As a Level II trauma center, Sutter Roseville Medical Center (SRMC) in Roseville, California, treats serious injuries and illnesses on a regular basis. However, when patients were ready to begin the often long and arduous process of rehabilitation and related physical therapy, they were transferred elsewhere. The new Sutter Rehabilitation Institute-a two-story facility that includes 40 rehab beds and shell space for 16 more, as well as for an additional 51 future rehab, med/surg, and ventilator unit beds-changed all that, becoming the largest standalone facility of its kind in the region and enabling patients to experience a previously impossible continuity of care. HEALTHCARE DESIGN Editor-in-Chief Todd Hutlock spoke to Lead Designer Stan Chiu, AIA, LEED AP, and Project Manager Greg Osecheck, both of HGA Architects and Engineers, as well as Harumi Lanier-Hauptman, Principal Interior Designer at Arktegraf, Inc., about the project.

Beginnings


Stan Chiu, AIA, LEED AP: At the formal kick-off for this project, we were shown a video featuring a teenage boy who had been skateboarding and hit his head on a rock. Just a typical kid, sunny day, out doing kid things, and suddenly he had a traumatic brain injury; he went through a long rehabilitation process. He became a sort of living symbol of the challenge to design the Sutter Rehabilitation Institute-what would it take to make a home for these patients that are in rehab for typically a pretty long time? How do we create something that is not as institutional as some other rehab sites, where people can get to know each other as they heal. We didn'twant it to look like a typical hospital, but we still wanted to provide state-of-the-art care.


Greg Osecheck: The vision for this facility was to create an environment that would encourage patients in the rehabilitative process by making patient care the highest priority. The focus was on patient safety, clinical processes, positive outcomes, and family involvement. Also important to Sutter Health was promoting employee satisfaction, teamwork, and operational efficiency, thus creating market distinction in the region and maintaining the Rehabilitation Institute as a Center of Excellence.

Site planning

Chiu: By the time this project was conceived, the Sutter Roseville campus was just about out of space. The campus is bounded by a ravine and has a fairly wild environment. For instance, when you walk around the ravine, there are signs that say, “Caution: Rattlesnakes.” This facility is perched at the end of the ravine, which has some nice advantages: there are some really nice views, and it's a quieter area of the campus, effectively separated from the rest of the campus by a parking structure. It is connected, but it is still independent. It was tough to fit this much program in this spot, but the advantages of the isolation, the quietness, and being able to provide an outdoor exercise area meant that the benefits were big.

The building has different sides to it, creating a bit more of an urban condition next to the adjacent parking structure. We were able to create a small outdoor area next to an administrative faéade. On the one side of the building, it feels more urban; the other is more wild and open. The outdoor areas take advantage of some changes of topography and the shape of the building. The outdoor area in the front of the building that comes off the gym is part of the rehab program by design; the kink in the building allowed us to fit that space in there and to include some of the vital function areas, such as the basketball court.

Unique challenges


Osecheck: Designing and planning an acute rehab facility versus other acute care facilities has similarities and differences. Nurses' stations, med rooms, and utility rooms are similar programmatic functions, while the therapy gym, activities of daily living (ADL) treatment rooms, independent living apartments, and an outdoor therapy course are not typical.

Also, specialized patients with brain and spinal cord injuries have different needs than most hospital patients. For example the brain injury unit needs to be secured and monitored because those patients tend to wander. They can also be very sensitive to noise, so special attention to adjacencies and acoustical details is required. For patients with spinal cord injuries, the design team at HGA discovered that semiprivate rooms are sometimes preferred because it helps with the coping and healing process.

Chiu: There are a lot of heavy-duty spaces that need to be in close proximity to the patient rooms, and circulation has to flow very well. Overlaid on top of that is the desire to feel a bit more secluded, a bit more out of the way. The challenge was to balance those two elements. Many times, with healthcare architecture projects, you have a tendency to let efficiency principles rule and you begin planning around them. We had to accommodate that, as well.

We created a “Main Street” spine that runs through the units, but none of the rooms have direct access to it; they're all in neighborhoods, if you will, off of the central boulevard. The boulevard is almost like a commercial district in urban planning. Once you get beyond that area, you get to the residential areas. That decision became the great “aha!” moment. We made the neighborhoods compact and efficient while separating them from the primary circulation. It highlights the paradox of this operation-you want everything to feel isolated and separate, but nursing needs to be able to flex back and forth easily, as well. We used L and C shapes to achieve that so each leg feels a bit independent from the other.

The site itself was really challenging to work with, as well, but I think it led to a more interesting project in the end. We had to be more creative with the plan by necessity.

Architectural plan


Chiu: You enter the main lobby into an octagon which we used to resolve a lot of the conflicting geometry of the site. The octagon achieves the feeling of a lodge, surrounded by glass and wood accents, with seating in the middle. From there, you can move either straight back into an administrative area, or off to the right into the Main Street corridor.

As you move down the corridor, there are connections to the units through the nurses' stations. The corridor has a kink in it, so you see angles and signs of life rather than a straight, long hallway surrounded by doors. As you move into one of the units, or “neighborhoods,” through the nurses' stations, you are really separated from that main corridor, with all support spaces right there. There are about 15 beds in each neighborhood, with two neighborhoods on each side of the kink.

On the first floor, there's a connection back to the outside through the gym; as you walk down the corridor, you can see through the gym and then outside to the ravine and oak trees. The program is repeated on the second floor in smaller scale, but you look through the dining area onto the tops of the oak trees rather than the gym. At the very end of Main Street, there are elevators and some other service areas.

Interior design


Harumi Lanier-Hauptman: Arktegraf has been working with HGA on SRMC's projects since 2003. During the course of our work with SRMC, we developed an interior finish master plan for them, and we followed the master plan finishes throughout the hospital as our baseline theme. We tailored each project to fit each department's needs.

For the Sutter Rehabilitation Institute, we wanted to create a nonstressful environment for the patients and visiting family members. We achieved this by incorporating visual wayfinding methods through the use of accent colors at the ceiling soffit and floor tile design at the key decision making point at all the corridors.

Because most of the patients are faced with long-term rehabilitation work, which at times can be very challenging, we also wanted to add artwork that would give the patients and their families uplifting feelings. Together with the client, we selected four custom-commissioned artworks from local artists. They included mobile ceiling art, three-dimensional wall sculpture art, whimsical and colorful outdoor sculptures, and local landscape art. All of the art was a huge success with the patients and their families.

Conclusions

Osecheck: SRMC is a highly cohesive campus of healthcare buildings with a strong palette of forms, building materials, and colors. The Sutter Rehabilitation Institute is an extension of the hospital and intentionally captures the same flavor, with the sloped mansard roof structure, arched openings, and the thick horizontal datum bands in the exterior insulation finish system. Although these are relatively common elements, HGA used them creatively to create a unique stand-alone building. The strict adherence to these elements really helps to brand SRMC as a campus of excellence. HD

For more information on Sutter Rehabilitation Institute, visit http://www.sutterroseville.org/rehab/. For more information on HGA Architects and Engineers, visit http://www.hga.com.

Healthcare Design 2009 June;9(6):42-48