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Project Overview

  • Project Name: Martha Jefferson Replacement Hospital
  • Location: Charlottesville, Va.
  • Total floor area: 540,000 square feet
  • Number of floors: 6
  • Number of beds: 176
  • Project cost: $305 million
  • Construction cost: $228 million
  • Groundbreaking date: October 2007
  • Opening date: August 2011

Project Team

  • Owner: Sentara Healthcare
  • Architect and Interior Designer: Kahler Slater Inc.
  • Construction Management: M. A. Mortenson Co.
  • Owner's Representative: Matthews Development Co. LLC
  • Structural Engineering: Graef
  • Mechanical, Electrical and Plumbing Engineering: Ring & DuChateau
  • Civil Engineering: Graef and Rummel, Klepper & Kahl
  • Medical Equipment Planning: Korbel Associates
  • Landscaping: Nelson Byrd Woltz

There's a moment each evening as the sun sets behind the Blue Ridge Mountains that it can be seen shining through a large window at the top of Martha Jefferson Hospital. "It's a pretty stunning view," says Jennifer Schlimgen, principal, architecture and design firm Kahler Slater Inc., Milwaukee.

Kahler Slater designed the hospital, a replacement facility for the more than 100-year-old Charlottesville, Va., health care institution, to complement and capitalize on the natural beauty of its mountainside location. In 2012, the building was voted Most Beautiful Hospital in the United States by health care staffing company Soliant Health.

"From the beginning of the design process, it was our aim to provide our patients, visitors and staff with a comfortable, pleasant atmosphere," says Jim Haden, president, Martha Jefferson. The hospital believes this type of environment improves patients' overall experience and outcomes, especially when accompanied by advanced clinical services.

"Now that we are settled into our new space, it is clear our new facility has allowed us to provide a greater level of personalized patient care, as well as increase our clinical capabilities and provide for superior outcomes," Haden says.

Meeting patient needs

Faced with a local population that is growing and aging, and a facility that was becoming outdated and undersized, Martha Jefferson decided to rebuild on a new site. The new facility was relocated to a 242-acre business park two miles from the existing hospital. The business park includes a number of professional buildings that attracted area physicians, averting the need for the hospital to build a medical office building as part of the replacement project. Amenities like a hotel, banks, restaurants and an art museum also are nearby.

The hospital exterior features natural stone and a low-profile entrance with a pitched roof — a noninstitutional appearance meant to provide an intimate, soothing welcome.

"As you walk in the front door, you're immediately presented with a beautiful view of the property," says Schlimgen. This is a principle borrowed from the hospitality industry for fine property design, she says. Floor-to-ceiling windows allow mountain views to serve as a dramatic backdrop for a relatively simple, understated lobby design.

Computer work alcoves, a small café, and a retail area that includes image recovery resources for cancer patients and lactation consulting services, are located just off the lobby. Patients are greeted and their needs are begun to be met as soon as they enter the building, Schlimgen says.

The main hospital dining room is one floor above the lobby. This location, at the top of the entry pavilion, is out of the way of patient traffic and affords major views in three directions. The one-and-a-half-story space features a large fireplace and two dining rooms with a variety of seating options, including built-in banquettes.

The hospital is built into the side of a mountain [see sidebar, Page 19], with the patient units and diagnostic and treatment areas located at a lower elevation than the main entrance. In its position at the top of the building, the dining room is a beacon for the facility.

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Attention to detail

The patient units also take advantage of the scenery, with family lounges at the entrance to each unit and small, glassed-in seating alcoves that offer panoramic views at the ends of the corridors. Similar glass bump-outs at the midpoint of the patient units serve as staff lounges. "We wanted our caregivers to have a place to go that is comforting, so they can do their job well," says Barbara Elias, director of service line development at Martha Jefferson and director of the replacement hospital project.

The patient units were built to enhance caregiver efficiency and effectiveness. Major supplies are stored near the point of care to allow nurses to be closer and more attentive to their patients [see sidebar, Page 21].

Patient rooms were designed through a collaborative process in which staff, patients and community members tested and reviewed design mock-ups. "Features were incorporated based on that in-depth input," says Elias. As an example, she notes an additional leaf in the door to each patient room and bathroom, which opens automatically to provide room for caregivers and patients to pass through alongside IV poles or other medical equipment.

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Specialty services

A cancer center with radiation oncology and medical oncology services is horizontally integrated with the oncology inpatient unit. Chemotherapy patients have a range of options for receiving treatment, from group infusion rooms with a social atmosphere to individual treatment rooms.

A Surgical Interventional Procedural Center (SIPC) cohorts the facility's main technology programs, which have similar engineering requirements for ventilation, power and sterility. This design allows the hospital to share prep and recovery areas, as well as staff, for these services. Since moving to this design, the hospital's on-time starts for surgeries and procedures are up and staff overtime is down.

Setting the standard

At the outset of design, team members determined they wanted the project to set the standard for clinical quality and personal health care. According to Ronald Cottrell, vice president of planning at Martha Jefferson, the patient experience at the new hospital is "transformational." He says, "I think it has been inspiring for all of our caregivers to be able to deliver that hands-on experience in a facility that is fully designed to support their work."

Amy Eagle is a freelance writer based in Homewood, Ill., who specializes in heath care-related topics. She is a regular contributor to Health Facilities Management.

Sidebar - Design provides human scale, institutional presence

Charlottesville, Va., home to Martha Jefferson Hospital, has a rich tradition of Georgian architecture. The red brick and white trim of Monticello, the nearby home of Thomas Jefferson (father of Martha Jefferson Randolph, the hospital's namesake), are seen throughout the city.

In the design of its replacement facility, Martha Jefferson Hospital wanted to project a contemporary, high-tech image that would encourage the community to view the hospital in the same light as the city's large, academic medical center. It was equally important for the design to express warmth and respect for local heritage.

The hospital site, on the side of Pantops Mountain, drops about 100 feet from top to bottom. The steep slope — a challenge in its own right — presented a solution to the design quandary.

A previous master plan called for leveling out the site. Architecture and design firm Kahler Slater Inc., Milwaukee, recognized a more sustainable, less expensive option that would achieve the hospital's goals regarding its public image. After survey work to identify the location of major rock, the hospital was built into the mountain.

Only the top two stories of the building can be seen on the approach to the hospital's main entrance. "We really wanted that approach to give people a sense of human scale," says Ronald Cottrell, vice president of planning at Martha Jefferson. On the other side of the site, the hospital's diagnostic and treatment block and patient wings extend toward Charlottesville, demonstrating a major institutional presence.

Besides capturing all sides of the hospital's personality, this design allowed entrances to be built on several levels. Direct access is available to services on different floors, including back-of-the-house functions, the emergency department, cancer center and main hospital lobby.

"We were able to work very creatively with the topography," says Al Krueger, principal, Kahler Slater. "From a designer's perspective, it's important that the architecture take hints from the land that it's on."

Sidebar - Larger footprint, fewer footsteps

In moving from a more than 100-year-old building with semiprivate patient rooms to a replacement facility with all private rooms, Martha Jefferson Hospital was concerned that the new, larger floor plate would mean longer walking distances for caregivers. But in terms of travel distances, the hospital's patient units are now 30 percent larger and 20 percent more efficient, says Jennifer Schlimgen, principal, architecture and design firm Kahler Slater Inc., Milwaukee.

To achieve this result, the project team conducted Lean operational studies concerning the number of footsteps required to reach support components on the patient units, such as medication and nourishment stations. As a result of these studies, additional stations were added to the design to reduce travel distances.

A multidisciplinary team, including members of the hospital's materials management department, respiratory therapists, pharmacists, nurses and others, worked together to design nurse servers for each patient room that contain many of the supplies needed for everyday nursing tasks. "[The servers] are all standardized, they're all brought up to par daily, and it saves the nurse many, many steps running to a supply room for commonly needed supplies," says Ronald Cottrell, vice president of planning at Martha Jefferson.

The nurse servers include locking mechanisms to secure patients' daily medications. Pharmacy department personnel can stock the servers from the corridor without disrupting patients' rest. Clean and soiled utility areas in each nurse server allow hospital staff to stock or remove linens without entering the patient room.

Computers at the bedside and in charting station alcoves in the corridor allow physicians and caregivers to place orders and perform documentation within sight of the patient.

With this design, "you spend more time with the patient," says Barbara Elias, director of service line development at Martha Jefferson and director of the replacement hospital project. "That's the goal."

Sidebar - SPEC SHEET

Principal Design Materials Carpet tile: Shaw Contract Group Ceiling: Armstrong World Industries Inc. Curtain wall framing and windows: Kawneer Door hardware: Assa Abloy Doors: Graham Flooring: Armstrong World Industries Inc., Johnsonite and Teknoflor Glass (decorative): Krauski Art Glass and Skyline Design Lighting (exterior): BEGA Lighting, Philips Gardco Lighting and Winona Lighting Lighting (interior): Davis Muller Lighting, Legion Lighting Co. Inc., Linear Lighting Corp., Lithonia Lighting, Prudential Ltg. and Stonegate Designs Inc. Lighting (parking garage): Lithonia Lighting and Philips Day-Brite Lighting (site): Cooper Industries and Kim Lighting Inc. Paint: Benjamin Moore & Co. and Master Coating Technologies Plumbing accessories: Sloan Valve Co. and Zurn Industries LLC Plumbing fixtures: Elkay Manufacturing Co. and Zurn Industries LLC Roofing: American Hydrotech Inc. Signage: Gropen Inc. Tile: Daltile and Oceanside Glasstile Wall coverings: Designtex, MDC and Wolf-Gordon Window treatments: MechoShade Systems Inc. Principal Furnishings Cafeteria seating: Loewenstein Cafeteria tables: Aceray Casework (laminates): Formica Group and Wilsonart Conference tables: Coalesse Lounge seating: David Edward, HBF and St. Timothy Chair Co. Office desks: Gunlocke and OFS Office seating, files and shelving: Steelcase Inc. Patient room seating: Cabot Wrenn, Carolina, Nemschoff Inc. and Weiland Major Medical Equipment Central sterile processing: Belimed Inc. Diagnostic imaging equipment: GE Healthcare Headwalls: Amico Corp. Patient beds: Hill-Rom Physiological monitoring: Philips Healthcare Radiation therapy equipment: Varian Medical Systems Inc. Surgical lights and booms: TRUMPF Inc. Infrastructure Boilers: Cleaver-Brooks Building management system and chillers: Trane Electrical equipment: Asco Power Technologies (synchronizing switchgear and transfer switch) and Square D (service entrance switchboard and panelboards, transformers, etc.) Elevators: ThyssenKrupp Elevator Fire safety: SimplexGrinnell Generator: Caterpillar HVAC (misc.): ABB (variable frequency drive), Baltimore Aircoil Co. Inc. (cooling towers), Buffalo Air Handling (custom air handling units), Emerson Electric Co. (computer room units), Greenheck Fan Corp. (fans), Maxi-Therm (heat exchangers), Multistack (heat recovery chillers), Trane (packaged air handling units and terminal units) and Xylem

Information provided by Kahler Slater Inc.