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In this era of vanishing bottom lines in health care, it’s rare to hear of a hospital embarking upon a major building project. That’s exactly what Salem (OR) Hospital is doing, however, and it’s one of the reasons admitting manager Charlene Overfield, RN, CHAM, decided to come on board last year. With much of the access arena consumed with shrinking reimbursement and burdensome government regulation, she notes, it’s nice to be part of the "fun piece" of the business. One of the most intriguing parts of the design phase, Overfield says, was an evening when hospital personnel gathered to do a "rapid design" of their new facility.
Hospital managers, directors, physicians, and administrators came together, under the direction of project consultants and architects, and were broken into three groups, Overfield explains. "They tried to put enough people in each group to represent clinical, administrative, financial, and physician [viewpoints]."
The groups were given cards representing the various departments in a typical hospital. The bigger the department in terms of square feet, the more cards were allocated to represent it, Overfield says. "They said, We want each of you to build a hospital, placing the cards horizontally as well as vertically, and thinking 10 years out!"
Each card represented so much square footage, so there were five or six cards for surgery used to represent a surgical suite, recovery room, and so forth, she notes. Participants talked about how the needs of various departments had changed or would change in the next five to 10 years."It was really fun to design a new facility," she says, "not only what should be on the first floor, but what makes sense to be adjacent or on top of that. It was very interesting to see what each group came up with."
It was interesting, Overfield adds, to see the emergency department (ED) physicians and the psychiatrists, for example, jockey for position. "They talked about how much space they needed, what they wanted to be next to, and remember, this is for five or 10 years from now. They had to look at, How is your medical practice going to change?’ and How will new technology change the way you’re dealing with patient care?’
"ED people were saying they needed to be close to new scanning equipment, and to surgery, and to an elevator devoted to the transporting of patients," she says. "They also wanted to be next to the angioplasty department. They get so many cardiac patients, and with the new technology, felt [patients] could go from a heart attack to the angio room."
The architects and consultants chose the best plan from among the three groups, Overfield says, and participants then dissected that proposal, suggesting changes. "That’s what the architects used to plan [their design]."
The people at that initial rapid-design session were put on one of four different design teams, representing patient support, emergency department, mother/baby services, and a steering committee, she notes. Those teams meet monthly to continue to fine-tune the hospital design. Overfield is on the patient support team, but also has sat in with the ED design team.
The admissions department traditionally has been part of "the front door" of the hospital, and that needs to be maintained, she says, but there has been discussion of how the admitting space may be modified because of changes in operations. "We talked about bringing much of the outpatient scheduling, insurance verification, and authorization to the front end, so we’re looking at more preregistration, scheduling, and financial counseling space," Overfield notes. "We’re also looking at having a point of service where we register everyone, and then have the departments [where the patient receives a service] activate the account. The patient will wait there. Our goal is to have more than 90% of patients preregistered."
That means, she says, that while in the past there has been more lobby space in the admitting area, the new design may focus on having more space in the various ancillary departments.
Salem has a number of distinguishing characteristics that figure into the design challenge, Overfield points out. It is the capital of Oregon, with a population of about 150,000 — 200,000 including surrounding areas. Salem Hospital is the city’s only hospital, as compared to Portland, which is 50 miles away and has a whole group of hospitals. "Some departments are totally overtaxed," Overfield says. "With 250 patients a day, we have one of the largest EDs in the state as far as volume is concerned. Every piece of real estate is taxed, and [the ED] is very busy and very crowded." Salem Hospital is licensed for about 460 beds, and sees about 18,000 patients a month, she adds.
Because downtown Salem has a number of skybridges, which are part of the atmosphere of the community, they are part of the existing hospital campus and will be used in the design of the new facility as well, Overfield notes. Site preparation will begin in the spring, she adds, but it will be more than three years before any departments actually will occupy the new hospital.