Hospitals R Us
The design of Hadassah Ein Kerem's new wing was based on a survey of potential patients and their needs. A first look at the state-of-the-art facility that will open in six months.
The new wing of Hadassah Hospital in Ein Kerem is to open its doors in about six months. It will be not only the main hospital facility serving residents of Jerusalem and the surrounding area, but also the newest in Israel.
The new wing is located in a 19-storey tower, including five underground floors, amounting to 100,000 square meters, nearly double the area of the current buildings. Costing $350 million, the Sarah Wetsman Davidson Tower will contain all the internal medicine and surgical departments, 500 beds, and an infrastructure that is the first of its kind in the country.
The wing, whose central features are detailed here for the first time, was designed using an innovative model, and one that is unprecedented in Israel: It was preceded by a thorough survey of potential patients and adapted to their needs. The survey was prepared by the Smith-Kolker office and involved five focus groups of 44 participants from Jerusalem and the center of the country, some of whom had been hospitalized at Hadassah or other hospitals in Israel or abroad in the past. Hadassah, the Women's Zionist Organization of America, who are the owners of the hospital and raised the money for the new wing, began the planning process in 2005, together with the hospital administration, headed by Prof. Shlomo Mor Yosef. The new planning model reflects a change in the concept of the nature of a hospital and its role in the West. "The hospital is no longer conceived of as only a place to carry out medical procedures. In its place is an approach that looks at all hospitalization needs in their entirety," says Amitai Rotem, Hadassah's marketing director.
From the beginning the planners were influenced by an American trend, and operated under the assumption that the new building should contain only private rooms for each patient. Hadassah legally operates a private medical service which offers such private rooms, and those in charge of public medicine decided that private rooms would upgrade care conditions for all patients.
But participants in the focus groups indicated that under certain conditions, mainly those who faced long hospitalizations, they would in fact prefer to have another patient in the room. A focus group of women from Jerusalem, for example, said that if they had to remain in hospital for several weeks, it would be boring to be there alone, and also expressed the fear that they would suffer from isolation. "People with serious, chronic diseases are fearful of being left alone," said one.
A focus group consisting of Arab men from East Jerusalem, in contrast, said that they would prefer private rooms, since their wives stay at their sides during hospitalization. Parents of children and ultra-Orthodox families preferred a private room in situations in which there was a danger of catching an infectious disease.
In the wake of discussions within the focus groups, it was decided to plan two types of rooms: private rooms for one person and rooms for two people comprised of two levels separated by a divider in a way that provides each patient with private space including a window looking out over the Jerusalem hills.
In accordance with the style of new hospitals in Israel, a personal television screen will be installed near each bed. Hospital technology enables each patient to use the screen for "a variety of activities, starting with the ordering of restaurant food, to reading one's personal medical file, and surfing the Internet, watching films and choosing background music," says marketing director Rotem.
Hospital mattresses will be orthopedic, and an electric curtain will enable patients to adjust the amount of light that enters the room. At the side of the bed will be remote controls for emergencies, and for controlling room lighting and temperature.
Planners also paid attention to hospital clothes. "Pajamas are considered a necessity due to circumstances, but patients have other considerations about how they look while hospitalized," the survey concluded. Most of those surveyed expressed dissatisfaction with existing pajamas and robes. They requested that these items not bear hospital logos and that they be designed more attractively. "In winter, the pajama should be flannel, while in summer a thin fabric like tricot," added one participant. It was also recommended that bedclothes not bear the hospital logo.
While Hadassah is unwilling to do without its logo on clothing and sheets, it is now working on a new design. "Some things disturb patients, we learned from the survey. For example, the large opening in the back of shirts. We will relate to these points," Rotem says.
The survey also dealt with the food served to patients. Many hospitals in Israel have tried in recent years to cope with the complaints of patients forced to eat "hospital food," by improving its quality. "There is no good reason why food served in hospitals should not meet 'different' standards," survey participants said. They requested that it approach the level of home cooking, to change the uniformly blue dishes for dairy meals and orange ones for meat meals, and to pay attention to the aroma of food.
The kitchen at Hadassah has undergone a massive renovation in preparation for the opening of the new wing. According to Rotem, "The entire area of food will change significantly. There will be greater flexibility in menu choices and in delivery hours."
Participants in the focus groups were asked whether they would like a kitchenette in their rooms. In the end this idea was abandoned but each room will have a space for making hot drinks.
No spa and no sauna
The new wing will enable patients to check in in an innovative way, with a dedicated reception area, in order to avoid the harassment of new patients who require x-rays and other exams. In the pre-planning survey, some participants described their reception at the hospital as "an adventure, the beginning of which is known but the rest of the way is not."
There were those who opposed the plan, fearing that one unified reception area would become a bottleneck increasing the length of lines at the entrance to the hospital. According to Rotem, "The reception process for hospitalization and surgery will change dramatically and will be concentrated in the new wing, so that patients will not suffer and will be absorbed more quickly." Release procedures will also be hastened, in accordance with the survey's findings, in order to avoid lengthy waits for release papers.
The survey recommended leaving some green spaces within the new facility, "unlike today, when the [hospital] is all asphalt," said one participant from Jerusalem. It was decided that the building's first four floors would contain gardens with bushes and trees, running water and benches to sit on. The outer walls of the gardens, known as "green therapy," will permit a view of the landscape.
Some participants in the survey asked that a movie theater be included in the new hospital wing. Massages, a sauna and a spa were considered, but it was decided to refrain from offering them at this stage. Planners were cautious about making the new building overly commercial. The survey concludes that "over-emphasis on other needs is likely to have a negative effect on the concept of the hospital as a place for [medical] excellence."
"We won't offer massages in the patient's bed," Rotem says. "At the same time, we already have hairdressing and make-up services at no cost, and we will offer them in the new wing. We also decided, in connection with the screens at bed side, not to sell Internet, television and telephone services for an additional fee, but to make this part of the services given to the patient."
It has also been decided that the entrance to the hospital, which in recent years has required walking through a commercial shopping mall, will be changed. It will be possible to enter the new wing from a central area outside. "In the wake of critical comments, it was decided that entrance to the mall will be only for those who choose to do so."
The new hospital tower was planned by the American architects at HKS in Texas, among the foremost hospital planners in the world, in cooperation with the Israeli Spector Amishar office, the architects of the hospital's Ein Kerem campus.
Additional features of the building are 14 elevators, eight of which are reserved for patients only, bridges and an underground tunnel that connects the building with adjacent structures, green construction using energy-saving materials, electronically-controlled escalators, and an underground level for the most innovative surgery rooms in Israel. In 2006 the building won an American competition for the modern architectural design of medical centers, in the category of buildings still to be constructed.
The service given patients and their families also demands upgrading. One participant in the survey said, "I arrived at the emergency room 10 days after my mother had died there and encountered an inhumane doctor," adding that "he treated me like a disease and not like a patient - the doctors spoke to each other and not to me." According to Rotem, "We take care to pay constant attention to services. The new building presents us with a greater challenge, because each patient will have more space and the medical staff will work in a wider expanse. An entire team is working to find solutions to these issues right now."