This article is from the New York Times international edition. It illustrates how a basic rethinking of workflow in hospital rooms leads to simple changes in position of equipment and fixtures that has significant impact on medical error rates, fall rates among patients and ultimately, improves patient recovery rate. Remember, functionality makes a big difference in operating outcomes.

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Copyright © 2014 The New York Times
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MCI (P) 034/07/2014
SATURDAY, AUGUST 30, 2014
INTERNATIONAL WEEKLY In collaboration with
A former top Vatican ambassador is accused of molesting boys, including Francis Aquino Aneury, in the Dominican Republic.
By LAURIE GOODSTEIN
SANTO DOMINGO, Dominican
Republic — He was a familiar fig-ure
to the skinny shoeshine boys
who work along the oceanfront
promenade here. Wearing black
track pants and a baseball cap
pulled low over his balding head,
they say, he would stroll along in
the late afternoon and bring one of
them down to the rocky shoreline
or to a deserted monument for a lo-cal
Catholic hero.
The boys say he gave them mon-ey
to perform sexual acts. They
called him “the Italian” because
he spoke Spanish with an Italian
accent.
It was only after he was spirited
out of the country, the boys say, his
picture splashed all over the local
news media, that they learned his
real identity: Archbishop Jozef
Wesolowski, the Vatican’s ambas-sador
to the Dominican Republic.
“I felt very bad,” said Francis
Aquino Aneury, who says he was
14 when the man he met shining
shoes began offering him increas-ingly
larger sums for sexual acts. “I
knew it wasn’t the right thing to do,
but I needed the money.”
The case is the first time that a
top Vatican ambassador, or nuncio
— who serves as a personal envoy
of the pope — has been accused of
sexual abuse of minors. It has sent
shock waves through the Vatican
and two predominantly Catholic
countries that have only begun to
grapple with sexual abuse by mem-bers
of the clergy: the Dominican
Republic and Poland, where Mr.
Wesolowski was ordained by the
Polish prelate who later became
Pope John Paul II.
It has also cre-ated
a test for
Pope Francis,
who has called
chi ld sexua l
abuse “such an
ugly crime” and
pledged to move
the Roman Cath-olic
Church into
an era of “zero
tolerance.” For priests and bishops
who have violated children, he said
in May, “There are no privileges.”
Mr. Wesolowski was defrocked
by the Vatican on June 27, reducing
him to the status of a layman. The
Vatican, which as a city-state has
its own judicial system, has said it
intends to try Mr. Wesolowski on
criminal charges. It would be the
first time the Vatican has held a
criminal trial for sexual abuse. The
MERIDITH KOHUT FOR THE NEW YORK TIMES
church recently announced that Mr.
Wesolowski had lost his diplomatic
immunity and could face prosecu-tion
in criminal courts in another
country, though it is unclear if he
would be sent to that country.
But the Vatican has caused an
uproar in the Dominican Republic
because it abruptly recalled Mr.
Wesolowski last year before he
could face a criminal inquiry and
possible prosecution there. Acting
against its own guidelines for han-dling
abuse cases, the church failed
to inform the local authorities of
the evidence against him, secretly
recalled him to Rome, and then in-voked
diplomatic immunity.
Mr. Wesolowski has appealed the
Vatican’s decision to remove him
from the priesthood, a process that
PLAINSBORO, New Jersey —
Can good design help heal the sick?
The University Medical Center
of Princeton realized several years
ago that it had outgrown its old
home and needed
a new one. So the
management decid-ed
to design a mock
patient room.
Medical staff
members and
patients were
surveyed. Nurses and doctors
spent months moving Post-it notes
around a model room set up in the
old hospital. It was for just one
patient, with a big foldout sofa for
guests, a view outdoors, a novel
drug dispensary and a bathroom
positioned just so.
Equipment was installed, pos-sible
situations rehearsed. Then
real patients were moved in from
the surgical unit — hip and knee re-placements,
mostly — to compare
old and new rooms. After months of
testing, patients in the model room
rated food and nursing care higher
than patients in the old rooms did,
although the meals and care were
the same.
But the real eye-opener was this:
Patients also asked for 30 percent
less pain medication.
Reduced pain has a cascade ef-fect,
hastening recovery and reha-bilitation,
leading to shorter stays
and diminishing not just costs but
also the chances for accidents and
infections. When the new $523 mil-lion,
59,000-square-meter hospital,
on a leafy campus, opened here in
2012, the model room became real.
So far, ratings of patient satis-faction
are in the 99th percentile,
up from the 61st percentile before
the move. Infection rates and the
number of accidents have never
been lower.
Often ignored by front-rank
architects, left to corporate spe-cialists
who churn out too many
heartless buildings, hospitals are a
critical frontier for design. A British
charity for cancer care, Maggie’s
Centres, has taken one approach,
enlisting a Who’s Who of stars like
Rem Koolhaas, Frank Gehry, Sno-hetta
and Norman Foster to devise
In the Case of an Accused Envoy, Dominicans Want Justice at Home, Not Abroad
Rethinking
Hospital
Rooms
Whisked Away by the Vatican
MICHAEL
KIMMELMAN
ESSAY
Con tin ued on Page 5
INTELLIGENCE
Concerns about Iran
for U.S. allies. PAGE 2
Con tin ued on Page 4
WORLD TRENDS
Myths about minorities
in China. PAGE 6
MONEY & BUSINESS
Cambodia’s quest
for better rice. PAGE 8
NEW YORK
At summer camps,
global faces. PAGE 13
Jozef
Wesolowski
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5 SATURDAY, THE NEW YORK TIMES INTERNATIONAL WEEKLY AUGUST 30, 2014
WO R L D T R E N D S
The Hospital Room as a Frontier in Design
OFF-THE-RACK HEAD WALL
The new head wall isn’t
custom, and the button
layout isn’t ideal,
resulting in more than
150 false alarms
since the opening.
FAMILY SPACE
The room includes
a two-meter sofa,
which pulls out
to a bed.
A Model Room Becomes Real
Redesigned patient rooms at the University
Medical Center of Princeton at Plainsboro have
more space for patients and families, but some
features still frustrate.
SUBTLE CHANGES
A window in the door allows
nurses to look in without
disturbing patients. A privacy
curtain is installed, too.
This double-door lock box is
accessible from the hallway and
inside the room, so pharmacists
can deliver medication without
entering each room.
NEW, LARGER SHAPE
Rooms are all singles and face
the same way, as opposed to
“mirrored” rooms, where sinks
and cabinets are on the left
side in one room and the right
in another. It’s easier for
doctors, nurses and patients to
orient themselves in the new
rooms, but their larger footprint
has separated some nurses
who used to work closely.
OVERHEAD VIEW OF ROOM
HOW ROOMS FIT TOGETHER
HALLWAY
ENTRY
WINDOW
BATHROOM
HAND RAIL
DESK
PRIVACY CURTAIN
Source: HOK/RMJM THE NEW YORK TIMES
buildings. In Brazil, the architect
and urbanist João Filgueiras Lima,
known as Lelé (who died in May,
at 82), devoted his final years to a
remarkable series of rehabilitation
hospitals: simple, airy and visually
arresting.
But maybe most interesting,
some young design firms are get-ting
into the act. Not long ago, Mass
Design Group in Boston made news
with a hospital in Rwanda — “way
too cool to be a hospital,” The At-lantic
magazine cooed — that pro-voked
some debate in professional
circles about whether socially con-cerned
design can also be Architec-ture
with a capital A.
In many ways, this is the cen-tral
argument in architecture
today, with a new generation more
attuned to issues of social respon-sibility
and public welfare. The
discussion has posed a larger, fun-damental
question about the role of
architects, and to what extent they
can or should be held responsible
for how buildings work.
At the new University Medical
Center of Princeton, all rooms are
singles. Research shows that pa-tients
sharing rooms provide doc-tors
with less critical information.
Ample space is given to visitors
because the presence of family and
friends has been shown to hasten
recovery.
Same with the big window: Nat-ural
light and a view outdoors have
been regarded as morale boosters
since long before Alvar Aalto de-signed
his Finnish sanitarium in
the 1930s (a “medical instrument,”
as he called it), bragging about cu-rative
balconies and a restorative
sun deck.
There are also some fine points
to the Princeton plan, like a sink
LENS
positioned in plain sight, so nurses
and doctors will be sure to wash
their hands, and patients can watch
them do so. A second sink is in the
bathroom, which is next to the
bed, a handrail linking bed and
bathroom, so patients don’t have
to travel far between them and will
fall less often.
All the rooms are “same hand-ed.”
In many hospitals, adjacent
rooms are “mirrored” because
they share a head wall, the one
behind the bed with all the equip-ment
and attachments in it. Mirror
rooms are cheaper and take up
less space, but they require that
everything — the position of the
bed, the IV tubes, the call buttons
— be reversed, right to left or left
to right, from room to room, in-creasing
the chance that nurses
and doctors will make mistakes
when they reach for buttons or
equipment. A recent study showed
that medical errors were the third
most frequent cause of death in the
United States.
But how much each or any of the
design moves contributed to health
care is not clear, which frustrates
Barry S. Rabner, the hospital’s
chief executive. He gave the exam-ple
of antibacterial flooring, which
cost more than equivalent flooring
without the antibacterial agent.
A new generation is
attuned to socially
responsible ideas.
“Sounds like a good idea,” he said.
“So we did it. But that’s around a
$700,000 difference. And where’s
the evidence that it works?”
He said he believes architects
should provide more hard research
and in turn be paid more if their de-signs
improve health as promised.
“It’s hard to isolate some par-ticular
design metric and say it’s
responsible for a certain health out-come,”
said Christopher Korsh, the
principal architect on the Princeton
project.
Mr. Rabner said it was his hospi-tal
staff, working with Mr. Korsh’s
team, that came up with the idea
for a double-door lock box in which
to store drugs in each room. The
box can be unlocked by nurses
from inside the patient room but
also from the hallway outside. So
instead of the traditional method
of dispensing drugs — nurses
sorting drugs from one dispensary
for all patients on a floor, a system
prone to error — pharmacists can
now deliver drugs from the hall
to specific patient rooms. Nurses
can then retrieve the drugs from
inside the room, with the patients
watching.
O.K., but is the room beautiful?
No. It’s less antiseptic, cluttered
and clinical than your average pa-tient
room, with a modern foldout
sofa under a big window; soothing
colors; and a flat-screen TV. The
room is dignified, which matters
to a patient’s mental health. And it
mostly works.
Con tin ued from Page 1
Anything Men Can Do
In a month when Major League
Baseball chose its first new com-missioner
in 22 years, the biggest
baseball story in America was a
13-year-old girl.
Mo’ne Davis
of Philadelphia,
one of only 18
girls to ever
play in the Little
League World
Series, became
the first to win a
game as a pitch-er
when her
team defeated a team of boys from
Tennessee, 4-0. By the next game,
demand to see her had grown so
strong that tournament organizers
decided to give away tickets as a
crowd-control measure. The give-away
went like this: Fans began lin-ing
up at 7:30 in the morning, tickets
went on sale at noon, and they were
gone by 1:30. The game was still six
hours away.
More than 34,000 people watched,
though Mo’ne had an off night and
Philadelphia lost. No matter. She
made the cover of Sports Illustrated.
She had gotten people’s attention,
and made them consider the possi-bilities.
Less than a week after he
was chosen as the new commission-er,
Rob Manfred was being asked
whether a woman might someday
make it to his major leagues.
“Fifty years ago, people would
have had a list of things women
couldn’t do that was as long as your
arm, and they’re doing every single
one of them today,” he said. “So I’m
not betting against the gender.”
Neither is Gregg Popovich, the
coach of the San Antonio Spurs, who
won their fifth National Basketball
Association championship this year.
Just 10 days before Mo’ne Davis’s
World Series victory, Mr. Popovich
hired a new assistant coach: Becky
Hammon. Ms. Hammon, who just
retired after a career as one of the
best players in the Women’s Nation-al
Basketball Association, becomes
the first woman to hold a full-time
coaching job in the men’s league.
Jeré Longman of The Times
called it “another encouraging
summer of awakening and appreci-ation
of female athletes.” Perhaps
Mr. Popovich had not thought about
this. When he announced the move,
he talked about Ms. Hammon’s bas-ketball
intelligence and work ethic.
He never mentioned her sex.
“Honestly, I don’t think he gives
two cents that I’m a woman,” she
said.
Mary Jo Kane, director of the
Tucker Center for Research on Girls
and Women in Sport at the Univer-sity
of Minnesota, told The Times:
“It’s a terribly important moment.
Rather than, ‘Oh, my God, this is a
publicity stunt or a circus act,’ the
reaction has been, ‘Good for Becky
Hammon, and good for Mo’ne Da-vis,
and it’s about time.’ ”
There are plenty of attitudes left to
change, though. Michele A. Roberts
knows that. Earlier
this summer, she made
her own pitch to break
ground in the National
Basketball Associ-ation,
as the head of
the players’ union. No
woman had ever led a
major North American
sports union, often a contentious
position standing between rich and
powerful people — most of them
men, and in this case, most of them
very, very tall. As The Times report-ed,
she did not flinch when trying
to persuade the players that they
wanted to hire her.
“My past,” she told them, “is
littered with the bones of men who
were foolish enough to think I was
someone they could sleep on.”
She got 32 of the 34 votes.
ALAN MATTINGLY
For comments, write to
nytweekly@nytimes.com.
In sports, a summer
of awakening to
women’s potential.
ERIC GAY/ASSOCIATED PRESS
Becky Hammon,
center, will help
coach an N.B.A.
team, the San
Antonio Spurs.
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