According to Al Deininger, vice president of construction for the White Memorial Medical Center in Los Angeles, hospitals will meet future demands by putting patients first
Written by Ian Armitage and produced by Michael Magno
At 4.30am on January 17, 1994, residents of Southern California were awoken by the catastrophic Northridge earthquake – one of the costliest natural disasters in US history. In 30 seconds, the magnitude 6.7 quake ripped through one of Los Angeles’ most populated areas, killing 57 people and injuring 9,000.
The damage was widespread and hospitals were left useless, seriously hampering the state’s ability to deal with the crisis. To ensure this never happens again, California state legislators passed senate bill SB 1953, calling for all acute care hospitals in the state to meet stricter seismic safety codes. “All acute care hospitals now have to meet the current earthquake code,” says Al Deininger, FACHE, vice president of construction and facilities for White Memorial Medical Center.
Patients first
For numerous reasons, many of us have unpleasant experiences of hospitals. They are often stressful and usually cramped. Officials at White Memorial Medical Center kept that in mind when they started planning their rebuild. They came up with the simple goal of building something that would make patients, and their families, as comfortable as possible. As a result, over and above meeting state seismic safety codes, the new White Memorial Medical Center, enables staff to practice modern approaches to patient care – a dramatic improvement to the healthcare environment.
In order to create a more user-friendly center, which made patients as comfortable as possible, White Memorial visited several hospitals that use concepts developed by Planetree, a not-for-profit organization, which supports health facilities in creating patient-centered environments. The medical center has opted to incorporate certain aspects of the Planetree model into its ambitious rebuilding program.
Taylor, a Californian architecture firm, designed the new hospital and ‘Patient First’ was the guiding principle the project’s steering committee developed at the outset of planning. Everything has been designed and constructed to adhere to that.
What patients see
The design of each floor, for instance, incorporates a report room, with doors that close, near each nursing station. Nurses consult with physicians and do the majority of their work in the report room when they’re not with the patient, resulting in a less noisy, more restful environment. Computers on wheels (COWs) allow nurses to spend as much time as possible with the patient – nurses chart on the computers while in the patient room.
“Inside the report room, the health care professionals can communicate without compromising patient privacy,” Deininger said. “Outside the report room, they can focus entirely on patients, families and visitors. Keeping certain things offstage helps provide a peaceful, healing atmosphere.”
The nurses stations are now primarily areas where the charge nurse talks with family or visitors, or where physicians are present to assist patients and visitors.
To make families more comfortable, White Memorial‘s Neo-natal Intensive Care Unit (NICU) also provides short-term live-in facilities for parents. “There are many times when there is a very sick baby and the parents don’t want to go home,” explains Deininger. “In such circumstances they can stay here. The facilities are built with Planetree in mind. It is like a very nice hotel; the rooms are very comfortable and use warm colors.”
The adullt intensive care unit has similar facilities, popularly used when a patient is ready to go home, and the family is learning how to provide care at home. “In such cases, they can stay here and we will offer them around-the-clock assistance until they are ready to take the patient home and care for them themselves.” The adult Intensive Care Unit also provides a family kitchenette with microwave, and a small dining area.
A hallmark of the Planetree model is linking architectural design and use of space and color with care that preserves a patient’s dignity. Planetree calls for rooms that resemble home bedrooms, with comfortable furniture and warm colors. “What happens when you’re a patient is you lose control. One of the things in Planetree is to have control of the environment,” says Deininger. White Memorial accomplishes this in part by writing key information about a patient’s care on a board in the room where the patient can see it and understand it. Family members are encouraged to visit.
Onstage/Offstage
An apt idea for any LA hospital, White Memorial has also introduced the “Disney approach”, to accompany and support Planetree concept implementation. According to Deininger, this concept involves separate spaces for onstage activities that involve direct customer care, and offstage activities, which do not. “You never see Mickey Mouse eating a hamburger,” he says. As a result, when White Memorial staff members are in the hospital’s patient and public areas, they are considered onstage. “When you step into the onstage area you’re in character,” he continues. “You’re focusing on the patient; you’re focusing on the family; you’re not talking with staff.” This idea influenced much of the hospital design, including the patient rooms, nurses’ stations and elevator system.
The ambitious four-phase plan to rehab the entire campus, which was launched in 1998, has brought existing buildings up to state seismic standards and created a new patient care tower that opened in 2006.
The project is funded by private donors and nearly $90 million from the Federal Emergency Management Agency (FEMA).
The first phase, completed in 2003, included a revamp of the central utilities plant, which supplies all the heating, cooling, and emergency power to the hospital. The second phase was the construction of the new patient tower. The third phase included renovating the east and north buildings. The last phase, which began in January 2008, includes abatement and demolition of the old main and west buildings, and the creation of a new main lobby, dramatic new hospital entrance, a concourse, chapel, outdoor cafeteria seating and extensive landscaping . The entire project is slated to finish by late 2009.
Driven to succeed
Responsible for the daily facility operations of the New White Memorial, Al Deininger has worked within Adventist Health throughout his career. He has worked hard during this time to provide the resources needed for people with motivation to achieve the goals of the organization and achieve personal growth and daily job satisfaction.
Even though the new hospital won’t be entirely completed until 2009, the main portion of construction is already done. However, this doesn’t mean the project is over. Demolition still lies ahead and it will have to be performed in a way where there will be as little disruption as possible in any hospital services.
Deininger knows this is a challenging task, and comments: “Our biggest test right now is demolition,” he says. “Doing that in a way which minimizes disruption is essential, but challenging. For instance, the vibration, noise and dust as a result of the demolition will be huge. That is why it is important to remain focused and show the same discipline we have shown to date.”
White Memorial is one of the oldest hospitals in California. The hospital is owned by Adventist Health, a Roseville, California-based religious, non-profit health system associated with the Seventh-day Adventist Church. The health system determined that it would be more efficient and effective to replace the hospital’s main building than to retrofit it. While Los Angeles residents benefit most directly from the new health care facility, Deininger believes the White Memorial project is something about which the entire country can feel proud.
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