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Lessons learned from breaking the mold at Northwestern Memorial Hospital

The advent of patient first design and integrated care on this healthcare campus still reverberates

By Rebel Roberts, Vice President, Chicago, IL

The planning process for Chicago’s Northwestern Memorial Hospital (NMH) unfolded over 10 years; it was time well spent. At the dawn of the 21st Century, the hospital set the early guidepost for executing the philosophy of “patients first.” In NMH, designers and health professionals realized a long-term vision that led to a balance of form and function, innovation and evidence-based design that still holds lessons for healthcare design today. 

Transcript of the video follows
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<p>Rebel Roberts – buildings have signatures. You go into a building and there is almost an immediate visceral response to the building. And if the building can deliver the message of the institution, it’ll create a memory for you, it’ll create a legacy over time.</p> <p>James adams – when people walk in, the immediate reaction is “oh, this doesn’t even look and feel like a hospital. It’s comforting, and it feels welcoming.</p> <p>Rebel – Feinberg Galter was able to create this very distinctive connection between the patients and the people who were coming in the building. The architectural character came from the precedents of the older buildings on the campus. This ascendant neo gothic that is sort of inspirational architecture, that sort of lifts you up.</p> <p>Jim mladucky – the cathedral of healing was a theme that was brought forward, and so the vaulting of the ceilings that you see, the wood, the marble, the limestone</p> <p>Rebel – everything that someone would see, touch, and feel, so that you see something, you understand it, generates a feeling about it, and it affects your behavior.&nbsp; Every place where you can touch we would light wood handrails, every feature wall we light it was a natural wood material that had a warmth to it. the use of natural light is extraordinary. So all the public spaces have multistory natural light that comes in from the north light.</p> <p>The Streeterville neighborhood is characterized by extraordinary residential environment, and its populated with people who care deeply about the quality of life in this neighborhood. They wanted to see a mixed use building. They wanted to see an extension of Michigan Avenue, and landing of that use into the residential neighborhood.</p> <p>Julie Creamer - The whole environment here feels like a community. The open space that we have on the first three floors is open to our community, and it really feels almost like a little city.</p> <p>Jim – it’s warm, it’s welcoming, it’s inviting. And people come here, not only because they’re seeing their doctors now but our neighbors use our pathways and our retail every day.</p> <p>James - The retail component: it’s like the town square, it’s like the city center, and every city, every town needs that town square to anchor it.</p> <p>Jim – having people in the building who aren’t here for medical reasons really makes this a vibrant campus. It’s really helped, I think, in the whole patient experience.</p> <p>Innovation in healthcare, it’s all about flexibility.</p> <p>James - This building, designed in the 1990s has stood the test of time for a full generation, and in that generation, almost everything inside that building has changed. On the mezzanine above the emergency department was medical records. We’ve now become completely electronic. We don’t need those large file rooms that we used to have. As those file rooms went away, we turned that into care space where we created an authentic and true emergency department. As the emergency department volume and complexity and demands increased, we realized that the rooms that we designed in the 1990s are essentially all critical care rooms.</p> <p>Rebel – the patient rooms at Feinberg became the building block for the way we think about patient rooms going forward.</p> <p>Julie - Our mission here at Northwestern is patients first, so as we were designing we thought about what that meant, and there are simple examples. We built shelves specifically for flowers, so that if a patient received cards and flowers, they had a place to put them. We have a zone for the families. That zone includes a pull down bed so that family members can spend the night.</p> <p>Rebel – you reduce average length of stay if you have more family involvement in the patient room and patient care.</p> <p>Julie – so we tried to pay attention to the details that we heard from our patients, their families, and our staff that were important to them.</p> <p>Jim – what makes me the most proud is the commitment that we have to the patient, and how that commitment transferred translated through the building and through the facilities.</p> <p>Julie - Many of the successes we have, and again things like the design of the patient room, the sense of confidence that you get when you walk into the building, the ease of navigation for our patients and families, those are things that have become hallmarks of Northwestern Medicine, and they’re things that we’ve carried as we do new projects around the health system.</p> <p>Rebel – what animates these buildings, the purpose of these buildings is caring for people. It is a legacy that says we can do better, we can take care of people in a powerful and compelling way. To me it’s always been about the people and about looking in someone’s eyes to make sure that we got it right.</p> <p>Julie – the story of this building is one of innovation and I would say discovery. And so as we look to the future, that spirit will continue. As an academic medical center, that’s what we’re all about.</p>

Built in 1999, NMH was clearly cutting-edge, but today it’s an icon. Last year, the American College of Healthcare Architects selected Northwestern Memorial Hospital for its Legacy Project Award, its most prestigious award. The honor recognizes hospitals that have been in operation for than 15 years, and that continue to inspire and motivate the industry.

As a Fellow with American College of Healthcare Architects and the design and planning principal for the NMW campus master plan and Prentice Women’s Hospital projects as well as design principal on Feinberg/Galter Pavilions (designed by VOA- now Stantec - in association with HOK and Ellerbe Becket) I consider this honor among the very brightest highlights of my career. I also believe that NMH taught us lessons about healthcare design that we’re still learning.

Today, with help from Kristina Hedley, director of special affairs, Northwestern Memorial HealthCare, I’m looking back on some of the innovations present in the project and what they say today. Here are 13 reasons the design for NMH is relevant now.

  1. It was designed for the community, with community input.
    NMH is located in the dense, downtown neighborhood of Streeterville right off Chicago’s Magnificent Mile retail district. A bland institutional-looking facility would have made a poor neighbor. Instead, the hospital was designed with massing, exteriors, colors and fenestration that speak to its context. The building was designed to fit in, grow and change. NMH’s growth had to be carefully communicated and coordinated with the community which was engaged throughout design and construction. Details such as the impact of traffic, addition of retail and lighting, benches, landscaping were important to get right. Creative solutions included locating a busy (70+ trucks per day) loading dock connected to Feinberg/Galter under a parking deck. Today, neighbors move across six city blocks through the buildings and access its retail elements.
  2. It showed us that integrated care is a viable model.
    The NMH building consists of an eight-story podium and two towers: the Feinberg inpatient tower and its outpatient tower, Galter. A typical 1990s design separated inpatient services from outpatient services. But the redevelopment project designed the towers with a common building base featuring surgery, radiology and other diagnostic and treatment functions that served both inpatients and outpatients. This promoted effective and efficient care delivery which NMH reports “allows physicians to easily transition between inpatient and outpatient settings without ever leaving the building. This arrangement can save 15 to 20 percent of a physician’s time.”
  3. It was an early example of integrated project delivery.
    Three firms, Ellerbe Beckett, HOK and VOA (acquired by Stantec in 2016), formed a joint venture to deliver the $580 million replacement facility for inpatient and ambulatory care facilities.
  4. It bought the hospital and medical school together.
    The campus plan and the Feinberg/Galter towers were important means for NMH to break into the upper tier of academic medical centers. The NMH campus project brought people together from both sides of Northwestern--clinical department heads and section chiefs. The joint plan helped catapult NMH from a regional leader to the national stage.
  5. Patients First was its guiding principal, and it still is.
    “‘Patients First’ is the core mission of Northwestern Medicine and drives every decision that we make, including in our physical facilities,” explains Kristina Hedley of Northwestern Memorial HealthCare. “It means that we listen to our patients, visitors and caregivers in order to design environments that feel comfortable and welcoming, and facilitate our ability to provide excellent medical care.”

    Many of NMH’s innovative design features came from this emphasis on patient centered care.

    a) single bed rooms, each with toilet; b) public and visitor orientation with hallways that were carpeted and windows consistently offering north views for visual confirmation of place; c) 44 elevators in the two tower building designed to minimize waiting times; d) a cafeteria that could accommodate 3000 tickets per day; e) bridge connections to parking garages and other adjacent buildings; f) location of diagnostic testing in the same building as physician offices; g) grade level protected entry plaza. 
  6. It took art seriously. 
    Art reduces stress and promotes healing—it can also tap into biophilia, or the innate human affinity for nature. Art featuring landscape and pastoral settings strategically placed in public spaces at NMH comforts and helps patients heal faster.
  7. It made room for families.
    Evidence shows that patients heal faster with support from their loved ones and relatives. The single bed private rooms at NMH were outfitted with toilet and pull-out bed for overnight stays from family or friends. They’ve emerged as a new standard for NMH going forward.
  8. Its circulation model is innovative.
    NMH adopted a circulation model that separates patients from off-stage activity in parallel corridors. This makes it possible for doctors and staff to move freely apart from visitors and patients. Public circulation was placed on the outside of the building to maximize patient access to daylight and views of the skyline and Lake Michigan.
  9. Instead of trendy colors, NMH was designed with long lasting materials… like wood.
    In its exterior architecture, Feinberg Galter took inspiration from the older Neo-Gothic buildings on campus. Designers incorporated materials such as wood, limestone, and marble in its interior. Every place that you could touch, we liked wood handrails, for example, because these natural materials comfort and promote healing. Seventy-five percent of the flooring used was naturally based linoleum. The major public areas have durable terrazzo.
  10. The project helped build the campus and led the way for NMH as a nationally recognized Center of Excellence.
    Before expansion, Northwestern was a well-respected regional medical center with one location. Three decades later, NMH is a seven-hospital system with 25,000 employees and consistently ranks on US News & World Report Honor Roll. The building and master plan put NMH on the map and allowed it to achieve strategic financial goals which in turn gave it resources to expand its programming, recruit talented doctors, and support innovative research.

    It also set the tone for NMH planning—as well as showing the importance of brand and experience. Delivered on time and on budget, it gave NMH high expectations for delivery.
  11. It’s still influential.
    “The fundamental rules established for the building have not changed and some of the key features such as gracious entries, retail, and ease of navigation have become hallmarks that are implemented in all our large facilities,” explains Hedley. Planning and zoning strategies emphasized in the original building have been followed in subsequent renovations—as has the pioneering patient room layout.
  12. Flexibility has proved an asset.
    “Good bones allowed us to make changes,” says Hedley. Without the ability to grow horizontally, the chassis at NMH had to be able to adapt to renovations and expansions over the years. NMH transformed three floors in the Galter Pavilion from office space into inpatient beds, an ICU, a med/surg unit and an inpatient psychiatry unit. In 2010, the Feinberg mezzanine was renovated to increase emergency department volume.
  13. It was a financial success despite the odds.
    “Our CEO during this period, Gary Mecklenburg, was fond of saying the best way to plan the future is to create it,” says Hedley. NMH took on significant debt to build replacement facilities, did its homework on growth patterns in the city and emerging medical technologies and bet on the need for inpatient beds in Chicago—while the industry was moving away from them. “Admissions exceeded our modest predictions of an increase of 4% annually. In our first year, they grew 16% and 9% in our second. After three years we needed more beds.” 

Northwestern Memorial Hospital

Designed by VOA- now Stantec - in association with HOK and Ellerbe Becket

Before expansion, Northwestern was a well-respected regional medical center with one location. Three decades later, NMH is a seven-hospital system with 25,000 employees and consistently ranks on US News & World Report Honor Roll.

Northwestern Memorial Hospital

Designed by VOA- now Stantec - in association with HOK and Ellerbe Becket

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