Case study: Dublin Methodist Hospital.

Several years ago, we built a new hospital from the ground up in Dublin, Ohio, for the OhioHealth system, and we found ourselves presented with an opportunity to try to put the Fable hospital concept into practice. This planned ninety-four-bed community hospital was intended to serve the growing northwest quadrant of Franklin County, along with areas to the west and northwest. With tertiary facilities already a part of the OhioHealth system, Dublin Methodist was intended to provide primary and secondary care. Our goal was to be as innovative as we could afford to be, to challenge the status quo at every turn. Our stated purpose was to "redefine the way patient care is provided" through the development of a less-stressful healing environment, with an emphasis on patient safety and the patient/family experience. In addition, we promised the community a high level of customer service and elected to incorporate a fully electronic medical record management system in the new facility. The senior leadership and the board of directors of OhioHealth fully supported these efforts. When planning began in 2004, it was apparent that evidence-based design could help to achieve many of our goals. We became aware of evidence-based design from Rosalyn Cama, a consultant on our architectural team who supported its use and employed its principles. The Fable hospital article provided guidance as we began our design journey. First and foremost, we chose single-bed rooms, although they were not required by the American Institute of Architects until 2006. The evidence for this decision was strong; while single rooms create additional square footage and more expense during construction, building them was clearly the right thing to do. Private rooms supported our commitment to patient safety, as they have been shown to reduce infections, medication errors, and falls. Noise levels are lower, communication is enhanced, and social support is easier to provide in rooms with only one patient. All of these benefits contributed to both the healing environment and the level of customer service we wished to ensure. Private rooms with doors were also built into the emergency department, as well as the pre- and postoperative treatment area. At no time in their journey through our building do patients share a room. Because of the positive effects of natural light, such as its contribution to a better mental outlook, we also chose to incorporate windows wherever we could, resulting in access to daylight in approximately 90 percent of the occupied spaces in the building. There are windows in all inpatient rooms and most emergency department rooms, in addition to the corridors surrounding our surgery suites, many offices and administrative spaces, and all public areas. Four open-air courtyards enhance the access to natural light and allow people to step outside. The nature theme is consistent, with live trees, plants, and a three-and-a-half-story waterfall in the main atrium. Trees also serve to bring nature to the emergency department walk-in patient lobby, and enlarged photographs of natural scenes are scattered throughout the building, serving as both stress reducers and way-finding clues. Natural materials were used whenever possible, and the colors of flooring and walls were chosen for both their timelessness and their representation of the outside environment. Since there are few ninety-degree angles in nature, many of our walls and soffits are curved to soften the appearance of corridors and corners. Noise is a stressor and a distraction that we aimed to minimize in this facility. Measures taken to reduce sound levels include acoustic ceiling tiles throughout the building, carpet tiles in the hallways of inpatient units, ceilings of various heights, patient beds in pavilions out of mainstream traffic patterns, and the use of a hands-free, wireless communication device. …