Nor are they more than 100 feet or so from a well-stocked, home-style kitchen open to all patients and visitors 24 hours a day. Sometimes patients cook as a sort of therapy; one patient who was a chef cooked dozens of complete Thanksgiving dinners while waiting for his appointment with surgery. Some families gather in the kitchen, put on a pot of coffee, and then make life-and-death decisions that somehow would be that much harder in a hospital room or hallway or lounge.
Everywhere you turn at Griffin you see similar unhospital-like touches--touches that were mostly inspired by ideas solicited from Griffin's customers. But remaking the hospital at large to suit the needs and whims of its customers was a task on a different scale from that of redoing the maternity wing.
In a way, Griffin had been cherry-picking when it focused on maternity--that is, it had selected the easiest target, the one most likely to meet with success. After all, expectant mothers tend to be young, robust, and upbeat. They generally aren't actually ill, are in the hospital for only a few days, don't require extensive treatment, and tend to provide good revenues, relative to what they cost the hospital.
Providing an emotionally satisfying, minimally inconvenient experience to a broad population is a different story. Patients are typically senior citizens who can be hard to please under the best of circumstances, let alone when they're suffering from heart attacks, having parts of their bodies removed, or fighting for breath through failing lungs. Nevertheless, the Griffin team again prepared community surveys and focus groups to determine what it would take to make people in that age group like a hospital.
Again, the resulting wish list was staggering. They wanted nice furniture. They wanted kitchens. They wanted carpeting. They wanted nurses by their beds essentially all the time--it turned out that elderly patients often pressed the call button not because anything was wrong but just to make sure someone was out there just in case. They wanted unlimited visits at any time from anyone and everyone. They wanted their pets to visit. They wanted spouses or family members to have beds to sleep in right there in the room with them and help take care of them. And they wanted a better understanding of what was happening to them, medically speaking.
Again, Charmel said, Let's do it. The hospital was operating in a 60-year-old building that hadn't been renovated since 1969; it was due for a new building. Why not design it to meet all these newly identified needs?
Extensive community-hospital building projects need approval from a state commission, and the commission literally laughed in Charmel's face when he told its members how he wanted to spend some of the money. But the commission finally agreed to let Griffin do what it wanted, as long as it did it for no more than the average cost of adding on a similar-sized conventional hospital building--about $145 a square foot. "To do this right, we had to go first-class on everything," recalls Powanda. "We just had to find a way to go first-class really cheaply."
It threatened to be slow going. Simply coming up with a basic layout for the new rooms, normally a boilerplate sort of process, turned out to be a painstaking experience. The design not only had to meet patient demands for a homey, nonthreatening feel but also had to accommodate medical equipment and extensive gas and plumbing fixtures, and provide convenient access and movement to nurses, technicians, and the housekeeping staff, along with their equipment. The management team and the project architects sketched ideas, then employed a computer-aided-design system, then played around with cardboard models, and finally built a full-scale mock-up of a hospital room in a warehouse across the street from the hospital. Hundreds of patients, staff members, technicians, builders, and board members paraded through the room, each one carrying a "ticket" with which to submit ideas for modifications. "We must have moved the sink six times," recalls Charmel.
Charmel personally picked out furniture, favoring warm, semicontemporary wooden designs. He even selected the hospital's trash cans. "I'm usually pretty hands-off with my staff," he says. "I feel I'm just here to listen to their problems and help get obstacles out of their way. But sometimes I do get obsessed with certain details." And with bargain hunting, too: after he had found the designs he liked and purchased one of each from area stores, he had them all stuffed into vans and brought to furniture manufacturers in Pennsylvania to get them knocked off at about a third of the retail price.
No detail seemed too unimportant to fuss over. Handrails were tried out in a bewildering variety of materials, shapes, and heights. "You'd be amazed at the difference a slight adjustment could make in a patient's impression," says Charmel. Hospitals almost always go with stainless steel, but Charmel insisted on wood for its added warmth--not to mention the fact that it cost less. Fluorescent lighting was banned. "It makes people look sick," explains Powanda. "Patients already look sick."
When executives told focus groups they were planning on going with all private rooms, they expected nothing short of applause. But senior citizens sometimes frowned at the news. Under closer questioning, some of them--especially those who lived alone--confessed that for them, having a roommate was one of the few perks of a hospital stay. OK, asked the team, what if we had some double rooms for those who wanted them? More frowns--they didn't like the lack of privacy in double rooms. But didn't they just say they didn't want privacy? No, replied the senior citizens; they said they wanted the companionship of a roommate, not a lack of privacy. And while you're at it, they said, make sure nurses don't have to walk by our beds to get to our roommates' beds, and that we don't have to cross by our roommates to get to the bathroom, and that we don't end up staring at a wall while our roommates get a nice window view. "The politics of double rooms can get kind of complicated," notes Charmel.
