Plans for Palomar Pomerado Health's "hospital of the future" have been scaled back in recent weeks, but it does not mean patient care will suffer, nor does it mean construction will be delayed.
Dr. David Tam, chief administrator and chief executive for facilities for PPH, said plans for the new hospital, Palomar Medical Center West, are "full speed ahead" despite financial issues.
The new hospital's estimated price tag of $957 million reported in December 2008 was $86 million more than the projected cost in May 2007.
To reduce spending, the hospital has made several cuts, including a children's playground and trying to obtain LEED certification.
Other cuts include a "healing garden" that would have cost $1.5 million that will now be an open lawn until funds become available.
The hospital also made smaller changes to save money. For example, purchasing 60-inch box trees instead of 120-inch box trees saved the hospital $100,000.
"We're counting paperclips and boxes of toner," Tam said.
Tam added that elements from the project could only be cut if they fell under two criteria: it would not change the projected capacity of care and it would not change the quality of health care.
The hospital will save about $38 million with the cuts it has already made, and hopes to find more savings with construction bids.
"We have already been able to realize some savings because of changes in the economy," said Tam. "As more companies are looking to get business, we've seen a reduction in the cost of the bids as compared to what we estimated."
He said 50 percent of contracts have not been let yet, including those for drywall and cabinetry.
However, because the hospital is publicly owned, it must pay the California Prevailing Wage Rate, which requires it to pay a minimum rate for various services that is higher than some of the bids the hospital has received.
Additionally, the hospital has recently hired Terry Green, the former chief fundraising officer for Children's Hospital in Los Angeles. PPH hopes Green will be able to raise funds to close some of the remaining gap and possibly pay for some of the projects cut from the original plan.
"If somebody like a large company or a very generous donor wants to donate money for the garden, we could put it in," Tam said. "We're leaving in the pipes. We're leaving in the sprinklers. It's something we could bring back."
The hospital's design tries to maximize patient care while minimizing the potential for medical error.
All of the patients' rooms are "same handed," meaning beds are always on the left while bathrooms are always on the right. Additionally, each room holds the same equipment.
However, the biggest change from a conventional hospital might be the elimination of nurses' stations for a "distributed nursing" model. Everything done at a typical nurses' station, like keeping track of charts, will be done in front of the patient's room.
Tam said this model reduces the number of handoffs of charts, which reduces the potential for errors and mix-ups.
Nurses have tested out the new rooms in some model rooms set up near the main PPH campus.
The mock rooms are currently used for training. Originally, however, nurses were asked to make suggestions on how to improve the layout and function of the room. Tam said the rooms have since been redesigned to maximize their efficiency.
The hospital is just one part of PPH's master plan expansion project that includes upgrades to its current facilities as well as new outpatient clinics in Ramona and Rancho Penasquitos.
Funds from some of PPH's other projects are being deferred toward the new hospital.
Palomar Medical Center West is scheduled to open in 2012.