Planning for the design and construction of a new hospital building is a daunting challenge in and of itself. Couple that with the ambitious goal of transforming the culture of a hospital, and the task at hand can quickly become overwhelming. Yet Bronson Methodist Hospital has done just that, and the award-winning results have been extremely positive for the Kalamazoo, Mich., facility.

“The answers to, ‘How do you improve physical design?' and, ‘How do you transform culture?' are intertwined,” says Susan Ulshafer, M.B.A., Bronson's senior vice president, human resources and organizational development. “We realized that we needed to do both at the same time.”

As part of its $181 million redevelopment, Bronson—also a participant in RWJF's Transforming Care at the Bedside initiative—signed on with the Center for Health Design's Pebble Project in 2000. The Pebble Project works with hospital partners across the country to demonstrate how health care facility design can improve the quality of care for patients, enhance operational efficiency and productivity, and increase staff engagement and retention.

The new Bronson Methodist Hospital is a state-of-the-art facility, bringing together inpatient care, outpatient care and physician offices in a patient-centered healing environment. Private patient rooms are one of the most important design features of the overall healing environment. Since opening the all-private room facility, Bronson's rate of hospital-acquired infections has dropped 11 percent.

“Private rooms give the patient and family members an opportunity to make the room their own space without being worried about their roommate. They can close the door. This really does promote healing,” says Katie Harrelson, R.N., M.S., vice president of patient care services and chief nurse executive at Bronson.

Ulshafer adds that private patient rooms reduce the need for transfers, and give patients, family members and caregivers the opportunity to discuss care planning more openly, without fear that a roommate or visitor may overhear sensitive discussions.

The medical unit at the new Bronson has also been redesigned. Eight to 10 private rooms are arranged around a smaller, decentralized nurses' station, called a pod. Linens, medications, equipment, and staff areas are located throughout each unit, reducing the amount of time nurses spend hunting and gathering.

The participation of nurses in the entire redesign process has been key to the success of the project.

“Nurses are experts,” says Harrelson. “Engaging them up front saves time and energy, because the nurses begin to own the process, offering rich suggestions on how design can improve the way they deliver care.”

Harrelson added that during the planning stages, it was nurses who accompanied the project architects on site visits.

Involving nursing staff from the beginning was only one aspect of Bronson's cultural transformation. Gathering and considering employees' input, and showing them how their input has been used, is an important component of that work. Bronson hears from its employees via several channels, including regular rounds by leadership, open office hours with management and an annual employee opinion survey. This feedback is entered into a centralized system through which employees receive responses to their comments and learn about how Bronson will address their concerns.

Another key component of the cultural transformation at Bronson was an investment in leadership, beginning with frontline supervisors and continuing up through senior leadership.

“Employees do not leave organizations,” says Ulshafer. “They leave managers.”

Everyone at the supervisory level at Bronson is required to attend six days of training each year to hear updates on Bronson's strategic initiatives and also to develop leadership skills in areas such as communications, finance, diversity and recognition. All new managers also participate in a six-month New Leader Orientation Pathway to learn about process and function from managers throughout the Bronson organization. Bronson offers follow-up educational sessions to provide additional instruction to managers who want it.

Bronson has a robust leadership accountability program. Every 90 days, managers' goals are reviewed to ensure that they align with strategic initiatives. In addition, all Bronson managers are required to complete rounds (12 per quarter) and send 12 thank-you notes to employees each quarter. Managers are also required to attend at least 75 percent of monthly management meetings.

The final piece of Bronson's efforts to improve hospital culture was to keep employees informed and engaged in the future direction of the facility.

“Employees want to know where we are headed, and how they can us get there,” Harrelson says. “Actions complement words, and we recognize employees and teams when we achieve our goals. When we do well, we share it with our employees.”

Bronson has paid out $11 million to non-management employees as part of its gain- sharing program. In addition to its generous financial rewards, Bronson acknowledges its employees on the spot when a good deed is done. Each manager has a recognition tool box, containing special items like coupons for the cafeteria, massages, movie tickets, additional paid time off, and awards them to those employees who go above and beyond.

“Rather than spend time focusing of the 5 percent of employees deemed a problem, we instead are focused on the 95 percent of employees who are providing good care to patients, and rewarding them for that work,” Harrelson continues.

Bronson's efforts to improve physical design and transform the hospital's culture are having a profound institutional effect. In 2005, Bronson's turnover rate for all positions was 9.4 percent, and only 4.1 percent for nursing, down from 5 percent in 2004, 7.8 percent in 2003, and 8.5 percent in 2002. In addition, vacancy rates for both all positions and nursing only stand at 6 percent. The nursing vacancy rate reflects both growth and newly added positions. Since opening the new hospital in 2000, Bronson has seen a 32 percent increase in market share, as well as continued high marks on its patient satisfaction scores.

That success is only part of Bronson's story. In late 2005, Bronson was named one of six winners of the prestigious Malcolm Baldrige Quality Award, and the only health care organization to receive the honor. Bronson has also been honored by both Fortune and Working Mother magazines as one of the “100 Best Companies to Work For” for the past three years.

Upon receiving the Baldrige Award, Bronson Healthcare Group President and CEO Frank Sardone told the Kalamazoo Gazette, “It's a validation of many years of work by many people in the organization to improve processes and establish best practices.”