Outside In

For decades, residents of Johnson City, Tennessee, and its neighboring communities had been served by three hospitals that came to be an integral part of the local fabric, for both the patients who visited them and the staff members who worked there. However, Mountain States Health Alliance determined that two of them were too inefficient to maintain and opted to plan a new replacement hospital.

The health system challenged Karlsberger not only with the consolidation, but also with constructing a facility in the mountainous landscape that would achieve LEED certification.

The preliminary design and planning phases for the project began in May 2007, with the last bid package for the fast-track project going out in August 2008. The team beat its original owner occupancy date by one month, and, thanks to minimal change orders, completed the project $4 million under budget.

HEALTHCARE DESIGN Managing Editor Jennifer Kovacs spoke with Karlsberger team members Paul Carney, LEED AP, associate, project manager; Jill Grdina, LEED AP, interior designer; and Brent King, MLA, ASLA, CLARB, LEED AP, associate, senior landscape architect; as well as Bill Alton, assistant vice president, construction and facilities, Mountain States Health Alliance; and Franklin Woods CEO David Nicely about the 80-bed replacement facility.

David Nicely: We had two longstanding facilities that had very different cultures and services. North Side Hospital had been in existence for more than 30 years, and Johnson City Specialty Hospital for about 22 years. North Side offered primary care and had a very busy emergency department that saw about 80 patients a day. It did not have any operating rooms—no surgeries or women’s services were performed there. Those services—surgery and family childbirth—were provided at the Specialty Hospital.

The two hospitals were aged. They really outlived their meaningful use. So the idea was to merge the two into a brand new community hospital and really have a hospital that worked hand-in-glove with our large tertiary care sister facility, Johnson City Medical Center; but Franklin Woods would be something that served the community’s low to moderately acute patients and certainly would be very unique, very high-tech, high-touch, and also be the first green hospital in the state.

Both North Side Hospital and Johnson City Specialty Hospital had very good reputations within the community, among loyal physicians who worked at both places and among loyal followers in the area. One of the things we wanted to do in the creation of Franklin Woods was to take what was working really well in those two facilities and actually improve upon it.

Focusing on efficiency and regulatory compliance
Bill Alton: North Side Hospital was inefficient since it was a single-story building with long corridors, which made service a bit more difficult. Service efficiency was a problem for staff, and there was no easy or inexpensive solution. The situation was similar at Johnson City Specialty Hospital. It was a two-story facility that was more efficient operationally but created energy consumption difficulties. Again, both facilities were old and expensive to operate and provide economical healthcare services. They served the community well, but it was time to combine these services into one facility that met the organization’s expectations and community needs most effectively. Energy consumption and capital demands for these two existing facilities were driving the cost of healthcare up for the organization and consuming resources. We were spending a lot for inefficient facilities, so we incorporated multiple energy-saving designs into the new facility with state-of-the-art equipment and control systems, allowing us to match the building load to demand and better meet the environmental needs of the staff and patients. We also were able to provide greater amounts of natural light, which improves healing and reduces energy costs.