Patrick Ross

Opened in late November 2009, the new $268 million, 585,000-square-foot, seven-story Western Maryland Regional Medical Center located in Cumberland, Maryland, replaced and consolidates two aging hospitals and provides the local community with a level of care that patients once had to travel miles to receive. The 275-bed hospital includes 18 surgical suites; an emergency department; ICU, CVU, and pediatric units; laboratories; pharmacy; café; chapel; and a healing garden. In addition, the project was financed through the HUD 242 program.

HEALTHCARE DESIGN Editor-in-Chief Todd Hutlock spoke with Kevin Turley, vice-president of planning and construction administration at Western Maryland Health System, and Rolf Haarstad, AIA, LEED AP, principal with Baltimore-based architecture firm Hord Coplan Macht, about the project.

Patrick Ross
Patrick Ross

Beginnings

Kevin Turley: There were two existing hospital campuses that had been around for a long time. Even with the consolidation of these hospitals to create the Western Maryland Health System, we were still working with two separate hospitals with two separate master plans. We commissioned a study with our engineering team and the study indicated that there would need to be significant investments in infrastructure to maintain both of the existing hospitals. Based on this information, it was decided to build a single new hospital rather than try to update and operate two separate old buildings at considerable cost. It was a better solution for the community, as well. When services are consolidated into one central location, consumers don't need to figure out whether they need to go to campus A or campus B for specific services.

In Cumberland, the two hospitals were located on opposing hilltops that surround the city. The locations led to inherent problems, as well. For example, one hospital was located on Haystack Mountain, and the roadway would be very challenging particularly in the winter. The other hospital was in more of a residential neighborhood, and therefore also presented some challenges with access. The new hospital is in a much better location, with access to Interstate 68, and also access to the state and county highway. The land is also much flatter in the new location.

The campus is also directly across the street from Allegheny College of Maryland, and we have a very good ancillary relationship for some of the college's health programs: radiology, respiratory, nursing. The hospital is actually on the site of the former Allegheny County Health Department; we relocated that facility at the front end of this project, and that created some synergies between the two groups that did not exist prior to this move.

Site selection

Turley: We looked at a variety of potential locations and we had criteria as far as what we wanted in the new location and what we wanted in the new facility. One was better accessibility via highways and close proximity to the city; because we are in a somewhat mountainous region, to find a site that accomplished both of those goals was quite a challenge.

We also wanted the one campus to be able to bring all major services from both hospitals together. Specifically, we needed to bring together all inpatient and outpatient services, and also have room for expansion. The overarching vision, then, was to create one new facility that could serve all stakeholders in our market, as well as our secondary market in adjoining counties and even as far as parts of West Virginia and Pennsylvania.

Patrick Ross
Patrick Ross

In bringing all of our service lines to one new central location, we were able to improve those service lines. The infrastructure of the new facility is significantly enhanced compared to the old buildings, and also has improved technology. The campus itself was also planned with expansion in mind, so that adds flexibility to all service lines as technology evolves even further.

Rolf Haarstad, AIA, LEED AP: The basic design vision for this facility was to build a truly iconic presence in the community; Western Maryland Health System is the area's number one employer, and they really wanted to make a statement. That vision started to evolve as we looked at several sites; there are no flat sites in Western Maryland. Eventually, the site that we chose had key synergies with the neighboring institutions; we wanted to create a true medical and health center campus for the community.

Patrick Ross
Patrick Ross

The site was definitely the most challenging aspect of this project-it slopes 100 feet from back to front and is less than 40 buildable acres. You'd be hard pressed to find a hospital nearing 600,000 square feet with a 120,000 square foot MOB on the site and more than 2,000 parking places fit onto 40 acres. We addressed that by stacking the D&T podium and the patient tower; the D&T podium is tucked in the site. The main entry of the hospital is at ground level; all of the service aspects are actually on the second level of the hospital, allowing us to take advantage of the slope. The secondary entrance on the second level is very important because it comes over from the main parking garage. So fitting the buildings on such an extremely small site with an extreme slope presented one challenge, but we also had challenges with circulation because of those factors.

Patrick Ross
Patrick Ross

HUD financing

Tom Holdsworth
Tom Holdsworth

Turley: When we were in the early design phase of the project, estimates for the capital and ongoing operational costs were also being developed by our finance team. Traditional financing options weren't feasible and would not have allowed us to move forward with the project. The HUD 242 program was suggested to us as an alternative, and it became clear after the initial interviews that it was a viable financial option for us. It has worked out extremely well for us. It is safe to say that without this program, we would not have been able to achieve success on this project. We heard horror stories ahead of time, but once we met with the HUD folks, we found that these stories simply weren't true. It's been great.

Patrick Ross
Patrick Ross

Haarstad: HUD didn't really affect us from a design standpoint, but through the process, we wound up with an extra set of eyes. They reviewed and commented on all of our drawings at the end of every phase; it was like having our own internal quality control department.

[For more on the HUD 242 program used on this project, see “Found Money,” HCD

July 2009, page 61.]

Layout

Haarstad: Coming in through the main entry, visitors enter a two-story atrium space that serves as the hub of the hospital. To the right, the MOB is connected to the main building. As you enter at the first level, then, you move either to the outpatient areas to the right or the inpatient areas to the left. The first floor is also occupied by the Emergency Department, which also has its own entry. Towards the front left is the Cancer Care Center, which also has its own entry.

On the second level, there is a fairly large public function, including the cafeteria, which is already becoming something of a “destination” restaurant in the area. There is also a small healing garden and the chapel, which features stained glass taken from one of the two decommissioned hospitals, providing a nice connection to the past. The rest of the floor has administration, pharmacy, and materials management.

Patrick Ross
Patrick Ross

The third floor is the engine of the hospital, containing the ORs, PACU, interventional imaging, IPU, and the cardiovascular ICU.

The entire fourth floor is mechanical space; if you look on the exterior, you'll see a series of louvers on that level. These allow fresh air to circulate into the chiller spaces, etc. We located it at that point because we wanted to take as much equipment off the rooftops as hospital to keep the breathtaking views intact, and also because it was the most central part of the hospital. This allowed us to minimize our duct runs, which also would eliminate noise and increase efficiencies.

The fifth floor includes three patient units, as well as the dialysis area, which also have great views and lots of natural light. The sixth floor is a repeat of the fifth floor, and the seventh floor includes two more patient units.

Patrick Ross
Patrick Ross

Patrick Ross
Patrick Ross

Patrick Ross
Patrick Ross

Notching

Haarstad: There are multiple intentions at play with the notching on the outside of the building. At the beginning of the project, we were concerned with having too massive of a building because of all the stacking we would have to do to fit it in the site. We really wanted the tower to feel as if it was sliding up from the base, as opposed to looking like it was just plopped down there. The use of the notching, the colors, and the metal panels on the exterior recalled the layering effect of the landscape all around Western Maryland, as well as the Western Maryland Health System logo itself.

Patrick Ross
Patrick Ross

Patrick Ross
Patrick Ross

Patient areas

Haarstad: I believe we created a fairly innovative patient unit. As opposed to standard racetrack layout, which would have created a more massive footprint, we pulled off the areas at the end and created some simple double-loaded corridors. This allowed us to bring more natural light in towards the center of the unit, as well as more access to the beautiful views of the mountains and nature, creating a great healing environment.

The patient rooms are mirrored; at the end of the day, the nursing staff preferred it that way, and it also saves space and money by consolidating medical gasses and equipment between rooms. Every room has a family waiting area, and the vast majority are single rooms. From looking at the overall census, Western Maryland felt it was effective to go ahead with some double-occupancy rooms. Currently, all the patients are occupying single rooms, but when census hits peaks, some of the doubles may be utilized.

Tom Holdsworth
Tom Holdsworth

Interactive design process

Patrick Ross
Patrick Ross

Patrick Ross
Patrick Ross

Tom Holdsworth
Tom Holdsworth

Turley: We needed to determine very early in the project what our process structure was going to be with Hord Coplan Macht. We established a master facility plan steering committee charged with oversight of the process. This group was key in establishing the parameters of design, as well as program requirements, financial control, and planning.

We also established a series of functional planning teams. For example, a functional planning team for oncology would be led by the oncology department director; HCM would have someone assigned to the team, as well as physicians and other key staff members from the department. This meant that a specific team would work directly with Hord Coplan Macht to talk through each program. The process engaged approximately 300 staff members and 50 physicians. Those people really drove the design, which was important, but there was also be a built-in series of checks and balances, as the team's decisions would also roll back up through the steering committee. The process was very smooth. We worked with these same people in this same process through the schematic design process, design development, right up to the construction documents phase. This gave our staff ownership of the building before they even moved in, which helped tremendously with buy-in. HD

Patrick Ross
Patrick Ross

For more information, visit http://www.wmhs.com.

Healthcare Design 2010 January;10(1):44-52