"Floating" to Success
Client: Baptist Medical Center
Architecture, Planning, and Interior Design: Cannon Design
Photography: Neil Rashba Architectural Photography; Robert Pettus; Cannon Design
Completed: August 2005
Total Project Area: 195,000 sq. ft.
Total Construction Cost: Not released
Cost/Sq. Ft.: Not released
Baptist Medical Center first approached Cannon Design to design a “surgical services pavilion.” While planning for this program, Cannon learned that Baptist's ultimate goal was the relocation of surgical support services from the existing hospital to the new pavilion, so that the heart programs could later expand into the vacated space. Given the prominence of the site and Baptist's stated goal to aggressively promote the cardiovascular program, the design team felt compelled to advise the hospital that they had been asked to design the wrong building. Cannon's alternative proposal led to the creation of the Heart Hospital at Baptist, consolidating cardiovascular services in a signature building and propelling Baptist into the new millennium.
The new building serves heart patients but is also the entry pavilion to the entire medical center. Recently, HEALTHCARE DESIGN Managing Editor Todd Hutlock discussed the project with Design Principal George Nikolajevich, FAIA, and Principal, Healthcare Planning and Programming, Michael Pukszta, AIA, from Cannon Design, and John Wilbanks, FACHE, Executive Vice-President and Chief Operating Officer of Baptist Heart Hospital.
Pukszta: After Cannon Design was commissioned for the project, the client revealed that the reason we were selected was because we developed the most creative architectural solution. We won this commission not solely on our healthcare expertise, which is our traditional strength, but for innovation and imagination, as well.
Nikolajevich: This project had to address a unique site problem. The site is landlocked between the existing hospital, a 500-car parking garage, and St. John's River. It is a beautiful site, but extremely dense with numerous challenges: placing the building and parking structure, achieving a clear approach to multiple entrances, segregating vehicular traffic, properly orienting patient rooms, and creating a welcoming image for the Heart Center. We also had to maintain existing entrances and connect the floors of the Heart Hospital with corresponding floors in the existing Medical Center.
Rather than conceiving the site in a flat, single dimension, we proposed to create two sites out of one, with one on top of the other. We lifted—or “floated”—the main floor to the second level and established an entry point there. This second-floor entry functions as the public entrance, with the emergency entrance below. Then, we positioned the helipad in the middle of that platform, stacking all three arrival points on one stem, so to speak: trauma on the upper level, public access in the middle, and emergency services at the lowest level.
Wilbanks: The concept that most influenced Cannon Design's selection as architect was the creative ramping of traffic that diverted emergency department traffic from Heart Hospital traffic. The elevated heliport that served dually as a cover for patient drop-off was also unique.
“Floating” the Site
Nikolajevich: The concept was based upon elevating the road as people approached the site, so that they arrive at the second level of the hospital—the main public entrance. By “floating” the platform above the existing site, we were able to reorganize circulation and access and eliminate potential conflicts caused by introducing multiple entrances on one plane. A good design analogy is the airport—the public accesses one level, while luggage travels on another. One lesson learned is that all too often, buildings are approached as a two-dimensional problem. Here, we had the opportunity to apply our knowledge of design to a site where three-dimensional considerations were key.
The Heart Hospital has been referred to as the “butterfly” building in form, and at the point where the two wings of the butterfly meet, the building is very narrow. This is the central hub where the public enters, and it features a signature staircase and 30-foot glass wall that introduces abundant light and provides spectacular views. You feel like you are floating above the river.
Pukszta: Two triangular spaces with mirrored and rotated curved edges create the unit's unique shape. This shape develops a curvilinear form along the river and therefore maximizes perimeter length, creating both more window area and additional patient rooms with a view of the river and downtown Jacksonville. If we had simply established a flat faeade following the river, we would only have been able to accommodate two-thirds as many patient rooms.
We also developed acuity-adaptable rooms, all private, throughout the building, so the level of patient care can be stepped up or down over time from ICU to progressive to acute. The unit design accommodates three options for nursing operational structure: centralized, clustered, or decentralized. In other words, the 24-bed units can be supervised from a single nurses' station or staff split among three nurses' stations, each covering eight rooms; or nurses' stations can be staffed at every room or every other room. This affords Baptist a high level of operational flexibility.
Wilbanks: The patient rooms are 300 square feet, significantly larger than other rooms on campus. This larger size allows for distinct zones: patient care, hygiene, caregiver, and family. Bedside controls give patients a sense of control over their environment and enhance comfort and well-being. The furnishings and art used throughout are natural in theme and color and contribute to the healing environment.
Pukszta: In 2000, when we were in design, we put forward the idea that surgery, interventional radiology, and cardiology services were going to overlap over time as individual practitioners began using common pieces of equipment. We went so far as to suggest that we should marry those functions in one combined, universally adaptable suite, so that as those practices transitioned and eventually coincided, the building would be flexible—able to adjust to emerging technology. Today, I believe most people embrace this concept, but in 2000, it was a fairly radical approach.
We designed universal, minimally invasive/invasive treatment rooms that can be adaptable for cardiology, radiology, and open-heart ORs, with a common room size of 650 square feet.
Wilbanks: The colocation of the cath lab and OR suites is a feature that has already had positive clinical impact. The proximity of the suites creates a greater sense of the overall team.
Nikolajevich: The team members at Baptist Medical Center were knowledgeable, thoughtful, and open-minded and, as a result, we were able to develop a high level of mutual support and trust. This building is light, airy, and fluid, and in perfect harmony with its environment.
Wilbanks: The physician, staff, and patient responses to the facility have been overwhelmingly positive. The connectivity of the functions has improved integration and patient safety. Patient satisfaction scores are high, and other feedback has been superb. This is a large facility, and one has to engage the right design and construction team and “sweat the small stuff” to get it right and meet the objectives. Overall, the design team understood the mission and delivered a project that fulfilled it magnificently. HD