When Alegent Health was formed in 1996 by joining two 100-year-old-plus healthcare entities—Bergan Mercy Health System and Immanuel Medical Center (part of Immanuel Health Systems)—many opportunities arose to integrate support services among the six total hospitals in the Omaha/Council Bluffs, Nebraska metro area. For the community, that integration was most apparent in the way Alegent Health created a consistent “public face” in its hospitals, including one of its tertiary care facilities, Bergan Mercy Medical Center in Omaha, Nebraska.

Alegent Health's priorities for these hospitals were to create identifiable main public entrances with separate staff access, enhance the healing environment using noninstitutional spaces featuring views and daylight, and establish intuitive wayfinding, clear traffic flow, and separation of public and patient traffic through effective organization of departments and circulation, as well as landmarks and signage. Other criteria included development of consolidated care areas to house diagnostic centers; integrated prep, surgery, and recovery areas; and bringing services to patients using grouped admission centers and bedside check-in. Underlying these challenges was the mandate to decrease variations between facilities and install system-wide qualities that emphasize compatible images among all of its hospitals.

Bergan Mercy Medical Center's $44-million renovation and expansion, including a first phase scope of 210,000 square feet, successfully meets these challenges through effective imaging and wayfinding, a cardiac center at the heart of the hospital, and a new procedure center linked with the hospital. Moreover, through careful construction phasing and coordination, all work was completed without disruption to ongoing hospital services.

Clear wayfinding, improved image

The concept for the remodeling project was to create very clear traffic paths and make public areas less institutional and more hotel-like. Before construction, patients had been moved between surgery and emergency or diagnostics and then to the bed towers using the same paths as people coming in the front doors and heading to the bed towers. Shared circulation paths between visitors or outpatients and inpatient or hospital services were eliminated or drastically reduced, except within departments. The revised layout (figure 1) includes a dedicated hallway connecting the main inpatient elevator for the bed towers and surgery. The proximity of surgery, emergency, and diagnostics allows for circulation among these areas without moving patients into the main public concourses.

The revised layout of Bergan Mercy Medical Center includes a dedicated hallway connecting the main inpatient elevator for the bed towers and surgery

Existing corridors were dark and took many turns, creating the sense of being in a maze. The new design creates a major north-south public concourse with access points to all major department waiting areas, and is anchored by the procedure center waiting area on the north and the new main entrance atrium on the south. All bed tower elevator lobbies are accessible from this public concourse and are easily differentiated from service elevators.

Inside the main lobby, patients and visitors experience the soothing effects of natural light coming through stained glass, the smell of the coffee bar, and the sounds of a grand piano. This noninstitutional atmosphere is similar to a hotel reception experience, which helps calm the usual fears people experience associated with entering a healthcare facility.

Finishes remain consistent for all public areas to help people feel comfortable in their surroundings and make a clear distinction between public and procedural areas. Public access points, such as reception desks, are designed with visual cues to help with wayfinding. Within departments, nurses' stations are also similar to help patients and staff identify where they can obtain information.

In addition to the interior program and design issues, the building exterior was dated; Alegent Health felt it did not send the right message for a 21st-century medical facility. As a practical concern, it did not include insulated windows, and walls were minimally insulated. The new curtainwall system was applied to existing buildings to integrate the older buildings with the additions and to increase operating efficiency of the entire facility.

These improvements define a clear main entrance and create a new image for the Bergan Mercy Medical Center campus.

Integrating Procedures

The new 67,500-square-foot procedure center integrates all surgical, gastrointestinal, and catheterization procedures into one area, including preoperative and recovery areas. The new center was built behind the hospital, in a site “carved out” of the side of a hill (figure 2). The new facility's siting also allowed for better departmental adjacencies between the emergency department, diagnostics, and surgery. Outpatient access is improved, eliminating conflicts between inpatient and public traffic. The new procedure center includes dedicated underground parking and a patient drop-off area.

The new 67,500-square-foot procedure center was built behind the hospital, in a site “carved out” of the side of a hill

The new procedure center provides for all phases of pre-op, surgery, and recovery. Catheterization labs and an endoscopy suite with a minor procedure room are located at one end of the building, and 12 new surgery rooms at the other, with shared patient care and staff support areas in between, to enhance efficiency.

At the heart of it all

A new 15,000-square-foot cardiology center is located at the hub of the main floor in proximity to diagnostic imaging (in particular, nuclear medicine); the 5,000-square-foot catheterization labs are located in the procedure center. This provides easy access for outpatients and proximity to related hospital services for staff.

The direct connection to the catheterization laboratories of the procedure center creates a contiguous department dedicated to cardiology, resulting in staff efficiencies that were not possible before. Whereas the hospital cardiology group and private cardiology group formerly practiced in separate facilities, the new heart center brings them together.

Maintaining uninterrupted services

Architects were tasked with assuring that the project could be completed through a phased construction approach, with no interruption of vital hospital services. The project team collaborated with the owner, hospital administrator, building engineer, and department heads to develop a phasing schedule that would accomplish this important goal. In addition, the project team accelerated the construction schedule using various techniques—in particular, phased release of bid packages as design progressed.

Scheduling the new procedure center as the first phase of the project was crucial to allowing current hospital operations and patient access to services to continue uninterrupted during construction, and also allowed for a “turnkey” relocation of the surgery department. As new areas were completed, this tactic also allowed departments such as nuclear medicine, the diagnostic laboratory, and cath labs to move from the main hospital into the new space, in turn, opening areas within the hospital to begin reorganization and remodeling.

Choreographing the new concourse

After completion of the procedure center, the existing main entrance was closed and all public traffic was re-routed to the maternity entrance for 16 months while the new main entrance was under construction. Following completion of the new main entrance, the contractor began construction of the new north-south concourse connecting the lobby with the procedure center. Circulation was maintained using temporary passages and a succession of shifts in pedestrian traffic from old to new corridors as they were completed. Careful coordination with the owner and contractor identified optimal timing for these shifts to occur.

Construction of the curved forms of the concourse created additional challenges for the project team. The “choreography” involved in maintaining circulation during construction required the contractor to construct the two ends of the concourse followed by the central segment. Close cooperation between the architect and contractor ensured that all of these curves successfully “met in the middle.” In addition, utility cut-ins were smoothly managed, with much of this work accomplished after peak hours to avoid disruptions.

Communication is key

Communication among members of the project team and owner is a key to the success of any project, but especially a multiphase project with an accelerated schedule, such as this one. The project team and owner's representative met weekly throughout all phases of the project. Use of a Web-based project management system expedited responses to requests for information (RFIs) by various members of the project team, as well as critical decisions by the owner, by providing access to all RFIs, an up-to-date activity log, meeting minutes, correspondence, and other critical information at each phase online. Hospital departments and key staff were apprised of upcoming construction activities through e-mail announcements and newsletters.

Overall, the remodeling and expansion of Bergan Mercy Medical Center successfully unifies the hospital under the Alegent Health banner which, since 2000, has also involved Leo A Daly's designing of Alegent Health's new 200,000-square-foot, full-service Lakeside Hospital, the renovation and 90,000-square-foot addition at Immanuel Medical Center, and the renovation and 50,000 square feet of new space at Midlands Hospital. HD

Jeff Monzu, AIA, NCARB, is a Senior Associate and Project Designer at Leo A Daly. He is a member of AIA's Academy of Architecture for Health Leadership Council. In addition to his project leadership for Alegent at Bergan Mercy Medical Center and assistance on Lakeside Hospital, he also has served the Nebraska Medical Center on numerous projects, including the Hixson Lied Center. Monzu can be reached at 402.391.8111 or

jsmonzu@leoadaly.com.

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