Some 150 community residents and others packed the Palo Alto Arts Center June 20 to glimpse how innovative building design drives hospitals of the future — and to find out why a replacement medical center complex is needed in the first place.

Local residents packed the Palo Alto Art Center June 20 to find out why Stanford needs a hospital rebuild project.

A panel of two physician leaders and two architects answered the not always rhetorical question, “Why do modern hospitals have to be so big?” They explained that more spacious rooms — private and closer to key diagnostic and treatment facilities — have been shown in studies and experience to better serve and empower not only patients but also family members and friends who are becoming a greater part of the treatment/recovery process. So, probably due for the chopping block are such barriers as formidable nursing station counters that keep caregivers on one side and everyone else on the other. Slated for patient rooms are not only an increasing array of monitors and equipment, but a place where a family member can watch a second TV, work on a laptop computer, or rest in the visitor beds similar to those innovated at Packard Hospital in 1991.

Overall, explained the panelists, hospital design can drive — not just support, patient care and safety. The event was sponsored by SHC and Packard Children’s Hospital as part of a series of community forums.

The public was told how hospitals have evolved from an era when overall size was based on the number of beds to a present and future world where sicker patients stay for shorter, more intense, hospitalizations.

Speakers included:

• James R. Diaz, director KMD Architects, San Francisco. He was involved in the design of some early replacement units at Stanford several decades ago, including the original neonatal intensive care unit, considered groundbreaking at the time.

(1) Greg Mare, foreground, and fellow panelist Marty Scott, a physician from South Carolina. (2) Architect Jim Diaz answers a community member’s question while, in background left, fellow architect Greg Mare listens.

• Greg Mare, senior vice president, director of planning, Karlsberger Architects, Columbus, Ohio. He leads an evidence-based design initiative through his firm and is a major national spokesperson for the concept that design improvements, based on hard evidence showing best practice, contribute directly to patient safety and quality.

• Marty B. Scott, a pediatrician and vice president, quality and patient safety, Memorial Health University Medical Center, Savannah, GA., cited by Consumer Reports as one of the safest hospitals in America. Scott was credited for promoting to physician colleagues the concept of Crew Resource Management (CRM), which creates a culture that all members of the professional team must be empowered to question the caregiving process at all times.

• Kevin Tabb, chief quality and medical information officer at SHC and Stanford Medical Center, and a national leader on utilizing clinical information systems to improve patient safety and institutional efficiency.

• The event was moderated by architect Mark Tortorich, vice president, planning design and construction at SHC and LPCH.

The talk was part of an ongoing speaker series entitled Healthcare Tomorrow and is presented by the Stanford University Medical Center Renewal and Replacement Project.

The replacement project is both a necessity and an opportunity for improvements, hospital leaders have said. The oldest portions of the hospital, constructed in 1959, will not meet state-mandated seismic requirements and must be shut down or replaced by 2013. However, hospital leaders say even more recently built facilities will become obsolete in the coming decades, and in any case, must be supported by an integrated, functional center once the original core hospital is taken out of service in the next six years.

In Palo Alto, SHC has proposed an integrated 1.1-million-square-foot facility that will house 600 beds, house a new Emergency Department, new surgical diagnostic and treatment suites, while providing support services on site. Packard Hospital is also proposing an expansion to its current facilities, and an outpatient facility in Redwood City is intended to accommodate the expanding role of outpatient vs. inpatient medicine.

The panelists stressed that programmers and designers were carefully observing the workflow of physicians, nurses and other caregivers to provide optimal design of patient units and treatment suites in medical centers around the country.

Diaz noted that vendors, such as imaging manufacturers, are increasingly making full-size room mockups with medical equipment to allow the design teams the opportunity to test work flow. This can help designers understand how much space is needed for hospital personnel to perform their job functions and work with the equipment used every day. In this way future hospital room sizes and needs can be better predicted.

After the discussion, panel members greeted community members and continued the discussion.

Some other key messages from the panelists included:

• BIG ROOMS — SHC and LPCH — as well as other progressive hospitals being built nationally — will have larger rooms to accommodate new technology equipment that wasn’t invented when Stanford Hospital was first built in 1959. Some of the needs will be space to house increasingly sophisticated monitors and interventional equipment, but other changes will enable the IT infrastructure, such as fiberoptic wiring, to be placed seamlessly throughout patient care and operational areas. Another example: the doorways of the current patient rooms can’t accommodate computers on wheels (COWs), which to be effective must be wheeled in and out of patient rooms in lieu of the paper charts they are replacing.

• PRIVATE ROOMS — Rooms need to be bigger AND private. This creates an atmosphere that not only is more pleasant for patients but has been shown to be safer. Among other benefits: privacy and quiet contribute to rest and a demonstrated greater probability of healing.

• STANDARDIZATION — Caregivers should be able to walk into a room and know where supplies, equipment, hookups, and monitors are located without having to reorient themselves each time. Unfortunately at most older hospitals, such standardization wasn’t built into new construction or remodeling.

• ADAPTABILITY — Rooms should be easily configured quickly for various levels of acuity as the census changes.

• PATIENT COMFORT/SAFETY FEATURES — Anyone who has ever had to get up and go to the bathroom from a hospital bed knows that the location of the toilet matters. But where should it be? For example, is it easier for patients to get to the bathroom on the left or right side of the bed — or opposite the head or foot of the bed? Another example: recent research indicates that placement of intake air ducts should be on the floor to circulate air to outtake ducts near the ceiling. That way germ-filled air rises from the bottom of the room to be removed at the top, reducing the cross flow of germs in the air at the level where people are breathing. This is a relatively new but potentially fundamental concept in health care facilities design.

Keep an eye on PATIENTS/TRAFFIC FLOW — Nursing work areas on units should allow staff to look up and monitor every patient. No patient should be “down the hall and out of sight.” Good observation and traffic flow starts before an inpatient stay begins. Hospitals do a good job of isolating and treating emergent patients, but subacute patients often fall between the cracks. For example, new patient care standards require that pneumonia patients receive an antibiotic within four hours of arrival — but crowded waiting areas and turbulent conditions often mean that these patients don’t get treated until they are transferred to a patient unit. Research indicates more space would help staff isolate, evaluate and begin treatment of every patient even when staff ratios are tight.

INTEGRATE FAMILIES AND CAREGIVERS — Circular consultation tables that allow patients and caregivers to huddle around a computer that everyone can see at one time, should replace the traditional model of a caregiver reading from a screen to patients and family seated on the other side of a desk or counter. Circular counters create an egalitarian feeling that allows caregivers, families and patients a more collaborative environment to discuss the patient’s care.

Replace waiting areas with ACTIVITY AREAS — provide areas for waiting family members so they can do something actively — use a computer, eat, read, and children should have a place to play. Ideally, providing activity areas within the hospital that encourages family togetherness and interaction with the patient is beneficial and reassuring to both family and patient. What could simply be a long wait in a lobby can be transformed into a less stressful experience by providing outdoor patios and gardens, computer stations, private seating areas and play areas for children.

Provide MULTIPURPOSE ROOMS that can be used for family meetings/ gatherings, either with caregivers or without. Such rooms can also do double duty as informal classrooms for staff or for patients to do some research or their personal work on computers. Caregivers should be encouraged to mingle collegially in staff rooms that provide nooks and crannies for various activities, including, eating, chatting, reading — or conducting informal patient or general health discussions.