A hospital without beds
Bellevue Medical Center Bellevue, Washington
Project Completion Date: July 2008
Owner/Client: Group Health Cooperative
Architecture: Ellerbe Becket, 501 2nd 2nd Street., Suite 701, San Francisco, CA 94107
Local architectural partner: NAC Architecture, Seattle
Engineering: AffliatedAffiliated Engineers, Inc., 160 Fifth Street., Seattle, WA 98101
Construction: Mortenson Construction
Photography: Benjamin Benschneider
Total building area (sq. ft.): 190,000 square feet
Total construction cost: $120 million
With an isolated facility in Redmond, Washington, that wasn't meeting its full potential, Group Health Cooperative decided to develop its replacement facility in nearby Bellevue, Washington, adjacent to the existing Overlake Hospital Medical Center. Group Health's new Bellevue Medical Center is equipped to provide outpatient care—even surgery—to more than 1,000 patients a day, with overnight patients staying next door at Overlake Hospital Medical Center, allowing Group Health to provide essentially a “hospital without beds.” The four-story, 190,000-square-foot facility was planned using evidence-based design principles to achieve a more positive patient experience, including abundant sunlight and decorative elements native to the surrounding area, resulting in an deceptively simple yet beautiful construction. HEALTHCARE DESIGN Managing Editor Todd Hutlock spoke to David Derr, AIA, principal at Ellerbe Becket, and Michael Harder, general manager of the healthcare practice at Mortensen Construction, about the design and construction of this remarkable building.
David Derr, AIA: The building is at the gateway to the new Bellevue Medical precinct. The building has been sited to take advantage of the corner property, and provide Group Health as much visibility on that corner as possible. There is a nice little pocket park in the front, which we've turned into a meditative space. We sited the building in direct view of Mount Rainier from the end of the building. The big, long glass that you see from the lobby looks directly at the Cascades. We've provided some nice distant views and tried to drive as much natural light into the building as possible. The color choice was all earth tones and natural colors.
Derr: The design was inspired by the Pacific Northwest and regional materials were selected throughout the building—the theme of the design is “Northwest Elegance.” Northwest Elegance starts outside with the landscape, the water features, and the architecture of the building. We think we've taken it successfully into the building, as well. The building Group Health moved from was built in the 1970s and was a fairly stark concrete building, but it was sited in a pine forest. Figuratively, Group Health wanted to take that forest with them. We used a lot of natural materials in the building: lots of wood, wood veneers, and stone. If you look at the exterior, you'll see tall columns hold up the canopy with four branches at the top; that was our nod to the trees.
Michael Harder: It rains a lot in Seattle, so giving the enclosure on the building is really important. The building does have a lot of long windows on it. We partnered with Goldfinch Brothers who did our curtainwalls early on. They prefabricated everything in the shop and came out with full assemblies rather than doing it in the field, which is the traditional way. We were able to install entire curtainwalls in a couple of days and glaze them very fast. That was instrumental in getting the building enclosed so we could continue with the interiors. The systems are basically precast and curtainwall, for the most part. Our curtainwall contractor was instrumental in helping us close up that building. The radius curtainwall took only seven days, and every one went like that. We were really happy working with them.
Patient and exam rooms
Derr: Group Health is a physician-directed, multispecialty practice, with 20 or 30 specialties using this building. Particularly in these economic times and the challenges facing healthcare delivery, we find ourselves needing to find a way to use space more efficiently and effectively. We talked to Group Health about the universal room concept and worked very hard with its staff members to come up with a patient room size that would work for everyone. We did it first through plans and elevations, then turned it into a virtual 3-D model. We then turned that virtual 3-D model into a full-scale mock-up for the staff to view, experience, and critique. We also conducted focused meetings with each specialty to make sure they could, in fact, use the space effectively.
Every room is exactly the same size. The only exceptions, in terms of final configuration, are the eye rooms, which are the same size, but the door is in a different location. Everybody else, from obstetrics to primary care to orthopedics to pediatrics, can use the same room. There is a parking place for the specialty cart that would come in for each special exam need, and there are certain things that are universal in an exam room, so they're all there.
Each exam room has a couch. The idea is to have a private curtain space for the patient to change into an exam gown and get ready for the exam. When the exam is done, Group Health decided it wanted the patient to be dressed in their street clothes again and have a comfortable place to converse with their physician after the exam. I'm in this business and I would still rather talk to a physician with my shirt on than my shirt off. What we've done here is a little bit different, so the patient is asked to sit on the couch and can bring a family member in if that's needed.
During the consult, the doctor can switch off the exam light and switch on an indirect light to create a very different physical environment in the room—much more calming, not quite so bright, but certainly enough light to read and consult and so forth. The colors we chose provide the extra calming environment.
Planning and circulation
Derr: The key to this building for Group Health has been focused on its membership. The exam rooms were named patient rooms so the staff could remember the focus here is the patients. At the edge of each door, there is a natural wood marker to let people know where they are.
The plan is pretty simple: six exam rooms, three on either side of the corridor. Then there's the medical assistant [MA] station followed by six more exam rooms, three more on either side. The lighting levels in the corridors are kept lower than normal. It's adequate for walking and so forth.
The staff notes how quiet it is in the space. People tend not to talk loudly in spaces that are not brightly lit. We've also zoned the staff space so it goes from clearly onstage to clearly offstage, with the MAs clearly at that center, core spot. They are free to circulate around to different modules from their station; they don't have to walk around the module.
In most of these exam modules, there is natural light at the end of each corridor, so when you walk into the exam corridor, you're looking at a natural light wall, providing that extra little connection to the outside. The MAs are in the middle and in some cases, depending on how the module works and whatever else is on that floor, the MA spans four modules. The design allows the MAs to respond to whatever the demand is for them that day. Without doing any physical renovation, these rooms can be assigned to different specialties on different days as demand warrants.
We put the specialty places at the south end of the building, the one that faces Mount Rainier. The building has that curved end to it, and the very top floor is the infusion area—we've got 10 infusion bays plus two private bays that all look out to Mount Rainier.
Derr: I've always said if we have to use the word “wayfinding,” our buildings are too complicated. We went as far as we could to design this building as simply to use as humanly possible given its size. At some point, we were limited by, the distance needed to walk because of the number of exam rooms, for example.
The patient comes up in the elevator at one end of the long public corridor. Because you can see the entire distance, there are either two or three check-in stations. The patient will be able to check in any place in the building, go up to the specialty area, and then be escorted into their space—the patient exam room; that's part of the customer service initiative Group Health put into place.
It's almost impossible to get lost in the building. Everything works off the public space. There are two interconnecting corridors besides the MA stations. There's a corridor in the front that allows you to circulate to either side of the corridor and there's a corridor in the back, which is the offstage corridor for the staff; it's finished completely differently than the front corridor. If a patient was to get beyond that onstage space and walk into the offstage space, there are visual clues to let them know they're really in a workspace and not in a patient space.
One of the tenets that we follow is to let people orient themselves naturally, not necessarily by signs. You simply can't make people read signs. You can do this in really big buildings; there's nothing particularly magical about it. You come out of the elevators and you're in exactly the same orientation in that building as when you went into the elevators. You can pinpoint yourself—“Yep, I know where I am”—and then you can walk off and go where you need to go.
“A hospital without beds”
Derr: This is a really interesting model for healthcare as we move forward. Group Health has been very successful for 60 years at treating its patients. It did get into the inpatient business fairly successfully, but it decided that it really wanted to focus on its core business. It wants to treat its patients, get out of the inpatient world, and really concentrate on what it does well—health and wellness.
This is effectively a hospital without beds. Group Health is basically an HMO, and it wants to keep as much of its market share as it possibly can. We've given them operating rooms that are capable of doing anything they need to do, fully equipped, very robust in size; the primary ORs are around 650 square feet. Three of the five ORs have natural light because we were able to put them on the front of the building. There are automatic blinds so they can darken the rooms, but the surgeons just love the natural light. If people were in those rooms for quite a while, they'd like some connection to the outside. If you are an inpatient, you could transfer post surgery to neighboring Overlake Hospital, via the connecting underground tunnel, where Group Health doctors have full privileges to see their patients. The connector tunnel has a wall down the middle, providing a private connection for patients who are gowned or on gurneys so they're not in the public space.
The arrangement with Overlake is an interesting win-win. Everybody is playing to their strength. We've been able to build a really effective, very robust outpatient ambulatory care building for Group Health. If you put beds in, you could keep people in here if you wanted to, but that wasn't the goal or Group Health's core business.
Harder: There were some fun challenges and some frustrating challenges. We had to maintain fire truck and ambulance access through the site the entire duration of the project because that was the access for Overlake hospital. For instance, when we set up cranes, we had to make sure that an ambulance could pass right by the crane on the road. Concrete pours had to be staged in a certain fashion so they weren't in the way of the ambulances. Ambulances would weave right through our construction site. It was very unusual.
Because we sunk the site, building the basement into the water table was pretty challenging. We had to build a bathtub concept below the water table and so we used well-point systems to bring the water down in the vicinity. The system pumps the water into a beaker tank and ionic system that takes all the sediment out before we can discharge it again. It was pretty complicated water-tension system. There are also permanent pumps in the basement that pump water 24/7, forever, if you can believe it. And if they fail, there's corks and caulk. There's relief in the basement that will pop out when the pressure gets too high; it will flood the basement and they'll lose cars, but they won't lose the building—that's pretty unusual construction.
Group Health also has a high interest in sustainable construction. Working with everybody to manage the products that were installed in the building from the very simple ones like using low-EOC paints and the right caulking systems and making sure all the contractors were using the right caulking systems, to sourcing and buying sustainable wood products, was a challenge. It's fun, but it's a challenge.
Derr: We've gotten rave reviews from the public. It's such a different environment from the old building, which was literally in the woods.
We actually had a late start and managed to deliver this project on time and on budget. It's a real testament to the guys at Mortenson who pulled their subcontractors together to get the job done. Our designers, architects and engineers worked in a very collaborative manner between design and build, resulting in very few change orders on the project. When we finally agreed with Group Health on the full scope of the building, it ended up being the full scope of the building. There wasn't any value engineering. I think Mike Harder did a great job of marshalling his contractors and pulling that process together. Once you get under construction, it can get kind of crazy, kind of quickly.
I love my buildings and I love doing healthcare. But most everyone that comes to one of my buildings comes as a patient and they would rather be some place else. So what do you do? You do everything you can to reduce the stress of that visit. I think we've been successful with Bellevue Medical Center. You do it through simple wayfinding, calming colors, good lighting levels, comfortable seating, and natural light. I think it's one of those models that, certainly in our practice, we can look at and learn from. HD
For further information on Group Health Cooperative, visit http://www.ghc.org. For further information on Ellerbe Becket, visit http://www.ellerbebecket.com. For further information on Mortenson Construction, visit http://www.mortenson.com.