital’s new Pavilion, a five-story facility that’s a shining example of a new type of healthcare architecture known as evidence-based design. The idea is to build better hospitals by taking into account factors like natural light and noise level and their impact on patient care, medical errors and infections.
The Pavilion—so named because its three-story atrium lobby resembles a gatehouse or giant tent— includes 124 private patient rooms, a ground-floor emergency department (with its own entrance and corridors) and 12 operating rooms known as OR “suites” because of their spacious size and state-of-the-art amenities.
In all, the 259,000-square-foot addition nearly doubles the size of the hospital. The older section, which retains its former entrance off Lancaster Avenue, now houses only two departments: maternity and outpatient services. A renovated 737-space parking garage is linked to the new addition by covered walkways on two floors.
In the weeks leading up to the Pavilion’s grand opening in June, the new space was described as quiet, light-filled, spacious and easy to navigate. Such adjectives are better suited to a destination hotel than a busy suburban hospital located in a region that’s been dubbed the fastest growing in Southeastern Pennsylvania.
The Pavilion cost $145 million to build and required more than four years of planning and design. So it’s no wonder that it’s considered the most significant milestone in the hospital’s history, short of its relocation from West Chester in 1968. Hospital president Barbara Tachovsky describes it as “visionary thinking” manifested in design. “More and more hospitals are building environments to be safer, more efficient, more accessible, more natural and more supportive of healing,” says Tachovsky. “We’re at the forefront of that movement.”
The project’s architect was Bob Mainwaring of Robert D. Lynn Associates, a Philadelphia firm that specializes in evidence-based hospital design. He describes the plans for Paoli as practical above all else—such as the well-placed sink to encourage hand washing and the small locking cabinets for each patient to avoid medication errors.
Anyone who’s had to endure a night in a so-called semi-private room should understand the value of privacy. But in the Pavilion, it goes deeper than that.
On the three floors devoted to patients, the single rooms resemble private spaces in a sleep clinic. Painted in calming blues and greens, each has an identical layout, with a sink, bed, handrail and bathroom. Architects call this “same-handed” design, and it’s mostly for the hospital’s benefit, increasing efficiency and saving precious time in case of an emergency, when personnel must rush in with equipment.
Consideration is given to both the patient and the family caregiver. The room’s “zones” include an area on one side of the room for storage, nooks for flowers and card displays, and a foldout couch in case someone wants to stay overnight.
Then there are the less obvious features. Gone are those flickering lights over the bed that cast an eerie florescent glow over the patient. And, of course, you won’t see those sturdy gooseneck lamps that were always part of the scenery in old soap operas.
Natural light and the outdoors are major Pavilion selling points. Private rooms that don’t face the woods alongside Lancaster Pike have views of a central courtyard, where visitors and staff can relax among herb gardens and flowering plants. Surgeons and other staff need only to take a few steps from the OR to find a window-lined corridor.
Indeed, hospitals have come a long way since the days “when you had a ward with eight beds side-by-side,” jokes Mainwaring on a recent tour of the new Pavilion and its towering, three-story atrium that serves as both a second entrance to the old section of the hospital and an admissions area for in-patient care.
Mainwaring is joined by Frieda Schmidt, the Paoli Hospital’s longtime public relations rep, who serves as a virtual one-woman docent and tour guide. She’s also the resident expert on the Center of Health Design, the nonprofit advocacy group that’s been the focal point of Paoli’s involvement with evidence- based design. The California group developed many of its concepts to address what’s known as “best practices” in healthcare—those that reduce the likelihood of medical errors, infections and falls, for instance.
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On the tour, Mainwaring pointed out details only an architect would notice—like seamless floors (where “lips” are eliminated from thresholds) and doors that open at unusually wide angles to better accommodate stretchers.
As early as the 1970s, Paoli Hospital became the focus of a decade-long study that examined the effects of natural light on patient recovery. “They showed that patients who had a view from a window healed faster than patients who had a view of a brick wall,” Schmidt says.
This study and others at hospitals in Boise, Idaho, and Kalamazoo, Mich., (to name two) formed the basis of the Center of Health Design’s list of top 10 recommended design features. The importance of sound-absorbing ceiling tiles and special air filters, for instance, emerged out of research that examined the correlation between noise levels and patient sleep quality, as well as airflow design and hospital-acquired infections.
In fact, the “evidence” so crucial to evidence-based design was culled from more than 1,500 studies, including the one conducted at Paoli Hospital from 1972 to 1981. Today, Paoli is the first such facility in the state—and one of only 50 hospitals selected nationally—to take part in the Center of Health Design’s Pebble Project, so named for the ripple effect they hope to achieve in healthcare environments across the country.
Space alone is a good reason to build a new hospital, especially when you consider that a majority of the aging facilities in the U.S. have undergone several expansions or renovations, their rooms and corridors becoming rabbit warrens of complexity in the process.
“One of the things you do when you build a new building is to correct all the idiosyncrasies that your existing building has,” says Mainwaring. “Now we have a very streamlined process where everything occurs on one floor.”
The Pavilion space includes 24 private rooms and a 23-bed post-anesthesia care unit known as PACU. The prominent nurses’ station there—along with an ice-making station and a pneumatic tube system linked to the pharmacy and blood bank—points to nurse-centered care and patients in a certain recovery stage.
Paoli was among the first to replace the central nurses’ station with smaller ones closer to patients, says Schmidt. But a majority of the concepts promoted by the Center of Health Design could only be made with new construction. The use of angled patient rooms, for instance, serve to create sight lines from a hallway to the bed so that nurses in a nearby station can easily see patients—or the patients can see them. Either way, care is improved.
Mainwaring spent countless hours in staff and design meetings to address patient concerns. “Discussions are all part of the process,” he says. “If you talk to anyone who works in a hospital, one of the things that always comes up is the amount of activity just outside the rooms. They say it’s a constant battle to keep the corridors clear.”
Those in Paoli’s Pavilion are not only wider, they’re angled in a way that creates short sections of hallway, leaving space for tucking away a stretcher when another comes rolling down a hall.
Another oft-overlooked aspect of the hospital environment are the “turf wars” that arise among staff members who spend their time making rounds and writing reports on the go.
“One of the things we learned in our discussions was that people needed their own space,” says Mainwaring. “You have case managers, nutritionists, social workers and even doctors who need a place to think and to work.”
Work areas with banks of phones, Internet connections and the like, plus consultation rooms and private areas for taking dictation, are found on the third floor. It also features 16 private intensive-care rooms, 14 “progressive care” patient rooms, and 32 private rooms for patients recovering from medical procedures or surgery. The fourth floor comprises an additional 62 rooms, along with the same small nurses’ stations, private work areas, and family accommodations that make visiting hours a thing of the past.
All in all, Mainwaring sees evidence-based design as the only way to reconcile the varying experiences and needs of patients, staff and family caregivers in the hospital environment.
And, yes, there are curtains in the Pavilion’s rooms—but not by the bed. They hang in the front, near the entrance, by a counter with a sink. Pulled shut, they create an instant work area where a nurse or doctor can review a chart. Or it could be a place for family members to go when a patient needs privacy.
“The idea is that you should have areas where you can step away but also remain with the patient,” says Mainwaring. “So you can still feel you’re always there as their advocate.”
To learn more about Paoli Hospital’s new Pavilion, visit mainlinehealth.org/ph.