The facility features an open entry space, large multipurpose rooms, a dedicated women’s wing and serenity garden, administrative offices and classrooms, a training kitchen, specialized bariatric units and public spaces for social gatherings. During their stay, veterans will receive on-site training and services to help them learn to live on their own. HC+O News spoke with Nicos Katsellis, director of operations for LEO A DALY Los Angeles, about the project and how the team focused on improving the patient experience for veterans.

Q: What was the main goal of the project?

Katsellis: Our main goal was to transform a historic mental health hospital that had fallen into disrepair into a modern, comfortable residence that would support formerly homeless veterans in their transition to civilian life. Rather than create an institution, we strived to create a place of support, positivity, cooperation and dignity. Every design decision served the purpose of creating a home-like place for their rehabilitation.

Q: What were some of the key design elements involved?

Katsellis: Establishing a sense of community was a primary driver throughout the design process. Each floor and building wing is organized as its own neighborhood with social spaces that create a sense of community and familiarity. Park-like areas for socialization were placed at intersections between primary and secondary corridors to give residents casual places to engage in social activity, while comfortable private units give each resident a sense of home and ownership.

During the design process, we met with veteran groups to find out what design elements would make the biggest impact on their comfort and rehabilitation. The resulting talks produced solu-tions that maximize daylight, views to the exterior and efficient configurations, while addressing the veterans’ concerns about safety, stress and motivation. Bathtubs, for example, were specifi-cally requested as well as ceiling fans to supplement the air conditioning. Providing a sense of security for female veterans was also a key consideration, leading to the decision to allocate a secured women’s wing and outdoor healing garden.

Q: How is it different designing for a veteran than a typical health care resident?

Katsellis: Our approach to design has elements of the Trauma Informed Care (TIC) model, which is an organizational structure and treatment framework that involves understanding, recognizing and responding to the effects of trauma. At its core, TIC mandates that treatment should occur in an environment of physical and emotional safety, and in a way that values the “voice” and self-determination of the individual. Building 209 uses architecture, space planning, lighting and interior design to reinforce the residents’ sense of physical and emotional security and indi-viduality.

Building 209’s dwellings are warm, inviting and rehabilitative “cocoons” complete with living, sleeping, cooking and dining accommodations, and small, intimately scaled socialization spaces of their own. [The rooms] are oriented in a way that allows them to be flooded with daylight from multiple directions and are dressed in durable and sustainable materials inspired by nature.
Moreover, the design process was inclusive. By meeting with veterans groups and giving them a voice in the decision-making process, we ensured that the identity and needs of veterans were heard and felt in the final design.

Q: What were some of the biggest challenges on the project, and how did the team overcome those challenges?

Katsellis: Two goals of this project were historic preservation and LEED certification, each of which is a challenge. Combined together, the challenge is even greater but through thoughtful design, we managed to surpass the LEED Silver target and achieve LEED Gold.

Because of Building 209’s place on the National Register of Historic Places, modifications to the building’s exterior envelope were off limits. So, to reach sustainable solutions, we dug deeper in other areas such as window glazing, the materials used and the building’s mechanical systems, which have all been replaced with highly efficient systems. Building 209’s original steel window sashes were carefully removed from their frames, abated from lead paint and rehabilitated on site with glazing added for increased energy efficiency.

Replacing the building’s mechanical systems posed a challenge, given the difficulty of coring through the concrete structure and relatively limited floor-to-floor height. In order to accommo-date the new, super-efficient HVAC system while maximizing ceiling heights, the air-handling units were installed in the attic. A series of vertical shafts supply air to the spaces below to min-imize the horizontal runs of ductwork that would otherwise restrict ceiling heights.

Q: How was this project different than ones you’ve completed in the past?

Katsellis: This project is unique because it utilizes an emerging model of homeless intervention called Permanent Supportive Housing. Rather than providing temporary shelter, Permanent Sup-portive Housing gives the resident a permanent address, a sense of home and a strong foundation on which to build the skills necessary to transform their lives.

Our firm has completed one other such project — the La Casa supportive housing project in Washington, D.C. — that recently received a national housing award from the American Institute of Architects. We’re also currently designing two sister facilities to Building 209. Buildings 205 and 208, which form a quad with Building 209, are currently undergoing transformations based on this model. When complete, this historic campus in Los Angeles will be much better equipped to meet the needs of veterans.

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The project was designed by Leo A Daly and constructed by McCarthy Building Companies. Both firms hold offices in Atlanta.

The $24 million, 65,000-square-foot Liberty Wing is the first of two phases with a total cost of $74 million. The first floor of the new wing houses physical therapy, occupational therapy, orthopedics and podiatry programs. Behavioral medicine and social work services occupy the second floor. Phase I also includes an expansion to the facility’s central utility plant.

“Our work on this project is particularly rewarding because it’s helping soldiers and their families,” said Michael Svoboda, vice president and manager of the project for Leo A Daly, in a statement. “And with its evidence-based-design and additions, this facility will continue to do so for the next 50 years.”

The additions to the hospital will seek LEED Silver certification and extend services to approximately 40,000 soldiers and active duty family members based at Fort Stewart. Due to Base Realignment and Closure and Grow the Army initiatives, the hospital is also expected to see an increase of 15,000 patients.

The name for Liberty Wing was chosen from an organization-wide naming contest. It was chosen from dozens of submissions because it speaks to multiple missions of the new wing.

“On the first floor, we are restoring physical liberty and the freedom of movement in our physical therapy and orthopedics sections. However, physical limitations are not the only challenges our soldiers and their family members face,” said Col. Kirk Eggleston, Fort Stewart Medical Department activity commander, in a statement. “The entire second floor is behavioral medicine and family therapy, where our dedicated professionals strive each day to liberate people from the bonds of depression, anxiety and PTSD.”

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Landscaped courtyards throughout the hospital will provide a calming and relaxing space for healing, while a new central atrium takes in natural lighting from the clerestory windows above and through the north-facing glass wall for the main interior walkway.

“One of the key commitments we make to our soldiers and our families is that we’re going to take care of you,” said Brig. Gen. Pete L. Jones, Third Infantry Division deputy commanding general for support, in a statement. “Nowhere is that more apparent than at the hospital. Whether it’s our wounded warriors who come here to be treated and healed, a young child who breaks their arm playing football or a soldier who redeploys with questions about behavioral health, as you walk into this hospital, you see that commitment and that next level of care that we promised our soldiers, our families and our veterans.”

Sustainable design features at the clinic include vegetative and highly reflective roofs, recycled materials, energy-efficient building systems and stormwater reduction systems.

Phase II of the project, which broke ground in March 2013, includes the construction of a two-story, 43,600-sqaure-foot addition that will include a new emergency department on the first level and administrative services on the second level. The phase also includes 55,000 square feet of renovations to family medicine, internal medicine, pathology, pharmacy, patient records, urology, nutritional care, security, business and legal offices and conference center.

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LEO A DALY, with offices in Atlanta, served as the architect on the 21,000-square-foot project. The renovations consisted of a new eight-bed admission and recovery area, which provides clear sightlines from the nursing stations, as well as support areas and storage rooms. A new catheterization lab primarily used for electrophysiology procedures was also incorporated into the project, as well as a larger stress-testing lab with two stretcher bays, two treadmill stations, a comfortable waiting room for families and five physician offices.

The enhancement allows the cardiac center to provide more services to patients. “The electrophysiology lab will allow us to perform procedures that we were previously unable to do at Grady. For example, through a technique called Ablation, we will use wires to go into a patient’s heart to fix a rhythm disturbance by creating a series of burns inside the heart,” said Dr. Allen Dollar, Grady’s chief of cardiology and assistant professor of medicine, Division of Cardiology, Emory University School of Medicine. “This is just one of the many new procedures we will be able to do thanks to the new Correll Center.”

Former Georgia Pacific Chairman and CEO Pete Correll, his wife, Ada Lee, and their friends helped fund the $5.4 million project.

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Leo A Daly served as the design architect and engineer, partnering with Abu Dhabi-based AE7, which served as the architect and engineer of record.

The facility’s design was inspired by the canyons scattered throughout the lowlands of the regional landscape. The campus buildings mimic the curvature of the canyon walls, while roadways and paths wind in the same way that mountain floods carve rock formations within the canyons. The hospital building is also specifically located at the high point of the site, which represents a location for nurturing and healing in several cultures.

The design team is using advanced building information modeling techniques to enhance coordination, visually represent data, program the geometry of the buildings, perform daylighting analysis, create building material models, and select locations for mechanical and electrical systems.

The new hospital replaces a 45-year-old facility in downtown Abu Dhabi. Scheduled for completion in 2016, Zayed Military Hospital will serve as a teaching hospital that focuses on specialties such as cardiology, orthopedics, pediatrics and burn care. It will support and share services with Maliha Military Hospital, which is also under construction and anticipated to open in 2014.

Future expansions to the Zayed Military Hospital will include additional residential accommodations, parking structures, a separate utility plant, a hotel for patient visitors, rehabilitation and long-term care facilities, and on-site recreational facilities.

This Leo A Daly’s largest-ever international health care project.

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For both phases, Leo A Daly is providing planning, programming, architectural, engineering and interior design services, while McCarthy Building Companies Inc. is the general contractor. Both have offices in Atlanta.

Winn Army Community Hospital provides services to about 40,000 beneficiaries. However, with an estimated population increase of nearly 15,000 active-duty soldiers and active duty family members — due to a round of Base Realignment and Closure and Grow the Army initiatives — the hospital needed the new additions and alterations to be able to provide enough services to meet future demands.

Phase I, anticipated for completion in 2014, includes a new two-story 65,000-square-foot medical clinic that will house physical and occupational therapy, orthopedic services and behavioral health services. It also includes an upgrade and addition of the hospital’s central utility plant.

The medical clinic addition continues the design concept of the current central corridor, which Mike Svoboda, vice president for Leo A Daly, calls “the spine,” and enhances it with a two-story atrium, grand staircase and a water feature. Plus, there are new courtyards between the medical clinic addition and existing buildings that were added for therapeutic value. In fact, occupational therapy patients will be able to use the courtyards for gardening or active therapy or for outdoor exercise. The exterior façade of the new addition mimics the precast concrete structure that’s already in place, and modernize the look by utilizing metal sun shades and metal column covers.

Phase II of the project features a 43,600-square-foot addition to the hospital, plus 55,000 square feet of renovations. Included in the addition is a new emergency department and relocated service offices. The emergency department building features a green vegetated roof and a large, two-story contemporary glazing system facing the courtyard. Plus, a new dining area will be built adjacent to the existing kitchen, which will be fully renovated with a new serving area. The existing hospital will have 55,000-square-foot of hospital space renovated to support family medicine, internal medicine, pathology, pharmacy, security, nutritional care and legal offices. Phase II is estimated to be complete in 2016.

Because it is a government project, there are several parties involved — the USACE-Savannah District, Health Facilities Planning Agency and U.S. Army Medical Command, to name a few — when it comes to decision making. It’s a design-bid-build project, so both Leo A Daly and McCarthy have contracts with the government, which means if they want to make changes they need approval from the government instead of speaking directly to each other to solve a problem. That and the 50-step project phasing process have slowed down the project’s schedule and added additional costs.

“Working with the military means that the number of people involved is dramatically increased and the paperwork is more extreme,” Svoboda said. “Plus, there are different procedures you have to follow.”

Apart from having to keep up with communication among all involved parties, the unforeseen conditions have also posed a problem, according to Svoboda. In this particular project, the construction team found site utilities that were not known, which has also added time delays and additional costs.

“That part has been very dramatic on this particular project,” Svoboda said. “There were a number of buildings that were demolished as part of the site work and there was no documentation for all the underground utilities. We did do some exploratory borings for underground utilities to do the best we could to find them, but the site is so expansive that you couldn’t do that.”

Because of the complexity of the project, Svoboda recommends that other architects doing a project of this kind use experienced staff. “You really want dedicated and experienced staff so that when people start this project they do it from the beginning and they go all the way to the end,” he said. “We call it cradle-to-grave services. In doing that, you can really control the quality of the project and can get answers back quickly to the contractors. There are always going to be issues, but if the people you’re using are experienced, they can answer questions quickly and keep construction rolling.”
 

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