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In the Hospital of the Future, Patients are Pampered Guests

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AURORA, Colo. -- A waiter wearing a crisp white shirt and a sharp black vest strides into Peggy Johns' room carrying a tray of hot food. Johns smiles at the sight of her room-service lunch.

She's watching a game show on the flat-screen TV. She could be on the Internet or watching a DVD or a video. Her family is working so, for the moment, nobody is sitting on the sofa that also is a hideaway bed. They'll be back, she says.

They also like ordering room service: $5 for breakfast and $10 each for lunch and dinner. In fact, they are a bit too comfortable in her private hospital room, she says. ''I have too much family. The food is better than at home.''

This is the hospital of the future, a facility designed by a medical conglomerate with the help of the magic kingdom -- the Walt Disney Co.

The University of Colorado Hospital's new $145 million Anschutz Inpatient Pavilion in this Denver suburb is a shining example of what the American Hospital Association says is a national trend. Medicine is redesigning the way it does business to give patients and their families what they need during a crisis: personal care.

Some of what Colorado officials have done is difficult for other hospitals to duplicate because of space limitations, says hospital president Dennis Brimhall. Traditionally, hospitals have been forced to do the best with what they have by remodeling older facilities.

But with interest rates low, philanthropy high and hospitals in desperate need of improvements for the sake of patient safety and family comfort, more and more are starting from scratch.

''We have a building boom going on now,'' says Rick Wade of the American Hospital Association. ''You can just start over and change everything.''

When Colorado University obtained 230 acres from the U.S. Army's decommissioned Fitzsimons Army Medical Center in 1995, Brimhall says the windfall allowed the teaching hospital to start anew.

Even so, Brimhall says he and his colleagues knew the huge opportunity had put them in over their heads. ''In medicine, we're arrogant. We think we do everything right. We knew we would build a great building for us but a terrible building for the patients. So we went to Disney and said, 'How would you build it?' ''

A focus on emotions

The Disney concept, which has been adopted to some extent by hundreds of other health facilities across the nation over the past 20 years, is focused on the emotions of guests. Designers at the Disney Institute, based in Lake Buena Vista, Fla., try to work with the emotions of the situation. At a theme park, they tap fun. In hospitals, they cope with fear.

And in the end, Colorado officials found that it doesn't cost more to treat patients like guests. At $1,120, a night's stay at the new hospital costs the same as it did at the old one.

But the difference is dramatic.

There are subtle elements of theater throughout the hospital, where Disney designers consider staff members ''on stage'' when they interact with patients.

Downstairs, as the hospital door slides open, music from a grand piano mixes with Mile High sunshine streaming into the lobby.

At the curb, the valet parking is free. Inside the lobby, employees are cheerful and friendly, and no one is wearing white coats or surgical scrubs.

Only 15% of patients report having to wait to see their doctor. Meals come from room service, made to order and delivered piping hot whenever the patient or their visitors want to eat. Patients and families are treated as ''guests.''

''The message to patients when they walk into a hospital has always been that they are walking into somebody else's territory; this is our place,'' Brimhall says. ''We designed this hospital with places just for them.''

Every room is a private room. Each has a sleeper sofa that pulls out so that visitors can spend the night.

The staff acts more like a team at a luxury hotel than hurried and overworked clinicians at a big teaching hospital.

New tools are everywhere.

Computerized patient records help prevent deadly medication errors. Embedded nanotechnology chips track everything from drugs to newborn infants. If an infant is carried outside of a secured area, alarms sound, and the hospital immediately is locked down to prevent a kidnapping.

Computers also are used to limit the time people spend in the waiting areas, which have stunning views of the snow-capped Rocky Mountains. A confirmation of the appointment is e-mailed to the patient the day before an exam or procedure. A patient who prints out the reminder can run a bar code on the page under a laser scanner near the hospital's front door to check in. The staff sees this on a computer screen and prepares to greet the patient heading toward the waiting area.

By evening, the patient gets an e-mail from Brimhall asking how the visit went and whether the patient had to wait. Each case in which there was a delay is sent back to the department, which must explain the delay to Brimhall. He reports back to the patient.

But even when there is a delay, Brimhall says, patients usually ''look at these views, and they don't get the sensation of waiting.''

The illusion is part of the design.

Everything in the University of Colorado Hospital's design was judged based on how it makes the patient feel. The Disney team put planners in wheelchairs, both literally and virtually, so that they could see the hospital from the patient's perspective.

''We said, 'Notice who is stealing your parking spot,' '' says Jake Poore, who led the design team. At most hospitals, doctors and staff members get the spaces closest to the entrances. ''Then you have to park on the roof in the rain with your grandmother who only gets her hair done once a month. You have three chips on your shoulder before you ever get to the door.''

The 'team' approach

Parking in the lot in front of the Anschutz Inpatient Pavilion is reserved for patients. Staff, including physicians, park half a block away.

The staff -- here, they're called ''team members'' -- have their own entrance, their own elevators, their own walkways and their own private spaces. By keeping scores of people in white coats and scrubs hidden away in their own halls, elevators and working areas, the designers built in an unusual amount of calm. At Disney, design enhances the experience.

''Anytime the guest could hear you, smell you or see you, you were on stage,'' says Poore, who started at Disney selling balloons. ''You are holding the brand of the company in your hands. When you are in a guest area, when you are on stage, your customers are watching everything you do and listening to everything you say.''

Disney knows that if actors are to perform well on stage, they need a place to go when they are not face-to-face with the audience.

''Backstage are the decompression chambers,'' says Poore, who now has his own consulting firm, Integrated Loyalty Systems of Orlando. ''One of the missing things in health care is rest areas.''

Hospitals are full of stress, he says, so the staff needs ''a place for attitude adjustments, a place to hide our dirty laundry and complain about the woman in 103.''

He recalls his mother's surgery a few years ago in upstate New York. Although she was recovering well, she was growing more tired each day in the hospital. Of course, a nurse said, nobody can sleep well in a hospital. The cleaning crew vacuumed the hall outside her room every morning at 4:30 a.m.

''That time worked for them,'' Poore says. ''No thought went into the impact on the patient.''

A kitchen employee brought a tray of food into his mother's room even though she was not yet allowed to eat solid food. The smell of the forbidden food filled the room as the staffer shouted out the door for a co-worker to wait for him to go have a smoke.

When the staffer realized his mistake, Poore says, he grabbed the tray and left without saying a word to the woman in bed. ''We're trying to put care back into health care,'' Poore says. ''Over the last five to 10 years they've cut so much that service is a random act of kindness, not business as usual.''

The effort seems to be working.

Donna Gianarelli of Colorado Springs sits on the sofa in her hospital room recovering from surgery and sipping tea that was delivered hot by a room service waiter. ''It's quiet, and they are attentive,'' she says.

Physical therapist Amy Rich says making the patients and their families and friends comfortable is good medicine. It helps get patients back on their feet faster. ''The patient does better when they have family support,'' Rich says.

Says Brimhall: ''We're giving them space so they feel comfortable and not like they're being pushed out of the room. Building a new place like this gives you the chance to change a culture.''

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