Jones Lang LaSalle


Extreme makeovers for hospitals
Patients seeking quality care and comfort are force behind overhaul
Sunday, April 30, 2006
By TRACEY L. REGAN
Staff Writer

After years of hospitals nursing sickly patients back to health, many aging facilities are finally getting a powerful dose of modern medicine designed to make them medically and financially well again too.

Recent surveys document a national boom in hospital construction not seen since the end of World War II. In Mercer County, for example, two of the four hospital systems have plans for new facilities. And a third is planning a multimillion-dollar expansion and renovation.

What has changed in the past decade is a sharp leap in patient expectations for quality of care, comfort and the latest-generation medical technology amid growing competition for paying customers among what were once sleepy community-care centers.

The hospitals now being designed to meet those rising expectations are substantially different in look, layout and amenities from those built even 20 years ago.

They are sleek structures with hotel-like lobbies, wide corridors uncluttered by dinner or trash carts, and light-filled rooms filled with cutting-edge communications and medical technology.
Treatment areas, such as cancer centers, cardiac-care centers and labor and delivery departments, are self-contained.

In addition to their own specialty equipment, they have all of the imaging technology and diagnostic devices they need so that patients don't have to be wheeled around the hospital to other departments.

Barry Rabner, chief executive officer of the University Medical Center at Princeton, had unsparing words for the hospital he oversees in downtown Princeton Borough.

"It's dead," Rabner said of the 86-year-old building, which less than a decade ago underwent extensive remodeling, including the construction of a new emergency department.

But like a growing number of hospital executives around the country, Rabner has looked at a rapidly changing marketplace and concluded that UMCP's landlocked brick facility cannot be adapted to meet contemporary demands for care.

Instead, the company has decided to abandon the building and build a new one from the ground up.

And he and the hospital's board are not thinking small. The $350 million facility they are designing more closely resembles the sprawling campus of a grand teaching institution -- with physician offices, an ambulatory-care center and a cutting-edge acute-care facility on a 155-acre site -- than the small community hospital that the medical center was just a decade or so ago.
Meanwhile, Trenton-based Capital Health Systems is planning to build a new hospital in suburban Lawrence that will include two 800-square-foot rooms to accommodate "robotic surgery," hospital executives said.

Architects and health-care workers say such modifications are not just desirable but enhance operational efficiency while reducing the risk of infections, hospital accidents and patient stress -- all leading to better outcomes.

That sort of efficiency reduces hospital stays, which has a significant impact on the bottom line. The money-makers in health care are quick procedures that involve specialty doctors, cutting-edge technology and short hospital stays.

Other hospitals, including Robert Wood Johnson University Hospital at Hamilton, are opting for the expansion of existing facilities and adoption of cutting-edge medical and support technology to give themselves an edge.

RWJ-Hamilton, for example, currently a 204-bed facility, is spending $63 million to build 96 new private rooms for patients.

Each of the new single-occupancy rooms, which are expected to be ready next March, will have more chairs for visitors as well as a couch "so that family members can stay overnight," said Christy Stephenson, the Hamilton hospital's CEO.

The rooms also will be "completely wireless so people can have computers there" and connect to the Internet, Stephenson said.

She said RWJ-Hamilton also was an early adapter of full digital mammography, and an all-digital radiology system for X-rays.

The latter allows a patient's X-rays to be reviewed instantly on computer screens simultaneously by doctors and other medical staff without requiring the traditional hard-copy of the X-ray image.

"As these kinds of technologies become available, we are early adapters of all of these so we stay ahead of the curve," Stephenson said, adding that the incentive is to provide patients the best quality care possible.

The notion of technology coming to the patient governs the design of operating and emergency rooms as well.

"Rather than wait for the lab and X-ray results to come down from the fourth floor, you bring the lab and the X-ray facility into the center of the ER," said Ron Czajkowski, spokesman for the New Jersey Hospital Association.

In general, health-care managers say they want to minimize patient transfers and design departments accordingly.

A patient coming into the emergency room would have a quick ride to the operating room. Following surgery, the patient would be wheeled to a room close by.

Patient rooms themselves are highly adaptable to avoid transferring patients.

The labor and delivery rooms at the recently built Jersey City Medical Center, for example, have panels in the ceiling that contain operating room lights to allow physicians to perform minor surgery on a patient there if necessary.

"It's not just a big rectangular building made of bricks," said Czajkowski.

There is not only more sophisticated technology in hospitals but more of it in general.
Operating rooms are now being designed in some cases to be twice as large as the traditional 450-square-foot rooms, in part to accommodate technology that does not yet exist.
Because of the growing competition among hospitals for well-heeled customers, the newest facilities are not only technology-saturated but steeped in amenities as well.

So much of the bustle of hospitals is now hidden or squelched. Medical specimens, for example, travel in pneumatic tubes from one department to another. Overhead public announcement systems are being scrapped in favor of wireless technology that is worn in lanyards around the neck, allowing staff to silently page one another.

A new hospital in Dublin, Ohio, has even scrapped the reception desk in the lobby. It has greeters instead, with hand-held computers and headsets, who usher patients to the proper department.

"It's about understanding how the culture has changed," said Rosalyn Cama, a Connecticut-based interior designer and chairwoman of the board at the Center for Health Design, adding, "It doesn't cost more money."

Hospitals are now suffused with natural light, which is believed to aid in the healing process.
When designing the Jersey City hospital, for example, architects put a hollow in the middle of the building to bring in natural light to the ICU.

Major changes in hospitals' attitudes about comfort and service began with birthing centers, industry watchers say.

"These were well patients with six to seven months to shop for services," Cama said. Once one hospital upgraded, "They all did." The next thing was palliative care to "create a comfortable and healing environment."

"Now that baby boomers are starting to have health problems, couple that with a lot of choices," Cama said. There is an effort by community hospitals to retain those patients.

According to a 2004 survey by the American Hospital Association, 60 percent of hospitals and 68 percent of health systems said they needed to replace aging facilities. At that time, about 800 new hospitals were planned.

"There was a stay-the-course mindset where hospitals adjusted and adapted to community needs by expanding and renovating," Czajkowski said.

"It costs about 5 percent more to build in the additional amenities," Cama said. "But if you look at the outcomes -- operational efficiencies and increased revenues -- then you can get that back in a year or two."

Jonathan Metsch, CEO of the Jersey City Medical Center, said the hospital's revenues jumped immediately after it abandoned its 1930s hospital, a drafty monster with capacity for 1,500 beds and highly inefficient infrastructure.

"Our first year, admissions were up 15 percent," Metsch said.

Unless they are operating in poor neighborhoods and can qualify for backing by the U.S.

Department of Housing and Urban Development, hospitals must look to the private investment banks to sell their bonds. As nonprofits, they qualify for tax-exempt bonds, however.

"Hospitals traditionally have had a life cycle of 40 to 50 years," Cama said. "In 40 or 50 years, who knows how care will be delivered. We may not even need hospitals."

Staff writer Robert Stern contributed to this report.

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