A collaborative effort
Completion Date: October 2008
Owner: Florida Hospital
Architecture: HuntonBrady Architects
Interior Design: HuntonBrady Architects
Construction Manager: Brasfield & Gorrie
Photography: Joe Brooks Photography
Total Building area (sq. ft.): 656,000
Approximate Construction Cost: $163,800,000
Cost/Sq. Ft.: $250
The saying goes that two minds are always better than one. This concept was at the core of the new Ginsburg Cardiology Tower addition to the Florida Hospital's downtown campus in Orlando. After an initial design for the hospital was created by HuntonBrady Architects, Florida Hospital-in order to assure the best possible design for its investment-called on other national healthcare architects, experts in hospitality design and environmental psychology, The Center for Health Design, and even Disney representatives to come and critique the project and offer suggestions. The major result of these sessions, which were termed “contrarian charettes,” was a complete relocation of the addition, requiring the rerouting of a road to place the building squarely on the adjacent Lake Estelle-a process that involved the demolition of three buildings, as well as rerouting electrical, water, and gas lines. HEALTHCARE DESIGN Associate Editor Chris Gaerig spoke with HuntonBrady Architects President of Healthcare Design Principal Chuck Cole, AIA, ACHA; Tim Burrill, assistant vice-president and project administrator at Florida Hospital; and Karen Saslaw, one of HuntonBrady's independent healthcare planning consultants, about these and other innovative aspects of new facility.
Chuck Cole, AIA, ACHA: We had an initial concept that located the addition on the campus land area that was most readily available. We drew that up, and then Florida Hospital said, “Before we spend $250 million for project costs, let's get a second opinion.”
Karen Saslaw: Chuck likened it to his experience in architecture school when the professors come in and beat up your project that you're doing for class. They brought a very unique group of people in. Being in Orlando, we had folks from Walt Disney Entertainment, representing hospitality and hotel design; we had people that do a lot of the work for the Marriott and Wyndhams; and Dr. Roger Ulrich, an environmental psychologist who teaches at the College of Architecture at Texas A&M, a school with a very strong healthcare design curriculum. Dr. Ulrich is a very prolific researcher and author on evidence-based design, so he was giving us his insight into making sure that our design was based on evidence.
Tim Burrill: When we started, it seemed like the right decision was where we placed the building. There were really no other ideas in our heads at all. When the contrarian exercise occurred, these people came in-who had no preconceived ideas at all-to look at it. They asked the simple question: Why here and not there? Of course we had lived and grown up here and didn't see that site as a possibility. There was a road right through the spot they had suggested. Of course our reaction was, “There's a road right there. Why would we put it there?” Then they asked if we had ever thought about moving the road, and once they said that…. They told us this in September, and by October, we not only had a plan, but it was thought through pretty well by a month later. It was amazing how all the problems we had with the building before seemed to go away. It was clear that that was the right choice.
Cole: Florida Hospital believes in healing mind, body, and spirit, so they pay a lot more attention to how the environment affects both their patients and staff. They had built Celebration Health 12 years ago in Orlando, where they really transformed a traditional hospital model into a healing environment. Celebration focuses on health and wellness along with healing and hospital care. Celebration served as a benchmark for success; they had already evaluated the importance of public spaces, family member space in patient rooms, and a slightly higher level of finish for those spaces than other hospitals had. The Florida Hospital campus didn't have those kinds of spaces. In fact, it was too small for a 900-bed hospital. With the addition of a 400-bed patient tower, it could accommodate the growth on the campus and incorporate many of the lessons learned from celebration.
Emergency department observe care
Cole: Florida Hospital had been working under tough conditions for many years in its downtown campus in terms of limited facilities for the emergency department. Patient wait times, average length of stay, and a patient's door-to-doctor waiting time were all very lengthy periods. In 2004, the ED staff had started implementing Lean process change with consultants from Johnson and Johnson, Six Sigma, and Herman Miller.
Burrill: It's one of those things that we struggled with partway through the project. You have all these moving parts going on. It took about three years to get from the beginning of a thought to pushing the dirt and things coming out of the ground because we had to move a road. Besides that, the emergency room was going through a metamorphosis in how they actually do their work. They were going through a Lean conversation: How do you make things in the emergency room go quicker and faster for patients and staff? One of the ideas that came up through that Lean thinking was that we shouldn't just put patients in a room and leave them there. Instead, guide them through the process. There often are patients who sit around for tests and treatment in a room. They don't benefit from being in that space from a care standpoint, and it's kind of lonely in there; you're not connected. Our actual working process-and we tested it out in our old emergency room-was to place an observe care space where patients can wait for their tests to come back and not simply occupy a room. We can increase throughput in those rooms.
We redesigned the ED again, after we started with the design, and stepped back and said, “No, we're learning things here so let's make sure our design is flexible and supports this new thinking.” Then we created this observe care space. Instead of creating this large waiting room that the emergency department would have needed, we placed a portion of that square footage inside of the actual emergency department. Now there's an observed lounge where these patients wait with their families for their tests to come back. In essence, we have a small waiting room and put that inside the department.
Burrill: The “imagination station” was a place where we could really test some ideas and engage the staff in the design process. It was a place where we could get away and think, as well as test out dimensions in a real space. We were able to actually measure out and build walls, and we actually were able to build up a final room with the final finishes, which is a step that most people don't take. We decided we'd try and see if we got any results. We got to the final finish stage so that we could test the final finishes and make sure we didn't mess anything up. Sure enough, we did. We built it out and then we started playing around with it-pushing stretchers in and out-and realized that we had corners that were unprotected. They were laminated edges of millwork that, our stretcher one time, all it had to do was hit it once and it was dead. We had that opportunity in that finish stage to get protection on those corners that we would've overlooked. Now, they're protected. But we wouldn't have had that if we didn't build up the mock-up.
Cole: Those rooms started with moveable walls based upon the space program and evolved as we tried to find the optimal size and configuration. The rooms were rebuilt, probably six or seven times, until they were entirely complete with all the finishes, working light fixtures, plumbing fixtures, and headwalls. Equipment and furniture were brought in by various manufacturers and tested by the users. We ended up with model rooms that are now in the Ginsburg tower.
Healing environments for patients and staff
Saslaw: One of the things that we learned from evidence-based design research is that if we can provide views of nature, an abundance of natural light, and access to the outdoors, both patients and staff benefit. Patients heal faster and for the staff, there is a correlation to higher retention rates and a happier group of people working there. They're not in a core where they never see the light of day.
Cole: Two important staff spaces on each floor have been placed on the exterior for the views and access to daylight. One is a staff lounge, which is at the midpoint of the floor and is shared by all of the staff on the floor. And then on the end of the tower, there is a round spire, which contains a conference room for every single nursing unit allowing easy access to staff education on a daily basis. That really ties in with the Adventist belief that education and health is part of healing. It also became a symbol on the exterior as a spire for the sanctuary of healing.
Burrill: We knew we had to grow and wanted to do it right. You get one shot at this, especially in a large hospital like this. Land is at a premium, so when you build on a piece of property, you want to make sure that you build it right.
Saslaw: HuntonBrady and Florida Hospital went through a very rigorous exploration of the brightest and best minds in healthcare at the time. We did literature searches, looked at colleges and universities that had strong hospital administration or healthcare architecture programs, looked at who was doing the writing and research, and what were the trends of the time.
Cole: The contrarians were people who were really involved in broad thinking and philosophy. We weren't necessarily looking for people who would just have an opposite opinion. We didn't know what this expansion was yet. We were just trying to formulate it and we were looking for people who were willing to challenge our assumptions and design and speak out. HD