The Penrose-St. Francis Health System built or renovated over 200 patient rooms in three different facilities over a period of eight years, providing optimal conditions to discuss, test, and refine the layout of the patient rooms and the nursing units.

Several evidence-based design concepts were discussed, debated, and selectively implemented, including:
Private versus semi-private patient rooms;
Decentralized versus centralized nursing;
Inboard versus outboard toilets;
Same-handed versus mirrored patient rooms;
Three distinct zones of patient rooms;
Evolution of the electronic record;
Universal room;
Optimal size of patient rooms;
Patient safety and infection control;
Sociomedical implications of technology-driven bedside or nurse alcove charting versus nursing propensity to gather at large stations;
Utilizing noise control and natural environment to improve patient outcomes.

The first project in 2000 encompassed renovating the 11th floor patient unit of a fifty-year-old building originally designed with semi-private rooms and four bed wards. The new design created all private rooms and attempted to maintain staffing efficiencies and decentralize nursing. The vertical chases and dimensions of the existing facility had enormous impact on efforts to embrace new nursing unit functionalities and improve the process flow. Decentralized nursing functions most effectively in tandem with electronic records but the technology could not yet support this idea, so the unit fell back into a centralized nursing process. This unit was the first at the hospital to incorporate a home-like atmosphere and successful focus on patient comfort.

Planning for the new bed tower addition began in 2002 and provided new 36-bed Cardiovascular and Critical Care Units to the Penrose Hospital campus. These two new units further enlarged the patient rooms and attempted again to decentralize nursing. The larger unit size created the potential for increased walking by the nurses, but the alcoves located at the patient rooms proved effective for both nursing staff and, unexpectedly, physicians. Two centralized nurse stations for each floor ended up being larger than needed as the nurses transitioned from the central location to charting at the alcoves. The units accommodated a transition to electronic patient records, implemented in January 2008. The noise reduction was so successful that all cardiovascular patients slept through the night on their first night in the new unit unheard of in the old unit. In spite of the lack of empirical data to draw from, these successes occurred due to the long-term involvement of the staff in the planning and design process.

The most recent example from 2005 was a new green-field hospital for the healthcare system with 156 beds and the flexibility to expand to 300. The success of the previous two projects framed the decision making for the nursing units of the new medical center and carried the lessons learned to the facility. Alcoves were again created at patient rooms, although because nursing staff was relocating from an intimate community hospital, there was some push-back regarding the decentralized nursing. The size of the central work area was reduced and the facility planned for the use of electronic records, utilizing mobile charting stations instead of incorporating desktop charting at the alcoves. Staff turnover during the planning and design process increased the need for continual education as to how to optimally utilize the completed facility. Specifically, director-level leadership was absent in the OR, radiology, birthing center, and emergency department during design and construction, and during the process, the CEO and driving force behind the new facility also left his position.

Every nursing unit, whether in an existing facility or new building, has mitigating factors that affect the outcome and success of the design. Future projects will continue to draw from these previous experiences and continue the learning process of creating the ideal patient room.