Project Summary

Owner: The Health Alliance of Cincinnati

Architecture: RTKL (Dallas, Texas)

Medical Equipment Planning: RTKL Healthcare Technologies

Low Voltage Systems: RTKL Special Systems Design Group

Construction Management: Mortenson-Messer Healthcare Construction (Cincinnati, Ohio)

MEP Engineering: Fosdick & Hilmer (Cincinnati, Ohio)

Structural Engineering: Zinser Grossman Structural (Dallas, Texas)

Civil Engineering: Woolpert LLP (Cincinnati, Ohio)

Landscape Architecture: Vivian Llambi & Associates (Cincinnati, Ohio)

Photography: © Jeffrey Totaro/Esto

Total Building Area: 389,520 square feet

Project Cost (approximate): $195 million

Construction Cost: $116.5 million

With a population of 56,000 (and growing quickly), West Chester Township, Ohio-located about 30 miles north of Cincinnati-had a great profile, rated as one of the country's most livable communities in several magazine polls. The only thing missing? Area healthcare services. Enter The Health Alliance of Cincinnati, who began planning for a “new market” hospital in 2004, a start-up project with the advantage of having ties to an existing main campus in Cincinnati, but none of the baggage. The resulting West Chester Medical Center is a 162-bed, 100% digital acute care community hospital, designed to accommodate a 144-bed expansion, as well as some noteworthy design and technologic elements. HEALTHCARE DESIGN Editor-in-Chief Todd Hutlock spoke with Project Manager Michael Hoffmeyer, AIA, ACHA, and Designer Steve Biller, AIA, principal, both of architecture firm RTKL, as well as Peter O'Connor, RCDD, principal and leader of RTKL's Healthcare Special Systems Design Group, about the project.

Designing for flexibility and visibility


Steve Biller, AIA: The client gave us the directive from the beginning that they did not want the hospital to look institutional; they wanted it to be a state-of-the-art, all-digital facility, and for the exterior of the building to reflect that.

Because the site is more linear than rectangular, some of the parking is a bit removed, therefore we oriented the building towards that parking to improve the patients' ease of access. The building is also adjacent to an interstate highway, so from a site zoning perspective, we tried to shield the open public spaces from that sound. There was also a desire to provide some legibility of the design concept from the highway to help provide branding for this new start-up hospital. The exteriors that you see from the highway begin to tell you about what you might encounter as you approach and use the facility.

Michael Hoffmeyer, AIA, ACHA: There is no “back door” to this facility; every side of the building has a visible public access. There is the front entry with the adjacent Medical Office Building, and on the opposite side, the patient bed tower and the Emergency Department, which faces a busy retail drive. The other side faces the highway, which also provides visual access from a distance, as Steve mentioned.

Biller: We designed the hospital to expand in place very easily, both physically for a future bed tower addition, and internally from week to week, if needed. It can expand and contract easily to accommodate high census one week and a lower census the next if need be.

Incorporating technology

Peter O'Connor, RCDD: One of our favorite phrases is, “Just because you can doesn't mean you should.” Often, it is the technology team that tries to be realistic and keep things reined in a bit. The technology at West Chester is very much cutting edge, but not really bleeding edge, which was intentional. Good technology makes the processes in the hospital happen faster. If you don't have the right processes in place, all that technology can be dangerous.

One key to the early part of the process of installing the technology systems at West Chester was to make sure that the facility would not be painted into a corner later when it comes to new and evolving technology, as it costs a significant amount of money to add after the fact. We worked closely with the architectural team to ensure that we had the proper spaces and pathways defined early on in the project so that the technology rooms could support all of the infrastructure required for a high-tech building like the West Chester campus.

From a wireless standpoint, the facility has a public network for laptops and the hospital's clinical wireless network. We also deployed a Distributed Antenna System to allow mobile cellular carriers to bring their signals into the campus. Throughout the building, mobile cellular carriers are available to doctors, staff, patients, and visiting family members. From a security standpoint, West Chester is being monitored from across town at the main campus, so we were able to drive many applications across a wide-area network to the main campus in Cincinnati.

Connecting to the main campus was a logistical challenge, especially considering that some key staff members are in a building 30 miles away. Function and operations were the largest challenges for the technology team; understanding what was our plan B if our connectivity went down or if there were problems with the service providers was vital. We had to build in enough safeguards to make sure the facility could stand on its own two feet if need be.

Public spaces and wayfinding


Hoffmeyer: Many new hospitals utilize a center atrium to simplify the patient focus and to aid in wayfinding; West Chester takes the idea to its full potential by moving the entrance into the middle of the building. From walking into the lobby, one can practically visualize all the activity and all of the access points to services. Throughout the building, visitors do not need to walk very far from the elevator to find someone to register or otherwise direct them to where they need to go.

Often, elevators are put in clusters, where the elevator doors face each other. In this case, the elevators were lined up side by side, so when you exit, you are looking directly at the outside through the expansive glass.

The designers also used a rough, naturalistic stone around the elevators, providing another visual cue that aids in wayfinding. The only place this stone is found is in that vertical circulation on every level, making it easily identifiable.

Biller: The atrium is a two-level space, with the lower level including registration and discretely tying into the emergency department. The medical office building, which is closely adjacent to the hospital's imaging department, is also connected via an enclosed walkway on the first floor. The perioperative platform is located on the second floor, combining cath lab, ORs, and endoscopy. At this facility size, ORs are often found on the main level, but this would have expanded the building; we wanted everything grouped as close as possible to the central atrium.

O'Connor: The public spaces feature extensive digital signage, which allows the staff to be in touch with the public throughout the building. For example, in the OR waiting room, we have multiple screens: there's a screen that shows the status of a patient so family members can be up to date on the procedure, there's a television for entertainment and positive distraction, and there's digital signage so the hospital can keep in touch by broadcasting general announcements. There was a concerted effort to keep families in the loop throughout the facility. We worked hand-in-hand with the interiors and architecture teams on all of these solutions; this was most definitely not an afterthought.

Hoffmeyer: The chapel is located at grade level next to the main entry. It features a large window that looks out onto a reflecting pond. This reflecting pond then flows down into a lower basin that creates a waterfall near the outdoor portion of the dining area.

“Touch points”

Hoffmeyer: In a large medical center, often patients need to travel down long hallways to get to where they need to go for treatment. In this case, everything in the diagnostic and treatment areas is organized where as soon as you get off the elevator on any floor, you can see a registration or information station and waiting area. These “touch points” help this fairly large hospital feel more like an intimate clinic.

Patient areas


Biller: The concave form of the patient tower was dictated by the shape of the patient rooms, allowing for an inboard toilet and ample staff access. This also allowed for a larger family area in the room, as well as access to views of the landscaped areas of the site. From a functional standpoint, we also wanted to maximize the connection to the patient room for the staff who needed to access them. We were able to accommodate a chart area between every two rooms while controlling the size of the patient room to help adhere to the budget. The med/surg unit is very similar in design to intensive care, allowing maximum flexibility in how the staff can use the facility in the future.

The idea of the room-side chart areas completely replacing the traditional nurse station has been pushed to its full potential, at the same time however, we acknowledge the psychological need for staff to communicate face to face. For that reason we developed what are called “care centers” on either end of each unit, each one serving 18 beds.

O'Connor: More and more hospitals are moving toward the type of high-tech nurse call system that we installed at West Chester, which enables work flow as opposed to simply serving as an alarm system. The challenge for our design team is making sure that the touch-screen devices being used are placed properly, so nurses aren't reaching across a patient's head to grab one, for example; they need to be placed off to the side.

Operating rooms

O'Connor: For the integrated operating rooms, we worked with the West Chester team to design a system that allowed the flexibility to choose between multiple equipment manufacturers. Early on, we designed a technology space within the ORs that holds a roll-out equipment cabinet. Working with the architecture team, we carved out a space that allows all of the technology needed throughout all of the ORs.

The other innovative thing we did in the ORs was to position the circulating nurse, who traditionally faces the wall, behind a custom kidney-shaped table that actually pivots on the wall, allowing the nurse to see the field and have all of the technology in front, as well as the technology cabinet behind. The architecture team came up with the concept, and it worked out really well as far as keeping the technology accessible for the users, which can certainly be a challenge.

Conclusions

O'Connor: When a hospital is designed around a philosophy and concepts and processes, you must ensure that those processes are translated properly to the nursing team. If we don't communicate well, the technology will get lost in the translation. You'll have a fantastic new building with all these great processes built in, but they won't be utilized because no one properly transitioned the team. If I could put my finger on one thing that made this project successful, it would be the involvement and energy provided from the West Chester management team. From day one, we had full involvement with all the technology decisions. By the time we actually went live with the hospital, the transition for the staff was a very natural one because the staff knew in advance what they were getting into. The technology wasn't planned and installed in a vacuum; we didn't want the nurses to simply show up and be told, “Okay, here's your new hospital!” West Chester deserves full credit in helping the integration with the technology go smoothly. HD

For further information, please visit http://www.westchestermedcenter.com.

Healthcare Design 2009 December;9(12):38-45