(10) The Mouse-Man and the Computer Geek

Throughout my strife in my reconstruction project, I have had the opportunity to read medical journals and research organizations that did not know existed. Life is such an extraordinary and brilliant gift, and hospitals should be the face of this belief. Medical centers across the nation can be considered miracles on earth. It is in these great shrines that magic, as we know it, is practiced every day. A hospital should forever be revered as a place of tranquility and hope. As a society, we are naturally intrigued by the negative and remember failures. Hospitals should not be paired with images or thoughts of death and sickness. My ultimate goal is to change this view--not only in the eyes of the community, but in the minds of the patients within.

A clear blueprint has been laid which portrays the goals of my reconstruction project, as well as the resources I will use to get there. I have supported my arguments with clinical studies, and have proven the health benefits of colors, sounds, space, and community relationships within the hospital. I have identified my change agent, Miss Linda Dierks, and have included several other organizations who will assist me--Turner Construction, the Institute of Hospital Improvement, the American Hospital Association, and the Transforming Care at the Bedside initiative.

I hold this blog in higher esteem than just a school project. I pray that it will fall into the eyes of a powerful and intrigued subject; someone who shares my passion and has the will to take on such a tremendous feat. During my research, I came across an article by the European Health Management Association which displays case studies and visions just like mine. If you would like to hear the opinions of several other researchers and medical teams, please click here.

As a twenty year-old college student with academic pressures, financial stress, sports obligations, and life's many obstacles, it is difficult to fathom myself making a distinguishable difference within the world. However, every dream begins as a seed inside the mind of one individual. While some die in the process of achieving, many others withstand the odds.

Walt Disney once imagined a cartoon show with a rodent as the main character. Eighty-one years later, Disney's Mickey Mouse has his own cement star on the Hollywood walk of fame.

Once upon a time, an 8th grader reprogrammed the general electric system in the Beginner's All-purpose Symbolic Instruction Code (BASIC) that allowed users to play games against the computer. Today, this same person is one of the richest and most successful human beings in the world; his name--Bill Gates.

If a mouse-enthused man and a thirteen year-old boy can change the way the world operates, so can I.

A Whole lot of Zeros

It is time to discuss budgets, compare figures, create a timeline, and put this project into action!

First, a recap of my main source:

The Saint Mary's Foundation, led by Dierks, is expected to collect hundreds of thousands of dollars annually. The total revenue raised each year is not stated; however, with only seven employees, the foundation has been successful in collecting revenue through a variety of mediums. Contributors are individuals, businesses, public and private foundations, and government sources. One hundred percent of the income goes to state-of-the-art medical services, which maintains Saint Mary's reputation as the number one medical provider in Northern Nevada. The foundation's sponsored events are the Hospice Golf Tournament (June), the Guild Clay Shoot (September), and the "celebrities take a bough" Holiday Gala (November).

As I stated in a previous post, contributors come in guest attendance, grants, cash donations, stock and property, planned and estate giving, and endowments. Donors are recognized in one of the following groups:

Society of Philanthropy

Dominican Council: $100,000+

Founders: $50,000+

Leadership: $20,000+

Community of Caring

Patron: $10,000+

Fellow: $5,000+

Partner: $1,000+

Friend: $500+

Supporter: $250+

The west campus expansion of Saint Mary's, which was completed in June 2005, has not yet released its total construction cost; however, similar construction projects will help me budget a complete reconstruction of the existing health center of Saint Mary's.

Stanford's 600-roomed hospital, aimed for completion in 2015, has an estimated cost of $2.5 billion. As it stands now, Saint Mary's Hospital only has 380 rooms; therefore cost should be slightly over half of Stanford's project if I were to build from scratch. I will not be taking down the whole building, but only knocking out walls on the inside.

The construction of El Camino Hospital will be $480 million. This does not include a new cyberknife ($11 million) that will enable doctors to remove tumors noninvasively

The Regional Medical Center of San Jose is building a $47 million patient wing; and the Good Samaritan Hospital is undergoing a clinical lab remodel worth $3 million. Additional technological buys include a $6 million IT system, and a $22 million seismic upgrade purchased by the Community Hospital of Los Gatos; hyperbaric oxygen chambers for wound care ($500,000), and electron electronic medical records (1.5 million) purchased by the O'Connor Hospital.

I want to broaden the hospital rooms of Saint Mary's--either by eliminating some of the existing rooms to create more space, or reconstructing the inside and adding an additional wing to the building. This will be determined by available space and budget. For now, I will sacrifice some of the existing rooms by knocking out walls and creating fewer, yet bigger, hospital rooms. Additionally, the inside of the hospital will be completely modernized. From medical equipment and decorations, to fees for live performers; the cost continues to compound. Judging by the previously done construction projects, I estimate this project to be around $40 million.

Costs will elevate from year to year; therefore, I will make my estimation as accurate as possible. In order to complete this project in five years, it would require an annual fundraising of $8 million. It sounds like a lot of zeros; however, with all of the teams working together, it is a feat that can be accomplished.

A Movement at Stanford.

Have you ever looked into the night sky and wondered what else is out there? With an infinite outer space, I do not believe we are the only living creatures in the universe. There has to be many other forms of life that exist beyond our diameter of exploration.

With this philosophy in mind, I thought about my reconstruction plan and wondered if there isn't a group out there that is taking similar strides. I know I am not the only person who feels depressed and pessimistic upon entering a hospital. Therefore, I did some research and found that the Stanford Medical Center is building almost an exact replica of what I imagine.

Between the years of 2015-16, Stanford's new hospital will contain a one million square foot interventional services center and an enlarged emergency department with 600 beds. Additionally, each room, including intensive care, will have an extra bed for a family member to sleep in over night. The patient will be able to regulate sunlight with individual shade controls, as well as watch movies, view x-rays, and order meals on flat-screened TVs.

Adults are living longer than ever before, but with more complex needs. Rita Ghatak, PhD, Director of Aging Adult Services at Stanford Medical Center, believes that their hospital needs to transform in order to accommodate an aging population. After sitting with many focus groups, she has concluded that the hospital environment need improvement in the following: lighting, sound, distances, doorways, waiting areas, room layouts and signage.

Betsy Brawley, president of Design Concepts Unlimited, and a specialist in designing interior environments for aging adults, also commented on how to improve hospital environments. She says that lighting design and paint colors could improve the safety and well-being of senior citizens. Her other suggestions included showers with a threshold, electronic dimmers, bathrooms with sliding doors, lighting over the toilet and garbage can, and fold-down grab bars.

George Tingwald, Director of Medical Planning for the hospital renewal project, compared Stanford's current medical clinic to a geriatric patient. It is very old and its resources and design are inefficient. Tingwald verifies his argument by saying, "we now have evidence that the environment has huge impact on patient outcomes."

It is a wonderful feeling when the passion I have felt for so long is shared with professionals. This verifies that my plan is accurate and encourages me to move forward.

(9) Proof, proof, and more proof

There are countless studies which stand as proof that a positive attitude is conducive of good health. Rhonda Byrne's, The Secret, is all about the laws of attraction and positive thinking. She believes that we can make anything happen if we think actively and positively about it. Bryne talks about the importance of emphasizing the good rather than the negative. For example, if a person's goal is to lose weight, he or she should repeat the phrase, "I want to be healthy and fit," rather than, "I don't want to be fat."

An additional study shows that positive attitudes help fight the common cold. Psychosomatic Medicine published a story in July 2003. Researchers examined 300 people three times a week for two weeks. Each patient was tested on three categories of positivity--vigor, well-being, and calmness. They were also tested on three areas of negativity--depression, anxiety, and hostility. After each assessment, the patient was injected with the cold-causing germ, rhinovirus, and monitored for five days. Results showed that people with positive attitudes had less symptoms of the cold, and negative people had more symptoms.

In 2004, researchers at the University of Texas found that positive attitudes delay the aging process. This study was published by the Psychology and Aging journal in which 1,558 people were tested. During the seven year study, researchers examined positive and negative attitudes in relation to frailty. They measured frailty by weight loss, exhaustion, walk speed, and grip strength. Although results found that optimistic patients showed less symptoms of frailty, science demanded more proof. Therefore, scientists concluded that positivity may alter chemicals in the brain. Additionally, an upbeat attitude makes the individual believe that they will be more successful in life.

Not all people are born with the optimism gene. I am passionate to help and influence these patients in experiencing the joys in life. It is amazing how the quality of a person's life can improve by approaching each day from a slightly different angle. Hopefully my hospital reconstruction project will get us there.

Linda Dierks, Larry O'Brien, Turner, AHA, and TCAB.....Let's do it!

(8) Transforming Care at the Bedside

When my mother gave birth to my youngest sister, the process felt more like a business transaction than a joyous gift of life. Our doctor was extremely dry and impersonal; not to mention we were rushed in and out as quickly as medically allowed. Of course, the excitement of my new baby sister outweighed negative thoughts I had for the hospital staff. Nevertheless, I will never forget my experience.

In July of 2003 The Institute of Healthcare Improvement (IHI) and The Robert Wood Johnson Foundation (RWJF) launched an initiative called Transforming Care at the Bedside (TCAB). The goal of this program is to "enhance the quality of patient care and service, create more effective care teams, improve patient and staff satisfaction, and improve staff retention.

The TCAB imagines each hospital room with a whiteboard and collage of the medical staff's pictures. On the bedside table is a notebook with common questions that the patient is encouraged to ask his or her doctors and nurses. At the end of each service, the patient will be given a write-up of everything that was done that day, including medications given, blood pressure, clinical results, surgical news, etc. The organizations emphasizes the importance of learning all of the patients' names and improving doctor/patient time by 70%. Whiteboards will display encouraging personal notes and goals for the patient to accomplish each day.

In the fall of 2003, three hospitals were selected as prototypes of this program: Seton Northwest Hospital (Austin, TX); UPMC Shadyside (Pittsburgh, PA); and Kaiser Foundation Hospital (Roseville, CA). In July of 2004, the organization had come up with over 200 ideas for the program, ranging from getting better equipment to giving patients more input in their treatment.

When the TCAB was officially started in 2005, it aimed to:

• Make care safe and effective
• Promote care team effectiveness and vitality
• Support and involve patients and families
• Increase value of care and care processes

Additional advancements of this project include:

• Night shift nursing rounds: Nurses check up on patients before the night begins and make sure they are properly set for the next 12 hours.
• Streamlined paperwork: GYN surgeons will use one universal post-operation evaluation sheet that includes medication instructions, lab work, and activity level.
• Skin Integrity cards: Nurses will keep small cards with a sketch of the human body that corresponds with their patient. They will circle areas of irritation in order to constantly monitor patients' skin.
• Patient self-medication: Option for patients to take medications on their own. Some thought it was empowering, and others were afraid.
• Revamped food services: Improving quality, variety, and flavor of food.
• Workplace Safety Enhancement: Making sure the staff is safe and free from harmful machinery or hazards.

The TCAB has not made its way to all hospitals in the United States. In 2004, only 13 major hospitals had integrated the program. In addition to my revamping efforts, I want to initiate the TCAB in every hospital I meet. Doctor/Patient relationships are vital to the positive atmosphere that I aim to create.

For more about the TCAB, click here.

(7) Let us Laugh

Although I have put much emphasis on changing the visual and aural aesthetics of Saint Mary's Hospital--colors, openness, music, decorations, and artwork--a positive atmosphere does not end here. There are psychological and physiological needs that seek further help than a Monet painting. One of the most effective and inexpensive ways of achieving good health is through laughter. Many research have said that laughter releases endorphins and rids the body of harmful toxins. Now, there is scientific proof to back up this claim.

In 1979 Dr. Norman Cousins published a book entitled, Anatomy of an Illness. More than a decade prior to his publication, he suffered from a painful disease known as ankylosin spondylitis, or "bent spine." It is a form of inflammatory arthritis that specifically effects the joins in the spine and hips. Eventually, the spine becomes crooked and the rigid vertebrae fuse together.

During his illness, Cousins received enjoyment from watching hilarious Marx Brother movies. After a while, he noticed the pain beginning to subside, until one day it was gone completely. Cousins attributed his miraculous recovery to laughter. He then spent ten years researching at the UCLA medical school where he established the Humor Task Force. Cousins did work in the field of psychoneuroimmunology (PNI), which studies both the psyche and nervous system as they affect the immune system. Cousin's work evolved, and in 2005 the University of Maryland Medical center proved that positive emotion has a positive effect on cardiovascular health.

Atherosclerosis, hardening of the blood vessels, is caused by constricted inner lining of the vessels--otherwise known as the endothelium. When a person laughs, blood vessels dilate, creating larger passageways and more blood flow.

The University of Maryland's clinical study involved healthy, non-smokers who were subject to 30 minutes of two emotionally charged films. The first, Saving Private Ryan, caused mental stress; while the second film, King Pin, was lighthearted and humorous. After testing the patients, they found that their blood vessels decreased in diameter by 35% from the stressful film. Conversely, blood vessels increased 22% after watching the comedy. The results confirmed Cousins' earlier study that laughing helps the body.

Dr. Michael Miller was in charge of the Maryland study. He relates laughing to exercising, in that they both contribute to elevated blood flow. Miller advises that 30 minutes of exercise three times a week, and 15 minutes of laughter will maintain a healthy body.

Now, the question is: How do we make our hospital patients laugh? There are many ways, really; however, an effective tool would be to bring in comedians once a week for hour-long shows. This may sound far fetched, but such a performance will produce more than just laughter. It will create a sense of friendship, belonging, community, and love--all of which are components of Maslow's hierarchy of needs.

In a previous post, I spoke of guest performers and shows brought to the hospital to entertain patients. After construction is finished, Saint Mary's will have its own theater in which it can host the entertainers. This, again, is where Linda Dierk's enthusiastic fund raising comes into play!

In conclusion, when you're having a bad day, tune into Dane Cook, Brian Regan, or read the comics section in the newspaper. You'll be surprised at how much better you will feel!

Back to the Source

The St. Mary's foundation is an organization which functions within the hospital. This branch is responsible for collecting charitable donations, recognizing donors, and distributing money in the correct places. Linda Dierks is the vice president of the foundation and has done well with encouraging philanthropic efforts. Every cent of the money collected goes to programs and services within the hospital. I chose Dierks as my change agent because she will help fund raise the multi-million dollar reconstruction project.

Dierks generates funding for Saint Mary's through events, cash donations, stock, real estate and bequests. Once I have communicated with Saint Mary's corporate officials, and determined construction details with Turner, I will host a banquet for my cause. Dierks will contact current and previous donors who would like to attend. Additionally she will help me advertise for the event and recruit people to attend. The banquet will only be the kick-off to a long list of fund raising efforts.

Larry O'Brien is the CEO and chief administrator of the West Campus Expansion. This project took place in 2005 as a complimentary structure to Saint Mary's Regional Medical Center in Reno. The beautiful new addition includes a 215,000-sq.-ft., 6-story Saint Mary's Center for Health; a 1,090 car, 8-level parking structure; and a plaza that also provides parking below.

With O'Brien's will and commitment in his latest project, I have no doubts that he will take on my project with the same drive; therefore, I have decided to contact O'Brien as a secondary change agent.

I have gathered my team, submitted the roster, and all that lingers ahead is the coin toss. It's time to play ball.