The future of health care is now

Innovation, collaboration and commitment spark the next generation for Kaiser Permanente

The Sidney R. Garfield Health Care Innovation Center is based in San Leandro, Calif., but the research conducted there influences the design of Kaiser Permanente facilities across the country. Named after Kaiser co-founder Sidney R. Garfield, M.D., this 37,000-square-foot testing facility has been operating since June 2006 as a resource for Kaiser Permanente.
    If you walk into the medical/surgical unit at the new Kaiser Permanente Medical Center, Vacaville, once it’s fully constructed, you will see the same design as that which currently resides inside the Garfield Center. From the triangular-shaped medical/surgical unit to the nature-inspired full-spectrum color palette on the walls, and down to the PVC-free rubber flooring, the Garfield Center’s mock-up of Kaiser Vacaville is nearly exact.
    “At the Garfield Center, we take a holistic look at how technology, architecture and people interact,” says Jennifer Ruzek, Garfield Center director. So, whether architects are planning the modification of an exam room or the layout of a facility, it is essential to get alternate viewpoints from the health care staff before any final decisions are made.
    Jim Caroompas, local spokesperson for Kaiser Permanente, explains, “These architects aren’t medical practitioners, so their best design would be from an architectural perspective; the physician’s best design would be from a physician’s perspective. Get them together in the same room and you get the best of both worlds.” Ruzek adds, “They run through scenarios to narrow down the ideal design. We’ve come up with ideas that can really change practice.”
    One innovative process takes place in a 600-square-foot operating room––the same as will be in Vacaville—that is used at the Garfield Center to perform mock surgeries and test new equipment. When it comes time to make a purchase, the vendors are brought to this room for a side-by-side equipment evaluation, “kind of like Consumer Reports,” says Ruzek. “Then we bring in nurses and we have them enact scenarios.” Once the staff decides which equipment is the most practical, an informed purchasing decision can be made.
    “Odd as it seems, the health care industry has been very slow to adopt technologies, for safety and a variety of reasons,” says Caroompas. “It is just now catching up to the technologies that are out there.” For example, in newer facilities, the entire medical record will now be completely electronic using the KP HealthConnect system––in this way, Kaiser Vacaville will open with paperless medical records. There is also research being conducted for other advancements such as a wheelchair locator with ultrasound technology, a vital signs-monitoring hospital bed and a slew of others––but even patients emailing their physicians is a relatively new phenomenon for health care.
    As efforts to improve Kaiser’s health care facilities remain at the forefront, the truth is that relatively soon, an increasing proportion of Kaiser’s health care services will not take place in a hospital, but from within a patient’s home––via email, webcams and interactive programs. There is currently a mock-up in the Garfield Center of a kitchen and a family room, complete with refrigerator magnets and a television set. “This is a physical reminder to the [employees] of Kaiser Permanente that the home is going to be the hub of care,” says Ruzek. “This is a realm that we have to be very mindful of, because it’s our future.”

---

About Dr. Garfield
Sidney R. Garfield, M.D., co-founder of Kaiser Permanente, was a physician, but had a lot of interest in architecture and was fascinated by computers. “He designed a new model for health care,” says Caroompas. “He also helped design the buildings that care was delivered in. He was an innovator, and that's why we named the Garfield Center after Sidney Garfield.”

The national standards program
Kaiser Permanente has a template, a design that can be built over and over again. “We set a standard so that each hospital on its own doesn’t have to figure out the best way to do it,” says Ruzek, explaining that the more fine-tuned the template, the faster construction is and with fewer expenses since the margin of error consistently decreases the more times a template is used. “What we chose to mock up were the rooms and spaces that we were going to build over and over again,” she says. “So it makes sense to really nail it.”

The public benefit
“Part of what we do is share with some of our community benefit partners,” Ruzek says. Kaiser Permanente and the Garfield Center have worked with other nonprofit hospitals, community clinics and their safety net providers––hospitals that care for the poor and uninsured. “We share very openly with what we’re doing. It’s part of our public benefit.”

The wireless cart
This is currently in Kaiser Antioch, and will go into rooms in Kaiser Vacaville as well. Other than a plug, there are no wires attached to this computer monitor atop a cart on wheels. The wireless cart allows the nurse or physician the ability to simply type in the patient’s name and number, and all of their information comes to the computer. “The patient will have an arm band with a scanner, and whatever medications that patient is supposed to get will be on that scanner,” says Caroompas. “The doctors orders come up––it’s just amazing.”
 
The tablet
The tablet is a possible alternative to the wireless carts, holding much of the same information for the patient. It can be safely dropped from four feet, which is a valid precaution for a busy hospital day.

The design process
When a plan for construction comes to the table, its implementation is organized in two phases; the first involves research and decisions on the size and key features of the area, and the second constructs a life-sized prototype in which doctors and nurses can enact real-world scenarios and help decide exactly how the space should be designed.

An example of this innovative design process can be explained with the Garfield Center’s mock-up of a single-bedded NICU (neonatal intensive care unit).

The NICU is used for premature or seriously ill infants. Typically, a NICU has all of the babies treated in one big room, full of hospital staff and emergency alarms. “There’s research that some of these alarms can be harmful on these little babies,” says Ruzek. “Our architects did a significant literature review and then went around the country looking at many hospitals that were trying out single-bedded NICUs. They came back with a lot of ideas that helped them develop concepts that they tested at the Garfield Center.”

Since a single-bedded NICU would be a new innovation for Kaiser Permanente, it is essential for its development to undergo the design process at the Garfield Center to be certain that it is a change worth implementing.
 
The single-bedded NICU is first built as a mock-up, constructed out of cardboard and plywood. It is designed to be a completely flexible partition system––the walls are all adjustable and the features inside are completely moveable as all the cardboard computer screens, sinks, soap dispensers, etc. are affixed to the walls.

“It’s like a big movie set,” says Ruzek. With architects taking notes, the entire care staff comes into the space and runs through a normal days practice, similar to actors rehearsing for a play, and “they just keep running through scenarios to narrow down the ideal design,” she says. “It’s a way for the architects and our clinical caregivers to really speak the same language, and really understand each others' needs.

“Our architects have always asked doctors and nurses what makes sense,” says Ruzek. But, as some of the health care staff still approach innovative changes with skepticism, she adds, “Once you try something out and you get to iterate what works and what doesn’t, you walk away feeling a lot more comfortable with the decision that you’ve made.” It is the collaboration among architects, doctors and nurses in the mock-up situation of a real-world facility that makes the Garfield Center unique.

These scenarios are not necessarily enacted in a “make-believe” manner; often times, computer-programmed mannequins will be used in place of human patients. “[These] mannequins are pretty commonplace in medical and nursing education,” says Ruzek. “You can program scenarios from a control room so that the ‘patient’ has vital signs, its pupils dilate, its chest will contract––you can program the mannequin to crash.” Caroompas adds, “You’re really pulling for a piece of plastic.”

Care board
For a patient staying in the hospital for days, weeks or months at a time, often sleeping through most of it, it can be difficult remembering the schedule for the day, or even what day it is. “We have this hands-on low-tech care board,” says Caroompas, “which plays as big a role in patient care as these billion dollar high-tech systems.” Basically functioning along the lines of a dry-erase board, it keeps the patient involved with the daily plan for care. Especially since the care staff alternates shifts throughout the day, the patient is always aware who is on duty at any given time. “Also, if the family or patient has messages, they can write them here,” says Caroompas, so if the patient is sleeping, the family (or staff) can still communicate in this way.

Labor and delivery room
This room has been specially designed in the Garfield Center to feel like a hotel environment. An open room with wood-type floors and natural colors, it is fully equipped with a bed, mini-fridge and a sofa that expands to a bed for families to stay overnight. All of the medical equipment is hidden behind casework until the time comes to deliver the baby, allowing for a peaceful and organic experience in as stress-free an environment as can be. 


Keep up with the Garfield Center here.

Do you like what you read? Subscribe to Solano Magazine »