| PROJECT NAME / Community Hospital North Patient Tower LOCATION / Indianapolis OWNER / Community Health Network TOTAL FLOOR AREA / 400,000-square-foot patient tower plus nearly 600,000 square feet in additional construction and renovation NUMBER OF FLOORS / Six, plus a basement and penthouse NUMBER OF BEDS / 166 (60 LDRP, 36 NICU, 22 pediatric, 48 general med-surg) PROJECT COST / $200 million (includes patient tower, five-story professional office building, six-level parking structure and renovation of 135,000 square feet of the existing hospital) CONSTRUCTION COST / $156 million GROUNDBREAKING / November 2004 OPENING / April 2007 |
When it comes to hospital design, architect John Castorina, AIA, refuses to be boxed in. “Most people think health care comes in boxes—it’s either square or rectangle,” he says. “I happen to believe that functions lead to unique forms and shapes. When you start defining the function, you will be surprised at some of the forms and shapes that come out.”
This philosophy is apparent in the design of the patient tower that opened this spring at Community Hospital North in Indianapolis. Castorina, a vice president at the Dallas office of architecture firm RTKL Associates Inc., led the design of the building, which includes such unique forms and shapes as curved corridors, football-shaped patient units and a bowed front. The design was based on careful study of who will use the health care facility and how they will use it.
Community Hospital North is part of Community Health Network, a not-for-profit health system based in Indianapolis. The health system celebrated its 50th anniversary during the patient tower project. “We marketed this as the next evolution of Community Hospital North,” says Mark Hayden, Community Health Network senior project manager. “We really mean that. Every project we do is a synthesis of what we know is happening at other institutions and what we’ve experienced over the last 50 years to move to the next level of better performance for our patients.”
The project included a five-story medical office building that connects to the hospital on every level, a six-level parking structure and the six-story patient tower. The 400,000-square-foot tower more than doubled the size of the hospital, providing room for additional bed capacity and new amenities like private rooms for all patients, even those in the neonatal intensive care unit.
Form follows function
The building’s design began with an examination of how people and materials would move through it. “First of all, we analyze circulation patterns because that’s the lifeline of any hospital,” Castorina says. The architects considered how to improve patient and visitor access; segregate patient, family and staff activities; and quickly and quietly distribute meals, medications and supplies. “That’s the hardest part, to make a very complex system simple,” he adds.
Castorina believes health care design requires this type of analysis. “We deal with a very complex building, and we deal with systems that are just unbelievable,” he says. “Technology in health care changes every three months and legislation changes every six months, so you always have to do something different. What happens is, we lose the ability to see the obvious.”
One obvious point that is often overlooked, Castorina says, is that the one-point perspective that tends to dominate traditional, boxy hospital design does not always work well for these types of facilities.
“There’s nothing stronger than a one-point perspective,” he says, noting the use of this strategy in the grand cathedrals of Europe, in which design elements seem to lead to a single, distant point. “But if you use it in the wrong way, it’s a disaster. How many times have you been in a hospital and you’ve looked down a corridor that’s a mile long? That’s a disaster. Psychologically, it kills you. And functionally, it’s not great sometimes.”
Curving long hospital corridors gives them a less intimidating scale; it also improves visibility for caregivers. “If you’re in a nursing unit and you want to see multiple entries or multiple doors, geometry tells you that you need to create a curve that basically bows inward,” Castorina says. “[Extend] your arm to the left, then make a little bow so your fingers start pointing to the right. You’ll be able to see more of your fingers than if [your arm] were in a straight line,” he illustrates.
The curved corridors in the new patient tower at Community Hospital North give the patient units somewhat of a football shape, with patient rooms aligned along the exterior of the building and a service corridor flanked by two atriums in the interior. The corridors form a continuous loop walking track for patients. Seating areas along the corridors provide comfortable resting spots, and the atriums offer positive distractions.
Aligning the rooms on the unit eliminated noise problems that occur when rooms are located directly across from each other. The central service corridor, which has its own elevator bank, also eliminates much of what Castorina calls the “clang and bang” of supplying a patient unit. The smells and sounds of meal carts and other service activities are contained within the central corridor, providing “a much more restive, restorative environment for everybody,” says Hayden.
Each maternity floor has its own suite of Caesarean-section rooms. The hospital floors are also tied directly into the adjacent medical office building, for the convenience of patients and physicians.
‘Right environment’
The facility’s 60 labor-delivery-recovery-postpartum rooms also have a unique shape based on the rooms’ function. The patient headwall in these rooms was angled away from the entry to provide the mother maximum privacy from the corridor. By angling the headwall, space was also created for a separate room to store equipment and supplies.
Like most new hospital rooms, the rooms each have a specific zone for family members. On the maternity floors, this area is known as the “daddy zone.” The daddy zone of each room is in an alcove somewhat separate from the rest of the room. This allows family members to welcome newborns without unduly disturbing postpartum patients. “All the family and dad can gather in their part [of the room] and not really bother mom too much,” explains Castorina.
The daddy zones extend outward, creating a bowed front to the building. This architectural feature helps showcase the human drama taking place inside. Says Castorina, “At night when you drive up and families are there holding their babies … you can see that activity. It’s really an endearing image. They’re not doing anything but smiling.”
The neonatal intensive care unit (NICU) also features private rooms, in accordance with an emerging standard of care for these patients. Private NICU rooms provide increased infection control and privacy for families, but the main benefit, Hayden says, is increased noise control.
“Developing, preterm babies have a high susceptibility to noise,” he says. “The noise from other babies crying, their monitors, alarms and whatnot—it has been demonstrated to have an adverse effect on the development of those babies.” Ambient sound is monitored in each room and a multicolored light device indicates whether the noise level is too high. To help control noise, televisions and bathrooms are not included in the NICU rooms. Finishes, colors and artwork were carefully selected to help with the acoustics and alleviate stress, says RTKL interior designer Dori Mommers, IIDA.
Most ambient lighting in the NICU rooms is tied to a system that raises the light level during the day and lowers it at night, to help babies develop circadian rhythms. Given the fragility of some NICU patients, “there’s a lot of sensitivity to providing the exact right environment,” says Hayden.
Each of the 36 rooms in the NICU is large enough to support twins, but five of these are oversized to better meet the needs of multiple births, with one even larger room for triplets. Each room also has its own refrigerator and freezer to store breast milk. “We never have an issue of moms’ breast milk being mixed up or confused,” Hayden says.
Caregivers were very involved in the design of all patient rooms in the new tower. “We mocked these rooms up at least three times in every specialty, and really had a lot of staff interaction and involvement in positioning everything,” says Hayden.
The rooms were designed to be sensitive to the needs of patients and caregivers. Positioning outlets higher on the walls and installing higher, handicapped-height toilets improved ergonomics for nurses. The rooms also have patient safety features like handrails in the medical-surgical rooms that reach all the way from the bedside to the commode to reduce falls.
Hayden acknowledges the ongoing debate in the health care industry about whether or not all patient rooms in a facility should be oriented the same direction. For this project, the design team chose to build left- and right-handed rooms that share a common headwall. This arrangement makes it easier for nurses to view more than one patient at a time from the decentralized nurses’ stations, he says.
Hidden treasure
The pirate adventure-themed pediatrics unit was clearly designed with kids in mind. A dashed line leads young patients along a treasure map through the corridors, past destination points with names like “Lookout Point” and “Paradise Falls.” Each of these areas is decorated with custom murals digitally printed on vinyl wall covering. Children can follow the dashed line to a playroom that features a pirate ship and a treasure chest to store toys.
“With a treasure map you always have to have a treasure, so the X marks the spot in front of the playroom,” says Mommers. The pirate ship, which includes a small slide, a ladder and a cubbyhole for hiding, is made of soft foam to ensure the children’s safety. The flooring in the playroom is underlaid with one-and-a-half inches of foam as well.
The design is meant to appeal to children of both genders and a variety of ages. Mommers says, “Most pediatric units are designed toward younger children and can be quite babyish. Since a pediatric unit can care for a patient up to 17 years of age, I did not want the design to focus too much on the younger children.”
Throughout the hospital, the interior design team played off the architectural design, to ensure the interior and exterior of the building were well integrated. “Anywhere we could introduce a soft curve to tie it into the actual building shape, we would try to do that,” Mommers says.
The curved hallways presented an opportunity to use the patient room doors as more prominent design elements, since they are very much on view to people walking down the corridor. On the second floor medical-surgical unit the designers created faux transoms for the doors, with porcelain tile between each pair of doors to create a sophisticated entry to the patient room.
On the labor and delivery floors, the doors feature five panes of frosted glass. These are designed to provide an elegant, spalike look while protecting patient privacy, says Mommers. The doors on these floors also have full transoms with decorative sconces placed between each pair of doors.
Throughout the hospital, the designers used natural materials, colors found in nature and natural light to help alleviate stressors and enhance the healing process, says Mommers. The building’s three-story glass gallery, six-story atriums and large patient room windows maximize natural light. On the fifth floor, designated for long-term stay mothers, patients and families can enjoy a glass-enclosed solarium and rooftop healing garden.
Shape of things
Hayden, who has worked for Community Health Network since 1978, says he has seen a shift over the years in the focus of health care facility design. “Through the course of my career, I think hospitals have gone from a need to project an image of security, that you’re going to an establishment of weight and merit, to a time now where that’s more taken for granted. Something that looks and feels more comfortable, more stylish, more contemporary, more modern, is certainly the thing you’re after [now].”
Patients appreciate health facility design that reflects the hospital’s adoption of the latest caregiving techniques, he says.
Castorina describes hospital design as “the greatest form of civic architecture.” More than simply a place to be “cut and stuck,” he says, “[a hospital] belongs to society, and it helps people in their most vulnerable state.”
By applying new ideas to the field, RTKL and Community Health Network have endeavored to create an architectural and medical landmark for the Indianapolis community. n
Amy Eagle is a freelance writer who is based in Homewood, Ill. She is a regular contributor to Health Facilities Management.
This article first appeared in the October 2007 issue of HFM.
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