Blending old and new to achieve the extraordinary
Clarification: Shepley Bulfinch served as Design Architect for the Bronson BirthPlace and NICU project featured in the April 2008 Pebble Report. The firm was retained by Bronson to ensure the new project was sympathetic to the design language it had established in the late 1990s at the Bronson replacement campus across the street. The firm's role on this renovation project was to lead the programming and planning effort and serve as Design Architect. Shepley Bulfinch carried the replacement campus exterior vocabulary into the new entry, created a skylit atrium that echoed the garden space of the main campus, and established an interior pallette to create the spa-like atmosphere the client was seeking. Shepley Bulfinch collaborated continuously with Diekema Hamann, the Architect of Record.
In December 2000, Bronson Methodist Hospital opened a $210 million replacement hospital in downtown Kalamazoo, Michigan, designed as a unique healing environment using art, music, nature, and light. The facility has become recognized as a best practice site for hospital facility design and has garnered significant national attention.
Well-known for high-quality care, as well as its all-private rooms, Bronson experienced a more than 40% increase in inpatients since the new hospital's opening. Based on this increase, Bronson decided to expand patient care services to a location on its former campus, adjacent to the new hospital. Rather than build a new facility, it was determined that renovating an existing 143,000-square-foot inpatient tower (North Pavilion) would result in significant time and cost savings and suit the hospital's master plan for long-term growth.
The $38.1 million project scope
The North Pavilion project included creating a new home for the Bronson BirthPlace and Neonatal Intensive Care Unit (NICU). The Bronson BirthPlace was expanded from 31 to 40 private rooms, allowing it to accommodate 4,000 obstetric patients per year (compared to 3,200 previously). Treating about 680 babies annually, the NICU was converted from an open nursery design to 45 all-private rooms.
With two floors retained and in operation throughout construction—a long-term acute care hospital and an adult medical unit—the North Pavilion now also features medical offices for obstetricians, nurse midwives, perinatologists, neonatologists, and related healthcare providers, a café and gift shop, a breastfeeding center, a concierge service, and a chapel.
Making the old new again
Diekema Hamann Architecture Engineering was challenged to keep Bronson's “new hospital” reputation and patient experience alive within the confines of an existing structure. From a broad view, the firm overcame this challenge by ensuring the North Pavilion included the following evidence-based design solutions:
Natural lighting, landscape views, and indoor garden courtyards—all associated with reducing patient stress levels;
Open, welcoming public spaces, corridors, and waiting areas that include Internet stations, family kitchenettes, and specially designed furniture selections;
Enhanced sound reduction through the use of special glazing, high-performance acoustic ceilings, and floor selections (e.g., carpeted corridors and rubber flooring);
Simplified wayfinding—a unique, colorful art wall at both main entrances moves individuals toward the elevators and provides directional cues without requiring visitors to locate signage;
Homelike, adaptable labor and delivery rooms that increase safety, decrease patient transfers, and minimize noise and disruption through the immediate access of equipment in the room; and
For seriously ill or injured newborns, a Neonatal Intensive Care Unit with all-private rooms—a pioneering design concept in place in only a few units in the country.
Nurturing those who need it most
Building on its Pebble research study's success at reducing patient infections (a four-year study was conducted at Bronson that revealed the hospital's all-private room design reduced hospital-acquired infections by 11%), the new NICU offers isolated sound and lighting in all-private rooms of 140 square feet per infant. At 40 square feet beyond minimum state requirements, this extra space ensures a comfortable and confidential healing environment for babies and families. All rooms feature a recliner for parents, as well as individual control of lighting and temperature.
Bronson is conducting research on the new NICU design and its impact on patient care. When finalized, research results will be shared with other hospitals via The Center for Health Design's Pebble Project.
The NICU also offers other conveniences and efficiencies, including:
Sinks in every room to improve staff compliance with hand washing and further decrease the potential for infection;
Charting stations and supplies in every room to reduce staff time away from patients (early studies of the new NICU indicate that the nursing staff is walking up to a mile less per shift);
An on-site, full-service milk bank to provide breast milk for NICU infants; and
A designated training and sleepover room to help parents feel more confident about caring for their baby after leaving the NICU.
Throughout the Bronson campus, every encounter a patient or visitor might have has been meticulously planned to make navigation easy, from parking to outpatient services to physician offices to inpatient units. Keeping Bronson's desire for “ease of use” in mind, the North Pavilion's private labor and delivery rooms were designed to not only provide moms-to-be with a homelike environment, but also to improve staff flow and efficiency.
Each room has all the necessary equipment at hand for a smooth delivery; baby scales and warmers, dual monitors (for staff and moms), and bassinets are built right into the casework. This immediate access to equipment reduces disruptions and excess noise, which have been shown to increase patient stress and diminish the body's ability to heal. For added comfort, transition strips at door openings were eliminated to reduce bumping of patient beds as they're transported in and out of rooms.
Fresher air, quieter surroundings
Because of innovation in ductwork design, the North Pavilion exceeded code requirements for fresh air by 30%. While newer hospitals are typically built with floor-to-floor heights of 14'6", the existing North Pavilion tower had floor-to-floor heights of 12'8". Because air pressure was higher and ducts were smaller, noise and balancing became key issues. To maintain proper balancing and quiet surroundings, computer simulations were used to replicate pressure drops and sound levels. Based on these simulations, duct-system arrangement and size were both designed to allow for the same pressure differences at each outlet—avoiding the need for sound attenuation. All patient rooms in the Bronson BirthPlace and NICU have a thermostat to control air volume, air temperature, and perimeter radiant temperature.
Selected in 2006 by the Green Guide for Health Care as one of the nation's top 10 green hospitals and holding the ENERGY STAR label for energy efficiency, Bronson's goals for the renovation of the North Pavilion required an environmentally responsible approach. For the project, the architects and engineers used the LEED rating system as a guide for sustainable building practices. Sustainable design features that support a healthy and nurturing ambiance were used, including access to nature, light, and water. Several other “green” approaches were also implemented, such as rubber flooring; PVC-free products; low-emitting materials; carpet made from hybrid fibers; including plant sources to reduce the level of petroleum; and sheet vinyl made with 40% recycled content.
From the use of recycled content to indoor environmental quality efforts to abundant daylight and landscape views to improved sound reduction, the North Pavilion—like the new hospital Bronson opened in 2000—is the cumulative result of wide-ranging evidence-based design solutions. By blending old with new, this revitalized facility achieves the extraordinary for patients and staff alike. HD