Atlanta-based Heery International, program manager for the new project, broke ground in mid-July. Dennis LaGatta, Heery’s project executive overseeing the work, said there would be three components to the construction process. First, the facility’s central plant is set to be replaced, then a new addition will replace the emergency and operating departments, and at the same time, the hospital’s nine-story patient tower will be revamped to give the 1950s exterior a more modern look.

“We anticipate that the central plant will be operational in November 2015, and that has to be done first so that we can connect to the new OR-emergency department expansion in December of 2015 to allow the completion and opening of the OR/ED in the winter of 2015,” LaGatta said.

The new central plant will serve as the hospital’s connection point for vital building services, so it’s important for it to be operational first. It also houses the hospital’s back-up generator system.

“The next phase would be, once we have the operating room and ED up and running, that we’ll go back and reconnect the rest of the existing hospital to the new central plant for the purposes of upgrading their emergency power system. Running concurrently will be the re-cladding of the [patient tower],” LaGatta added.

The transformed patient tower will be the most visible element of the process with a glass curtain wall and metal panel system. The prominent tower can be seen from Broward County’s Interstate 95, and it overlooks the hospital’s 35-acre campus.

Inside the hospital, the newly expanded 53,000-square-foot operating suite and emergency department will allow the hospital to continue as the only Level II trauma center in the north end of the county. The ER has 53 treatment spaces, and each treatment space is identical in room orientation and available medical equipment. A decentralized nursing station model allows for flexible treatment space utilization during peak and non-peak event time frames. The operating department will feature six new class-C operating rooms.

When Broward Health hired Heery, the hospital system asked the program manager to use an integrated project delivery-lite (IPD-lite) approach. The traditional IPD delivery method creates a single team of project participants that are uniformly responsible for completion. IPD-lite uses some elements of traditional IPD, but there are still incentives to collaborate.

Heery then reached out to Dallas-based HKS Architects and Chicago-based Perkins + Will as well as Skanska USA Building in Parsippany, N.J., as the construction manager at-risk, to create a four-company team throughout the planning, design and construction phases.

“Our IPD-lite approach allowed our team to focus on meeting Broward Health’s needs in the most cost-effective and time-efficient way possible,” LaGatta said in a press statement. “The creative thought process yielded innovations in our approach to the program as a whole and substantially reduced the construction schedule timeline, which means these new facilities will be operational and supporting the hospital conservatively 12 months earlier than initially projected.”

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The 10-story Sky Tower includes 84 emergency center treatment positions, of which 10 are trauma rooms, 35 operating rooms and 420 new private rooms. Perkins + Will, with offices in Dallas, designed the building to fit the needs of the growing community with an art-filled, patient-centered design.

Emphasis on Art

The design of the Sky Tower emphasized the integration of local and international art. In a community with a longstanding appreciation for the arts, the incorporation of art was a dual effort between the surrounding community and health system officials. The art installations in the Sky Tower is an important and visible part of the patient, visitor and staff experience, according to Steve Milner, LEED AP, senior medical planner with Perkins + Will.

“The spirit of the art program with this project and this client was to create a familiar and reassuring cultural response, creating a sense of place uniquely San Antonio by employing color, pattern, form and known cues, integrated with the architecture and the site,” Milner said.

Eight countries and 21 states are represented in the art program. However, the art program placed a large emphasis on local artists with the majority of artists being from the San Antonio area. All framers and installers were also local. Coupled with the inclusion of design enhancement, which Milner defines as development of narrative or lyrical ideas into the building and site, the art in the building is integrated into the construction process as a collaborative engagement between the architect, interior designer, artist and contractor, not simply an after fact measure, Milner said.

“When art and architecture meet, there are opportunities to go beyond the common expectations,” Milner said.

A Healing Atmosphere for Patients and Staff

The interior of the Sky Tower promotes a healing atmosphere with abundant daylight, gardens, lounges and extensive views.

“Several studies have linked healthy, sustainable environments as having positive effects on people in those spaces,” Milner said. “Patients have had very positive results in hospital rooms with access to views and daylight, and now research is being used to support improvements to staff environments for positive effects on staff.”

The design focuses on reducing as many stressors as possible not only for patients, but for staff as well, which is equally important to consider, as patient safety is dependent upon health care staff, Milner said. With the amount of intensity and concentration required of health care staff, the built environment must reflect a calming atmosphere.

“The project team is focused on creating a healing environment where anxiety and stress are reduced. Positive distraction will provide psychological relief for patients, visitors, and staff,” Milner said. “Employing active and passive design strategies —such as a quality sense of arrival, dedicated staff spaces, both indoor and outdoor, and additional support programs — help encourage staff well-being.”

Sustainable Focus

The building is currently pursuing LEED Gold certification, and with Perkins + Will’s sustainable health care design, the energy-efficient goals aligned with the sustainable integrity of Perkins + Will.

“We saw early on that the health system’s deep level of stewardship to create an environmentally responsible project was very much in alignment with long time missions of Perkins + Will,” Milner said. “UHS was extremely supportive of the sustainable design strategies, systems and technologies that addressed our common goals for the project.”

The building uses one-third less energy than required by code. Sustainable practices include recycled water for landscaping irrigation and rooftop gardens. The gardens contain vegetation and art program sculptures that, in addition to adding to aesthetics, help reduce the radiant heat of the site and reduce demand on the building’s cooling systems, Milner said. The project also maximized the use of local and regional materials.

“The 1 million-square-foot-plus project is a study in how innovative design can maximize resources to minimize environmental impact,” Milner said.

The construction management team for the project was a joint venture between locally based Zachry Construction Corporation, J.T. Vaughn Construction, with offices in San Antonio, and Salt Lake City-headquartered Layton Construction Co.

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Located on a redeveloped brownfield parcel in the Charlestown Navy Yard, the replacement hospital is divided into two connected sections: an eight-story patient tower and a three-story therapeutic gymnasium and pool. It was erected as a gathering place for the community and includes resilient and sustainable features.

“I think the choice of site for Spaulding was an inspired choice that wasn’t immediately evident. It’s inspired because the metaphor for rehabilitating an industrial brownfield is such a perfect metaphor for what rehabilitation medicine is. You take people who have been damaged by injury and bring them back into their life,” said Robin Guenther, FAIA, LEED AP, principal for Perkins + Will, the architect on the project with an office located in Boston.

Because rehabilitation medicine is traditionally done on a campus with a fair amount of natural surroundings, recreating the patient’s connection with nature was one of the bigger design challenges, Guenther said. “The challenge on a tight urban site is to provide the direct connection with the outdoors that gives people the range of experiences that they really need to move from an institutional setting back into the world,” she said. “The range of outdoor space that the design team was able to cull was a really great solution.”

The community connectivity was another major influence on the design because the Boston Redevelopment Authority placed some fairly strict community connectivity conditions on the site. The organization wanted to preserve the view shed from the street grid out to the water site, as well as required 75 percent of the ground floor to be accessible to the public across the site to the Boston Harborwalk. Spaulding used the requirements as a way to unlock a lot of program potential, making the hospital’s dining room and café, as well as public toilets, available to the public on the ground floor.

“[The Boston Redevelopment Authority] is trying to encourage development along the harborwalk that is accessible to the public and gives people amenities among the harborwalk,” Guenther said. “Spaulding really took advantage of that in a way and really delivered a really unique situation.”

This community-inspired environment makes it an ideal place for family members and friends to visit and help in the recovery process. The trail along the waterfront even features therapeutic equipment to encourage healing.

The design has this same inviting aspect with a glass curtainwall, which creates transparency and lots of natural light throughout the facility. On the building’s façade, gray materials were used to pay tribute to the site’s naval yard history, mimicking military battleships and aircraft carriers docked at the site during much of the 20th century.

Perhaps the most innovative part of the project is its attention to resilience. With natural disasters such as Hurricane Katrina and Hurricane Sandy continuing to raise concern, Spaulding wanted a building that would account for the rise in sea level and have energy efficient features.

To accommodate future flooding, the project team raised the main floor by one foot and placed all of the HVAC equipment and infrastructure on the roof. The gymnasiums, multipurpose rooms and educational rooms have natural ventilation due to the installation of automatic operable windows, which also allow the building to remain operational when mechanical systems aren’t working.

Guenther noted that operable windows are also in the patient rooms for emergency reasons but also as a sustainability feature to “test operable windows because there’s a lot of concern about infection control in more medical settings, so the larger partners set up an experiment at Spaulding so they can measure in a set of controlled rooms what happens if you open the windows, and they’re hoping that they can learn from that some lessons that they can use on their other buildings.”

Vegetated roofs that mitigate water runoff, therapeutic terraces and gardens are also contributors to the project’s achieved LEED Gold certification.
 

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The firm was recently awarded the vertical expansion and renovation of Medical City Hospital. The project is expected to begin in October and will include a 160,307-square-foot, four-story expansion above the existing emergency department and ambulance drop-off. It will also feature a 68,576-square-foot, phased interior renovation of several campus departments, including surgery, medical oncology, surgical oncology, stem ell and the emergency department/cardio diagnostic unit. This will be the fifth — and largest — renovation project that Brasfield & Gorrie has completed for the facility. Perkins + Will, with offices in Dallas, is serving as the project’s architect of record.

On May 31, the firm also celebrated the official topping out of the South Tower addition at Kingwood Medical Center. The 152,000-square-foot project, which began in October 2012 and is slated for completion in October 2014, includes a three-story addition and renovations of the existing hospital.

The first floor of the addition will feature 12 labor, delivery and recovery rooms, eight high-risk antepartum beds, 24 neonatal intensive care beds, two C-section operating rooms and a four-bed obstetric triage suite. The second floor will include 36 postpartum beds and 32 well-baby nursery beds. On the third floor, there will be shell space for future pediatric and medical or surgical beds. Also part of the project is the new central energy plant. Nashville, Tenn.-based Gould Turner Group is the architect on the expansion.

During construction of the addition, Brasfield & Gorrie is also working on several renovations of the existing hospital, including ones to administrative, admissions and kitchen and dining areas. Parking will also be added to the southeast and northwest corners of the campus.
 

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“The number of people turning to Swedish/Edmonds for their cancer treatment has grown over the last decade,” said Richard McGee, M.D., one of five Swedish Cancer Institute medical oncologists who practice at the new center, in a statement. “This new facility will allow us to offer enhanced care to a growing population.”

The modular building was developed using 29 factory-built units that were erected over the site in just two days in December. Aventura, Fla.-based RAD Technology Medical Systems, a specialty modular health care contractor, collaborated with the Seattle office of design architects Perkins + Will to develop the facility. Skanska USA, headquartered in Queens, N.Y., worked on the site development.

“Modular provides two key benefits. The client benefitted from early design coordination and prefabrication, which took time off the schedule and allowed for a quicker delivery of the building. Additionally, prefabrication also means work on modules happens with less hazard exposure to workers, helping increase job site safety,” said Pete Maslenikov, project manager at Skanska.

The Swedish Cancer Institute was created in 1932 and has a history in the area of bringing high-quality treatments, services and expertise to people affected by cancer. The new center is the latest addition to the institute’s network of community-based cancer centers. It offers comprehensive medical oncology services to patients through an infusion unit, laboratory, pharmacy and access to Swedish’s electronic medical record system. Known as a hospital-based department, patients also get access to social services, support groups, American Cancer Society navigation and resources, financial counseling, cancer-specific patient education classes and a resource wall.

“This project is exciting for numerous reasons. One of those is that later this year, Swedish will enhance cancer-care services at the Edmonds campus by starting construction on a vault to house a new $4.95 million linear accelerator for radiation therapy that will go into use in late 2013,” said David Jaffe, chief executive of Swedish/Edmonds. “Another huge advantage of the new center is that it will bring state-of-the-art cancer care closer to home, which makes a real difference for patients and their families.”

Because Swedish is a nonprofit health care provider, it asked for support from the community to help fund the $10.9 million cancer center. Several community and business leaders coordinated efforts and raised $220,000 for the project. Efforts like this will continue to play a key role in helping local patients get quality cancer care, including the latest technologies and a variety of support services.

RAD Technology Medical Systems and Perkins & Will also developed a new cancer center at Swedish Health Services’ Ballard Hospital facility, which was completed in January 2011. In less than 60 days from arriving on site, the center was erected, equipment was installed and commissioned, and the center was considered clinical. It features a TomoTherapy Hi-art radiation treatment system, which is the first of its kind for the Seattle metropolitan area. The project earned LEED certification.
 

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The hospital will include a level III neonatal intensive care unit (NICU); advanced medical and radiation oncology and open-heart surgery departments. Other services will include OB/GYN, cardiovascular, bariatrics, orthopedics, a cancer center, women’s health, outpatient services, and minimally invasive robotic procedures. The construction costs came in at $150 million, while the project cost totaled $265 million.

The building is designed around a multi-story atrium that creates an entry to the hospital and orients views to the Norristown Farm Park across the road. Views of the park helped set the tone in terms of interior design for the hospital and brought inspiration from nature and sunlight, according to the New York City office of Perkins+Will, architects for the project.

“Natural materials like wood and stone in neutral colors were used to allow the focal point to be the changing scene outside the building,” said Laura Morris, senior interior designer at Perkins+Will.

“Every effort was made throughout the planning of the building to provide access to daylight for staff and visitors. Patient rooms feature expansive windows that take advantage of the views, and are designed to promote patient comfort,” said Carolyn BaRoss, design principal at Perkins+Will.

The 363,000-square-foot medical center will have an attached medical office building that will take up to 75,000 square feet. The office building, known as the Medical Arts Building, will have a freestanding ambulatory surgical center with four operating rooms, radiation and medical oncology programs, the antenatal testing unit, and space for private physicians.

In addition, some services will go into one of three off-campus sites. The Women’s Diagnostic Unit will be housed right across the street from the hospital, and the Sleep Center and Wound Care Center will be located about five miles down the road. A professional office space located on the EMCM campus will host hospital-based services to continue to service the community that remains around the old campus.

Design began in 2007, but construction for the hospital didn’t begin until July 2010 due to the dip in the economy in 2008, which made financing more complicated. Construction of the office building followed a year later, with a start date of July 2011.

“The projects were deliberately timed to end at the same time,” said Rick Montalbano, vice president and project executive for Einstein Healthcare Network. “If the projects had started at the same time, the Medical Arts Building would have sat empty for a year while construction continued on the hospital.”

The Medical Arts Building is 100 percent occupied, with 11 tenants in the two-story building.

Funding for the project came from equity, with bonds from FHA Mortgage Insurance rounding out the balance.

Currently the hospital has enough points to achieve LEED Silver certification, something that the Einstein Healthcare Network had aimed to achieve.

“I think there is a tremendous amount of excitement regarding the new facility. There is going to be a state-of-the-art medical center in the community that didn’t exist before,” said Beth Duffy, chief operating officer for Einstein Medical Center Montgomery.

A community day is being planned for September 22, a week before the official opening. Tours through the new facility will occur, with educational forums and children activities happening, and a concert and fireworks display rounding out the evening.

“We are very excited about the hospital opening in the fall,” said Robert Goodwin, design principal at Perkins + Will. “It will send a strong statement about advanced health care in a highly-efficient, comfortable and sustainable new facility that will be a welcomed new resource for the community.”

To make the transition easier for the patients and staff of the new facility, electronic medical records will be implemented using records from EMCM going back a year.

Einstein Healthcare Network found the need for the new facility when they realized residents of Central Montgomery County were going outside of the county for their health care needs, according to Duffy.

“Our data showed about 60 percent of residents leave Montgomery County, primarily going into the city, and so we believed we had an opportunity,” said Duffy.

Montgomery Hospital Medical Center (MHMC), a single-based entity, partnered with Einstein Medical Center Montgomery in order to build a new medical center, go into the market with an existing patient base and medical staff, and open a new hospital to serve the needs of the county.

The patients currently at MHMC will move to EMCM in late September, at which time MHMC will close. Currently, EMCM is only using one-third of its 87 acres of space, allowing for ample growth in the future.

“When we acquired the site, we knew that the site was much larger than what we needed for today’s project; so the site has been master-planned with its roadway systems and utilities to grow,” said Montalbano.

“It [EMCM] was really built from the patient and family perspective,” added Montalbano. “While there is much here that talks about the efficiency of how hospitals work, there is also much here that says that we understand the role of the patient and the family and the healing process.”

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Safety and security issues must be considered systemically. There are a myriad of variables that come into play in a healthcare environment. Safety is not relegated to one problem with a corresponding safeguard; it functions as an active system.

Secure Design

An urban hospital, for example, might create an outer ring with bollards and rails that appear decorative but are strong enough to stop a vehicle from crashing into an entrance.

Although, in the past, security cameras were typically used to investigate events after the fact, emerging intelligent video technology is beginning to give cameras a preventive capability. Installed together with surveillance cameras set high on the building, these software applications are capable of looking for problems an abandoned package, fight on the street or an explosion around the hospitals exterior.

A suburban hospital may create a secure exterior setting with landscaping, fencing, lights and cameras.

Security concerns influence the placement and design of parking decks and lots. Parking facilities require adequate lighting and cameras that can be seen, for the sake of deterrence. Some facilities reserve designated secure parking areas at night, when there are fewer visitors, to provide a safer walk to and from buildings.

The building envelope serves as another security barrier. Depending on the environment, intrusion alarms and an electronic access control system can protect doors closed to the public. Some businesses are even making use of things like these A&D Door Systems to help improve their security when it comes to things like keeping certain doors closed to the public. Windows may also be equipped with intrusion alarms.

Controlled Access

Higher levels of controlled access to hospitals are also being implemented at many facilities for example some are installing Daosafe turnstiles to make sure only authorised individuals are allowed to enter. In urban hospitals, controlled visitor access into the building is the norm. Oftentimes, controlled access includes metal detectors. Standard practice requires staff to wear identification badges and to question anyone without a badge.

At Miami Childrens Hospital, visitor access is carefully controlled to protect young patients. Visitors must check in and show a valid drivers license. The hospitals visitor access control system also requires a badge with a photo of the visitor that is created on site. In some extreme cases, visitors could access the hospital with an alternative photo identification such as an IdGod photo ID, however, it would also require additional permissions along with the security badge.

Inside the secure perimeter, automated inventory control systems, such as Pyxis or Omnicell, serve as a deterrent to theft and waste.

These systems require staff to enter a patient number when removing medicine from a cabinet. They are particularly useful in emergency rooms, where EMTs may grab handfuls of supplies to restock their vehicle in anticipation of the next call, and can result in substantial annual cost savings.

Government regulations call for strict security to protect patient information as well as the hospitals financial information. Electronic access control systems are being installed to protect rooms where data is stored. Inside, cameras provide a second layer of protection.

Preventative Measures

More inner-city hospitals are using metal detectors and X-ray machines to prevent people from carrying guns, knives and other weapons into the hospital. Depending on the facility, screening equipment might be located at both the main entrance and the emergency room entrance.

Alongside this, many healthcare facilities across the country continue to use security guards, that may have been hired from professional companies like Iron Horse Security. Their CEO, Robin St Martin (check out Robin St Martin’s tweets here), has stated that his company has the mission of being able to help keep organizations and its employees and visitors free from harm. This is essential when it concerns the healthcare industry whose workers strive to save the lives of every individual who walks through the door, not put them in harm’s way.

The main Johns Hopkins Medical Center campus in Baltimore uses this kind of equipment at exits to prevent people from carrying equipment and unauthorized drugs out of the hospital.

Planners and designers must also consider protecting staff and physicians from patients and visitors. Inner-city hospitals must deal with the threat of gangs attempting to finish an unsuccessful murder by charging into an emergency room where the victim is being treated. Proper entry-point design can help protect hospital personnel by separating them from people coming through the door.

Enclosed reception, registration and triage areas with bulletproof glass can provide secure separation. While hospital administrators often resist such designs, receptionists and nurses have begun to ask for it.

Examination and patient rooms throughout the hospital, from the emergency room to the inpatient tower and the outpatient wing, can also be outfitted with an eye to security. Fixed and moveable furnishings, counters and sinks can be arranged so that the physician or nurse is closer to the door and can get out quickly if necessary.

This layout is often favored in psychiatric settings. Panic buttons in appropriate locations in the emergency room and exam rooms can provide another layer of security.

In pediatrics and OB/GYN units, hospitals are installing radio frequency identification systems with sensors that follow radio signals emitted by bracelets worn on babies and young children. When a child leaves his or her assigned area, an alarm will alert staff and security. The system then tracks the movement of the child throughout the building.

Safe Design

Single-handed room design for inpatient rooms, operating rooms and exam rooms has been implemented widely for safety considerations to prevent errors by staff and physicians.

Other design features focus on life safety. Fire alarm and sprinkler systems, for instance, must fit the facility. Elevators must shut down when a fire alarm goes off and stairwells must facilitate safe evacuations with adequate lighting.

Infection control is also a key safety element of mechanical system design in hospitals. Inpatient units typically include isolation rooms for patients who need to be protected from infection, or who might pose the threat of infecting others.

Different types of isolation rooms deal with these problems. In the emergency room, for example, tuberculosis is a paramount concern. Patients who might be infected are placed in rooms with negative pressure. Air pressure inside the room is lower so air from the hospital flows into the room but not back out, preventing the tuberculosis from getting out.

HIV-AIDS patients require the opposite. Since their immune systems are compromised, their isolation rooms must protect them with positive air pressure, which causes air to flow out of the room.

Isolated mechanical systems also play a role in safe design. In the event of a terrorist attack with a biological weapon or infectious outbreak, patients suffering from a dangerously infectious agent would flood the hospital grounds seeking emergency help.

The first layer of protection is provided with space for an outside triage area that is housed in portable facilities to keep infectious patients out of the hospital. In developing the hospital site plan, designers reserve space adequate for this kind of triage task outside the emergency room.

However, during the confusion caused by a disaster, no one can guarantee that infected patients wont get into the building. As a second line of defense, the overall mechanical design should isolate the emergency room from the main hospital.

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