CNO on Hospital Redesign: 'You Can't Over-Communicate'

The chief nursing officer at a new Texas hospital made sure that the concerns of nurses and nurse managers were carefully considered in the new plans.

Not every nursing team gets to have a role in designing a brand-new hospital. That's why Irene Strejc, RN, BSN, MPH, CENP, CNO/vice president of nursing at Methodist Richardson Medical Center in Texas made sure that her nurses and managers were front and center when the chance to do so came their way.

Strejc says designing the newly opened, 125-bed, four-story facility was a "once-in-a-lifetime" opportunity for its nurses to really "put their imprint" on a hospital. But despite her role as vice president of nursing, realizing her own vision of the hospital wasn't Strejc's focus.

Instead, her focus was bringing to life the vision of the front-line caregivers and nurse managers who actually use the facilities every day and provide the patient care. "I stepped them forward and stood beside them, because this is not my hospital, it's our hospital," she says. "I was the coach, they were the stars."

The hospital's president, whom Strejc says was the most involved leader she's ever seen in a hospital rebuild, frequently hosted meetings with department managers, who would take the information back to staff during the two-year long project. In addition, nothing was finalized until nurse managers signed off on the design, Strejc says.

The new facility, which opened in April, was designed to stand the test of time, and not to be trendy, says Strejc.

"A lot of thought goes into what is in the patients' and the nurses' best interest," Strejc says. Without consensus-building and clear-set goals, "you may find yourself building for the moment and not for the millennium."

The design also includes elements that nurses helped bring to life.

For instance, "one of the things that we did was move the hand-washing sink into the patient's room," Strejc says. In the old facility it was either outside the room or in the bathroom, so "the patient didn't see you wash your hands."

"That was one of the things that the nurses felt strongly about," Strejc says, adding that patients have a right to see their healthcare providers wash their hands.

Other design elements contribute to both the flow and ambiance of the space. Gone are the traditional box-shaped units with desks at either end. Such design can lead to a "wild mix of acuity" and nurses having to race from end-to-end, creating the need for "more thoughtful assignment systems to counteract the design of the building," Strejc says.

Instead, the new facility's hallways have a serpentine shape with no corners, decentralized infection control carts, and a nursing workstation between every two rooms.

"Things are happening closer to the bedside," Strejc says.

In addition, the hallways' S-curves give a feeling of peace and quiet, serving to decrease noise and clutter. Also adding to the ambiance is indirect lighting in the hallways, rather than the customary row of fluorescent lights on the ceiling. Teaming rooms provide space for tasks like meetings and huddles, and break rooms open onto balconies for fresh air.

"It just feels and looks like a place of healing and a place of peace," Strejc says.

In order to make the patient rooms flow more efficiently and comfortably for everyone in them, the hospital worked with Steelcase Health to design distinct "zones" families, nurses, and patients. On one side of the bed is the family zone, which includes a couch under the windows that turns into bed; a recliner that vibrates and heats; lighting for reading; and a view of the TV. On the other side of the bed is everything that the nurses need to provide patient care.

Of course, not every CNO and nurse leader has the chance to design a hospital from the ground-up, but there are learnings here for everyone. For example, Strejc says anytime a hospital buys new equipment there's a chance to assess whether it's as patient- and staff-friendly as possible. There are also lessons about valuing and listening to your staff. Strejc says her hospital has a shared governance system, so staff is used to speaking up.

"If they don't speak up, I keep bugging them until they do," she says. "Silence is not an option. They know they have a voice, and I expect them to use it. I respect them very much. I want them to feel that they make a difference in everything that they touch."

And although it's easy to get lost in the busy, day-to-day management of a project, Strejc also points out that it's important to circle back with people who spoke up and championed something that didn't pan out.

"You've got to close the loop and communicate that," she says. "You need to get back to a person that championed an idea. You can't over-communicate."