Wisconsin safety-driven hospital under construction

What if physicians could design a hospital from the ground up using patient safety as the guiding principle? Well, then they would be duplicating the experience of West Bend, Wis., internist and primary care physician Robert Gibson, MD, who served on the committee that developed the new St. Joseph's Community Hospital being built in his hometown.

Although the $55 million, 80-bed replacement hospital -- located on the outskirts of the outskirts of Milwaukee -- will not be finished until May 2005 and won't open until August of that year, it is already attracting international attention because of how it was designed. The objective was to design a facility that would minimize medical errors and infection, and then create processes that would take advantage of the design.

Hospital officials and employees scoured medical research for data on how to design the safest possible hospital. On issues where no literature existed, they put their heads together to decide the best course.

"Some of it we found in the material, and some of it just made sense," Dr. Gibson said. "We're hoping we will create new reports and new findings."

Among these concepts was to build 55 identical single-patient rooms where everything is located in exactly the same place in every room, to use high-efficiency particulate air filtering and to do everything possible to eliminate noise.

"We may find that none of this will have an impact, but my gut says it will," St. Joseph's chief operating officer Barbara Knutzen, RN, said at a program sponsored by the Chicago Health Executive Forum in May.

John Reiling, SynergyHealth and St. Joseph's president and CEO, agreed. "You can connect the dots and know intuitively without a double-blinded study that, if you get people to wash their hands more, infections will go down," Reiling said. "If you reduce noise, safety and quality go up."

All together in one place

Dr. Gibson and Knutzen said that, when the decision was made to build a replacement hospital because there was no room for the existing hospital to expand, the Institute of Medicine report "To Err is Human" served as an inspiration to use patient safety as the driving force in developing the new facility.

"We've all seen the data on the number of errors and the lives that are lost," Dr. Gibson recalled. "So we said: 'Look, we have to do something different, and this is an opportunity to do it.' "

To help set priorities, a "learning lab" was held in April 2002, and experts from the AMA, the American Hospital Assn., the Joint Commission on Accreditation of Healthcare Organizations, the National Patient Safety Foundation, the VA National Center for Patient Safety and other health care organizations plus NASA, 3M and General Motors were invited.

Priorities were determined to be standardization; visibility of patients to staff; access to critical information near the patient at all times, not just at the bedside (so electronic medical records are necessary); noise reduction; and having space for families.

Rooms were also designed to avoid JCAHO-defined "precarious events" and with vulnerable patients in mind. "If it's safe for them, it would be safe for everyone else," Knutzen said.

Carol Haraden, PhD, vice president of the Boston-based Institute for Healthcare Improvement, said the scope of St. Joseph's patient safety efforts is unprecedented.

"A lot of hospitals are retrofitted, but we've not seen so many patient safety features in one place," she said. "People have built safer ICUs, safer med-surg units. As far as putting everything together in one place, it's not been done before."

Dr. Haraden said the main question that remains is how all these changes will affect clinician behavior and if people will fall back to old ways of thinking and working.

Gibson doubts this will occur because, in addition to the safe design of the facility, a "culture of safety" has been created where errors and near misses get reported and analyzed.

"Out attitude is: 'Don't try to hide it. Don't try to bury it. Don't worry about taking a negative hit for it,' " Dr. Gibson said. "Report it, and let's see how we can fix it."