Andrew Wilde stood with his chin in his hand, surveying hospital furniture and taped-up pictures of equipment. He and several other Roper St. Francis nurses nudged the hospital bed and moved paper versions of equipment around the mock room.
"Where's the big whiteboard go?" Wilde said. The question was met with "hmms" from the other nurses.
Though the detail may seem small, one day soon it could make a difference in Wilde's workflow. And for an intensive care unit nurse, efficiency is of the utmost importance.
Roper St. Francis has been bringing its nurses into a series of mock rooms to tweak the details of their layout. The finished designs will be used in the new hospital being built in Berkeley County.
The room layout won't just help nurses. Millions of Medicare patients who require hospitalization each year fill out surveys upon their release. The federal government asks the patients to rate the quality of care they receive and grade everything from the cleanliness of their hospital bathroom to nurses' responsiveness. Those scores are then used to calculate hospital reimbursement. That's one reason why hospitals are changing the way they approach the aesthetics of their rooms and buildings, said David Allison, Clemson's director of graduate studies in Architecture and Health.
"An increased focus on patient satisfaction has meant hospital systems pay greater mind to the look and feel of their facilities," Allison said. "Often our sense of satisfaction is about the perception of our experience, not about the health outcome."
Scott Broome, CEO of Roper St. Francis' Berkeley hospital, detailed some of the design nuances he hopes will improve workflow and patient happiness. In the new hospital, the Roper team is doing away with bed curtains altogether. Doors will open so that nurses can ask to enter the room without being able to see the patient straight away. Window sills will be low enough that patients can turn their head and see outside.
"Our goal is to bring a high level of care to Berkeley County," Broome said. A new medical office building is scheduled to be completed on site in the summer of 2018. The hospital will be done one year later, Broome said.
At the Medical University of South Carolina and Summerville Medical Center, teams are going through a similar design process for new hospital rooms.
Trident Health plans to move all labor and delivery services to the Summerville hospital by 2019 and has been busy designing new rooms there to "create a comforting and healing environment." The $53 million project "includes calming color pallets and nature-inspired accents that provide a fresh, contemporary feel that appeals to young families."
Meanwhile, at MUSC, construction is already underway for a new $385 million children's hospital and women's pavilion.
Robin Mutz, executive nursing director for the MUSC Children’s Hospital, said the staff formed teams, each of which included a patient's family. Altogether, there were more than 60 teams that worked on every room and floor, "down to the detail," Mutz said.
"It has certainly been designed to enhance the patient-family experience," Mutz said.
At both MUSC and Roper St. Francis, new labor and delivery floors will allow the mothers and babies to stay together through their care. Not only does that improve outcomes, Mutz said, but mothers want to stay with their babies in their first days. Many hospitals have eliminated the traditional nurseries altogether to promote this closeness.
In this model, nurses and doctors will act as coaches for the family, Mutz said. She said research has shown providing care this way reduces the family's length of stay and their readmission rates.
"It’s a very family-centered, culturally sensitive way of providing care," Mutz said. The new children's hospital is scheduled to open in the fall of 2019.
Allison said safety is the first concern for hospitals. Hospitals can save money in the long term by making their facilities safer and more efficient. But satisfying patients also means creating more space, improving light and noise levels and including room for families in patient areas.
"How you deal with these competing needs in a very small amount of space becomes challenging," Allison said.
For both MUSC and Roper St. Francis, noise was a serious consideration. The sound of doors opening and swinging shut is a top complaint among patients at Roper St. Francis. A 2012 study from the University of Chicago found noise levels in hospitals were much higher than they should be. Study authors found patients lost a fair amount of sleep, and much of the noise was because of "preventable sources such as staff conversation."
Roper St. Francis and MUSC are making efforts to move away from a centralized nurse station to address the problem of noise. At Roper, floors have been laid out partly to protect patients' ears from the sound of doors slamming shut.
Wilde said caring for patients has become more complex as hospitals deal with sicker visitors.
"Times have evolved. There's more equipment involved," Wilde said. "The idea of having something with space and open, it's great."
The new rooms will be much larger than those Wilde has grown used to in his seven years at Roper St. Francis. But when it comes to cost, designing rooms to be bigger and more welcoming makes up a relatively small amount of the $113 million total budget for the Berkeley hospital.
In the grand scheme of hospital costs, Allison said, posh designs represent only a small portion, especially when compared to the potential improvements in factors such as efficiency and health outcomes.
"Those things are much more powerful a variable," Allison said.
