Magazine October 2018

Careful Construction

careful

By Chris Price

Aesthetics and amenities have become major considerations when building, expanding health care facilities.

A quick look around Arkansas shows the medical landscape is rapidly changing. Health care organizations are in increased competition for patients and their money. As a result, the treatments they provide and how the treatments are delivered have adapted to better fit a customer service model and will continue to do so.

“Patient centered” is the hot buzzword in the contemporary health care industry, so much so that it is not just used to describe how medicine is practiced, but where it is practiced, as well. Technology has not only changed how medical care is delivered, it has also improved outcomes. For instance, smaller instruments and tools have decreased the size of surgical access sites, which has reduced the amount of time a patient needs to recover. That, in turn, has shifted how space and design are used within medical facilities. Combined with increased competition among health care providers to attract patients to their facilities, modern hospitals are taking a different approach to design that has dramatically changed their architecture and appearance in almost every facet, inside and out.

Hospital Design & Planning

Modern hospital design and planning has been changed from the ground up. Gone is a sensory-sterile environment. Today, the design and construction of hospitals and health care facilities focuses on using layout, design and decor to aid in not only bringing in patients, but also improving outcomes.

“Not only has health care changed a great deal in recent years, but how it is delivered has changed at least as much, if not more,” says William Clark, CEO of Clark Contractors, which has worked on a number of hospital projects including CHI St. Vincent and University of Arkansas for Medical Sciences (UAMS) in Little Rock, White River Medical Center in Batesville and the brand-new campus for Arkansas Heart Hospital in Bryant. “Health care providers are constantly working to be more efficient, patient-centric and budget driven, which wasn’t always the case. With the incredible advances in technology, health care facilities require a different approach to design that has really changed the architecture of what a traditional hospital looks like now.”

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Hospital planning has become much more targeted. It begins with a market study of a particular hospital’s market demographics, health trends, competitive landscape, physician mix and reimbursement levels. Analysis of these and other data points help hospital executives determine the service lines, case mix and volumes that best serve the needs of the community. Once the business model is established, design begins. Designers develop the space using industry trends and American Hospital Association Facilities Design Guidelines to program the types of clinical and non-clinical spaces as well as equipment and furnishings necessary to efficiently deliver the hospital’s intended service lines, says Mark Beach, vice president and Chief Operating Officer of CDI Contractors, the firm that built the Baptist Medical Center in Conway, alongside Bernhard TME, and is currently working with Washington Regional Medical Center in Fayetteville to expand its diagnostic, surgical and inpatient neurological services and improve the patient experience and access to those services.

“Construction managers like CDI are brought on early in the design process to aid the designers and hospital operators by providing cost and schedule information along the way. This early engagement ensures that the final design and its costs align with the business model,” Beach explains.

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Arkansas Children’s Hospital Northwest, opened earlier this year, is a testament to modern designs in health care construction.

Charley Penix, CEO of Cromwell Architects Engineers, which has designed hospital projects across the state, including Arkansas Children’s Hospital, CHI St. Vincent Infirmary Medical Center and Arkansas Heart Hospital in Little Rock, Conway Regional Medical Center, White River Medical Center in Batesville, Arkansas Methodist Medical Center in Paragould and Baxter Regional Medical Center in Mountain Home, says there are generally three big-picture goals when designing modern healthcare facilities: user friendliness for patients and families, spaces that promote collaborative processes for staff and maximum flexibility in the use of space.

In addition to larger, general facilities, there has been an increase in the number of specialty and ambulatory surgery centers being built as specialists, like orthopedists and urologists, have begun to practice in their own facilities instead of operating in a traditional hospital, Clark says.

Special Considerations

While all buildings are constructed using the same basic materials — concrete, steel, glass, drywall, flooring — hospitals and healthcare facilities are under much stricter governmental regulations and must adhere to a higher degree of building and safety codes than most buildings.

From a technical standpoint, hospital constructors must never lose focus on three major things: building systems, medical equipment and life safety.

“Hospitals operate 24/7/365 and are among the most complex institutional buildings in most cities,” Beach says. “The unique thing about the life safety strategy in a hospital is the concept of ‘defend in place.’ While most commercial buildings are designed to quickly and safely evacuate occupants in the event of an emergency, hospitals can’t take that as a primary approach because many patients are non-ambulatory.”

Paul T. Gregory, principal at Polk Stanley Wilcox Architects, which has worked on several hospital projects, including expansions and remodeling projects at UAMS, Children’s Hospital Northwest, Baptist Health, Mercy Health Orthopedic Hospital in Fort Smith and Johnson Regional Medical Center in Clarksville, says the codes divide each floor into multiple compartments that can be protected from fire and smoke for several hours.

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“When combined with sprinklers and structural protections, this building type is very safe,” he says.

With high-tech equipment that requires much more electrical power than most buildings and temperature and humidity control that must constantly remain within very tight parameters, mechanical and electrical design for a healthcare facility is much more complicated now than ever before, Clark says.

To ensure patient and staff safety, hospital buildings are designed with redundant systems to alert doctors and nurses of a life-threatening situation and neutralize the threat. Fire- and smoke-resistive construction materials as well as systems that detect and control the migration of smoke and fire are key elements of hospital construction. Hospitals must also have a reliable source of electricity even when the local utility is down. That means backup generators must be part of the plan to provide emergency power during a utility outage.

A major concern in modern health care facilities is infection control. Modern regulations mandate the separation of clean and dirty areas for items, including instruments and linens, handwashing sink locations, ventilation and how many times per hour the inside air is refreshed.

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Mercy Orthopedic Hospital in Fort Smith was designed by Polk Stanley Wilcox Architects to cater specifically to patients. Photo Courtesy of Polk Stanley Wilcox Architects.

Let There Be Light

Numerous studies have shown that sunlight improves worker productivity, general health, sense of well-being and recovery

from a medical procedure or ailment. Hospitals are incorporating its use whenever and wherever possible. Natural light in the clinical environment helps patients and staff maintain their circadian rhythm, which promotes rest and better healing. That’s why glass is such a major element in building construction. It also explains why outdoor elements, including courtyards and healing gardens with landscaped views and water features are being implemented in design.

Wow Factor

The vast majority of new hospital and healthcare facilities are stunningly beautiful. Glass and steel have replaced bricks and mortar, giving the exterior of these buildings a much more aesthetically pleasing look than traditional hospitals. Comfort and confidence play a significant role in a patient’s outlook, and hospitals that are aesthetically pleasing communicate a sense of value to a patient. As such, interior design is now considered an element in assisting the delivery of care and aiding patients’ healing and recovery.

“Studies indicate that a patient entering a health care facility begins forming a judgment about the overall quality of the facility within 15 to 20 seconds of entering it,” Beach says. “A visually pleasing environment improves confidence, and confidence reduces stress. Hospitalization, by its nature, is a stressful experience. Designing, building and maintaining facilities that are comfortable and pleasant to be in is one of the many important elements of a successful outcome.”

The look and feel of a hospital may well determine if a patient chooses to be cared for there.

“Many patients have options when choosing where to receive health care. One of the drivers of how a hospital is perceived by a patient is how the building makes them feel when they’re inside,” Clark says. “Architects have really given a lot of thought to how a patient will experience the building in addition to the health care they receive, and they’ve really done a great job taking the ‘institution’ out of ‘health care institution.’ Today’s hospitals look and feel like something totally different “Family waiting rooms are more comfortable and inviting, food and beverage options are much more appealing and it’s very common to see true art on the walls in public spaces.”

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