Academic OB/GYN

I recently had a chance to visit Celebration, FL, a town initially created by the Walt Disney company as an attempt to realize Walt Disney’s original dream of EPCOT, or the Experimental Prototype Community of Tomorrow.  EPCOT was Disney’s idea of a perfect community – no crime, no unemployment, and every family with 2.3 above average children.  That perfect community was created to some extent at Disney’s EPCOT theme park, but never became what Walt really intended – perhaps because his ideal image was a little too, well, Disney.   However, long after Walt’s death a somewhat more realistic, if still a little Truman Show, version of EPCOT came to fruition – Celebration.

Celebration is a fascinating place.  In some ways it is bizarre – assuming that one has never seen a town where every lawn is mowed on the same day, there is not a speck of flaking paint, the shrubbery is all perfectly trimmed, and everything is 50% more expensive than it should be.  But in other ways, it is an amazing accomplishment – a community truly in the image of the Disney idea.  A community Onstage.  Particularly at its hospital.

Celebration Health is in some ways like every other community hospital:  about 110 beds, operating rooms, a cafeteria, an ER, and hospital wards.   But in other ways, it is nothing like other hospitals – because its a Disney hospital.

Anyone that has ever been to a Disney themepark has probably noticed that everything they see around them is just about perfect.  From the lack of rubbish to the perfectly painted surfaces to the overestimated wait times in the lines, Disney creates a world that seems too good to be true.  We know it isn’t real, but the effect is good enough that for the time we are in the park disbelief is suspended and we and our families just enjoy the experience.
At the same time, Disney parks have a backside to them.  For every Snow White white there is a seamstress wearing normal clothes working in some back area.   For every Space Mountain ride attendant dressed in a perfectly creased, slightly but not too futuristic outfit, there is a normally dressed and normally greasy mechanic that makes sure the ride is running safely.

Disney has a name for this dichotomy – “Onstage” vs “Backstage”.    Onstage is anything a “guest” might ever see, whereas Backstage is everything they will never see.   And they do mean never.   Backstage is completely inaccessible to the guests, and for that reason the illusion is never broken.  Even behind the scenes tours are really just illusions of Backstage, because they’re really Onstage experiences.

Onstage means more than just a physical location.  Its also an attitude taught to everyone that works there.   When any employee walks Onstage they are taught that they are no longer an employee, they are a Castmember, critical parts of creating the experience of Onstage.  Whatever is going on in their lives, for those hours they are part of the illusion – more than anything else, it is that illusion that makes Disney what it is.

While Celebration Health is not technically a Disney Property, it is clearly designed that way.  To start, the hospital looks nothing like a hospital.  If anything, it looks like some kind of performing arts center.  When one walks in the front door (Onstage) you are greeted not by a normal hospital lobby, but by a huge atrium with windows on nearly all sides.  The entire front of the hospital is walled with huge windows, bringing natural light into every space.  One one end of major front hall are outpatient offices, but they don’t really look like offices.  Not only are the materials much better than anything one would see in most hospitals, but the waiting areas outside the offices feel more like what one would see outside a french bistro than your typical hospital based doctor’s office.

At the end of the hall is an entrance to a massive gym and spa, that is open to the public of Celebration, and serves as the community’s health club, and at the same time the place for all patient rehabilitation and physical therapy.  The idea behind this is twofold.   First, the spa brings the entire community to the hospital on a regular basis, emphasizing its role as a place of health rather than a place of sickness.  Second, it serves as the hospital’s physical therapy and rehabilitation center, comingling patients having directed therapy with community members doing there regular excercise.  The entire idea is to make patients and guests feel like they are not in a hospital – and it works.

Beyond the patio like outpatient waiting areas and the huge health center, the Onstage front of Celebration Health has one huge difference from every other hospital I have ever been in – a complete lack of sick patients.   In fact, Onstage I did not see a single patient in a wheelchair or a single gurney.  I thought that maybe it was just the time I came in, but my guide assured me that it was by design.   It turns out that the entire hospital was designed such that the Onstage experience rarely had anyone sick in it.   For example, all the elevators that area likely to be ridden by visitors (“Guests”) open up to Onstage areas, and while they feel spacious, they conveniently are of just the right size such that the hospital’s gurneys do not fit in them.  So that experience of going up the elevator with a guy on a ventilator?  Not at Celebration Health.  And hallways that have doors opening up into radiology reading rooms and big red flashing signs that say “X-RAY IN USE”?  Not at Celebration Health, at least not Onstage.

Backstage at Celebration Health is not quite is different as other hospitals, except that its just really nice.   But it also has a few features that show its Disney style.

One of the things that Disney always does is to try to force its Guests to do the things that will make the environment great, without ever letting them know they are being directed.  They also always try to underpromise and overdeliver, like the waiting time estimates at the rides, where 40 minutes estimated wait times are actually about 25 minutes.  This type of social engineering is in full effect Backstage at Celebration Health.

For example, patients room don’t look like patient rooms, despite the fact that they have everything in them that is needed for emergencies.   For example, oxygen, suction, and IV poles are all hidden behind trick headboards, such that they are invisible when they are not needed.   Monitoring equipment is similarly hidden, except when immediate use requires.  They also engineer the way the halls in the wards feel, by putting comfortable open waiting areas all over the place.   When a patient needs private time with their physician or nurse, any family that leaves the room is naturally going to go sit down in one of these areas rather than loiter in the halls. Unlike the labor and delivery in my hospital, these halls are always clear, even without any explicit policy about family standing around in the halls.

Radiology, unlike the relatively dark and dingy radiology departments one sees in most hospitals, is a trip.  Like many areas in the hospital, has a theme, and in this case it is a Trip to the Beach.   The entire area is decorated as such – and not a few pictures of sailboats and some beachy posters decorated, but Disney decorated.  From the ocean smell coming through the ventilation to the barium served in beach martini glasses, its a complete illusion.  The patients are even given beach tee shirts and board shorts instead of gowns when they go in for their exams.   The little workup rooms have beach chairs and chaise lounges instead of gurneys.

Nuclear Medicine is themed after Going to the Movies.  The lobby feels like the lobby of a theater, and is dominated by a large screen similar to what one might get if they spent a hundred grand on a home theater system – complete with a popcorn maker.  Since nuclear medicine studies often take hours to do, patients are encouraged to watch a movie while they are waiting, and even to finish watching it after their study is completed if they like.

While these themes in some ways seem a little hokey, in a lot of ways they make the relatively anxious experience of having radiologic studies pretty fun.  And lest that seem kind of pointless, Celebration Health has the lowest refusal rate for MRIs in the country, with less than 2% of the patients leaving without their study being completed.

At the same time, the hospital has some of the most advanced surgical suites in the world, including quite a bit of what I am interested in – DaVinci robots.  They have six of them in use, and more than that in their training center.

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So with all of this fancy stuff, one would think that Celebration Health would be inaccessible to most patients.  I was suprised to find out that this wasn’t the case – they take all insurance including Medicaid.  And because they provide an value added experience to their services, they are very popular.   So popular, in fact, that they area tripling their bed count over the next 10 years.

While Celebration Health is in some ways an odd hospital, it is a great thing to see.   Like the Patch Adams’ Gesundheit Institute (still to be built), it is a testament to the idea that there is more than one way to build a hospital.

I was super impressed with my visit there, and want to thank Dr Arnold Advincula and his partners and staff at their Center for Advanced Gynecologic Surgery for showing me around.   So impressed, that maybe I’ll end up working there.