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Project Name / Holy Cross Hospital expansion and modernization |
Older health care facilities have many strengths, but flexibility certainly isn’t one of them. Consequently, when hospitals with aging structures adjust to today’s emphasis on ambulatory and other services, they often just build anew.
However, throughout the country there are examples of older hospitals being reoriented to new market realities and rededicated as community resources through ambitious architecture and design projects.
Take the case of Holy Cross Hospital, Silver Spring, Md., which is a member of Trinity Health, a Novi, Mich.-based health care network sponsored by the Catholic Church’s Catholic Health Ministries.
Faced with an outdated building and a changing community population, Holy Cross recently undertook a $78 million expansion and modernization project in which nearly half the hospital was renovated or newly constructed.
Hospital President Kevin Sexton says that in the late 1990s “the hospital was almost 40 years old … and the whole world around us, as is frequently the case in health care, seemed to be changing. We knew we needed to set a new direction.”
“We clearly needed to grow, we clearly needed capacity [and] we clearly needed to enhance the flow of patients into our facility,” adds Holy Cross Senior Vice President Neal McKelvey. The hospital also needed to reorient itself to a new model of care.
The hospital’s original building “was largely designed to bring crowds of visitors into the hospital, into the elevators and upstairs to see their loved ones in bed. We had very little capacity or ability to get people to ambulatory services,” says McKelvey, project executive for the facility improvement effort.
The hospital now features new maternal-child health, ambulatory care and education centers, plus two new med-surg units and a new emergency department, surgical intensive care unit and cancer institute. The building also includes several floors of physicians’ offices.
A new main entrance opens into a multistory concourse that ties all these areas together, improving wayfinding and circulation routes throughout the facility. The project “fundamentally altered” the hospital, says Sexton.
Architects from the Washington, D.C., office of the SmithGroup designed the new building, which officially opened last September. The Bethesda, Md., office of the New York-based construction management firm Bovis Lend Lease oversaw construction.
Hospital leaders say the project has not only improved the level of care at the hospital, but it has also enhanced the religious institution’s ability to meet its goal of providing care to everyone in the Silver Spring community.
The community
The varied needs of the community posed a significant challenge to project planners. Holy Cross is located in Montgomery County, Md., the state’s most affluent and populous county, and an area that is rapidly becoming more diverse.
“This is an institution that says it has a mission to care for everybody in the community. ‘How do we balance all that?’ was the central question,” says Sexton. “We wanted to be a place that could earn everybody’s trust by giving good quality care and being open to anyone who needed to use us, whether they could afford it or not.”
For example, the hospital had officially agreed to care for all uninsured pregnant women in Montgomery County.
“That meant we had to be pretty successful. If you’re going to take care of people who have no other real good option, you have to make sure that you’re attractive to people who have lots of options,” Sexton says.
Holy Cross administration called in the SmithGroup to help design a master plan for their facility that would help them achieve this goal.
Big ideas
Phil Tobey, FAIA, FACHA, the SmithGroup’s principal in charge of the project, says the project team developed a set of what they termed “big ideas” to serve as a framework for master planning.
One of these was to create a separate mother-baby care center at the hospital. Holy Cross has the busiest maternity department in Maryland, with 8,800 babies expected to be delivered there this year.
“In a perfect world, we would have had a freestanding mother-baby facility,” Tobey says. “But the site isn’t big enough.”
Holy Cross is located on 14 acres hemmed in by residential neighborhoods and the Washington Beltway. As there was no room on-site for a separate building to house this type of care, the SmithGroup designed a mother-baby unit within the hospital. A new elevator tower off the hospital’s main lobby takes patients and visitors directly to the mother-baby center on floors two, three and four.
“It’s almost like a separate hospital,” says Sexton. “If you get dropped off at the front door it’s about 15 steps to the information desk and it’s probably no more than another 15 steps to the elevator that takes you right up to OB triage.” He says this has made a dramatic difference for women in labor and those who come to the hospital for high-risk pregnancy diagnostic procedures.
The hospital’s circulation system was also targeted for improvement. “The hospital had a very challenging wayfinding system in its current building, where the public, staff, patients and materials were all moving through the same corridor system,” says Tobey. “One of the big ideas we generated from the outset was to create a new, distinct circulation system that was more publicly oriented,” he says.
To do this, the architects designed a new main entrance and a public concourse that spans the entire front of the hospital. “Then we reshuffled the existing elevator cores,” says Tobey, “so that the entry points for the public were at one core and the in-house supply and material was at another core.”
Phasing the construction project became a necessity. “You’ve got to keep the place operating and functioning through all this,” according to Tobey. “You still have visitors, you still [handle] emergencies, you still deliver babies—everything still has to function while you’re going through this huge program.”
“One of the things that frightened me about this project was the thought of trying to get through this period without affecting our ability to see an increasing number of patients,” McKelvey adds. An earlier, less-extensive project had a “huge impact” on operations, he says.
“This time, with careful planning and phasing, we successfully added and renovated a good deal of space while accommodating a significant increase in patient volumes,” says McKelvey.
Project phasing
The first major phase of the project was the construction of a parking garage. The garage was built to provide parking for a planned increase in patients, staff and visitors, and to free up space for other development on-site.
The contractors then added two floors to the hospital’s east tower. This new space allowed for the creation of more private patient rooms on both new and existing floors, raising the hospital’s percentage of private rooms from 5 percent to 45 percent.
Next, a six-story addition was constructed to house an 80,000-visit emergency department, a 16-universal-bed surgical intensive care unit and four floors of physicians’ offices.
At 22,000 square feet, the new emergency department is spacious enough to provide patients with more privacy than was available in the hospital’s former emergency department. While the previous emergency department had curtained-off treatment areas, almost 90 percent of the patient space is now private, Sexton says. “The combination of space and privacy makes an enormous difference.”
The physicians’ offices are operated by a private developer. The office space was included in the project because, Sexton says, “anything you can do to make it convenient for physicians to be around, I think the care is better. The nurses and the patients are all happier, and the physicians aren’t as [harried], driving back and forth between their offices and the hospital.”
After the six-story addition was finished, the hospital closed its main entrance for construction of the concourse and a four-story north addition. During this time, the top deck of the adjacent parking garage was used as the main entrance drive to the hospital. A pedestrian bridge linked the parking deck to the first floor, where the architects designed an interim main entrance to the hospital.
Temporarily relocating the main entrance enabled the contractors to build the concourse and north addition in one major phase. “It was a wonderful temporary solution,” says Tobey. “It saved a lot of money, and then in the end, of course, it all reverted back once the new lobby entrance was built.”
Finally, a large education center was constructed off the concourse. Throughout the project, extensive renovations were undertaken on a number of floors in the existing hospital.
To power the added space, McKelvey says project engineers “markedly upgraded the building’s power systems with the installation of a larger electrical substation in the hospital’s existing engineering building. Three new, significantly larger, emergency power generators were also installed.”
Additional engineering spaces were added on top of the physicians’ offices and on top of the concourse. “Several more mechanical zones were added in this new construction. It’s a much more sophisticated system, with more redundancy and control features,” he says.
Building challenge
Building on top of and adjacent to the original hospital, which was built in 1963 and added onto in subsequent decades, was quite a challenge, according to Tobey. “There were many ways in which the existing [buildings] dictated how we were able to move ahead.
“Clearly, wherever we were attaching to the existing hospital we had to match floor-to-floor heights. It was more of a challenge to integrate engineering systems into the floor-to-floor height that we had to work with,” he says. Floor-to-floor heights in the original hospital ranged from 12 feet to 14 feet.
“Anytime you put a four-story addition and concourse onto an existing building, that gets to be fun,” says McKelvey. “The existing building had settled, so trying to structurally hook it all up was challenging and expensive. Besides, there are a lot of code changes that have occurred since the original buildings were finished that required you to go in and upgrade the existing buildings.”
The existing hospital’s exterior was also a factor in the design. The original precast concrete building “was not the prettiest building you’ve ever seen,” says Tobey. The new additions are also precast concrete, but with a larger percentage of glass to make the hospital “open and bright,” he says.
McKelvey says that with the new additions in place, “the dated buildings of the early ’60s and late ’70s faded into the background … because the appearance of the new buildings dominates and catches the eye.”
The new exterior “really changed the nature of how you look at Holy Cross,” he says. “You know that it is no longer primarily an inpatient facility—that old, two-tower, elevator-in-the-middle kind of thing. That’s harder to discern today because of the additions, and more importantly because of the design of the additions.”
‘All you can ask for’
Sexton says the extra space, increased privacy and improved amenities, such as comfortable waiting areas, custom artwork and a healing garden, have brought an increased calm to the hospital. The new building also seems to have brought about increased activity.
“There’s no such thing as provable cause and effect, but this will be by far the busiest year we’ve ever had,” he says. The hospital’s inpatient discharges are running 7.6 percent over last year and outpatient volume is up 6.5 percent.
Holy Cross provided more than $6 million worth of charity care in 2005, two-and-a-half times the county average. Sexton says this figure is projected to increase to $9 million this year.
“I really believe this project has made accomplishing our mission more likely to happen,” he concludes.
Amy Eagle is a Homewood, Ill.-based freelance writer and a regular contributor to Health Facilities Management.
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