Part I of this article focuses on research and how it affects the impact on hospital design, especially facilities geared towards veterans. One such facility focusing on patient-centered design is the Southeast Louisiana Veterans Health Care System Replacement Medical Center, a VA medical center destroyed when Hurricane Katrina devastated New Orleans. Designed by national architectural firm NBBJ with two local New Orleans firms, Eskew+Dumez+Ripple and Rozas Ward Architects, the new four-story, 1.6 million-square-foot campus, dubbed Project Legacy, now serves more than 70,000 veterans in a 23-parish catchment area and across the Gulf Coast with an anticipated 550,000 annual visits.

Read on to see the other elements of the project that made it a success in achieving patiet-centered design for veterans.

Timing

Planning for the project’s successful delivery began during the pursuit process when Clark/McCarthy Healthcare Partners (CMHP), the joint venture that constructed the project, proposed a phased construction schedule. Turning over the project in segments allowed VA personnel more time to commission, activate and move into their new buildings. In 2014, the project’s first building, the renovated and restored historic Pan-American Life Insurance building, was turned over to the VA for its administrative offices. The remaining eight buildings were turned over upon completion, the most recent being the diagnostic and treatment building in October 2016.

To maintain the client’s target date for medical care, CMHP further phased construction to turn over critical portions of the facility before buildings were fully complete. The team turned over the main computer room in the diagnostic and treatment building 10 months before the remainder of the building to allow VA medical center personnel to expedite the installation and activation of much of the campus’ technology infrastructure.

Construction Collaboration

The City of New Orleans and CMHP worked collaboratively on logistics, infrastructure planning, small business outreach and communications, which included working with the Louisiana Department of Transportation. Maximizing opportunities for small, local, disadvantaged, minority-owned and veteran-owned businesses was a CMHP priority throughout construction.

The team’s phased approach allowed subcontracting packages to be divided into smaller scopes that were more manageable for small firms. A typical project of this size would have between 70 to 90 subcontractors; this effort had nearly three times as many. More than $230 million of contracts were awarded to small businesses. The contracting team further increased opportunity for local businesses by hosting two, six-part training sessions to help educate small businesses on federal contracting and construction best practices. Approximately 50 companies completed this CMU Building Blocks program. CMHP also followed up with hands-on construction training and setting up a mentorship program. The result is that local businesses not only understand procurement, but individual tradesmen have developed a trade in coordination with this job.

The Result

Project Legacy, as this medical center is nicknamed, broke ground in June 2010, began accepting outpatients in December 2016 and is opening in phases throughout 2017. This facility sets new standards for VA’s patient-centered care, in a facility that honors veterans’ service and reflects the culture of New Orleans. The campus includes 200 inpatient beds, 370 outpatient exam rooms, 21 procedural suites, ambulatory clinics, emergency and imaging departments, mental health services, patient education facilities, transitional living and outpatient rehabilitation, a central energy plant and two parking garages. The hospital also features a gymnasium, swimming pool, healing gardens, courtyards, and walking paths. The facility is designed to meet the full array of VA missions — education, research and national emergency preparedness and assistance.

Conclusion

By linking health care construction and design strategies with key desired outcomes, such as reduced health care–associated infections, fewer falls, increased energy savings, better patient satisfaction and increased market share, the discussion at the design table is no longer about the first costs of health care facility design or about meeting immediate facility space needs but about the role of the physical environment in supporting the mission of the organization in providing high-quality care. This is a positive trend that will affect the quality of health care facilities being built in the years to come.

Barbara Wagner is senior vice president with Clark Construction Group – California, based in Irvine, Calif.

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More than $200 billion has been spent over the past decade on U.S. hospital construction. To increase the likelihood of designing facilities that function well for patients and staff, and are cost-effective, hospital administrators and facility planners are drawing on evidence-based design to increase the likelihood that new facilities will generate the expected outcomes. Forward-thinking health care organizations, architectural firms and construction companies know that the built environment plays a key role in treating illness, especially if that environment uses patient-centered design. To that end, many are conducting focus groups with patients and staff with results that greatly influence the design and features of a hospital.

Importance of Research on Design

Research can help facility professionals, architects and hospital administrators make more informed facility decisions. For example, in 2006, researchers at Texas A&M and Georgia Institute of Technology identified more than 600 studies demonstrating the impact of hospital design on outcome measures, including reductions in staff errors and stress as well as the amount of pain experienced and medication required by patients. Their conclusion was two-fold: First, there is more than sufficient evidence from the scientific literature to guide current hospital design; and second, using that information to improve hospital design does have a significant impact upon patient and staff outcomes. However, what may have worked in 2006 to help in the design process is now being taken a step further with the use of focus groups.

Information garnered from facilitated focus groups provides patient input and guides the design of a truly patient-centered facility. In order to best meet the needs of patients, focus groups should be used to identify what is of critical importance to them in the design.

Designing hospitals to be comfortable and accessible benefits more than just patient-satisfaction rates. This approach to design helps make patients partners in their care, and high levels of patient engagement make them more likely to follow up with their doctors, continue their medication and maintain healthy living practices, which also provide quantifiable outcome results. Additionally, this methodology allows hospitals to be designed with maximum adaptability and flexibility in mind, to accommodate changes and provide for future growth. Another benefit for the health care facility is that by listening to both patients and staff and applying their feedback into the design helps in both recruiting and staff retention.

Looking at New Orleans

After Hurricane Katrina devastated New Orleans and destroyed the previous VA medical center there, national architectural firm NBBJ collaborated on the Southeast Louisiana Veterans Health Care System Replacement Medical Center with two local New Orleans firms, Eskew+Dumez+Ripple and Rozas Ward Architects. Together, the team set out to design a new four-story, 1.6 million-square-foot campus to serve more than 70,000 veterans in a 23-parish catchment area and across the Gulf Coast with an anticipated 550,000 annual visits. Building from the ground up gave everyone the opportunity to reimagine what a veterans hospital should be.

To begin figuring out this specialized patient population and its health care needs, the design team engaged experts in other domains, including a quantitative psychologist/industrial designer with a focus in disability studies and a clinical psychologist. The architects and the client also recruited veterans as research participants, including men and women of different age groups and backgrounds, such as homeless veterans, those who lived through the trauma of Hurricane Katrina, 20-somethings who had served in Iraq and Afghanistan, and 80-year-olds who fought in World War II.

Overall, the research effort included more than 100 veterans, 180 VA hospital staff from Louisiana (many of whom are veterans themselves), 70 hours of observation and 600 pages of notes. From these immersive and interactive activities, the design team distilled several major insights that informed the design priorities of the project, which continued through the end of 2011.

Challenges & Unique Construction Requirements

A major challenge was designing the facility to withstand potential future natural disasters. Designed and constructed for maximum resiliency, the medical center can remain fully operational during a major storm or natural disaster. The plan quite literally overturns the conventional organization of hospitals, moving the emergency room and essential utilities above the 20-foot flood line and filling lower levels with less mission-critical features.

The design and construction also had to meet the VA’s antiterrorism security requirements. The shatterproof-glass façade does double-duty by protecting occupants from the impact of an explosion or the 129 mph winds of a Category 3 hurricane. This facility blazes a new trail in terms of how to create a resilient facility and how to integrate that with the VA standards for physical security.

Stay tuned for Part II of this article by Barbara Wagner, senior vice president with Clark Construction Group – California, based in Irvine, Calif.

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WASHINGTON — Ten veterans’ hospitals will soon be saving thousands of dollars annually in electricity costs thanks in part to solar system installations. 

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