Almost four months after its opening on April 18, the new Federico F. Peña Southwest Family Health Center hums with activity. Medical Director Dr. Michael Russum said, “The patients are really impressed with it — the newness, the grandness of some of the interior spaces. Many of them say that it looks much bigger inside than how it looks on the outside. I know our staff feels grateful to work in such a nice facility.”

Several years ago, a community needs assessment revealed that the South Federal neighborhood of Denver suffered from a severe lack of health care resources and had one of the largest populations of uninsured and under-insured citizens in the city. This assessment led Denver Health to launch the design and planning of the new Federico Peña Southwest Family Health Center in 2014. Like the eight other Denver Health community health centers, the Peña Southwest Family Health Center offers a full range of primary care services and is the first urgent care outside of the main hospital campus.

According to Dr. Russum, all of the clinics with primary care have the goal of establishing a family doctor or primary care doctor to follow the patient and their extended family throughout their life. “That’s the core of the medical home model,” Dr. Russum said.

The Peña Southwest Family Health Center offers a full range of services including primary care, women’s services (WIC), pediatrics, pharmacy, dental and vision care, laboratory, radiology, insurance enrollment and integrative behavioral health.

Denver Health searched for a team of designers for the clinic that aligned with their commitment to supporting the communities they serve. RTA Architects was chosen as architect of record because of the firm’s client-centric principles and expertise in health care, education and community-based projects.

The design portion of the process began with an immersion phase in which the RTA design team shadowed current Denver Health staff at the Westside Community Health Center for several days in order to understand the clinic’s processes and user needs. The design team also toured three other existing community health centers, including Montbello, Park Hill and Lowry. Next, the team held a weeklong Lean 3P (Production, Preparation, Process) event with RTA and a multi-disciplinary Denver Health team working together to rapidly create and test potential designs. Jessica Massie, interior designer at RTA, said, “Traditionally, we talk to user groups individually and then try to mesh together all of their needs and desires into a design. This time, all of the departments came together, and we were able to massage things to work congruently. Everyone saw what decisions were being made and why.”

Design elements of the Peña Southwest Family Health Center include a large interactive children’s play zone, expansive atriums and lobbies for large community gatherings, and a multi-purpose conference room, which can be used for patient, staff and community activities. Universal signage and intuitive wayfinding allows multilingual patients to easily navigate their way through the facility. With high-quality finishes and design touches such as warm wood, slate tiles, expansive skylights and vaulted ceilings, the Peña Southwest Family Health Center evokes a warm, inviting atmosphere for families. Departments that need to be most accessible to the community, like urgent care, pharmacy and dental services, are all located near the entrance of the building.

Kevin Gould, principal and project manager at RTA said, “The experience to assist the entire Denver Health team to deliver the ninth community health center has been remarkable. DHHA and RTA’s values are closely aligned and allowed the team to achieve mutual goals; a clinic that serves individual patients, whole families and the entire community.”

Project Team
Owner: Denver Health and Hospital Authority
Architects: RTA Architects, Colorado Springs, Colo.
General Contractor: Hensel-Phelps, Denver

Sue Rose is the owner of Sue Rose PR, and founder of Construction Writers Collaborative in Denver.

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The success of the Craig Hospital expansion is the result of the deep collaboration that took place early in the design process between Architect of Record RTA Architects based in Colorado Springs, Colo., and partner firm SmithGroupJJR, with offices nationwide, as well as general contractor GE Johnson, with offices in Denver, and hospital rehabilitation staff. The team united to resolve an extremely complex problem: how to build a new facility in and around an occupied traumatic brain injury (TBI) and spinal cord injuries (SCI) rehabilitation hospital with minimal disruption to patients and staff.

A critical starting point of the process was to pull in experts from all disciplines and break the enormous project into 22 phases. The planning phase took a full year, which began with a week of immersion at Craig Hospital by the design team. Using an integrated project approach with the general contractor, the team co-located at the Craig Hospital campus during concept and pre-schematic design to build the project plan, design and budget. The project team continues to meet on a routine basis at the on-site project trailers to provide a collaborative environment through to the completion of the project.

This theme of collaboration now extends throughout the entire facility. The new staff workstations are designed to encourage a team-oriented environment for therapists, doctors and nurses. Cozy bistros are located on each patient level of the hospital, offering space for families and staff to share meals with patients. Patient hallways are flared to widen at the north end to create family and patient sitting areas while accommodating expansive windows that stream natural daylight into and down the length of the hallway.

The details and finishes of the new Craig Hospital reflect the thoughtfulness and collaborative nature of the design process. The building is incredibly aesthetic with sand-colored walls that feature thematic nature-based artwork, and sound absorptive rubber flooring and acoustical ceiling tiles that create a tranquil serene atmosphere for patients. Even the lighting is designed to bathe the walls with warm, indirect light so that patients in wheelchairs don’t have the harsh experience of looking up into glaring ceiling lights.

Because the needs of TBI patients differ from those who have sustained SCIs the two groups have been placed on separate levels of the hospital. The top floor (level four) houses SCI patients and their brightly colored, active therapy gym. TBI patients are on level three, a quieter floor with a more tranquil gym. According to RTA Architects’ Paul Reu, all of the 52 beds are occupied, and the hospital maintains a waiting list.

Outside the front entrance, the architects designed a sensory garden, complete with wheelchair paths and raised plant containers positioned precisely at the height of a patient seated in a wheelchair so they are able to touch and smell the growing foliage. Water features provide an inviting node and add serene sounds to stimulate auditory development. The chapel — which is nearly complete — features a cork floor and pristine white stone accent wall with recessed shelves that can be adorned with items from any faith.

Craig’s PEAK Community Outpatient Rehabilitation Center has doubled in size with technology being the feature of this space. The floor of the therapy pool functions as an automated lift so that clients and patients in wheelchairs can be lowered into the pool, eliminating the need for a separate transfer lift.

Although the Craig Hospital footprint has expanded from 135,000 to 220,000 square feet, the patient capacity remains the same because the new facility now offers private suites with ample space for family to visit and confer with physicians and the rehabilitation team. Reu explained that the only pieces remaining to be completed are Craig’s outpatient clinic, outpatient therapy center, resident doctor’s office, and kitchen and servery renovations at the main cafeteria.

Sue Rose is the principal at Construction Writers Collaborative and owner of Sue Rose PR, based in Denver.

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The $73 million capital campaign, which was quietly launched in the fall of 2010 and announced publicly in May 2013, will help finance an expansion project that will expand the facility from 135,000 square feet to 220,000 square feet. The Craig Hospital Foundation was able to fund the expansion through former patients and donors. Mary Feller, executive director of the Craig Hospital Foundation, said that once the hospital let people know that they needed help financing the project it wasn’t difficult to get donations, according to BusinessDen. Through the generous giving, the hospital was able to surpass its previous donation goal of $68 million.

Construction on the new facility began in August 2014 and will remodel the entire hospital, according to BusinessDen. Among the changes to the hospital will be the addition of a fourth floor to the current facility as well as a new annex called the Peak Wellness Center. The wellness center will include bicycles that use an electrical current, which will help paralyzed patients during their rehabilitation.

Another key feature in the remodel is the addition of private rooms. Since the hospital is a rehabilitation center, many of the patients are in the hospital for months at a time and are having to share a room, according to Feller. Congestion in the rooms also became a concern during visitation hours. The shared rooms were hard on both patients and the families, who would prefer privacy for their recovering loved ones.

Craig Hospital, which is among the top 10 rehabilitation hospitals in the U.S., will spend $50 million of the campaign funding on construction and $23 million on financial aid programs for patients. The total cost of construction is $90 million, but the hospital will be funding the last $40 million through debt financing and cash reserves, according to BusinessDen. Colorado Springs, Colo.-based RTA Architects designed the hospital, and the general contractor was G.E. Johnson, also based in Colorado Springs.
 

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The project consists of approximately 85,000 square feet of new space, and approximately 135,000 square feet of existing space of renovation. The expansion will double the size of Craig’s outpatient clinic, including a new, state-of-the-art aquatic therapy pool and 52 new private rooms.

Craig has treated more spinal cord injury patients than any other single facility in the world, and has been rated in the Top Ten Rehab Hospitals by US News & World Report for 24 years. It’s remarkable given the antiquated environment staff has worked in since the hospital moved into the West Building in 1970. Sixteen months into the expansion and renovation’s five-year timeline, the site, foundation and updated utilities are complete; Clarkson Street is closed to allow for safe pedestrian and wheelchair access and the long-awaited unification of the campus buildings; and steel is now being erected. Projected completion is late 2016.

RTA Architects, serving as architect of record, partnered with design architect SmithGroupJJR and GE Johnson Construction to resolve an extremely complex problem: How do you build a new facility on top of and inside an operating brain and spinal cord injury rehabilitation hospital without losing beds or disrupting patients?

The answer, according to Randy Thorne, AIA, RTA’s principal in charge, was to pull in experts from all disciplines and break the enormous project into 22 pieces. “The planning process took a full year,” explained Thorne. “That began with a week of full immersion at Craig by the architectural team.” Working in an integrated project approach with GE Johnson Construction, the team co-located to the Craig Hospital campus during concept and pre-schematic design to build the project plan, design, and budget.

When first interested in the prospect of the Craig Hospital project, RTA Architects went straight to the nation’s top-designed brain and spinal cord hospitals to learn what few people know about the needs of this small population of patients. Thorne explained, “We discovered that the National Intrepid Center of Excellence in Bethesda, Maryland’s National Military Medical Center, the VA San Antonio Polytrauma and the Center for the Intrepid were each outstanding facilities designed for brain and spinal cord injured patients and all three had been designed by SmithGroupJJR. Because their expertise was staring right back at us, we decided they needed to be on our team. RTA is always reaching out to find specialists who will serve our clients. Our egos don’t stand in the way of what’s best for them.”

According to Thorne, every building ought to take on the character of its owner and occupants — not of the architect. “Some firms forget this and I think it’s a disservice. We knew right up front that the only way we would be able to fully understand the character and the needs of Craig Hospital would be to watch the interaction between Craig staff and patients.” Thorne and SmithGroupJJR’s Brenna Costello spent an entire week in full immersion at Craig.

“You go there and there’s a certain aura, a certain patient-staff relationship, that you can’t capture in a white paper. You have to experience it. There’s a Craig way. The only way we could get that at the beginning of the project, when you need to start the design process, was immersion,” Thorne said.

Seventeen months into the project, the architectural team as well as the contractors understand the Craig way. “But we needed to know their culture one month in as it was imperative to initiate the design concepts,” explains Thorne. “That immersion week was really key. We watched the interactions between staff and patients, the smiles on their faces, the concern with family members’ comfort and that they were getting the right information. We saw them brief a family and a patient in a room with six or seven professionals.”

From a design perspective, brain and spinal cord rehabilitation presents its unique challenges. The RTA/SmithGroupJJR team found that, even though you can design simple “fixes” for patients in wheelchairs, Craig’s rehabilitation staff feels it’s almost pandering to provide amenities that graduates won’t find in the real world.

Once graduates of the Craig program leave, they’ll have to cope with round door knobs, ill-fitted bathrooms, curbs, thresholds and the like. “All of these aspects of reality are present in our design for the new Craig Hospital facility,” Thorne adds.

Thorne admits the architectural team found the immersion experience humbling. “When we pulled a nurse or therapist aside and asked what they needed in a new work space, we’d get a response like, ‘I’ve got plenty of room…I don’t need a window,’ and that’s a staff member working out of a five foot by seven foot closet. They’re always focused on helping the patient. These wonderful conversations we had were consistent across all departments at Craig. We had to drag these people out of their makeshift office spaces to fully understand what was important for the end users of the new building.

“Full immersion, and bringing on SmithGroupJJR, with their expertise specific to designing for brain and spinal cord injured patients, allowed us to get right into the most important part of the project, which is this complicated task of building a new hospital around the people who operate here daily and not interrupting them. At the same time, we needed to create a design that would improve the operational environment for all who will use the hospital — patients, families, nurses, doctors, therapists and other staff,” Thorne explained.

After decades of working with patients two or three to a room, the new facility will offer 52 new private rooms in order to allow all 93 beds to occupy a private room. This allows for more privacy for family interaction and conversations with physicians and the rehabilitation team, full environmental controls and adaptable stimulus environments for TBI and SCI patients. It also will provide much-needed space for The PEAK Center at Craig Hospital, which houses wellness and fitness member programs and state-of-the-art fitness equipment for inpatients, outpatients and community members with neurological disabilities. To date, approximately 170 community members are members of The PEAK Center at Craig Hospital.

Paul Reu, RTA’s project manager, feels the closing of Clarkson Street was one of the most rewarding aspects of the first phase of the project. “Seeing the celebration the Craig staff had, literally turning Clarkson Street into a picnic area with music and dancing, wheeling patients around in the safety of the newly-barricaded street, added to our understanding of the importance of every design decision we made,” Reu explained. The old Clarkson Street will become the new cul-de-sac main entrance and accessible front garden area, Reu added.

According to Reu, the closure of Clarkson Street required multiple phases to achieve the final plaza design while maintaining access to the building entrance and the neighboring East Building entrance. Construction of the Craig Hospital addition and renovations while the facility remains fully occupied adds another level of complexity, making the team approach all the more vital to the project’s success. Five major phases are planned with an additional seven sub phases to allow for the construction of the superstructure and interior renovations within the occupied hospital.

GE Johnson utilized their dedicated Systems Integration Group, and their health care
preconstruction team to develop a target design and cost model that achieved the desired program while marrying the extraordinarily complex phasing challenges.

“GE Johnson is incredible at scheduling and we needed scheduling wizardry. But even more importantly, they were 100 percent invested from the first day of the project,” Thorne said. “To have a contractor on your team that is wholeheartedly in the project from day one while you’re designing, developing solutions that aid the design process and helping you help the client get the best value for their dollar is a gift. This has not been the industry norm. Often, the architect-contractor relationship doesn’t operate this smoothly.”

GE Johnson even developed a website dedicated for Craig staff, patients and end users to communicate logistics and daily construction activities weeks in advance to engage input from stakeholders into the design and construction process.

“The fact that this enormous undertaking is paid for by fundraising added another dimension for the architectural and construction team. “Every dollar is just holy to these people,” Thorne said. “Each person on our team understands this and focuses on solid design and construction decisions. With RTA, SmithGroupJJR and GE Johnson we’ve got a collective of professionals who are all fully invested in Craig’s goals. Without that kind of collaboration this project would not be unique to Craig and not reflective of the Craig way.”

When asked what is most compelling about the project, Craig’s President and CEO Mike Fordyce answered, “The deep collaboration going on here is remarkable. RTA Architects, SmithGroupJJR, and GE Johnson Construction are responsive to our patient needs to the point of appointing one of GE Johnson’s superintendents to be the staff/patient liaison. She is on call 24/7 for three years, to ensure no activity will impact patient comfort. Shutting down drilling for three hours to accommodate one patient’s need to nap and be relocated to a quieter room is one example of their level of commitment to the Craig philosophy of patient-centered care. For us, it’s the dream team we needed to carry out such an important community project.”

The hospital is funding $40 million of the project through cash reserves and the sale of bonds. The Craig Hospital Foundation is raising $50 million through its “Redefining Return On Investment (ROI)” capital campaign. The hospital has a remaining $17.5 million to fundraise.

Stuart Coppedge, AIA, LEED AP, is a principal with RTA Architects, a Colorado Springs, Colo., architecture, interiors, and planning firm serving primarily health care, K-12, and retail clients. Stuart enjoys a multifaceted practice, engaging with multiple client types and leading the firm’s business development efforts. He also is a member of the national board of directors of the American Institute of Architects.

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