Recommitting to the community
Owner: Provena Saint Joseph Medical Center
Architecture: HDR Architecture, Inc.
Interior Design: HDR Architecture, Inc.
General Contracting: Pepper Construction
Total Building Area: 254,342 square feet
Total Cost: $96 million (including equipment)
Cost/Sq. Ft.: $377.44
It's not uncommon for hospitals wanting to upgrade their concrete and brick piles of yesteryear into environmentally appealing modern facilities-except, how often does “yesteryear” go back 126 years? Provena Saint Joseph Medical Center has seen several upgrades since then, of course-most recently during the 1990s. But the impetus for the eight-story, 199-bed patient tower that opened this spring was a desire to move into the future of private rooms and healthcare hospitality as soon as possible, and show its home community of Joliet, Illinois, that it was as committed to the city's well-being as ever. The complex decisions this required and how they were implemented over the past four years were reviewed recently by key players in the project-Terrence Wright, Vice-President of Facilities Planning; David R. Redemske, ACHE, ASHE, Senior Designer for HDR; and Anne Rockwell, IIDA, an interior designer also with HDR-in an interview with HEALTHCARE DESIGN Editor Richard L. Peck.
Terrence Wright, Vice-President of Facilities Planning, Provena Saint Joseph Medical Center: Our initial goal in creating an eight-story, 199-bed tower was to decompress our semi-private rooms to all-private rooms. Esthetically, we wanted a visually appealing, comforting, rich look, and we wanted to plan for future flexibility-from patient rooms to ICU rooms, for example-and for possible vertical expansion by two stories. We were helped a great deal in this process by consultants from the Center for Health Design's Pebble Projects acting as facilitators. They conducted visioning sessions involving the Board of Directors, administration and staff in the presence of representatives from the architectural firm, HDR, and contractor, Pepper Construction, so that they could hear first-hand what our core values were.
David R. Redemske, ACHE, ASHE, Senior Designer, HDR: As part of the master plan for changing from semi- to all-private rooms, we redefined the medical center's main entrance to enlarge it and move it from the east to the west side of the facility. This allowed for provision of separate inpatient and outpatient entrances and of a new parking deck.
Anne Rockwell, IIDA, Interior Designer, HDR: We recommended finalizing the design of the new patient tower first so that we could develop a standards package that could be used not only for the new construction, but to renovate the existing facility, so that basic elements such as flooring, wall treatments, handrails, and so forth would maintain a consistent appearance throughout. The standards would also guide the changeover of the semiprivate rooms in the existing building to all-private, which is happening right now.
Redemske: We wanted a masonry façade to match the look of the existing campus. Because the facility's exterior design is somewhat repetitive, it lent itself to precast construction. This allowed a faster construction schedule-we could build right through the winter-and it gave us shop-based quality control. We used half-bricks, or “soaps,” inlaid in the concrete and set up in panels. Then, to match the warmer, richer tone of the new tower, the brick on the existing nearby buildings was slated to be stained.
Wright: Yes, we actually started the precast construction process using brick for the parking garage, because we didn't want it to look like a parking garage, and then used it for the patient tower. The central utility plant right next to the new entrance had the old yellow brick from the 1960s, but we were able to stain this and match the colors so closely that, from the street, there is no way of telling that one building is newer than another. The precast idea was brought to us by Pepper Construction, which had used this approach with HDR on previous projects.
Patient rooms and resource area
Wright: We had a great deal of discussion about what goes into the patient room and what doesn't. We wanted lots of amenities, such as wireless and Wi-Fi, flat-screen TVs, and art work, and we wanted to provide a safe environment. Also, now that we have 24-hour visitation, we wanted to accommodate families with comfortable furniture and our Wireless Guest Internet program.
Redemske: From a technical standpoint one of our biggest challenges in creating the new patient tower was matching the floor-to-floor heights of the existing building to which it connects-11 feet, four inches-a challenge for today's construction, with all the above-ceiling space needed for cabling and ductwork. To accommodate this need, we used concrete frame construction rather than a steel structure. As a result, we had two mock-up rooms: one for nursing staff to make comments and changes about the room layout during the design phases, and one for the subcontractors to get the pipework and conduits arranged right the first time in this very limited space during the construction phase. Operationally the rooms are same-handed, in the sense that whether you turn left or right on entering the room, the nursing desk is always on the corridor side, patient monitors are always along the exterior wall next to the bed, and toilet rooms are back-to-back. The other challenge, from a technology planning standpoint, was accommodating the technology closets, which are getting bigger and bigger these days. These ran about 120 square feet in this building, and there are as many as two per floor, despite the very tight footprint this building occupies.
A final important point about these rooms: They're designed to be readily convertible to ICU rooms, if desired, with a changeover from swinging to sliding doors and installation of a new ICU headwall. Such a conversion might be up and running in a matter of months to avoid a major renovation.
Rockwell: As for the interior design, our goal was to give patients and families plenty of options when it came to lighting, privacy and amenities. Lighting in the family zone is individually dimmable. The light fixtures are highly compact rather than the bulky multifunction 2 x 2 fixtures one typically sees in patient rooms. The furniture is designed for round-the-clock comfort, with a recliner that can be used for sleeping and a high-backed chair usable by both patients and families. Pull-out beds were not provided because we wanted to take up as little floor space as possible in these rooms, which measured 250 square feet, with an additional 55-square-foot bathroom. A hospitality look was highly important-Provena CEO Jeff Brickman had us visit traditional hotels in the Chicago area, such as The Drake, to get ideas, and we have lots of dark cherry wood on the first floor, while the upper floors have a more contemporary look with lighter woods, such as honey maple.
Redemske: This might be called “found space”-a gap between the old and the new buildings created by the necessity of maintaining privacy for the patient rooms of both structures. The Winter Garden allows visitors to cross directly from the main entrance to the existing elevators or from the outpatient side to the new tower elevators. It provides a welcoming environment of natural light, plants, and comfortable seating, and allows people to reorient from the patient care areas.
Rockwell: It was a way of bringing a feeling of the outdoors into the building, especially since Chicago weather doesn't allow access to the outdoors year-round. So we have this garden feeling, along with a faux fireplace, and a true healing garden adjacent to the south.
Wright: This area has exceeded our expectations. Medical center CEO Jeff Brickman, who is from the northeast, has empathy for people suffering through Chicago winters, and he thought it was important that visitors and patients get to experience the colors of nature and greenery in a quiet area. No phones are allowed here and it is a quiet zone. There is an attractive fireplace-everyone wanted it to be a working fireplace, but this wasn't allowed by the Department of Public Health.
Corridors and physician lounge
Wright: It was a priority that we have clean, uncluttered corridors and sufficient storage areas in the new tower, especially since we had serious storage issues in the old building. I'm a big fan of alcoves, and we spent a lot of time designing these so that they would be convenient, out-of-the-way, and able to accommodate everything from computers and crash carts, to lift equipment and portable pumps. The decentralized nursing stations are working well. Chief Nursing Executive Jackie Medland worked with her staff to get it right, and the physicians are excited to have such convenient access to patient charts and nursing staff.
Redemske: We provided onstage and offstage corridors, with main corridors for the public and staff to use, and cross-corridors for staff and service functions such as clean-and-soiled transport, food carts and the like. To prevent linen carts, med carts or computers from cluttering the corridors, we provided alcoves for all of those services.
Rockwell: It's interesting, I've been back several times since the patient tower opened and they've done a nice job of using the alcoves as they were designed and putting things away. This is not always the case in new construction.
Redemske: The decentralization is also working well. It's always a bit of a shock when you go from semiprivate to private rooms to see what a challenge convenient access to charting and storage can be, but we've distributed this as carefully as possible to make this work for staff. HD
For further information, please visit http://www.provena.org.