by Heather Livingston

Although it’s no surprise to the design community, good design does matter—and one initiative is beginning to offer proof that it matters in ways that significantly affect patient welfare. A network of health-care providers has partnered with the Center for Health Design (CHD) to provide measurable results of the impact of design on patient health and recovery, financial operations, and staff satisfaction and turnover. The mission of the Pebble Project, a four-year-old research initiative of the CHD, is “to create a ripple effect in the health-care community by providing researched and documented examples of health-care facilities whose design has made a difference in the quality of care and financial performance.”

According to Derek Parker, FAIA, RIBA, senior partner at Anshen + Allen Architects, and a member of CHD’s board of directors, between 48,000 and 94,000 Americans die of preventable deaths in hospitals every year. “Hospitals are dangerous places,” says Parker, “and there are a number of design issues that contribute to the problem: noise is a serious distraction, lighting, glare, overcrowding, and too few hand-washing stations.” Parker believes, and the Pebble Project attempts to prove, that design can provide solutions to some of these problems. Preliminary results are showing that evidence-based design can reduce the number of patient falls, infections, transfers, and staff turnover. In addition, the data show increases in patient and employee satisfaction and philanthropic giving.

Measurable results
The Center for Health Design Web site reports that Bronson Methodist Hospital in Kalamazoo, Mich., designed by Shepley Bulfinch Richardson and Abbott, which opened its new in- and out-patient facilities in 2000, has reduced nosocomial infections (those that originate or occur in a hospital) by 11 percent through measures like better placement of sinks, more private rooms, and better air inflow design; overall patient satisfaction increased to 95.4 percent; market share has increased 6 percent; and nursing turnover rates have fallen below 12 percent, especially significant given the nationwide nurse-shortage crisis. “Being a partner in the Pebble Project has allowed Bronson to develop an even greater understanding of how to create the ideal healing environment for our patients,” enthuses Frank J. Sardone, president and CEO of Bronson Methodist Hospital. “We made decisions regarding our new facility because we thought it was the right thing to do for our patients. The research from the Pebble Project provides validation for our decisions related to our new healing environment.”

At the Barbara Ann Karmanos Cancer Institute in Detroit, an alumnus of the Pebble Project, nurse attrition fell from 23 percent to 3.8 percent; patient falls were reduced 6 percent because angled doorways, lighting, and room layout provided patients better sight lines; and patient satisfaction rose 18 percent. Most significant perhaps is the 30 percent reduction in medical errors resulting from the location of and increased space in the medication room, better organization of medical supplies and visual cues, and acoustical panels that minimize ambient noise. Dore Shephard, RN, administrative manager at the Karmanos Cancer Institute, notes, “The Pebble Project gave us an organized and systematic way to collect, analyze, interpret, critique, and present data in a concise format.”

Methodist Hospital/Clarian Health Partners in Indianapolis reports that since opening its Comprehensive Cardiac Critical Care unit in 1999, patient falls have decreased by 75 percent because of the decentralized design, which allows better patient observation; transfers have fallen from 190 per month to fewer than 25; and patient dissatisfaction dropped from 6 percent in 1998 to 3 percent in 2001. In addition, medical paid hours per day have decreased, resulting in savings of an astonishing $12 million per year.

Pebbles united
Since embarking in 2000, the Pebble Project has expanded to include 19 partners and 2 alumni. The CHD requires each participating facility to commit to a three-year membership at an annual cost of $25,000: a significant amount, given that today’s health-care facilities are struggling to stay in the black. So what do the Pebbles get for their $75,000? Pebble Projects receive national publicity in major periodicals like the Wall Street Journal; access to current information on evidence-based design; consulting and technical assistance to facilitate the initiative; access to the CHD’s board, research committee, and industry experts through working sessions that meet three times per year; and use of select members of CHD’s staff as consultants, including a fundraiser, research development consultant, and marketing director.

“Being a member of the Center’s Pebble Project has been very beneficial to us,” notes Methodist Hospital’s Ann Hedrich, MSN, RN, former senior vice president, senior nurse executive, and Robert Wood Johnson Fellow. “The expert members of the CHD board provide an expanded resource for research and process development. The network between partners is extremely valuable to validate and test concepts.”

While the CHD ideally wants projects that are in the early stages of renovation planning to become Pebble partners, they will accept projects that are further along in the process. According to CHD President Debra Levin, one of the first Pebbles, St. Alphonsus Regional Medical Center in Boise, Idaho, was already at the design stage when they joined the project. The St. Alphonsus team quickly studied the information available through CHD and made use of its consultants. They even flew members of the board and staff to the facility to review their plans. The experts at CHD were astonished to see that the plan failed to use the site’s natural setting to the hospital’s advantage. Situated at the foot of a mountain, the site has extraordinary views of Boise’s foothills. The original plan had interior rooms looking upon interior rooms, minimizing patient privacy as well as access to the outdoors. After meeting with the CHD experts, the St. Alphonsus team decided that they had the wrong building and went back to the drawing board. Access to nature being a key determinant in patient outlook, the new facility looks out upon the broad mountain expanse and offers private rooms with an extraordinary view.

The CHD has recently partnered with the Robert Wood Johnson Foundation, whose primary philanthropic interest is “to improve the health and health care of all Americans” and assist in compiling and disseminating information to the people who can affect change. Together, they are working on putting together a summit in June that will present information to the national press and major players in the health-care world like Blue Cross/Blue Shield, Unicare, and Clarian Health Partners. In addition, they are hoping to present their findings in a congressional briefing as an attempt to change current regulations and induce systemic change in the health-care system.

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