Six years ago with the acquisition of the 217-acre Fitzsimons campus, the University of Colorado Health Sciences Center and Hospital had the rare chance to build an entire academic medical center from scratch. Dennis Brimhall, president and chief executive officer of the University of Colorado Hospital, discusses how hospital leadership seized the opportunity not only to design a state-of-the-art facility but also to effect a cultural change that puts patients first.

Q: What are the policies and principles that embody your patient-centered focus? How did building a medical center enable you to concentrate on patients?

A: It's been many, many decades since anyone has built an academ-ic medical center from the ground up. This is a tremendous opportunity for us; we were able to design everything with a patient focus in mind and to do things that are not possible if you have to retrofit. For example, we decided where to put parking first and built streets around it. Yet, this is a cultural change as much as it is anything else. The buildings just provided us with an opportunity to transform the culture.

When we decided on a patient-centered focus, we aimed at the aspects of doctors' visits and hospital care that most often frustrate patients. Specifically, we get few complaints from patients about their interactions with health care professionals. The dissatisfying experiences are registration, scheduling appointments, parking, waiting, billing, and other administrative procedures.

In response, we developed several guiding principles about patients. One is that no patient will wait. The bottom line is that waiting is a reflection of how well the entire system works. If we can improve it, the patient perceives a better experience.

Managing the time of doctors and staff is part of it, and we're working on that. But another part of it is the perceptions a patient has about waiting. So, our effort also includes creating an environment in which patients don't have the sense that they are waiting. That can range from keeping them informed on the status of the appointment to moving them quickly to an examination room to providing waiting areas that are pleasant places to be.

Another area in which we've made patients the priority is parking. Only patients are allowed to park at the front of the building. Staff, faculty, and everyone else have to park behind the buildings. Before, as at most academic medical centers, doctors and administrators parked front and center. And to ensure that patient concerns are addressed, we have an instant response system under which staff and faculty are required to respond to patient feedback and questions within 24 hours. This is not just lip service; we believe the patient comes first.

Q: Explain the building design and the role it plays in the hospital's goal of creating the "ideal patient experience."

A: One of the major problems in health care is that we've always designed from the provider out. If you ask only the faculty and staff what kind of building they want, you'll get a terrific building for faculty but a less than adequate one for patients. If you truly want to focus on the patient, you have to build from the patient back. For us, that required a profound rethinking of what we do.

Medical centers are traditionally designed with offices on the outside and patient areas in an atrium in the middle. We've reversed this. All of our outside space is patient area, offices are in the middle, and exam rooms are located where the two meet. Rather than traditional waiting rooms, the hospital has open areas with floor-to-ceiling windows overlooking 14,000-foot mountains. Recognizing that patients often feel like foreigners trespassing on someone else's territory when they visit medical centers, we designed our patient areas to be as comfortable as possible and to be used exclusively by patients. Collaboration with the Disney Institute was important to this concept.

Q: What role does technology have in your patient-centered focus?

A: We are concentrating on utilizing technology that will have a direct impact on patients' experiences. Rather than focusing on high-tech solutions, we're capitalizing on the Internet, to which more than 50 percent of our patients have access.

We're revamping our registration and scheduling processes so that patients will be able to choose an appointment time online. We also know patients are frustrated when they don't get quick answers to their questions. The Web will help us formulate more immediate responses. In fact, 34 percent of our physicians are now communicating with their patients via e-mail.

The most ambitious project the hospital is undertaking is providing patients with Internet access to their medical records. Most of our records are already online, however, they aren't written, stored, or catalogued in a way that is meaningful or accessible for patients. We've received grants from the Commonwealth Fund and CapCure to help us retool our systems to make records understandable for the patient. The concept is already being tested at one of our clinics. Patients are very enthusiastic about the idea, and we think giving them access to their records can improve the quality of health care.

Q: What has the faculty's reaction to the changes been?

A: As always in academic medical centers, the response is varied. We've had pockets of faculty who have been resistant or apathetic, but we've had other groups that are enthusiastic and more than willing to participate. We've found faculty champions for our changes, such as electronic medical record access for patients. We also involved hundreds of faculty in the design of the buildings. By and large, the faculty's willingness to adapt and accept things like less convenient parking has been impressive. I give great credit to the faculty for their willingness to rethink and reinvent. Most of them have great ideas for making things better now that they have an outlet for that thinking.

Q: How will this cultural change affect student and resident training in the hospital?

A: It will affect how they perceive the patient. We know that residents are quite adaptive. When they're on a rotation at a private hospital, they behave in the way that a private physician behaves. When they're at a public, general hospital, they behave the way medical staff behaves at a public, general hospital. We'll be role modeling patient-centered care for them. And we've upped the standards significantly in terms of the behavior we expect from all of our people at the Health Sciences Center, including residents.