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Hospital Spas
An Unusual Union Unfolds

By Karrie Osborn

Originally published in Massage Bodywork magazine, April/May 2005.
Copyright 2005. Associated Bodywork and Massage Professionals. All rights reserved.


In a handful of hospitals across the country, patients are being treated to a new level of healthcare where massage, reflexology, water therapies, and even body wraps and facials are par for the course. It's happening in hospital-based spas, a venue where sound medical focus and the power of complementary therapies combine to create a comprehensive, well-rounded approach to healing.

The hospital spa concept is somewhat reminiscent of the early 20th century when hospital nurses prepared patients for bed with an evening backrub, and touch was an intrinsic part of healing. Some might say this newest spa trend is coming full circle on how healthcare used to be administered and how it should be administered today.

Considering the large number of medical spas to open their doors over the last five years, the quick adoption of the term "medical spa" into the esthetic industry vernacular, and the recent creation of a medical spa association, the emergence of hospital-based spas seems a logical, progressive step in healthcare delivery.

The creators of these hospital-based spas say the motivation is about tapping into all avenues of health and healing for the benefit of the patient. This is a philosophy that follows suit with a new line of empirical inquiry surrounding optimal healing environments (OHE). These environments are those in which the social, psychological, spiritual, physical, and behavioral components of healthcare are oriented toward support and stimulation of healing and the achievement of wholeness. (For more information on OHE's, read the September 2004 supplement to The Journal of Alternative and Complementary Medicine.)

In addition to citing the need for health and wellness as reason behind opening their own spas, the hospitals' search for new, compatible streams of revenue is an obvious part of the equation. Just as hospitals once realized it would behoove them to upgrade cafeterias, revitalize gift shops, and bring in a host of other vendor services to cater to the visiting public, they're also realizing the opportunity that awaits by embracing, owning, and overseeing the health and wellness therapies a spa provides.

"Healthcare organizations seeking to enhance revenues, attract new customers, and appeal to the health-conscious movement will have to do more than add new ICU equipment," writes Carol Freshley of the Kaiser Institute, a Colorado-based company focusing on the development of future healthcare systems. "Moving into consumer-driven areas such as spas is a part of this broader approach."1

She goes on to say that hospital-based spas represent a new design in healthcare delivery. "They extend the concept of wellness centers and respect an expanded definition of health. As such, they are in a position to attract a new market and new sources of revenue." Additionally, Freshley writes, if successful, these spas will certainly differentiate themselves from other healthcare facilities in their community.2


Opening Doors
The first spa in this latest trend to set roots in a hospital environment was Beyond Spa at the Hackensack University Medical Center (New Jersey) in 2000. With no map to follow, the goal of the hospital was to create a relationship between beauty, medicine, and wellness, where a woman could go for a massage at Beyond Spa in the morning and follow it with her annual mammogram in the afternoon.

The hospital built a spa staff that includes estheticians, cosmetologists, massage and shiatsu therapists, nail technicians, and reflexologists, and a spa menu with services ranging from a green tea/sea salt scrub and an oxygen mist facial to a massage combining shiatsu, Thai bodywork, and reflexology.

"The integration of these services in a hospital setting is a unique and innovative way to provide clients with complementary services not always offered in the traditional hospital setting,"3 says John Ferguson, president and CEO of the Hackensack University Medical Center.

At the opening of Beyond Spa in 2000, Dana Points, then executive editor of Self magazine, called the spa's creation a giant step forward in healthcare. "This facility represents the future of wellness and how people choose to take care of themselves."4

A handful of hospitals slowly followed the Hackensack example and opened their own spas as part of an integrative wellness program. One of them was the Condell Medical Center in Libertyville, Ill., and its Inner Spa. Opened in 2003, Inner Spa not only offers traditional spa fare, but also gives clients access to physician specialists who can provide consultations on such subjects as breast health, integrative medicine, dermatology, and podiatry.

Scott Morcott, M.D., a practitioner on the Condell medical staff, says the alliance between spa and hospital makes sense. "Much of what I do as a physician deals with helping patients manage the constant stress and strain of daily life and responding to the health problems that result. Healthy habits such as good nutrition and regular exercise, and relaxation techniques like yoga, massage, aromatherapy, and self-pampering help minimize stress and ward off illness."5

When the Memorial Hermann healthcare system in Texas considered adding a spa to its nine-hospital repertoire, the big dilemma was space. "Do you give up patient beds for spas?" Travis Ochoa, director of Memorial Hermann's Garden Day Spa, says that's the question still plaguing the organization today as it considers putting mini spas in its eight other hospitals, having successfully opened its first spa facility in 2003.

Ochoa says the motivation behind opening additional spas is not in following a trend, but in grasping and implementing all means in which people heal. And the spa seems to be offering those means to an eager clientele.

The 5,200-square-foot Garden Day Spa offers an array of services that include aroma-steams, body polishing, dry brushing, body wraps, reflexology, pre- and postnatal massage, customized facials, Kneipp Water Kurs, makeup application, and hair care.

With a staff of 27, the Garden Day Spa is situated in the hospital's wellness center. In addition to physicians and staff, more than half of the spa's business comes from outside the hospital system; about 15 percent of their work takes them to a patient's bedside. "That [latter] number is not where we want it to be," Ochoa says, "but we are doing more permanent work in the rehab center, three days a week, working with post-surgery patients." The two to three hours of patient massage on those days has become more consistent as a standing doctor's order. Ochoa says he would eventually like to have permanent staff in the rehabilitation department, but space is still the issue of concern.

The acceptance of the Garden Day Spa into the hospital fray has been quick. When spa staff first started offering services to hospital patients, it was mostly within the high-risk pregnancy population -- mothers who had been on hospital bed rest for weeks, even months. Hospital doctors quickly saw how daily massage decreased the stress levels for these women and made them feel better overall.

In addition to hospital patients and outside guests, Ochoa works on staff and physicians as well. Educating these clients on the benefits spa services provide has been an ongoing part of the growth process. Many departments, including the emergency room, now utilize the spa as an employee benefit.

Being part of a hospital system, Ochoa says the spa focuses hard on HIPPA compliance, staff training, and utilizing intake forms as they were designed to be used. As for the training, it has become such an important part of the equation that the hospital opened its own school to train future employees. Just as Memorial Hermann has its own nursing program and radiology program, it now has a massage program from which it hires spa therapists. Doing so, Ochoa says, affords new spa employees a better feel and understanding for the goals and protocols of the hospital.

Having worked with patients at bedside, Ochoa says there is a tremendous benefit in serving this population. "We want to have their overall hospital experience be as stress-free as possible," he says. Whether it's a post-surgery massage or a makeup application, serving the hospital patient and making her feel better by doing so is at the core of the spa's mission. "We want them to feel at home as much as possible while they're here."

And they feel they're meeting their goals. Ochoa says proudly, "We've touched a lot of people's spirits."


Following a Philosophy
Some of those entering the hospital spa segment do so because it's a natural fit with their already established philosophies on health. This is true of Ology, a new, 3,500-square-foot facility that's part of the Clarian Health hospital system in Indianapolis, Ind.

Ology is somewhat unique in its design. Even though it's actually a tenant of the hospital in which it's based (Clarian West Medical Center), it's the first spa to be designed and built in conjunction with the construction of a new hospital. "I believe we are the first one to be built from the ground up," says Ology's Spa Director Andrea Bradley-Stutz.

Because of that, Ology is not being run out of an old hospital broom closet, nor is it an afterthought of Clarian. Instead, it's more like a crown jewel.

The reason why has much to do with the Clarian philosophy toward health. "Clarian is a traditional hospital in many senses," Bradley-Stutz says, "but it's also a healing sanctuary." She says Clarian has a philosophy of treating the well patient, and it holds a vision of attending to a person's total care -- mind, body, and spirit.

Described as the future of medicine, Clarian West Medical Center touts itself as "a healthcare environment unlike any other ... with a full range of patient care services -- designed to meet and even exceed patients' expectations of the 'typical' healthcare experience."6

Bradley-Stutz says Clarian West expresses that notion aesthetically: "You wouldn't believe this place. The hospital looks like a ski lodge." And the spa has its own aesthetic appeal. With an overall design created to embrace the concept of "circle of care," the spa has curved hallways and walls, the colors and decor are reflective of nature, and all the treatment rooms have a view of the nearby healing garden.

As for the services it offers, Ology provides standard spa fare like ayurvedic treatments, hydrotherapy, skin care, and massage. Oftentimes these are offered in conjunction with aesthetic and reconstructive plastic surgery procedures performed in the hospital by surgeons who are also full-time faculty at the Indiana University School of Medicine.

Ology is a little different animal when talking about true hospital-based spas in that even though it was designed and conceptualized as part of the hospital from the beginning, it's owned by a LLC made up mostly of Clarian Health physicians.

"They knew they didn't have the capability to do it," Bradley-Stutz says of the hospital administration and their desire to include a spa in the new facility. Yet, "a traditional spa does not have the expertise to fit into a hospital setting." The compatibility just wasn't right.

The solution came from one of the Clarian doctors who saw the problem as an opportunity. He put together an ownership group, including Bradley-Stutz, which then aligned itself with the philosophy of the hospital.

Now, having opened (along with the hospital) in December 2004, Ology is being embraced by patients, staff, and physicians alike. "We have had absolutely nothing but positive feedback," Bradley-Stutz says. Some of the spa's most frequent clients right now come from the operating room nursing staff. "They provide great word-of-mouth."

Physicians are a bit harder to get into the spa as guests because of their schedules, she says. "But when they do, they're amazed." Building trust with those same physicians is an important part of the process as they write the orders for the inpatient, bedside services. "We have to be on good terms with them, and they have to trust us."


Meeting the Challenges
Industry experts say the positive effects of the hospital spa trend will be rippling. "This will only increase the awareness of spa services and the benefits thereof for the general public," says Hannelore Leavy, founder and president of the Day Spa Association. "It will have a very positive effect on the spa industry."

She says in addition to overall awareness, hospital-based spas can illustrate the preventive aspects of taking care of oneself and "insurance providers will eventually start realizing that the only way to fix our healthcare system is to reward people who take care of themselves."

Leavy admits an increasing number of hospital-based spas might create some negative fallout for smaller day spas that are limited in what they offer. "Spas that are only offering beauty/skin care treatments will be at a disadvantage for a while," she says, "until the general public learns how to make a distinction between cosmetic/esthetic treatments and pure, therapeutic spa treatments."

It goes without saying that despite the positives, hospital-based spas will face challenges along the way. Whether it be educating hospital staff about spa benefits, marketing to a client base outside the hospital, or simply figuring out how to fit in, the half dozen hospital spas that exist today are meeting those challenges and creating a template that will be followed for years to come.

Bradley-Stutz from Ology has this advice for anyone considering a spa-hospital partnership. "Anybody thinking about doing this should really think it through," she says. "The amount of money you put into your space is much more than any other medical practice." She estimates that for just a basic spa design, plan on $125 per square foot as the low side, compared to $70 a square foot for a medical practice. "You're pouring money into the space initially," she says.

Other challenges are logistical. "When you create a spa and drop it into a retail setting, it's not that hard. But when you drop us into a hospital, you're a mouse on top of an elephant." Noise issues, laundry logistics, physicians writing orders for services, and HIPPA compliance are just some of the challenges.

Even with all of Bradley-Stutz's expertise in the spa industry, including a background in esthetic plastic surgery and spa equipment training, she says putting a spa in a hospital is a new animal that generates problems she's never dealt with before. "You're kind of creating the wheel again."


Growth and Potential
As complementary and alternative medicines continue to find acceptance from the general public and a sometimes reluctant medical community, this emerging trend of hospital-based spas will quickly become much more than a short-lived fad.

Some of those who've already put their toes in the water and opened their own hospital spa are talking excitedly about opening other hospital-based spas in the near future. Ology is already overseeing the development of a second facility for another Clarian hospital, 35 miles from its current location. It will include the same ownership group, plus a few additional partners. Memorial Her-mann, although in a slow growth mode, is trying to figure out the logistics of putting mini spas in its eight other Texas hospitals.

And the opportunity for growth will extend even further into the medical community. Beyond the strict concept of hospital-based spas, Leavy says it's not just hospitals who are planning to include spas on their premises. "It's also physical therapy and rehabilitation centers and health-related institutions such as assisted living facilities, senior centers, and nursing homes."

The numbers could grow exponentially as the healing potential of spa services is further realized in the traditional medical world -- even more so when that potential is understood for a bedridden hospital patient. Imagine it yourself: a patient relaxing with a Swedish massage before going into surgery, a new mother receiving a revitalizing session of reflexology after working through an arduous birth, a pre-term infant soaking in the strength offered during a delicate application of healing touch, a cancer patient finding comfort in the gentle approach of aromatherapy.

There is truly more potential than we can even begin to imagine. Both time and research will continue to help this sort of therapeutic partnership find its footing, and before long, we're sure to see it play out in more and more hospitals around the country.


Karrie Osborn is contributing editor to Massage Bodywork magazine.



Resources
www.medicalspaassociation.com
www.dayspaassociation.com

References
1 Freshley, Carol. Day Spas: A new trend in healthcare. Available at www.kaiser.net/articledetail.cfm?article_id=57. Accessed January 2005.
2 Ibid.
3 A New Horizon in Beauty and Wellness, Health Scene, Hackensack University Medical Center. Vol X,3, 2000.
4 Ibid.
5 Illinois' First Hospital-Based Therapeutic Spa Opens at Condell Medical Center, Libertyville. Available at www.condell.org/news/press/20030623.php. Accessed January 2005.
6 The Future of Medicine is Here, Clarian West Medical Center. Available at www.clarian.org/portal/patients/westhos pital?leftMenu. Accessed January 2005.











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