Healing Environments in Surgical Services

Healing environments in surgical suites

Surgical facilities participating in Planetree (www.planetree.org) and the Pebble Project (www.healthdesign.org) are finding ways to make their surgical facilities more comforting and less stressful for patients. Though good facility design is part of these projects, hospitals don’t have to remodel to create a more pleasing environment.

Mid-Columbia Medical Center

The surgical waiting area at Mid-Columbia Medical Center shows homey touches added by staff. Credit: Susan Garrett Crowley. (click on photo to enlarge)

"You could do Planetree in a MASH tent. It’s really about how we treat our patients and each other," says Jackie Mountain, RN, BN, director of services at Mid-Columbia Medical Center in The Dalles, Ore, which is based on the Planetree model.

"This is a very values-driven organization," says Mountain, who admits she was disillusioned and about to leave nursing before she accepted her current job 4 ½ years ago.

One of the organization’s tenets is the "Platinum Rule": Do onto others as they would like to have done onto them. That applies not only to the physical surroundings but the care process.

Mid-Columbia’s surgical area, which has three ORs, two eye rooms, and performs 250 cases a month, is not new, but Mountain and her staff have found ways to make it seem safer and more comforting. "It’s often the little things that are most important," she says.

When Mountain first arrived, the area where patients waited before surgery was a converted storage area that was barren and institutional. "I asked the staff, if you had a magic wand, what would you do?" They came up with ideas like adding a loveseat and comfortable chairs, soft music, and a fountain. The costs were not significant. The administration responded almost immediately: "Go for it."

Patients are offered other stress reducers. They can use the hospital’s portable tape or CD players to play their favorite music before, during, and after surgery. Massage therapists are on hand 7 days a week, and every patient coming to surgery is offered a massage. Massages may also be prescribed to ease tensions among the staff.

In another staff initiative, an old bathroom off the recovery room received a facelift. A secretary with a knack for interior design spent about $200 for a new mirror and some wallpaper.

But Planetree finds its truest expression in the way caregivers respond to the patients’ individual needs.

One woman called the hospital wanting to know if her husband could be with her in the recovery area. She had tried other area hospitals, but they had turned her down. Mountain learned the woman still had nightmares from surgery she had had in childhood and wanted her husband to be beside her when she woke up.

The anesthesiologist and the staff raised concerns. But Mountain said, "If we are a Planetree hospital, and the patient comes first, how can we make this happen for her? She adds, "When you put the patient first, it is no longer a nurse or an anesthesiologist issue. It is a patient issue."

Mountain invited the woman to visit the facility and meet the staff, and the woman decided to go ahead with the procedure. On the day of surgery, her case was scheduled for late in the day so fewer patients would be in the recovery area. The staff pulled the curtain around her bed and had soft music playing. Her husband was holding her hand when she awoke.

The ability to make these kinds of decisions has restored Mountain’s love for nursing. "With the Planetree philosophy, a lot of the barriers come down," she says. "We say, ‘Who brings us here?’ The answer is, the patients. So how can we make them as comfortable as possible? "That is what makes everyone feel good at the end of the day."

Longmont United Hospital

Longmont United in Longmont, Colo, another Planetree hospital, is incorporating healing concepts into its new surgical department. The department, including a new six-room OR, is part of an addition.

Longmont United’s CEO first heard about Planetree at a conference. When he got back, he persuaded hospital leaders to scrap their original plans and redesign the entire facility around the Planetree model.

In planning the surgical area, the hospital interviewed patients to find out what was important to them. High on the list were privacy and a comfortable waiting area.

Rosalie Hill, RN, BSN, MSM, director of critical care services, described some features the new surgical areas will have:

The preoperative area, which doubles as the postop area, will have private rooms. A nurse’s station in the middle will have table and chairs unlike the typical setup.
The waiting area will be comfortably furnished in soft colors. Chairs will be in groupings rather than lined up along the wall. An adjacent room will have coffee and snacks.
The waiting area will have a patient library that doubles as a conference room. There will be a computer linked to the Internet and health-care-related literature.
In the postanesthesia care unit, patients will be placed with their feet toward the wall. That way, patients can look at a picture rather out into the room, and their heads will be easier to access for airway management.
For the staff’s ergonomics and safety, the ORs have service arms that hold all of the major equipment. The equipment is easier to control, there are no cords to trip over, and staff do not have to push heavy carts from room to room.
The staff lounge is being planned so it will be pleasant and relaxing. "At first, we heard, ‘Well, we have a lot of furniture in storage we could use.’ But we said, ‘No, we don’t want second class.’ We are trying to focus on the needs of everyone, including the staff," says Hill.

Bronson Methodist Hospital

A flagstone path through the atrium at Bronson Methodist Hospital, Kalamazoo, Mich, leads to a pond and fountain. Benches and seats allow patients and visitors to enjoy the area. (click on photo to enlarge)

The outpatient waiting area at Bronson Methodist, Kalamazoo, Mich. (click on photo to enlarge)

The inpatient surgery waiting area at Bronson Methodist Hospital, Kalamazoo, Mich. (click on photo to enlarge)

Bronson Methodist Hospital in Kalamazoo, Mich, built its new $181 million facility, which opened in 2000, with an eye toward creating a healing environment.

Jon Dixon, vice president of the Bronson Healthcare Group, says, "Our goal is to get people to an appropriate level of overall health. That means going beyond clinical skills and technology to create an environment that fosters the healing process." Bronson is a partner in the Pebble Project, a research effort to document examples of health care facilities whose design has made a difference in quality of care and financial performance.

Bronson has an award-winning atrium flooded with natural light and plants. The area is visible from several vantage points, including the outpatient family waiting room.

The parking structure is aligned with the building so most patients can enter the building on the floor where they will receive care.

The inpatient and outpatient ORs, both located on the second floor, have separate patient flows and separate waiting areas. The reprocessing area is located on the same floor between the two departments.

Outpatients are screened preoperatively by telephone, while about 35% to 40% of inpatients come in for screening before the day of surgery. The preadmission testing area is a one-stop shop. Most of the diagnostic functions are arranged in a horseshoe shape with a waiting area in the middle. A patient can have an electrocardiogram, blood draw, chest x-ray, nursing assessment, and anesthesia interview all in one location.

When patients come in on the day of surgery, they are taken to a private room, which substitutes for the holding area.

Family waiting areas are spacious with windows and comfortable chairs. The outpatient waiting area has an aquarium and looks out on a garden. There is artwork throughout the facility, including in the preop rooms, to provide a homelike atmosphere.

Families are given beepers so they can go to the cafeteria, coffee shop, or garden. The beepers also help assure privacy because the family’s name does not need to be called when the surgeon comes out to meet with them.

For postanesthesia care, inpatients go to a conventional Phase 1 recovery area, then on to a private room on the appropriate nursing unit. The rooms are decorated in a homey style with large windows. A chair or sofa pulls out into a bed so a family member can spend the night. Individual thermostats let patients control the temperature in their rooms.

Outpatient surgery has its own Phase 1 recovery area, which includes four pediatric bays with walls and doors. Patients are wheeled to the Phase 2 area in recliners, where they remain until ready to go home. Eye surgery patients who have eye blocks and sedation get into the recliners in the operating room. They typically are in the hospital only 2 to 2 ½ hours.

"We have a big focus on wellness and integrative medicine," notes Beverly Anderson, RN, director of surgical services.

Patients can bring their own tape or CD player and keep it with them during surgery. Services such as massage and acupuncture, currently offered in the Bronson Center for Integrative Medicine, are available to patients in the hospital as well.