In 2011, Clark Kjos Architects (CKA) designed the 350,000 SF Dally Tower addition for MultiCare Health System’s Good Samaritan Hospital in Puyallup, Washington. With the hospital’s expansion for diagnostic and treatment services, the project included a total of 160 patient beds. Half of the designed bed count was constructed on floors 5 and 6, leaving the top two floors of the patient tower – the remaining 80 patient beds– shelled for future expansion.

In 2016, the planning began to outfit the two shelled floors, providing the MultiCare/CKA team opportunity to enhance the patient rooms within the existing footprint and completely redesign the support core with the goal of improving patient health outcomes. Specific design initiatives were focused on:

• Reducing patient falls
• Improving staff communication
• Improving acoustic performance
• Improving staff efficiency

At the beginning of the process, the CKA team embarked on a collaborative three-day Lean Workshop with the hospital administrators and the staff that would occupy these two floors. The new floors would consolidate small, isolated and outdated nursing units that were scattered throughout the hospital. The design team gathered all the known functional deficiencies from the lower floors of the 2011 expansion. As a team we focused on the ideal state for these workflows.

During the collaborative Lean design workshop, the groups developed:

One-Stop Shops

• “One-Stop Shops” distributed in the central core for supplies and equipment to reduce travel distances for the nursing staff

Drop Zone

• A “Drop Zone” for Ancillary Staff just inside the entry of each patient room to reduce cross contamination

Layered Nurse Stations

• “Layered” Nurse Stations to promote multi-discipline collaboration, and spaces for improved acoustical separation to discuss patient information steps away from patient care areas

Flexible Charting

• Researched-Informed flexible charting locations to allow nurses to chart real-time at the bedside, reducing interruptions at the satellite station or at the nurse station

Non-Verbal Cues

• Non-verbal cues using interior finishes and fixtures for wayfinding, supply management and infection prevention zones within spaces

During the Lean event, two floor plan options were developed by the large group. CKA then distilled the best attributes from each floor plan, tested and quantified the steps required for each design based on a variety of caregiver flows and processes.

By analyzing the new design in comparison to the previous 2011 patient floor, the design team was able to reduce the time required for trips to storage, equipment, medications and charting. This equals an estimated 22 minutes per caregiver of direct patient care time per 12 hour shift. The hospital leadership was able to select the ‘better’ plan based on quantifiable data, and that confidence translated to minimal changes throughout the design and construction process.

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