From Dreary to Dazzling: Trying to Change County Hospital Image

County hospitals are frequently stigmatized as bleak, dreary operations, understaffed, underequipped and overcrowded, the medical outpost of last resort for the indigent and a place for the rest of the world to avoid.

San Bernardino County hopes to change that image when its Arrowhead Regional Medical Center opens Tuesday.

The $470-million, 373-bed hospital is not only designed to serve the county’s poorest residents but will market itself to the top-dollar “private pay” patients and those with insurance who could choose to go elsewhere.

“We were a hospital of last resort, but now we want to be a hospital of first choice,” said Dr. Carl Jansen, medical director of the ultramodern facility.

Arrowhead will replace the old county hospital in San Bernardino, a tired facility whose medical staff is eager to move.

Among the features at the gleaming six-story medical center are an automated pharmacy, digitized medical imaging systems and mini-kitchens on each floor so the usually dreaded hospital food can be delivered hot to patients.

The hospital, Director Charles Jervis said, will aggressively market itself among patients, physician organizations and HMOs and is expected to draw patients from other hospitals in the area.

Bob Holt, regional vice president for the Healthcare Assn. of Southern California, a hospital trade organization, agreed that will occur. He noted that some of the neighboring--and competing--hospitals initially balked when the county decided to build Arrowhead.

“Patients will feel better about this hospital than the old one,” he said. “It doesn’t give the impression of being a county facility. It’s like walking into a new, private hospital.”

It was because of earthquake safety that San Bernardino County officials decided more than 10 years ago to build a new medical center rather than retrofit its 298-bed hospital. The structure was designed to withstand jolts from the San Andreas fault 10 miles away.

A new facility, they reasoned, would also give the county the opportunity to equip it with the latest technology, Jervis said.

Many of the amenities may mean little to a groggy patient recovering from a gallbladder operation, but they will go far in providing the best possible medical attention, he said.

The filmless radiology system will allow X-rays, MRIs and other diagnostic images to be transmitted digitally on computers so they can be viewed at the hospital or by experts elsewhere. Neurologists will be able to monitor a patient’s brain activity, even from their home computers at 3 a.m.

The automated pharmacy--with bar code reading devices and an assembly line--is designed to fill up to 250 prescriptions an hour, freeing up pharmacists from pill counting so they can consult with patients.

The gas, electrical and data lines in the emergency, critical care and operating rooms are not on walls, but efficiently grouped on portable, rotating utility columns that can swivel near, or away from, patients.

The patients will rest on air mattresses, which can provide different levels of firmness on different parts of the body to enhance healing and reduce bedsores. X-rays can be taken with portable machines positioned beneath the air beds, so patients won’t have to be shifted to an X-ray lab.

Hospital meals will be prepared--but slightly undercooked, then quick-chilled--in a central kitchen and delivered to the patient floors, where they will be cooked to completion and delivered hot when it is most convenient.

The hospital will continue to operate its regional burn and trauma centers.

The $470-million price tag was a bargain, Jervis said, because the project was put out to bid in the early 1990s during a recession when construction companies were eager to take on large projects.

Jervis said Medi-Cal patients are expected to generate about 60% of the hospital’s revenue; those with Medicare, 10%; and private insurance clients, 5%. The 25% balance will be absorbed through the county’s operating budget.

It is partly because of the sense of competition with other hospitals that Arrowhead’s staff is taking classes in charm and hospitality, under the direction of Elliot Kushell, who teaches organizational behavior at Cal State Fullerton.

“This is a gorgeous new facility with great technology, but if we don’t treat the patients well, they’ll still go elsewhere,” Kushell said. “And patients will come back to where they are treated well.”

Among the tips he is dispensing to staff and volunteers: Greet every “customer” in a hallway “so by the time they get to the outpatient lab, they’ll be saying to themselves, ‘Wow, this is a friendly place.’ ”

And his advice for doctors: Increase the perception of time spent with patients by touching them on the shoulder, sitting down at eye level with them and asking nonmedical questions about their lives.

Kushell said that studies have indicated “that if a patient likes a doctor, even if the doctor makes a medical mistake, the patient is much less likely to sue.”

The doctors, he said, are responding well to his suggestions.