Chapels are not at all unusual in healthcare facilities—you will find them in facilities of every size. But it is not often that the chapel is the visual and conceptual center of the facility’s design, observable from nearly every public space on the first floor and symbolizing the spiritually centered care throughout the hospital. That was one of the guiding principles for the Middle Tennessee Medical Center, which is located in historic Murfreesboro, Tennessee, and opened in October 2010.

The 286-bed facility includes 12 operating rooms, 40 emergency department exam rooms, 32 ICU rooms, 11 labor and delivery rooms, and 16 neonatal intensive care beds. Architectural firm Gresham, Smith and Partners (GSP), in integrated collaboration with contractors Turner Universal, Smith Seckman Reid, and Lawler Wood, brought the project home two months early and $4 million under budget. Recently, key GSP designers Gregory A. Gore, AIA, NCARB, principal-in-charge; Jane S. Skelton, IIDA, EDAC, LEED AP BD+C, associate ASLA, senior interior designer; and Ashley Roller, intern interior designer, discussed this ambitious project with HEALTHCARE DESIGN Contributing Editor Richard L. Peck.

The 286-bed Middle Tennessee Medical Center, Murfreesboro, Tennessee, designed by Gresham, Smith and Partners, is among the facilities available for tours as part of HEALTHCARE DESIGN.11 being held November 13-16, 2011, in Nashville. All tours will be held from 1 to 5 p.m. on Sunday, November 13. For more information on the conference and the facility tours, please visit


Gregory A. Gore: The chapel, which is the circular part of the building with a healing garden wrapped around it, is the focus of the facility. All public spaces—the lobby, waiting rooms, dietary, and so on—radiate from the chapel so that it is observable wherever the visitor goes on the first and upper floors of the building. Usually, architects try to get patients and visitors into the hospital as quickly as possible by locating the facility entrance in the center as close to the public elevators as possible.

Here, we located the entrance at one end of the wing, thus creating a long, curvilinear lobby enabling visitors to see spaces open up as they progress through the lobby and see the chapel from every vantage point. Gift shops, dining, radiology, the ED, and the waiting rooms are all accessible off the lobby. This is a Catholic hospital—part of the Ascension network—and the program was spiritually driven. This concept is reinforced on the exterior by a mullion pattern that symbolizes a cross; this pattern was brought into the interior and carried throughout as a design feature wherever possible.

Large expanses of glass in the lobby admit lots of natural light—a contrast with the original facility, which is 60 years old and cold, sterile, and dark. Opening up the new facility with natural light was done with the full support of the owner, who has a deep interest in Planetree.

Jane S. Skelton: Although the lobby is large and sweeping, the soffit brings it down two stories to human scale, with the curve adding visual interest. The healing environment it provides was enhanced by the use of natural materials and colors.

Ashley Roller: We were very careful in our selection of lobby seating, wanting it to be pleasant and comfortable, while positioned to give visitors a good experience of the space and views of the chapel and healing garden. Nature was important and, to evoke the nearby Stones River, we used a lot of natural stacked stone in the public spaces and near elevator banks. We also used glass screens, both clear and patterned, at the reception desk, dining room, and nurse stations to open up these spaces to light, yet retain privacy.

Gore: We laid out the floors in a front-of-house/back-of-house plan, both horizontally and vertically, so that patients and families can conveniently go anywhere in the patient care areas without encountering staff and other operational spaces. The shape of the building is such that all patient rooms and LDR rooms have large windows giving occupants views of the outdoors. The patient room units are laid out to minimize walking distances for the nursing staff so the distance from the nursing station to the farthest room in any unit is never greater than 75 feet.

In general, we prefer to design the basic healthcare facility unit as 36 beds because it is divisible in so many ways and therefore more flexible; staff can divide the units in varying sizes in line with new nursing concepts and different staffing patterns. In this case, the basic patient care area consists of two 18-bed units.

The patient rooms and, especially, the LDRs are very sufficiently sized to accommodate family care. The toilets are outboard to facilitate the zoning of the rooms for patients, families, and staff. The entire remainder of the exterior wall is devoted to floor-to-ceiling window space. All the rooms, including pediatrics, orthopedics, even the ICU, are same-handed to increase staff efficiency and patient safety; the owner was willing to make the tradeoff from the economies of shared headwalls and plumbing for the enhanced safety same-handedness provides.

There were some savings from the modularized, prefabricated approach this permitted. All of the components of the room were prefabricated and assembled on site. These items include, but are not limited to, casework, medical gas, and electrical portions of the headwall. One of the unexpected benefits of the same-handed approach is the peacefulness of the unit resulting from patient room doors on opposing sides of the corridor being offset, as well as by charting alcoves inset near the patient rooms. This produces a serrated effect that blocks much of the corridor noise.

Skelton: The owner’s rep involved in this project, Jennifer Garland, played a significant role in developing the family-centered concepts.

Roller:  All visioning sessions, mock-up rooms, and interior design packages were participated in and reviewed by the owner’s rep, who was very clear about what the client wanted.

Gore: The floors throughout the patient areas are luxury vinyl, a no-wax floorcovering that eliminates problems of noise and chemicals associated with floor maintenance. This not only enhances the environment, but the lifecycle maintenance cost of this floorcovering product is expected to pay off quickly.

Skelton: Used as wayfinding elements at the ends of corridors are custom digital wallcoverings displaying historic photos of the Murfreesboro area from the Civil War years and beyond. These custom digital prints help familiarize patients with the environment, as well as serve for wayfinding

Final thoughts

Gore: What made it possible to execute the unusual aspects of this design, particularly the same-handed rooms, was the close collaboration we had with Turner Universal and the sub-contractors in creating the design from day one. We collaborated in developing BIM models early in the process and used an integrated project delivery (IPD) method focusing a great deal of the design effort upfront to make sure we got everything right from the start.

In my healthcare design career, I’ve worked closely with healthcare companies and selected contractors for years, but IPD takes the partnership to a new level. Whether it was Turner, SSR for the MEP, or the facility ownership, all egos were checked at the door in favor of advancing the best interests of the project as a whole. This process fostered trust and accountability unlike any other I’ve been involved in.

And, at the end of the day, we were able to complete a project that met program goals and saved two months on the schedule and $4 million on the budget. HCD