DESIGNED TO HEAL

This month Health goes to the hospital.

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St. John’s Hospital in Santa Monica will stage a traditional groundbreaking ceremony Wednesday for its new health center--but from then on the half-century-old institution will be shattering the mold in all directions.

The new complex that will rise on St. John’s present site will incorporate so many futuristic concepts that the staff doesn’t even call it a hospital. “Healing environment” is the preferred phrase.

“We’re building for the 21st century,” says Bob Klein, vice president, community/public affairs, St. John’s Foundation. “We’re looking at care for the whole person--mind, body and soul.”

Severely damaged in the 1994 Northridge earthquake, the hospital was shut down for nine months, and, like all California hospitals, will be required to meet tougher state seismic safety codes by the year 2008.

“We had remodeled to the point where we couldn’t do any more remodeling,” says president Sister Marie Madeleine of the private, nonprofit hospital, which was built in 1942 by the Sisters of Charity of Leavenworth, a Kansas-based Roman Catholic Order. The hospital board, meeting the morning after the earthquake, decided to rebuild from scratch.

“It was a good judgment call,” she said. “It meant we could build to meet patient and family needs first.”

With the help of a $10-million W.M. Keck Foundation grant, the hospital undertook an extensive strategic planning study. Two consulting firms guided hospital officials to meetings with health-care futurists, visioning experts and user groups, among others.

“There are no swamis on this,” Klein says. “We had to travel--we took physicians and board members and staff to site visits around the country.”

The new St. John’s will be built on the current 20-acre hospital site, bordered by Arizona and Broadway on the north and south, and 20th and 23rd streets on the west and east. Santa Monica Boulevard will divide a north campus from a south campus.

The north campus, when completed, will include a diagnostic center and 150-bed hospital (down from the current 317 beds) to serve ambulatory and sick patients. Construction will take place in the grassy areas and parking lots around the existing complex which then will be “taken down piece by piece,” says Klein. Total construction cost of the north campus is estimated at $270 million.

“This should be completed by 2005, and we will have the south campus in the midst of development by then,” Klein says.

No completion date is set for the south campus, which is planned to eventually include the John Wayne Cancer Institute research facilities, education and conference facilities, a wellness and fitness center, and assisted living and senior housing. A hotel for relatives of patients will be augmented by a health-food store and retail services, such as dry-cleaning and banking, in collaboration with strategic partners.

“It will be a small city,” Klein says.

And it will be a futuristic one.

“We looked at the best out there, and we looked at what we’re doing now that does and doesn’t work,” says Maura Winesburg, vice president of quality improvement, St. John’s Hospital. “We aren’t designing a hospital here but a health-care facility that is focused on the way health care is delivered today, not 50 years ago.”

Out of their research into a changing health-care world came plans for a model urban center that encourages people to stay well in addition to treating the sick, recognizes homeopathic treatment as a complement to traditional medicine and emphasizes the importance of the environment to the healing process.

“Their timing is perfect,” says Jan Emerson of the San Francisco-based Health Care Forum, a national think tank. “It is just now becoming possible to design your facility around these concepts.”

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Sitting around a table in the St. John’s conference room, Winesburg, Klein and David Gibb, strategic communications director, recently discussed the ambitious plans for the community hospital that traditionally has offered services from obstetrics to geriatrics (including a 24-hour ER) to the west side of Los Angeles.

Architectural renderings and scale models dominated the room, symbolizing a dramatic break with the institutional grid known as the 20th century hospital, with its impersonal sterile tile floors, white walls and glaring banks of fluorescent lights snaking through a labyrinth of hallways and annexes.

Such hospitals were built for an era when patients were admitted for long stays and escorted or wheeled wherever they needed to go, which is no longer the case in today’s outpatient era, noted Winesburg.

“We worked from two basic design principles,” she said. “Providing very ‘clear way-finding’ for patients and visitors and creating a physical environment that promotes healing.” (Two Santa Monica architectural firms--Hellmuth, Obata & Kassabaum Inc. and Stone, Marraccini, Patterson--worked together on the project as St. John’s Associated Architects.)

The clear way-finding, Winesburg said, starts with getting there. Currently visitors can arrive by three different streets and seek parking in one of three open lots or a parking structure. When the new hospital opens, there will be only one set of directions: Arrive from Santa Monica Boulevard, and park under the building where the 470 spaces will more than double the current capacity.

As the primary focus for visitors, the hospital’s diagnostic and treatment building will be organized around a light-flooded central atrium with all outpatient services located within 60 feet of the entrance.

The emergency department, opening off Arizona Boulevard, has a separate traffic plan, and a “dignity elevator” will allow surgery and oncology patients the privacy of traveling to and from the parking lot without going through the main lobby.

“Homelike” is the favored description of inpatient rooms in the hospital itself, which will be easily accessible by following a single south corridor from the atrium lobby. All rooms will be private, with comfortable chairs, flat-panel TVs and a roomy window seat that converts to a sleepover bed for family members. Every patient floor will have a family kitchen, so that home-cooked meals can be prepared. And obstetric patients will check in to one room where a mother can experience labor, delivery, recovery and postpartum care without having to be transferred.

Throughout the buildings a comfortable atmosphere will be created with furniture, carpeting, warm, vibrant colors and natural woods. Fountains, flowers and views of nature will reflect the growing emphasis on environment as a healing factor.

“What stands out is there is nothing frightening. It doesn’t smell like a hospital--the waiting rooms look more like residential living rooms than an institution,” said Jain Malkin of San Diego, an interior architect. A nationally known specialist in health-care design, she was engaged by St. John’s to come up with a healing environment.

Significant research shows that patients heal more quickly in aesthetically pleasant surroundings with accommodations for family members and when they are a partner in the decision-making process rather than a passive participant, she said.

“There is a new generation of hospitals that has come about in the last five to seven years which are really a celebration of wellness--they are filled with natural light and gardens and water elements.”

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St. John’s, which has always been known for its lawns and gardens, will further emphasize views of nature in its new complex, which will include a healing garden for contemplation and a central fountain in the South Plaza. Aquariums and black-lit images of nature will be prominent in waiting rooms and exam rooms to reduce stress levels.

Technology also is being employed to reduce stress. Radiologist Dr. Dennis Sarti, who heads the technology steering committee, acknowledges that technology can be a cold, impersonal word.

“We have concentrated so much on bringing modern technology to the patient we have lost the human touch,” he said. “If you come in for a CAT scan, you should not have to wait 45 minutes.”

Hoping to reduce the hospital paperwork dramatically, his group is designing systems for the new facility that include computerized radiology, which would make X-rays and other images available any place in the hospital, personal “smart cards,” so that patients don’t have to keep re-registering between departments or on return visits, and fiber optic technology that will tie the hospital to all the physician offices in the area.

The committee has endorsed a concept called “Technology and Healing Hands,” which will emphasize a human touch.

“A patient will enter the parking gate with a smart card that will tell us you are on campus, and we’ll meet you in the lobby with a concierge,” predicted Sarti. “If you are returning to the hospital, we’ll have pictures of your grandchildren on the digital screen in your room, with music you like. We want to make this technology work for the patient.”

As for future earthquakes, the buildings will incorporate base isolation seismic engineering, described as the equivalent of a building on shocks with layers of steel and rubber between the base of the building and the ground.

“It was a blessing in disguise,” said St. John’s president Sister Marie Madeleine of the Northridge earthquake that tumbled St. John’s into the 21st century with just half a minute of seismic shaking. “We were God-blessed that no one was killed or injured. And the momentum of change has provided a rich opportunity to truly help patients.”

Help St. John’s Celebrate

The groundbreaking ceremony for the new St. John’s Health Center is set for Wednesday at 4 p.m. on the hospital’s north lawn, Arizona Avenue and 22nd Street. Free parking will be available. A free community celebration with music and barbecue will follow from 5:30 to 8:30 p.m. The public is invited and asked to RSVP at (310) 829-8909.