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Project Overview

Project Name   Chickasaw Nation Medical Center
Location  Ada, Okla.
Total floor area  370,000 square feet
Number of floors  3
Number of beds   72
Project cost  $148 million
Construction cost  $118 million
Groundbreaking date  November 2007
Opening date  July 2010

Project Team

Owner   Chickasaw Nation Division of Health
Architect, Interior Designer and MEP Engineer   PageSoutherlandPage
General Contractor   Flintco Inc.
Structural Engineering  Datum Engineers Inc.
Medical Equipment Planning Parallel Solutions Inc.
Landscaping  Clark Condon Associates

The 370,000-square-foot replacement facility is located on tribal lands of the Chickasaw Nation, a federally recognized Native American nation. Traditional Chickasaw crafts are directly referenced in the medical center's architecture and interiors, in a contem­porary interpretation that demonstrates the timelessness of quality design.

Lawrence W. Speck, FAIA, lead designer from the Austin, Texas, office of architecture, interiors and consulting engineering firm PageSoutherlandPage, says the medical center and tribal leaders "liked the idea of something abstract and more modern." But they wanted the design to honor Chickasaw heritage, "to be emblem­atic of their unity and their commitment to their people."

And, says Judy Goforth Parker, R.N., Ph.D., administrator, Chickasaw Nation Division of Health, they wanted "to provide the best care for Native Americans to enhance and improve their lives."

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New care models

The medical center replaces Carl Albert Indian Health Facil­ity, which was built in 1985 to accommodate 20,500 patients each year but was receiving more than 238,400 patient visits by 2005. "We needed to increase access for our pa­tients," Parker says. In the spacious new facility, the family practice department is now piloting an open-access model that gives patients flexibility in setting appointments. The medical center plans to expand this model to all phases of care. "That wasn't an option in our other facility," says Parker.

Advanced technologies like computed tomography and magnetic resonance imaging, which were not supported by the old building, are now available at the medical center.

The building also demonstrates the latest evidence-based design principles, such as same-handed rooms in the patient units, an abundance of natural light and connections to nature (see sidebar at right). "That's important," says Parker. "Nature's very healing."

Intuitive layout

The medical center contains a wide range of inpatient and outpatient services, including Level III emergency care, ambulatory care, diabetes care, diagnostic imaging, women's health, dentistry, tribal health programs and administrative offices.

Services are arranged along one continuous concourse that runs the length of the narrow, three-story building, a layout designed to be very easy for patients and visitors to navigate. "Literally, you don't have to make a single turn to reach every department," Speck explains.

This type of design also allows staff members to interact and communicate easily with their colleagues in other departments, to better integrate patient care.

The building's hospital and clinic functions are separated by a central, open lobby known as Town Center. Town Center and the adjacent café serve as dynamic gathering spots for patients, visitors and staff, as well as venues for civic activities. Walkways allow people on the second and third floors to cross un­interrupted through the multi-story Town Center space.

Cultural influences

Chickasaw culture inspired much of the design, both aesthetically and in the layout of physical spaces.

The texture and pattern of tribal arts are represented in the window and exterior wall articulation of the building, a reference Speck says is im­mediately recognizable to members of the Chickasaw community. "They have a great tradition of weaving baskets and textiles. So we tried to give the pattern of windows that sense of weaving," he says. This motif also is seen in the interior design, such as on the floors of the patient units.

The diamond pattern of a culturally significant beaded collar is reflected in the lobby flooring, ceilings, exterior canopy and landscaping.

Town Center features an exhibit of historic artifacts selected in conjunction with the office of Gov. Bill Anoatubby, leader of the Chickasaw Nation, and artwork by Chickasaw artists is displayed throughout the building.

Tribal elders worked with the project team to translate the names of departments, meeting rooms and major public spaces into Chickasaw, to promote language preservation. These areas are identified on signs by both their English and Chickasaw names.

The chapel includes an outdoor area where native rituals may be performed. And the medical center has plentiful space for visitors, in deference to the Chickasaw principle of caregiving as a community role.

"We knew from the beginning we'd have a lot more visitors in this hospital," says Speck. Parker, who worked in the obstetrics department of the previous facility, says it was not unusual for her to see 15 family members arrive for the birth of a baby. "It's just part of the culture," she says.

The patient rooms at the new medical center are sized to accommodate several family members, and there are many lounges where visitors can gather outside the patient room. On-site picnic areas and long-term parking are provided to assist family members and other visitors whose loved ones require extended hospital stays.

Town Center is designed to function as a community environment. Speck was happy to see many people, including patients with IV poles, interacting with one another in this area and on the adjacent terrace one beautiful day this spring. "That was something we hoped for," he says, "but you can't make it happen. You can only give it an opportunity to happen."

'Not just any facility'

Parker says she has lost 10 pounds since the medical center opened, simply because she enjoys walking in the new building. She says staff members have a great deal of pride in the facility, and the inclusion of specific Chickasaw design elements helps pa­tients understand they are important. "That's the message that I think our patients receive," she says. "It's not just any facility, it's special."

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

Sidebar - Harmony with nature serves as inspiration

Chickasaw Nation Medical Center is located on a vast, open 230-acre site in Ada, Okla. "The setting is awesome," says Judy Goforth Parker, R.N., Ph.D., administrator, Chickasaw Nation Division of Health. The facil­ity was constructed along a creek, framed by mature pecan and live oak trees. A meadow stretches beyond the building. Deer and wild turkeys often are seen on the grounds. One patient even has ridden a mule to his appointments.

Harmony with nature is important to the design of the center, which serves a primarily rural patient population. Copper, aluminum and stone building materials reflect the colors of the landscape. Interior colors and materials are equally in tune with the surroundings.

The building has several points of outdoor access. People walking along the main public concourse are "constantly invited to go outside," says Janet Zeitler, AIA, LEED AP, senior associate, PageSoutherlandPage. Exterior courtyards feature walking paths, seating areas and natural landscaping.

Large windows showcase the scenery. "From virtually everywhere in the building, you get exquisite views of this natural site," says Lawrence W. Speck, FAIA, lead designer, PageSoutherlandPage. "And from absolutely every patient room, you're getting a completely unspoiled view of the meadow and the woods."

"The window is the whole focus of the patient room," says Zeitler. Headwalls are angled slightly toward the exterior wall. Windows positioned high on the wall enable patients to see outside easily while lying in bed.

Prioritizing views from all parts of the medical center meant the architects could not simply place the service dock out of sight at the back of the building. "We didn't have a back — there's front everywhere," Speck notes. He says it took careful planning to work out all the necessary connections to the service area, which is tucked in at one narrow end of the building, without interfering with the phenomenal views afforded by the site.

Sidebar - Sustainability stressed in hospital's design

Sustainability, durability and patient safety features make Chickasaw Nation Medical Center in Ada, Okla., a high-performance facility.

One of the most innovative of these is a rain screen system that forms the exterior skin of the medical center. A water seal installed behind the rain screen creates a ventilated space between the surface of the building and the waterproof barrier in the wall. Reflective aluminum shingles reflect heat, which can be vented before it hits the vapor barrier and insulation — a particularly valuable quality in the hot Oklahoma climate. "From a thermal point of view, it behaves very nicely," says Lawrence W. Speck, FAIA, lead designer, PageSoutherlandPage.

The system also performs a waterproofing function, preventing the condensation that can occur with a conventional wall. The rain screen blocks most rainfall from reaching the surface of the building, but any condensation that does take place happens within the air space, on the outside of the vapor barrier. This helps protect against water damage to the building and inhibits the growth of mold, which can create a hazard for patients.

"It's a health issue, it's a water penetration issue, it's a thermal issue. It's the whole assembly that makes the building perform better in the long run," says Speck.

The interior design includes materials and furnishings certified by the GreenGuard Environmental Institute, and paints and adhesives that emit few volatile organic compounds, for improved indoor air quality. "That was critical in the choice of fabrics and ceiling tiles and carpet," says Janet Zeitler, AIA, LEED AP, senior associate, PageSoutherlandPage.

Extensive daylighting, which lowers the building's reliance on artificial light; and an efficient heating, ventilation and air conditioning system are designed for energy savings.

A commissioning process ensured all building systems were operating at peak performance prior to the opening of the medical center.

Sidebar - SPEC SHEET

Principal Design   Materials Carpet tile: Shaw Contract Group Ceiling: Armstrong World Industries Inc. Curtainwall framing: Kawneer North America Door hardware: Ingersoll Rand Security Technologies and Stanley Doors: Algoma Hardwoods Inc., Construction Building Specialties (steel) and Kawneer North America (entrance) Flooring: Azrock and Southwest Terrazzo Glass: PPG Industries and TriStar Glass Lighting: Oklahoma Lighting Supply (custom fixtures) Paint: Sherwin-Williams Co. Roofing: Johns Manville and S.P. Roofing Signage: P&B Graphics (custom) Wall coverings: Green Country Interiors (paneling) Window treatments: MechoShade Systems Inc. Principal Furnishings Cafeteria seating: Steelcase Inc. Cafeteria and conference tables: Vecta Files and shelving: Herman Miller Inc. Lounge and patient room seating: Nemschoff Inc. Office desks: Geiger International Inc. and Herman Miller Inc. Office seating: Herman Miller Inc. and Steelcase Inc. Patient beds and over-bed tables: Stryker Woodworking: Precision Millwork Major medical equipment CT scanner, and MRI and ultrasound equipment: Philips Healthcare Infrastructure   Elevators: Otis Elevator Co. Fire safety: Aluflam North America and Won-Door Corp. Security: Cookson Company Inc. (access control grilles)

Information provided by the Chickasaw Nation Division of Health and PageSoutherlandPage