Culture Change


When Hospital Sisters Health System’s (HSHS) St. Elizabeth’s Hospital and Ambulatory Health Center in O’Fallon, Ill., set out to build a 350,000-square-foot, 144-bed hospital and attached 140,000-square-foot ambulatory care center, its aim was to create an environment that supports collaborative, team-based care. The approach would include efficiently designed clinical areas that allow nurses to spend more time with their patients and amenities that highlight the need to support staff as well as patients and families.

A set of shared organizational values that are reflected in a common vision and purpose helped guide the project with the goals including:

  • Promote and support colleague, physician, and patient safety using technology, infrastructure, and enhanced processes.
  • Create a great place to work, with physicians and colleagues who desire to practice in the new medical campus and recommend it as the regional healthcare facility of choice.
  • Increase value and satisfaction for patients and families, physicians and colleagues.

Since moving into its new facility in late 2017, the organizational culture and patient and quality outcomes have been transformed. Here are three example of how those values were translated into the design approach and the outcomes the organization has experienced:

  1. The design gives providers and staff access to supportive amenities, an efficient workflow, well-lit environment, views to nature, and a balance of communal and focused individual workspace. Taken together, all of these elements have the ability to increase communication and collaboration, often resulting in better employee engagement. For HSHS St. Elizabeth Hospital, specifically, employee engagement metrics increased from the 24th percentile in 2017 to the 74th percentile in 2019.
  2. Good design, through common spaces, circulation, technology integration, and building support systems, provides an opportunity to encourage peer collaboration. For example, by understanding key adjacencies, such as co-locating all procedural services on a single floor to maximize proximity between the ICU, Cath lab, and emergency services, and situating the ambulatory care environment adjacent to the inpatient environment, HSHS St Elizabeth Hospital could improve access between programs for physicians, staff, and patients. Additionally, equipment is now easily shared, with travel distances for staff decreasing more than 83 percent between key services.
  3. Established elements of standardization throughout the hospital aid caregivers in knowing where to locate supplies so their attention isn’t diverted from the caregiving process. The patient room design incorporates a standardized nurse server with dedicated location of supplies and personal protective equipment (PPE) and establishes a safe zone at the patient door, allowing staff to communicate with patients without always needing to don PPE. As a result, the hospital’s Leapfrog Safety Score jumped from a C in 2017 to an A in 2019.

Overall, HSHS St. Elizabeth Hospital offers a more positive work environment with amenities throughout, including access to gardens, patios, and daylight. Efficient workflows and physician and staff support areas have created a more collaborative culture, which has become a magnet for recruiting top talent. Organizational values and vision have been translated into the new hospital design to create a high-performing culture and organization.

Amy Keller Frye, EDAC, is a design research consultant at Kahler Slater (Minneapolis). She can be reached at afrye@kahlerslater.com. Jen Voight, AIA, is project leader, associate principal, at Kahler Slater (Milwaukee). She can be reached at jvoight@kahlerslater.com. Jennifer Schlimgen AIA, is vice president at Kahler Slater (Madison, Wis.). She can be reached at jschlimgen@kahlerslater.com.



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