On May 22, 2012, a convoy of ambulances left the University Medical Center at Princeton on Witherspoon Street and headed for the brand new, $500 million University Medical Center of Princeton at Plainsboro. By the end of the day 110 patients had been moved — the first people to put the new hospital to its ultimate and most important test.
Barry Rabner, CEO of Princeton Healthcare System, knew that the hospital was full of features that had seemed well thought out, but had yet to be proven useful in real life. Everything about the building, from the lobby to the faucets in the patient rooms, had been designed with the goals of reducing hospital-acquired infections, reducing falls, reducing errors, improving patient satisfaction, reducing costs, and a number of other goals.
“I thought of the building as more than just a container for things and people,” Rabner says. “If it was designed properly, it could help achieve these very important objectives that we had.”
Its layout was novel, with “centers of care” replacing traditional hospital departments — cancer patients, for instance, would only have to visit one part of the hospital for various consultations and treatments rather than being shuffled from place to place. Each part of the hospital was designed to the hilt, with hours of planning going into details like the font on the signs.
To shoot the troubles as quickly as possible, the hospital administration set up a “command center” where any staff member could report a problem. Sure enough, problems cropped up: there weren’t enough signs to direct patients around the new hospital, and people got lost. The usual telecommunications glitches piled up. Before long 3,000 problems had been reported. Two years later those problems have all been ticked “resolved,” and Rabner has time to reflect on what worked and what didn’t, drawing lessons that can be used in any business, not just those building a hospital.
Firmly in the “success” column is the design of the new patient rooms. They are a radical departure from what existed on Witherspoon Street. To design the single-patient rooms, as with the rest of the hospital, Princeton Health consulted a team of experts and incorporated best practices from more than 1,500 pieces of hospital design research. They convened groups of patients, doctors, and nurses, and had them talk about their problems, their needs, and what they wanted in a patient room.
But before settling on the design, they built a model room at the old hospital and had 75 actual patients stay there. Rabner and other hospital executives spent the night on the couch that is in every room, playing the role of a visitor. Then they kept making changes based on feedback, until it was as perfect as they could make it. “We made upwards of 300 changes,” Rabner said. “To me, this is a good example of the limits of sitting around a conference room with well-intended people trying to solve problems.”
Even so, there were minor details that evaded detection. The clock, situated just to the right of the TV, is not visible from some places in the room. Another slight problem arose from one of the room’s most touted features — patients get plenty of sunlight and a great view from a large window on one side of the room, but the large window also necessitated a climate control system. The visitors’ couch, being situated right below the window, was subject to an annoying breeze from the vent.
“I consider that really modest considering all the decisions we had to make,” Rabner says.
If he had the process to do over again, Rabner said he would make “model rooms” based on other parts of the hospital, to subject them to the same trial by fire that the patient rooms got. That proved to be one of the more productive parts of the design process.
However, listening to focus groups’ ideas on how to solve various problems proved to be less than useful. “Groups made up of those professions do a really great job of understanding what doesn’t work in the current environment and describing what their jobs requires, and they are often very good at understanding what the patient and family needs,” he says. “They are not good at coming up with solutions.”
Some ideas seem great on paper, but in practice are difficult to evaluate. As Rabner told New York Times’ architectural critic Michael Kimmelman in a review printed August 22, the new hospital’s anti-bacterial flooring cost about $1 more per square foot than conventional flooring — a difference of about $700,000 overall. “Sounds like a good idea,” says Rabner. “Where’s the evidence that it works?”
Rabner would also make a change in the way the hospital dealt with the professionals who were assigned to design different parts of the plan: he would tie their compensation to how well they achieved larger objectives. For example, the makers of the hospital’s air system would be paid extra money if there was a low infection rate, not if their filters moved a certain volume of air per minute.
“We need to be more thoughtful in developing contracts that measure professional success in achieving the goals that go back to our guiding principles,” he says, noting that the approach would encourage more collaboration between different professions, such as engineers and architects. “The challenge is that there are all sorts of factors that contribute to achieving those goals,” Rabner admitted. “They can’t be held responsible for the quality of the policies and procedures of the staff.”
The best designed hospital in the world would be a failure if the doctors inside were poorly trained. In the end, even the most powerful person in the most controlled possible environment has to rely on others.
“I’m the CEO, and I can’t control everything,” Rabner says.