In 1992, when we began our journey to reinvent the healthcare environment and experience for patients at Bronson Methodist Hospital, we didn't have the benefit of evidence-based research as we do now through our involvement in the Pebble Project and the Center for Health Design.

But, we had a strong vision of what a hospital of the future should be, a firm commitment to remaining in the downtown area, and a critical focus on doing what is right for patients and their families. As a result, Bronson's experience was one of transforming not only our facilities, but also our organizational culture.

In December 2000, on a 14-acre site adjacent to our then 100 year old hospital campus, we opened a $210 million replacement hospital. Components include a Medical Office Pavilion, an Outpatient Pavilion and an Inpatient Pavilion that all come together around a Central Garden Atrium

Healing Environment
We focused on creating a healing environment, with comfort and ease of use built into the design. Nature, art, music and light all play a role in creating a welcoming atmosphere, assisting wayfinding, and in supporting the healing process. And, a significant innovation at the time-all-private rooms.

Redeveloping in a downtown urban environment was a challenge as we sought to bring the outdoors in. We were also mindful to create a building façade that was low rise and reflected the "look" of the neighborhood.

The Garden Atrium in the center of the facility provides a quiet place for reflection surrounded by plants, a view of the outdoors, and a water feature. Landscape views of the outdoors are available from almost every vantage point. Wayfinding is enhanced with natural light in entries and hallways, open circulation, limited internal corridors, a balance of natural and artificial light, and many places for activity and rest.

Art is an integral part of the Bronson experience. Commissioned art and revolving art gallery are the result of a collaboration with area schools, and arts council. There is sculpture indoors and outdoors, and soothing music plays overhead throughout the campus. A grand piano in the garden atrium adds to the relaxing atmosphere there.

Improving Access and Flow
From parking to outpatient services to physicians' offices to inpatient units, every encounter a person might have within the hospital environment has been meticulously planned.

For instance, physician offices in the MOP are in close proximity to information at Bronson HealthAnswers and on the same floor as related inpatient and outpatient services. This makes for smooth transitions between related services and contributes to overall efficiency.

Inpatient rooms are horizontally integrated based on patient status, with the most critical on the north end of the building and less critical patients on the south end. Each floor has a range of care from critical to general so patients won't have to travel as much on elevators.

One-stop centralized Outpatient Testing is one of our best examples of redesigning processes around the patient and is now one of the most sought after facility design models because of the success we've had in bringing a large number of diagnostic services together in one location so the patient does not have to travel throughout the facility.

Other service enhancements include: Convenient parking, greeters and valet, kiosks for wayfinding, hotel style food service, wireless internet access, concierge services for patients, employees and medical staff.

Private Rooms Reduce Risk of Infection
A unique feature of inpatient services at Bronson is that all patient rooms are private. With complete privacy, patients are able to rest without the distractions of a roommate, a roommate's family, or the roommate's health care team and are able to speak freely when using the phone and when discussing their personal situation with doctors and nurses.

The rooms are tastefully decorated to feel more home-like and are filled with light from large windows and the many lights throughout the room. We also recognized the importance of family support for patients, so each room has a chair or sofa that pulls out into a bed.

Private rooms contribute not only to a better healing environment, but also to reducing costs. Prior to our move, we determined that a hospital our size spends about a half a million dollars a year just moving people from semi-private to private rooms, due to infection control measures, incompatibility among roommates, or changes in the availability of rooms. Larger hospitals spend even more.

Not only have have private rooms contributed to increased patient satisfaction, but research we conducted pre and post move, shows they actually reduced the hospital-acquired (nosocomial) infection rate.

Bronson's 4-year study found that the private room design was associated with an 11% reduction in hospital-acquired infections thereby freeing up needed hospital beds, improving patient outcomes, and reducing hospital costs.

This study illustrates that the built healthcare environment can have significant effects on the quality of patient care beyond aesthetic issues. In 2006, the American Institute of Architects (http://www.aia.org/release_071906_healthcare ) went on record endorsing private rooms as the new standard for all US hospital construction.

Staff Involvement
Facility redevelopment presents a once in a lifetime opportunity to engage staff and we leveraged that opportunity to create a dynamic service oriented culture of excellence to match the promise of our new physical environment.

Today, Bronson is well ahead of many of our peers in the healthcare industry in meeting national healthcare quality and performance standards and in addressing the national shortage of nurses and other healthcare professionals. We have a waiting list for many positions, our turnover rate is less than half the national average, and we are engaged in many initiatives to improve care and safety for our patients.

Staff and physician involvement was critical to our success. Taking them on site visits to see what other hospitals were doing and bringing their perspectives to decisions such as how to layout the patient room for maximum efficiency was very important. We created mock up rooms to tryout various room layouts until a "winner" emerged.

Staff also participated in focus groups with customers on things such as best layout for the parking ramp and how to redesign patient wear. We also introduced new appearance standards for all patient care staff, color- coded so patients can tell, just by looking, the role of each provider.

North Pavilion Development
In 2007, we opened our third patient care pavilion help accommodate a more than 40 percent increase in inpatients, particularly in adult cardiac, orthopedic, neurological and surgical care, since 2000 when the new hospital opened. The North Pavilion is the new home of the Bronson BirthPlace and Neonatal Intensive Care Unit (NICU) and follows the same healing environment and design principles as our other facilities.

The newest design feature is that the NICU, which treats about 680 babies a year from throughout the region, will convert from a 45-bed nursery design to all-private rooms. Bronson's decision to design an all-private room NICU came after site visits to other leading hospitals and extensive research to understand the latest in best practice care for seriously ill or injured newborns. The research provided strong evidence that private rooms help reduce hospital-acquired infections, provide more control over sound, light, and temperature to support infant development, and offer more privacy for the family. Bronson's own successful implementation of all-private rooms in other patient care units also contributed to this new direction.

Bronson is one fewer than a dozen hospitals in the country to have researched and pioneered this new NICU design and the results will be shared with other hospitals via the Pebble Project at the Center for Health Design whose goal is to provide documented examples of how evidence-based design improves quality of care.