Enhanced Healthcare Environments

March 26, 2007
By Carol Tisch

Specialized design elements for healthcare are continuously evolving, even transforming into hospitality-like environments. Physicians at Sentara Heart Hospital sought a ‘wow factor’ and HDR delivered.

Planning Efficiencies

To promote access and wayfinding, outpatient areas at Sentara Heart Hospital are strategically located on the first and second floors. The first level places Cardiac Diagnostics and the Advanced Imaging Center (AIC) directly adjacent to the main lobby. The AIC has a 64-slice CT scanner—providing crisp, digital images of coronary arteries that previously required invasive procedures to view. This level also includes a gift shop, ATM, café, patient education, lending library, conference center, cardiac administration and family lounge.

The second level houses the Cardiac Procedure and Emergency Center, including 45 pre/post procedural daybed rooms, six cardiac catheterization labs, three electrophysiology labs (plus shell space for a future EP lab), and an eight-bed CICU.

The third level features five digital Cardiac Surgery rooms (plus shell space for future ORs), and an adjacent 20-bed CSICU. Placing the CSICU next to Cardiac Surgery minimizes patient travel distances and maximizes functional efficiency.

The fourth and fifth levels accommodate 84 cardiac step-down beds in large, universal patient rooms—providing nursing care flexibility and family involvement space. Shelled space on the fourth level can accommodate 12 cardiac beds in the future.

The sixth level includes offices for cardiac physicians and heart-related services.

The exterior design is sensitive to the architectural proportion in this part of Norfolk and remains true to the scale and theme of the existing campus. This is achieved with a continued expression of the loggia-style open base, brown granite accent walls, buff-colored modular brick, powder gray baked-enamel door frames and trim, and solar gray tinted glass.

The curved façade's base is composed of brick that matches the existing campus buildings. Architecturally finished, concrete-clad columns stand on top of this base, supporting glass walls that appear to float off the face of the building. Above the curved glass walls, medical office space is articulated by a recessed glass wall system—topped off with a projecting clear-anodized, aluminum coping feature.

Healthcare design is rife with an ever-growing number of challenges. Medical technology is advancing with rapid-fire speed; an aging population requires sensitivity to layout, color and pattern; and, within the context of many of the industry's strictest codes, designers are expected to deliver hospitality-like settings.

Omaha-based HDR Architecture Inc. was tasked with all of these variables and more when long-standing client, Sentara Norfolk General Hospital decided to consolidate cardiac services that were spread over five different Physicians at Sentara Heart Hospital sought a 'wow factor' in the front lobby. Knowing it would be a prime opportunity to make a great first impression, HDR designed the lobby to become the building's signature space. buildings into one consumer-friendly, state-of-the-art facility.

Even the site for the new 324,000-square-foot Sentara Heart Hospital posed a challenge. The only real estate available on the sprawling Norfolk medical campus that already houses the Sentara General Hospital was curvilinear in shape, and it was encircled by existing roadways. "Our palette was a radial configuration," says Gary Dubas, vice president and senior project design architect, who converted what might have been considered a physical constraint into a design benefit for patients, doctors and staff.

By shaping the building to conform to its site, HDR was able to provide enhanced patient visibility in the Cardiac Intensive Care and Cardiac Surgery Intensive Care units.

"These are the two most critical units in a hospital; patients require constant, direct surveillance even though they are under all sorts of monitors," explains Dubas. "You can see just a little better with a curved pattern than a linear one and that was an even bigger reason for the radial design."

While the curvilinear format yielded interesting architectural solutions inside and out, Dubas says the project's greatest challenge was to make efficient sense of the diversely located services and bundle them into one center of excellence.

"The cardiac program was scattered hither and yon throughout this complex," recalls Dubas. "And the traffic flow was just horrendous. The patient would have to go through all areas of the campus just to receive a normal treatment protocol."

But providing effective work flow, department adjacencies and efficient traffic flow is the name of the game in healthcare design. What made this project different was that physicians involved in the project came to HDR expecting all the above, plus a customer-friendly environment.

"The physicians came to us in this particular case asking for a 'wow factor' in the front lobby to make a good first impression on patients and their families," explains Dubas.

That mandate, he adds, was delivered in coordination with Paul Findley, director of design development for the interior architecture group in HDR's Omaha office.

Knowing the lobby would be a prime opportunity to make a great first impression, it was designed to become the building's signature space. Flanked by clerestory windows and a two-story cascading water wall, the lobby is calming, welcoming and light-filled. Natural woods and warm-toned colors convey a sense of peace and tranquility in the lobby and throughout the facility.

"It helped having a client that had the vision to want to improve the overall patient and visitor experience," comments Findley. Normally, healthcare clients have to be sold on the value of enhancing public image through design, but Sentara surprised HDR by initiating the request.

HDR complied with a series of innovative design solutions taken from the hospitality model. For example, one of the biggest challenges in hospital design is interior lighting. For the Sentara Heart Hospital, a great deal of thought went into creating lighting that looked more like something typically found in a hospitality environment.

"We tried to eliminate direct or down lighting, especially in areas where patients are on their backs," explains Findley. "Wherever possible we have cove lights shooting up toward the ceiling; we tried to get as far away as possible from the stereotype of a hospital's fluorescent lighting." HDR also deliberately avoided using 2 by 2 and 2 by 4 lay-in ceilings.

"Though we did use Armstrong tiles, you won't find any floating ceilings in the space. We used stepping and drywall, and a lot of detailing to make the ceiling more interesting," he adds.

Findley and his team warmed up the space with the wood tones he says patients and visitors associate with hospitality environments. "In the café, we actually used wood paneling, but in other areas we went to a Wilsonart wood laminate for budgetary reasons. It looks so real, you can't tell the difference."

In the last 10 years, healthcare design has been moving away from sterile environments and toward the hospitality model, according to Findley. "We made a big push to adjacent rather than linear seating at Sentara Heart Hospital," he explains, "and created discussion zones to break up the space and make it more interesting."

Indeed, HDR actually used large-scale tile with insets of carpet to warm up the space, and created the illusion of area rugs with the carpet insets within the lobby seating areas. Some of the floor coverings are patterned, and the motifs are quite soothing. "Hotels can get crazy with pattern and design," says Findley. "In healthcare, patterns are a challenge; when patients are medicated or elderly, color and pattern changes can be a disservice to them."

Amenities that contribute to the wow factor and make this space so unlike a traditional hospital are more than skin deep, according to the design team. "From the onset, Sentara staff and physicians wanted a facility that was truly customer friendly," says Dubas. HDR's design included spaces for storage lockers, refreshment areas, as well as quiet and active areas in waiting rooms.

"Sentara is a totally wireless, paperless facility; patients and visitors have wireless Internet access [for] online education," explains Dubas. The facility even boasts business centers for loved ones' use, guest pagers and plasma TVs.

"First and foremost, Sentara has cutting-edge technology, including 64-slice CT scanner and robotic surgical procedures," says Dubas. The combination of effective treatment, efficient traffic flow, and efficiencies of staff and physician workflow, plus its diagnostic and treatment equipment truly make Sentara a state-of-the-art facility.

From its Main Street gift shop and information kiosk, to a technology wall that explains the latest cardiac tools and technology, to the open and transparent patient corridors, café and lobby, every aspect of the design enhances the patient experience. "Making everything efficient was vital," concludes Dubas, "but once that was resolved, shaking in consumer-friendly aspects made this more of a fun endeavor than the normal functional planning endeavor."

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