Facility Focus: John Muir Medical Centers

When it comes to state-of-the-art hospital care, John Muir Medical Center’s campuses in the neighboring cities of Walnut Creek and Concord, Calif. are taking healthcare in the San Francisco Bay Area to the next level.

 

The newly updated healthcare facilities are using the latest in a trend in hospital design aimed at minimizing stress with private patient rooms, stylish furniture, natural lighting, soothing gardens, and professional art installations. But it is not just about comfort and aesthetics; behind the sparkling façade at John Muir lay functional innovations that are improving staff efficiency and patient care.

 

Take the neonatal intensive care unit (NICU) at the Walnut Creek campus’s new $600 million Tom & Billie Long Patient Care Tower, set to open next month. What look merely like aesthetic and comfort improvements over a typical NICU are actually changes vital to the health of a premature infant.

 

“Doctors have learned that the more time parents spend with their (premature) baby, the sooner they can go home,” said Tom Patterson, project manager at Ratcliff Architects, who worked on the John Muir Medical Center in Walnut Creek. “Kangaroo Care” — skin-to-skin contact between parents and babies — is believed to aid in a baby’s growth and shorten the amount of time spent in the hospital, but the practice necessitates a newly minted parent taking off his or her shirt. In turn, the parent needs privacy.

 

So Ratcliff designed the NICU as a cluster of semi-private rooms, with four babies to a room, to give parents and families the privacy they need to bond with their babies.

 

“Providing space for families to be with their infant is really important,” said Michael Monaldo, vice president of facilities development at John Muir Health.

 

The rooms, which feature a lounge area, recliners, shower, storage space, reading lights and access to a roof garden just outside the unit, provide space for families to spend time with their babies as they would in their own homes. Parents can also take time to relax, nap, change clothing, or putter around outside. “It is kind of like a family zone in each private patient room,” said Patterson.

 

A typical NICU consists of one big room with a series of basinets, but Walnut Creek’s cluster-style NICU allows nurses to control light and noise stimulation for each infant. “These are the absolute sickest babies, a lot of their functions, such as eyesight and hearing, have not developed yet,” said Ratcliff senior associate Lynn Drover, making the ability to limit such stimulation imperative to a premature baby’s health.

 

“There was a concern that putting babies in separate rooms would make it harder for nurses to support each other,” Drover said. But a nurse communication system and doors between each room allowing for rapid access ameliorate the problem while allowing the unit to keep the health benefits that privacy provides, she added.

 

Private rooms are a hallmark of the John Muir Medical Center. Every patient room at the Concord campus is private and out of the 242 rooms in Walnut Creek, 232 are private; the remaining ten rooms are shared solely due to design constraints.

 

“The (increased) efficiency is great because it is a real challenge to manage beds in semi-private rooms,” said Patterson. “By migrating toward private rooms, staff is able to provide better care to patients.”

 

A big part of that improved care is the minimization of hospital-acquired infections, a grave threat to patient safety. “Whenever you separate patients, they are far less likely to pass infections,” Drover noted.

 

The Intensive Care Unit beds at Walnut Creek are also private, a setup rarely seen in an ICU. Instead of bedding patients in one large room with nurses keeping watch from a central station, Walnut Creek’s ICU features private patient rooms with one wall – composed of a folding glass door (and a curtain for extra privacy) – facing the nurses’ station. Staff can see into the next room through windows placed between each room and a video surveillance system allows nurses to monitor patients 24 hours a day.

 

With the Walnut Creek campus located on 26 acres of land right next to Mount Diablo, Ratcliff designed the ICU to give each room a nature view. “Patients can see outside, which can serve as an inspiration to get out of there,” Patterson said.

 

“A hospital can be a stressful environment and the theme throughout the hospital is to reduce stress,” Patterson said. Privacy, acoustics and lighting control and visual access to the outdoors lessen that stress for both patients and visitors, he said.

 

Hospitals are trending away from the institutional feel – believed to add to a patient’s and a family’s stress – characteristic of previous eras, and John Muir has done that by dotting communal areas at both campuses with art, comfortable furniture and outdoor gardens.

 

“We do look to the hospitality industry,” said Monaldo. “We look at what we can do to make you comfortable from the moment you walk through the front door. In the lobby we have furniture like club chairs and loveseats so people can be comfortable and so we can still be effective on the patient floors.”

 

But while John Muir’s ammenities lulls visitors into a more relaxed state, KMD and Ratcliff designed its treatment areas with efficiency and the rapid delivery of care front of mind. The imaging department was placed directly adjacent to the emergency department to provide diagnostic information to ER staff as quickly as possible, while “the trauma center was designed to give patients very quick access to the best care,” said Patterson.

 

The trauma rooms themselves were designed similar to operating rooms – they are much bigger than typical trauma rooms to accommodate more equipment – allowing staff to deal with any problem.

 

“It’s about being effective and cutting down time,” Patterson said. “More streamlined flow and a convenient design makes a huge difference for staff in the emergency department. Time is of the essence.”

 

Surgery, the ICU and the cardiac catheterization labs are located directly above the emergency department to further maximize efficiency. “Relativity of spaces and adjacency are very important,” Patterson said.

 

Another innovation in efficiency at both Concord and Walnut Creek is the construction of one set of corridors and elevators for staff and patients and another set for visitors. “It is not unusual (in an older hospital) to get in an elevator and need to get out because staff is transporting a patient,” said Patterson. “The elevators separate patient and supply transport.”

 

Updated Emergency Rooms and Trauma Center
The emergency department at the Concord campus’s new $212 million Hofmann Family Patient Care Tower, which opened last November, features a separate cardiac observation suite adjacent to the emergency care zone and a separate fast-track zone contiguous with the emergency care zone to allow cross-support by staff, while “swing” exam rooms accommodate fluctuations in patient volumes, said Robert Matthew, principal and healthcare director at KMD Architects in San Francisco, whose firm designed the Concord facility.

 

The emergency rooms at both campuses are arranged to allow walk-in patients to be quickly assessed instead of waiting hours for treatment. Fast track rooms for minor cases were created to get patients out quickly, while triage rooms designed to treat more serious injuries were included in a separate space. “There is a sorting process as people come in,” Patterson said.

 

“We worked very closely with the staff in the emergency department, everyone from the nursing staff to the physicians were invited to (make recommendations on) how to make the emergency department more efficient, reduce the number of steps and make everything available right there,” Monaldo added.

 

Concord’s cardiovascular center has a patient prep and primary recovery area with day lighting “to assist patients in reorienting to a diurnal cycle and support staff well-being and productivity,” said Matthew. “And a step-down recovery area for seated recovery in a less clinical environment for patients with higher levels of awareness helps patients appreciate their progress toward discharge.”

 

The cardiovascular center features distributed staff stations and support space, such as medication rooms, equipment holding rooms and utility rooms, on the core-side of corridors to shorten travel distances for staff when responding to patients, which has been shown to reduce error rates and caregiver fatigue. The distributed stations also allow for simultaneous observation of several patient rooms, Matthew said.

 

Last year, the American Nurses Credentialing Center (ANCC), a subsidiary of the American Nurses Association, honored John Muir’s Concord hospital with Magnet status for excellence in nursing services and care. The Magnet program honors healthcare organizations that demonstrate excellence and adherence to national standards for the organization and delivery of nursing services, making the Concord hospital one of the best in the country.

 

Along with the Walnut Creek campus, which was recognized in 2008, John Muir’s hospitals are just two 21 hospitals to be recognized in California.

 

Foregoing LEED in Favor of Patients
Amongst the innovations in patient care and comfort, the design teams at KMD and Ratcliff didn’t forget their duty to the environment. The two campuses combined have garnered $1.1 million in rebates from Pacific Gas & Electric and another $500,000 is on the way for the facilities’ energy efficient features. John Muir chose to forego the expense of LEED certification in favor of serving patients and their families.

 

“We evaluated (the facilities) and we would be eligible,” Patterson said. “But we made the decision not to pursue LEED because (John Muir) wanted to save money for equipment and facilities to provide the best care.”