Picture a hospital: Bright lights, buzzing machines, crowded waiting rooms, and frazzled nurses. Anxiety runs high. Customer service is not high on people’s minds. They’re busy making patients healthy and filling out required paperwork.
If all goes well, none of that will be true at Memorial Sloan Kettering Cancer Centers’s new $300 million surgery building, slated to open in Manhattan in January.
Inside the nearly finished Josie Robertson Surgery Center (JRSC), the waiting room feels more like a fancy co-working space for families to camp out, play games, get work done, and grab a bite to eat. The patient rooms–all private, with private bathrooms–have floor-to-ceiling windows; the floors have unique art and poetry, central gathering places for a buffet breakfast and socializing; the figure-eight hallways double as walking paths for post-surgery exercise. Even the 550-person staff will get a well-thought out space that goes far beyond the usual hospital cafeteria. If cancer wasn’t involved, it’s a place you could imagine wanting to hang out.
But what’s most interesting is that JRSC isn’t a boutique hospital simply trying to cater to the rich. It will be the first outpatient surgery center that takes on some kinds of complex cancer surgeries–say a double mastectomy and a breast reconstruction–and then sends patients home within a day. Its amenities and design are a necessary part of its function: to alleviate nerves, re-envision how staff manages care, and have patients and their caregivers feel good about the quick turnaround.
At a basic level, JRSC is being built to meet rising surgical demand: Memorial Sloan Kettering’s main campus nearby had run out of operating room space, and the cases that needed to be moved out were more complicated than what would be typical for outpatient surgery.
“There’s nothing else like this that I’ve ever heard of,” says Brett Simon, an anesthesiologist and the facility’s director. “Typically, you go to an ambulatory surgery center and you have a biopsy or a knee arthroscopy. Here, we needed to move out real serious cancer care.” (By law, ambulatory centers can’t keep patients more than one midnight.)
Other health care trends may also help explain JRSC’s unique, patient-friendly setup. The hospital, a nationally leading cancer center, is facing more competition, as many hospitals build fancy facilities to attract business from aging baby boomers. And in the Obamacare era, both patient satisfaction and cost efficiency are important metrics for insurance reimbursement. So a one-night stay will obviously cost less than two, especially if a patient leaves without feeling rushed. “While it might not be that hard, medically, to get someone out the door, having them emotionally and spiritually happy and feeling supported is really a big deal,” says Simon.
To help, the hospital hired the architecture firm Perkins Eastman and ICRAVE, an design and innovation firm that started out creating nightclubs and restaurants but now works in diverse sectors, including higher education and airports. One of its recent projects was
JFK LaGuardia airport’s Delta Terminals, where passengers now order meals from iPads at their gate with no worries about missing flight announcements.
“We realized was that we weren’t designing for a really cool food experience, we were designing for people’s anxiety,” says Lionel Ohayon, ICRAVE co-founder and CEO.
They took that same theory to JRSC, where they learned from patients, staff, and families that one of the biggest anxieties for cancer patients was they felt they had lost control of their lives and their health. Knowing the hospital wanted to do things differently, one big goal became to use design and operational changes to turn that around.
Carefully designed “care pathways” will ensure a patient doesn’t, as Ohayon puts it, “show up at the hospital to have a hysterectomy and find out she’s going home tomorrow.” A mobile app might send the patient notifications before surgery, reminding them to complete a checklist of preparation steps. Right after surgery, bedside tablets will allow patients to Skype with their doctor, and when they go home, they’ll be able to securely text questions and send photos, as well as score their pain and remaining symptoms daily.
The surrounding environment will also contribute to the patient’s sense of security: “Privacy, dignity, infection control, and expansive use of natural light and sensational views are deliberate in stimulating the patient for the best possible outcomes and to get them home as soon as possible,” says Jeff Brand national healthcare practice area leader at Perkins Eastman.
At the hospital, JRSC will also do communication very differently. Everyone in the hospital–doctors, staff, and most importantly, patients, and their family–will wear a real-time location badges, which, says Ohayon, “changes the whole notion of what a hospital serves to do.” That means no annoying overhead pagers and a number of radical changes from a traditional hospital operates. When a patient arrives, rather than stand in line at a big desk, they can relax and someone will personally greet them at their seat. Families can track on a big board where their loved one is in the hospital, knowing exactly when surgery starts, when it’s over, and when they’re ready for visitors.
The hospital should also operate more smoothly: Orderlies will be notified, for instance, when they can clean a patient’s room, and a board will light up to notify nurses when all systems are go for a patient’s surgery: “All of those things used to require phone calls and pagers, or someone walking and finding someone else–giving opportunities for miscommunication and also wasted time,” says Simon. Little things will also give the patient more control: He or she will walk into the operating room on their own. No wheelchairs.
One of the most radical changes made–partly due to the hospital being tight on space and partly to improve patient experience–is that post-surgery recovery rooms, where patients are closely monitored right after their surgery, have been eliminated. Rather, patients will go directly to their own rooms and the nurses, monitoring equipment, and support staff will come to them.
“Patients don’t have to move and teams don’t have to hand off to each other. Medications don’t have to move, transfer orders don’t have to be written–it’s all in one stop, which in of itself nobody has ever done,” says Simon.
The designers treated the drama of the hospital as a soap opera, trying to think about where the emotional moments happen. In the doctor’s consultation office, for example, a family can exit the floor without going back to the waiting room, just in case they get bad news. Normally, in these situations, “everybody waiting looks to see what their expression is like. It’s stressful,” says Suzen Heeley, the hospital’s executive director of design and construction.
In a way, JRSC is a hospital thinking a bit like a startup trying to disrupt an existing business model.
“There are a lots of short-stay or fast track programs here and there. They are usually done in the setting of an existing hospital, and it’s just not the same. The food services staff doesn’t know who is a fast track and a regular patient. The nurses might have both kinds of patients,” says Simon. “No one has designed something from the bottom that is really focused on doing this.”
With a smaller group of surgeons (45 compared to the main hospital’s 130 surgeons) and a smaller number of types of surgeries, Simon hopes to get away from the “big box” hospital way of doing things.
As Ohayon says of the hospital’s desire for change: “When you say leap–what do you mean leap? Some people want to jump off the side of a highway, some people want to jump off a curb. We were really lucky that we had a group that really wanted to see things done differently.”