The cities of Katy and Sugar Land, Texas, are near-classic examples of what Joel Garreau termed “edge cities” in his 1991 book Edge City: Life on the New Frontier. They are among the new, self-contained suburbs of mixed-use commercial and residential properties growing and spreading just outside many of America's major cities. As two of the fastest growing such communities in the Houston area, Katy and Sugar Land are located on Highway 99—i.e., the Grand Parkway, the proposed third ring road—which at completion would traverse over 180 miles through seven counties to encircle the Greater Houston region. One segment of the road linking Interstate Highway 10 and Interstate Highway 59 is now complete.

Opposite page: Memorial Hermann Sugar Land Hospital in Sugar Land, Texas. Above: Memorial Hermann Katy Hospital, Katy, Texas.

Katy, located west of the city at the junction of IH10, is an upscale suburb with a population of nearly 12,000 people. Meanwhile, southwest on IH 59, Sugar Land is the fastest growing city in Texas—a 156% growth rate over the last decade. With a mix of master planned communities and corporate headquarters, it is home to more than 78,000 people.

As Memorial Hermann Healthcare System—a not-for-profit, community-owned system serving Southeast Texas—explored how best to continue its growth in the Houston area, its administrators looked closely at their existing hospitals in these edge-city locations. They realized that opportunities for extending healthcare services to existing patients and their families and attracting new ones exceeded what could be achieved by simply expanding their older facilities. “We are committed to providing people with high-quality healthcare in locations that are just five to ten miles from home, and in Katy and Sugar Land there is substantial demand for our services within that distance,” says Chief Facility Services Officer for Memorial Hermann Marshall Heins.

Once they decided to build replacements, Memorial Hermann committed to a planning and design process that would produce best-of-class community hospitals. “We wanted the finest acute care facilities in those communities, so we did our research. We worked with a consultant on the future of hospitals, we made benchmarking visits to other facilities, we talked to city officials and community leaders, and developed best practices for the new facilities,” notes Memorial Hermann's Chief Regional Operations Officer Rod Brace.

Working with WHR Architects, Memorial Hermann began asking questions that would shape the physical program for the hospitals, as well as a philosophy that emphasized the mental, spiritual, and aesthetic aspects of healing. For Memorial Hermann, with its dedication to patient-centered care, understanding the needs of the residents in these communities was critical. Families, attracted to these cities for the range of housing options and good schools, are a large part of the patient community. “We found that families make most of their important decisions around the kitchen table, so each of our nursing units has dedicated family nourishment space with equipment for volunteers to make cookies and bread, as well as a small dining table and an educational library. We are trying to create a nurturing environment that helps families cope with the challenges of illness and treatment,” says Brace.

Other family-friendly features include meditation rooms, a healing garden that can be enjoyed from multiple locations throughout the hospitals, and homelike patient rooms that include guest sleeping accommodations, flat-screen TVs, DVD players, desks and armoires. Families can relax in the ground floor Family Service Centers (figure 1), which have educational resource libraries, quiet areas, and play areas for children. For young families in their 20s and 30s, having information about health issues when they are making decisions is very important, and the hospitals provide resource centers with wireless Internet connectivity and access to Memorial Hermann's online resources.

Changing demographics were an important consideration, not only for the patients, but also for the hospital staff. “Considering the age profile of our caregivers, we wanted designs that use fewer steps, as well as furnishings and equipment that are easier to open, lift, and use,” Brace continues (figure 2).

“Each hospital is designed to provide state-of-the-art, inpatient acute care and emergency care, and outpatient care is available at the freestanding medical office building on hospital grounds,” observes Heins. “Most patients will find everything they need at these community hospitals although, depending on the acuity of the problem, they do have access to Memorial Hermann's flagship hospital in the Texas Medical Center or, in an emergency situation, there are our Life Flight helicopters, Houston's only hospital-based air ambulance program.”

Developed within the same time frame, the designs of the two facilities began as prototypes that were adapted to meet the specific demands of their locations and markets. Although the use of a prototype is unusual for a not-for-profit healthcare system, the design similarities of the two facilities provided a number of benefits. Memorial Hermann took advantage of the prototype to affect cost savings in the design and construction and to establish a set of best practices for building materials such as lighting, flooring, and finishes. Because speed to market was a factor—30 months for design and construction—the prototype facilitated decision making with the use of common elements, including the basic layout and functional relationships, architectural features, and mechanical systems.

Both Memorial Hermann and the communities benefit from the distinctive architectural features that brand the buildings as part of the system. A tall, lantern-like tower, reminiscent of the landmark tower on the historic hospital in the Texas Medical Center, leverages the high-visibility locations at the crossroads of major highways, even at night when the Lantern is illuminated (figure 3). The curved bed tower, the gracious height of the public concourse and lobbies (figure 4), the healing gardens and signage and graphics all help to create a memorable identity. In fact, the striking profile of the building at Katy (figure 5) has markedly increased emergency room visits, which has led to greater numbers of patient admissions, as well.

Technologic innovations at both hospitals include advanced electronic medical record systems, paperless check-in using tablet PCs, positive patient ID using arm-band scanning, and tracking in the operating room (OR) that enables physicians, staff, and families to privately follow a patient's surgical progress using large display screens in waiting rooms, ORs, and pre- and post-op areas.

Patient diagnosis also is enhanced with a new 3-Tesla magnetic resonance imaging (MRI) scanner, which is twice as strong as conventional units and provides unsurpassed imaging and diagnostic capabilities.

Differences in the programs were driven primarily by the ability of each community to support the services. Katy's $98-million, seven-story, 320,000-square-foot hospital has 127 private patient rooms. The hospital includes a 17-bed emergency center, with eight additional observation beds and an accredited chest pain center. Designated a Level IV trauma center, the emergency center will have Life Flight access. The hospital also features a 12-bed intensive care unit, six pediatric beds, and state-of-the-art surgery suites.

The hospital's large obstetrics and nursery program includes seven labor/delivery/recovery rooms, 22 private postpartum suites, and four antepartum rooms. The nursery provides care for 20 babies needing Level I care and nine needing Level II neonatal intensive care.

Sugar Land's $79-million, five-story, 220,000-square-foot hospital has 77 private patient rooms, including eight acuity-adaptable bedrooms located within the medical surgical nursing unit. These bedrooms allow an intensive care patient to stay in the same room for step-down care. The hospital includes a 16-bed emergency center with fast-track beds and two observation rooms. A Level IV trauma center, the emergency center will also incorporate Memorial Hermann Life Flight staff.

The smaller obstetrics and nursery program includes 13 labor/delivery/recovery/postpartum rooms with upgraded amenities (figure 7). The nurseries will provide care for 15 babies needing Level I and Level II neonatal care.

Since opening in December 2006, Memorial Hermann Katy and Memorial Hermann Sugar Land are enjoying positive responses from their communities. The new facilities bring big-city healthcare to their edge-city locations with buildings and programs that incorporate patient-centered care and the latest technology in healing environments. HD

William Ganshirt and Mark Vaughan are Principals at WHR Architects in Houston and Dallas, respectively. They can be reached at bganshirt@whrarchitects.com or 713.664.5665 and mvaughan@whrarchitects.com or 214.468.8505.