When patrons walk through the doors of the new Baptist Memorial Hospital in Collierville, Tenn., they may think they've just entered a Marriott or Hyatt hotel. Daylight floods the lobby through a large skylight. Trees and plantings surround a calming fountain in the center. Adjacent to the lobby is a dining area, a gift shop and a 175-seat auditorium. Intimate seating arrangements are scattered abundantly throughout the building.
Baptist Memorial is just one of numerous new or renovated hospitals that have taken cues from the hospitality industry in an effort to attract and retain patients.
"The sterile, uninviting look of typical health-care facilities intimidates visitors," says James VanderSteeg, CEO of the three-story hospital. "We created a hotel-like atmosphere to make everyone feel at ease. We thought it was important to make the hospital a place that residents would want to visit, even when they aren't ill."
Bringing hospitality to hospitals
Credit more savvy consumers for bringing hospitality to the health-care industry. No longer do patients invariably choose the clinic or hospital that their doctor recommends. Many will assess competing facilities, get second opinions and ultimately choose the best facility.
Large ceremonial lobbies, more private patient rooms and even themed hospitals (see "Hospital incorporates biblical theme," page 40) are just a few of the design strategies being employed to make hospitals more pleasant.
"Hospitals today are going all out to entice the ever-expanding educated consumer because they're having to win market share from competing facilities that are also catering to the softer side of health care," says John Castorina, vice president of health care for Baltimore-based architect/engineer RTKL. "For instance, many of the hospitals we are working on refer to their patients as "guests" or "clients" and have a concierge to greet patients and to provide any kind of amenities they might request, down to a terry-cloth robe instead of the uncomfortable gown patients are used to wearing."
Larger, more accommodating patient rooms are also attractive to potential patients, says Castorina. RTKL is designing bigger patient rooms to entertain and house the patient as well as family members. The larger rooms also permit the integration of additional equipment.
"We are now actually splitting patient rooms into two sections: a patient zone and a family zone," adds Castorina. "The patient zone has a bed, chairs and television, while the family zone has its own television, table and chairs, a pull-down bed and light and temperature control. It all goes back to the idea of empowering the family and patient."
In addition, health-care facilities are strengthening and marketing the services that generate the most revenue and help establish long-term patient relationships. For instance, although labor and delivery services are typically not a big money-maker for hospitals, Castorina says that many facilities are beefing up this department because it is a way to establish life-long health-care relationships with women, along with their families.
Moreover, hospitals are attracting regional, national and even international patients by building and heavily marketing new specialty acute centers that focus on such issues as heart, children and cancer. "These diseases are so special that people will travel to get special care," says Michael Baumbach, project manager for contractor Bovis Lend Lease of New York City. "It would not be unusual for a sick child from Charlotte to go to the Children's Health Center at Duke University Medical Center in Durham."
Attracting and retaining caregivers is also a top priority for health-care facilities, which, for example, now offer amenities like on-site day-care for children of staff members.
Adapting to outpatient care
Part of the impetus for these changes is increased competition, as well as industry-wide changes in health-care delivery, mainly due to advancements in medical procedures and technologies.
"Medical procedures and technologies have advanced so much that procedures which used to take days to administer and recover from now only take a few hours," says Castorina. "This is forcing hospitals to rethink their facilities."
Older hospitals originally designed for inpatient care are rushing to adapt to outpatient-focused care, which has led to a flurry of addition and renovation work.
"I would estimate that additions and renovations make up 90 percent of our health-care work," says Baumbach. "Some of our clients are simply expanding existing departments while others are adding space to house new specialty acute-care departments such as heart, children's and cancer centers."
Richard Miller, president of Nashville, Tenn.-based Earl Swensson Associates (ESA), a design firm specializing in health-care facilities, says he's seen growth in the construction of outpatient surgery centers within existing hospitals. Miller cites the recently completed addition at the Samaritan North Health Center in Dayton, Ohio, which encompasses a "bedless" outpatient surgery center and an expansion of the existing physical therapy, cardiac rehabilitation and occupational therapy departments.
"There are many inpatient-focused facilities that are now seeing 60 percent to 80 percent of the surgery work done on a 'day-surgery' basis," adds Miller. "Instead of having that sort of outpatient work scattered throughout the inpatient spaces, hospitals are moving it to designated areas to improve traffic flow."
Although ESA is working on several replacement hospitals, Miller also says that about 90 percent of the firm's health-care work involves additions and renovations. "There's a tremendous demand for health-care construction, and I don't anticipate that slowing down," he adds. "Part of the reason is that the [design and construction] industry has not caught up with refurbishing existing hospitals to meet modern technologies and outpatient care."
Rural hospitals in particular have had a difficult time retrofitting their existing facilities, says Roger Panther, president of developer American Health Facilities Development of Brentwood, Tenn. "It's mainly because the infrastructure-such as the mechanical, electrical and plumbing systems-is so obsolete that it's cheaper to construct a replacement facility," he explains.
"I estimate that 40 percent of the rural hospitals in the United States have reached or are going to reach obsolescence in the next five to seven years," says Panther. "Many of these hospitals cannot afford to spend more than $12 million on new buildings and equipment, which is forcing architects and contractors to think outside of the box to create economical and efficient replacement facilities."
Most important to designing an efficient and affordable facility, says Panther, is value engineering by the entire building team, starting at the design phase.
"To meet budget, [the building team] may specify multiple rooftop HVAC units instead of a traditional central plant, or a prefabricated wall system instead of brick or masonry," he adds. "Architects just can't afford to design award-winning traditional hospitals with expensive materials and systems anymore."
Panther says many new facilities are designed essentially as three separate buildings-inpatient space, outpatient space and medical office space-to improve traffic flow and reduce initial construction costs.
"Why locate the administrative and business offices in the inpatient and outpatient spaces that cost $165 per square foot to construct when you can build an adjoining business-occupancy building for the office space at $80 per square foot?" he asks.
Castorina says RTKL has been able to reduce initial construction costs by utilizing the downtime of non-24-hour departments. "If the emergency room [ER] peaks at night, we will locate the ER adjacent to a department that closes at 5 p.m., so that the ER can utilize those rooms during peak periods," he adds. "That way they don't have to build a huge ER."
For hospitals that operate with a smaller, yet more multiskilled staff, Castorina says the firm will often consolidate the ER, intensive-care unit and medical/surgical unit into one critical-care department to maximize the staff. Also common are centralized nurse stations that minimize the number of nurses on duty and duplication of equipment.
The consolidation of departments is a technique also employed by ESA, but for aesthetic purposes. "For smaller facilities that cannot afford to build large, extravagant lobby space," says Miller, "we will combine areas to create a more dramatic entrance."
For instance, the firm integrated the lobby and dining area at Baptist Memorial, which saved space, reduced construction costs and, most important, created a hotel-like atmosphere.
Like many new facilities today, Baptist Memorial's design is based on the "medical mall" concept. Popularized in the early 1990s, the concept integrates typical health-care departments-such as radiology and administration-into the layout of a retail mall. Consisting of a main lobby and several long corridors that lead to each department, the layout allows for smooth outpatient traffic flow.
"Ten years ago, it became very obvious that up to 80 percent of hospital visitors are outpatients who come and go like shoppers in a mall," says Panther. "[The health-care industry] simply copied that design and replaced the retail stores with ancillary health-care departments."
The medical mall design also permits future expansion, a very important trait, says Baumbach. Bovis Lend Lease is currently working on three expansion projects. Most notable is a 12-story, 400,000-sq.-ft. addition to the two-story Ardmore Tower at Brenner Children's Hospital in Winston-Salem, N.C. Designed by Gresham Smith & Partners of Nashville, Tenn., the massive, $82 million addition would not have been possible if the original structure had not been designed for future vertical expansion.
A flexible road ahead
What's the ideal health-care environment for the 21st century? An efficient and attractive building that is flexible enough to adapt to future medical technologies, says Panther.
"Ultimately, hospitals must be built for flexibility to allow space for future technology without major renovation," he concludes. "Building technologies such as honeycomb floors and movable walls are examples of how facilities can adapt these new technologies."