Nowhere could the patient-centered health care model be more fitting than at Griffin Hospital in Derby, Conn., a 160-bed facility that looks like an upscale hotel. Albis Turlington Architects has completed more than 50 projects for Griffin since the hospital adopted Planetree as its model 12 years ago. All of the projects exemplify the commitment of the hospital to fundamentally change the relationship of health care delivery to its patients.
The most recent project is the renovation of the inpatient psychiatric facility. Architects chose to find design inspiration from Planetree in each aspect of the project, from the largest planning decisions to the smallest details of hardware. As a result, Planetree can be felt everywhere. The design strategy brought about an architecture that nurtures the unique relationship between the patient and the provider.
One of the biggest satisfactions of renovating any medical facility is successfully accommodating new conceptual ideas within complex existing structures. At Griffin Hospital, architects were presented with many daunting structural challenges, such as limited area, low ceilings, columns and walls.
The existing 7,300 square feet of space was at the lowest level of the hospital, mostly below grade and heeled into the side of a hill with only partial access to natural light. This largely subterranean environment needed to be addressed to accommodate the Planetree model. So, the unit was reconfigured to allow daylight to penetrate as many patient spaces as possible.
Light is extremely important to patient healing, so maximizing daylight was a key goal. Toward that end, the hospital permitted the removal of selected structural elements to allow as much open area as possible.
In fact, the success of the unit was driven by the decision to remove the main load-bearing wall. This huge wall, which supported four stories, originally divided the whole unit in half. Worse, it prevented any effective monitoring of the patient bedrooms or the original day room, and limited the light that could penetrate the interior.
To remove the wall, construction workers jackhammered out the floor, poured new concrete pad footings and grade beams, and then erected new steel columns hidden in the sheetrock walls. These new steel columns, in turn, supported new precambered beams running parallel to and on either side of the existing wall above the ceiling.
Once the new primary beams were installed, new transverse beams were added to support the four-story portion of original wall that was scheduled to remain. After the new structure was in place, the original wall was jackhammered out.
Adding open space
Reducing the unit's patient population from 16 to 14 beds also added more community space for general patient activities and uses.
This openness allowed the design team to implement the Planetree model more effectively, helping them achieve important goals such as better communication between clinical staff and patients, better patient visibility, and better patient awareness of daylight in the community room, creating an increased sense of place.
The renovation removes the physical barriers between patient and staff, and also eases the loss of control patients commonly feel when they must surrender body and mind to someone else. Community spaces outside of the patient rooms are designed to encourage patient-to-patient interaction and mutual support.
The existing columns anchor the relocated main nurses' station and allowed architects to use existing overhead skylights more effectively. All the formal barriers of the station were either totally removed--no glassed-in enclosures--or modified to be more patient-friendly, with low countertop heights. The barrier-free nurses' stations and comfortable public spaces to encourage social interaction and the involvement of family represent a strong commitment of the hospital to its patients.
The new unit offers private and semi-private rooms, a residential-style kitchen and dining room, an inviting entertainment lounge and even a large saltwater aquarium. Traditional therapeutic approaches that include individual and group therapy are enhanced with space that accommodates Planetree programmatic elements, such as patient education, aromatherapy and arts.
Overall, the use of natural woodwork, softer and less-clinical finishes and indirect lighting provides a welcome and nurturing feeling, and the resulting sense of calm and dignity has been well-received by the Griffin Hospital staff, patients and visitors.
Good for business
Since Griffin Hospital incorporated the Planetree model, it has seen its patient-centered approach make a significant contribution in areas other than health outcomes.
For instance, profitability and staff productivity both saw boosts, and Griffin's patient satisfaction ratings rose, holding at 97 percent for the last four years. In short, managers have found that Planetree gave the hospital a competitive edge and is good for business. In the inpatient psychiatric unit, revenues have risen by about 4 percent, due to an increase in patients.
Staff feedback on the new design has been overwhelmingly positive. According to Eileen Carino, nurse supervisor of the unit: "The patients are reassured if the staff is not behind barricades, and the staff is definitely more connected to the patients." With the barrier-free environment, it is easier for staff to see when a patient needs attention, and to provide that attention without losing awareness of other patients, she adds.
"Planetree did not change how we treat our patients, but the new unit has definitely changed the patients' experience," says Carino. "They are less agitated, and less nervous than before we incorporated the Planetree design and programmatic elements. We have had no serious behavior problems since opening day. The beautiful, peaceful environment truly affects them." *
Richard G. Turlington Jr., AIA, is a principal of Albis Turlington Architects, New Haven, Conn.
Facts + Figures
Name: Griffin Hospital
Location: Derby, Conn.
Owner: Griffin Health Services Inc.
Type of project: Renovation
Architect: Albis Turlington Architects
Interior designer: S/L/A/M Collaborative
Contractor: Turner Construction
Cost: $1.5 million
Size: 7,300 square feet
Start date: January 2003
Completion date: June 2003
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