A place that heals

Spirituality, nature—and a hospital—teach lessons in patient-focused care
August 11, 2010

Can buildings heal the sick? If considered a physical extension of health-care practice and an embodiment of natural and spiritual forces, the built environment can certainly make a difference. An example of this healing triumvirate is a new hospital, its missionary owner and an idyllic setting not far from the busiest crossroads in Arkansas.

The structure's function and image reflect a broader shift toward holistic and patient-focused care, two health-care trends reshaping how leading hospitals work, says Harrison M. Dean, senior vice president and administrator of Baptist Health Medical Center, North Little Rock. "Patient-focused care as an organizing concept is not widely practiced in traditional hospitals; you have to cross-train staff and decentralize technology to the patient," he observes. "But the savings come on the labor side; it cuts down on staff travel and logistics."

Building patient-focused care

Baptist Health has embraced and invested heavily in the novel approach. At the same time, the fairly conservative and decidedly religious institution has captured elements of holistic curing-daylight, water, music, color, scale and communion with nature-in uplifting surroundings that are elegant, yet understated.

To turn their healing mission into a functioning, constructable reality, Dean relied on Dennis G. Hyland, the hospital's project manager and a trained architect. A top-notch team led by Dallas-based A/E firm HKS Inc. and Hyland made many tough choices along the way. Yet, each decision is a case study in best-practice hospital development. Some salient lessons:

  •  Site selection. For its holistic approach, Baptist Health sought a location with a direct link to the natural. The team found an answer not far from the busiest intersection of freeways in Arkansas amid 158 acres of woodlands-100 of which remain untouched.

While accessibility to the community made the site attractive initially, the real benefit to patients is the pastoral setting, says Hyland: "All patient rooms and public areas look out onto the woods. When people come here, their attitudes and emotions are immediately affected."

Working with Dan H. Noble, director of design, health-care and commercial work at HKS, the team created an entrance program that leads visitors past an artificial pond and cascade into public areas with prominent views of trees and grass. "When you first come onto the site, you immediately see water, an element that tries to set you at peace and relieve some anxiety," says Noble. "When you enter the building, you're in a four-story space flooded with light, with a view oriented towards the village green."

The entry area looks more like a corporate headquarters or hotel lobby, says Hyland, with a four-story, glass-wrapped atrium, escalators and grand player piano. "It changes people's concept of what health care is," he adds. "We sometimes see a look of confusion, like, 'Are you sure this is a hospital?'"

  •  Programming and circulation. As clients flow through the hospital program, however, an efficient layout and patient-focused amenities become quite apparent. The industry-wide move toward outpatient care-an effort meant to help hospitals conserve resources and compete with freestanding ambulatory facilities-demands convenience and straightforward circulation for occupants and visitors alike.

"The outpatient doesn't know they are sharing resources with inpatients," says Noble, referring to the surgery, diagnostic and other resources serving both patient streams. "On a pragmatic note, this helps alleviate the intimidation of going into a hospital." The two-story building mimics a shopping mall, adds Hyland, with seven perimeter entrances opening into dedicated circulation pathways for inpatients, outpatients, staff and physicians.

  •  Structure. The program is also driven by flexibility, says Hyland: "The building is sited so that we can add modules horizontally, and structurally designed to add more floors."

Hyland admits that the structural system was selected based on Baptist Health's experience. "I was biased that hospitals built with steel systems had some bounce, and in the operating room, that can be disastrous," he says, conceding that steel might have shortened the construction phase. "Still, I recommended to the board that we go with a concrete frame, which is more rigid at about the same cost and more acceptable for a hospital environment."

H. Frank Yin, project structural engineer with HKS, supported the choice but advised the client of tradeoffs. "Structural steel would have been easier to detail and design, but for fire resistance, performance and cleanliness, concrete is sometimes better," Yin says, adding that irregular forms, such as the atrium, several canopies and a 100-ft. spire with a stainless-steel finish, are all framed with steel.

Acute angles

While the floor plan for the main building presented Yin with challenging acute angles, the lateral design is a straightforward cast-in-place moment-resistant frame with conventional reinforcing. The team selected a skipped joist, 6 feet on center, rather than a 3-ft. pan joist.

Little Rock, Ala.-based general contractor Baldwin & Shell Construction Co. estimated both steel and concrete structural packages to compare costs. When the team started sitework, says Scott Copas, principal, the first surprise for Baptist Health was learning that the straight-shaft drilled pier would be founded entirely in hard shale. "We encountered about a million dollars worth of rock," Copas explains, adding that the firm didn't ask for a time extension. "Soil borings are a hit-and-miss situation, and practically all of them missed the rock."

  •  Electrical systems. As solid as the concrete structure are the hospital's highly redundant electrical and mechanical schemes, says Herb Jenkins, project manager with Nashville-based Smith Seckman Reid Inc. (SSR), an M/E/P engineering firm specializing in health care. For example, rather than run separate feeds from the utility company to a main-tie-main switchboard with ties normally open, the hospital employs a "spot network."

"Basically, there are two 2,500-kilovolt-ampere transformers feeding a switchboard with network-protecting relays on each main, and the ties are normally closed," says Jenkins. "So if the utility loses a transformer or a primary feed, the other transformer picks up the load seamlessly." He adds that spot networks are more typical of downtown facilities, and that the equipment is usually owned by the utility; in this case, Baptist Health sees a cost advantage in retaining control of the relays.

  •  Mechanical systems. The heating, ventilation and air-conditioning (HVAC) systems are more straightforward, according to Ronald W. Lion, senior mechanical engineer with SSR, except for the use of laminar airflow hoods in operating rooms, which are thought by some physicians to shield patients from infection better than traditional designs. Resembling a kitchen grease hood, the devices generate up to 80 air changes per hour; 25 to 30 is standard. "The idea with laminar air flow is that the distributed air is filtered of bacteria and germs with HEPA [high-efficiency particulate air] filters, creating an 'air curtain' around the operating table to protect the patient," says Lions.

Otherwise, the central hot- and chilled-water plant is standard, four-pipe hospital fare, with natural-gas boilers and fuel-oil backup as the code-mandated secondary fuel source. For indoor-air quality, surgical areas are positively pressurized, and toilets and utility rooms have a negative pressure. The system's medium-pressure steam is used for heat, code-required humidification as well as for sterilizers.

  •  Exterior materials. While the back-of-house program is as well hidden as the M/E/P systems, the hospital's visible image clearly bespeaks refined efficiency and earthy humility.

A spire and a cross serve as beacons to the facility, and entry points are marked by aluminum panels that contrast starkly with the indigenous, natural materials that band the majority of the facades, such as a split-face block made from native mortar and clays.

"The materials tie into the wooded site, but they were also economical," adds Hyland. "We added color with bluish-green glass and mill-finished aluminum panels at the circular entrances to make them easy to find."

Also important to both designer and client is the dialogue between interior and exterior. For example, all patient rooms-which are contained in three modular "pods" with views of the woods-open onto a veranda or porch looking onto "healing gardens with a color or floral theme," says Noble. "Patients can get out there, enjoy the weather and get some fresh air. The gardens work with the architecture ... and parts of the building turn into elements of landscape."

  •  Interior materials. Finishes and material choice within the structure reflect the neutral feel of the exterior, with a punch of color on partitions and other surfaces that are more likely to change. Each patient room offers a unique medley of muted colors studied to "act as an ally in the healing process," says Noble. "Overall, we have a soft, inviting palette of warm colors punctuated by some cooler colors on the walls, fabrics and wardrobe woods."

Surface choices reflect current hospital trends in clean and sterile surfaces, while emphasizing simplicity. For example, terrazzo and linoleum flooring are more prevalent than antimicrobial carpet. Cherry-stained ash doors and paneling wrap the lobby and escalators, adding warmth.

In public areas, windows and natural light are prominent, almost serving as wayfinding elements. "Visitors and patients are always circulating towards light," says Noble, "at the ends of corridors, in waiting rooms and in family alcoves in patient rooms." Light also serves as one of many symbolic elements that the building team developed over the course of the project, adds Hyland. "We asked HKS to make a statement: here we are, we thought about our mission and how you promote healing through the natural environment."

  •  Symbols. Other expressive elements of the design include a 100-ft. spire of polished perforated stainless steel, illuminated from within. Glowing or reflecting light, this beacon welcomes the community to the main entrance.

On the entry terrace, a cross announces the religion behind the organization. As they make their way past a pond and waterfall, visitors are treated to stained-glass windows with a water motif inspired by the Book of Revelations.

Hitting the mark

Metaphorical or utilitarian, each gesture has hit the mark, says Dean. "When people tell us what they think [of the facility], they use words that we used in creating it," he notes.

The result is no less than a model of contemporary health-care practice in a rigorously cost-effective package. In fact, Baptist Health's board of trustees, a fairly conservative group, can now revel in their innovation.