In the late ′80s and early ′90s, there was an increasing call for specialized diagnostic imaging services for women. As this subspecialty evolved to meet the unique needs of women, care providers responded by developing warm, welcoming spaces to serve their patients. The recently completed Sutter Diagnostic and Women's Imaging, Roseville in Roseville, California, continues the progressive evolution of women-centered care.

Sutter Medical Foundation, a Sutter Health affiliate, serves patients in the Greater Sacramento, California, area and offers diagnostic imaging services. When tasked with delivering a new care center in the Roseville, California, market, Eric Rasmussen, director of growth and development, and Nina Noldon, regional director of diagnostic imaging, challenged the project team to develop a “true women's imaging center, anchored in healthcare industry best practice.” They also asked the team to build on past imaging projects while successfully integrating the existing Breast Health Center located on the Sutter Roseville Medical Center campus.

Project preparation

The team developed a generous schedule preceding construction to provide ample time to develop a shared vision for the care center. Site visits to existing women's imaging centers, study of precedent designs, and discussion of caregiving goals inspired the team as it developed the program for the space.

Boulder Associates Architects led the team through a rigorous process mapping and value stream mapping exercise for each imaging modality. Mapping for the imaging center included ideal patient flows for mammography, stereotactic biopsy, ultrasonography, bone density scanning, and MRI. The maps documented the patient journey through each modality and were used by the designers to provide the right spatial, environmental, and qualitative elements for each discrete step in the process.

Once the mapping exercises were complete, the team began modality blocking and layout of clinical space in 15,000 square feet of renovation space in an existing medical office building. Early on, the team grappled with the challenge of maintaining a separate yet complementary relationship between Women's Imaging and Diagnostic Imaging, a best practice for successful women's centers. The team also flagged areas of concern including wayfinding and orientation within the MOB. Ultimately, the project team settled on a configuration straddling the existing corridor with Women's Imaging on one side of the corridor and Diagnostic Imaging on the other, with a shared waiting room between and facing reception desks.

Plush furniture, wood ceilings, and a large illuminated sky-image ceiling provide a comfortable and sophisticated gowned waiting area for female patients before procedures or mammograms.

The process mapping allowed the clinical areas of the floor plan to resolve quickly. The project team consciously chose to extend the study and development of lobby, hallway, waiting, and reception spaces. A team of diagnostic imaging technologists for each modality was assembled to work with the design team for a daylong “Super DD” exercise. Beginning in the morning and continuing into the evening, the design team met with successive groups for each imaging modality, reviewing each room and revising the design on the spot. A month later, a weeklong collaboration event also transformed the team. Hosted in a conference room at Boulder Associates Architects, this intensive session allowed all the stakeholders to work together in an integrated setting.

Project Summary

Completion date: October 2010

Client: Sutter Medical Foundation

Project management: Sutter Health Facilities Planning and Development

Architecture, interior design, and environmental graphics: Boulder Associates Architects

Contractor: Unger Construction

Structural engineers: Miyamoto International

MEP Engineering: Risse Mechanical and Rex Moore Electrical Contractors and Engineers

Total Building Area (sq. ft): 14,327 sq. ft.

Total tenant improvement construction cost (excluding FF&E): $3,788,911

The architectural team developed the drawings using building information modeling (BIM) and leveraged it by rendering views of the entry sequence using 3-D software. Boulder Associates directed the interior design by using photo-realistic renderings paired with sample boards. The integrated approach included lighting design, color and material selection, artwork imagery, and furniture upholstery and finish.

Specifying design elements

The firm also collaborated closely with Pamela Addy, director of outpatient imaging, to develop a design typology for the imaging center. A rich palette of materials, colors, and fabrics that aligned with the best practice vision for women's imaging was developed. Warm wood tones, rich fabrics, and lounge furniture were brought into the waiting room and gowned waiting area. Glass tile was also used and highlighted with lighting in signature areas to provide a warm accent.

Addy requested that a special design element, illuminated sky-image panels, a carryover from previous Sutter Medical Foundation imaging projects. The fine art and technology company contracted for those previous projects sent its mobile showroom to Sacramento, California, to visit the team and worked with the designers to develop custom solutions in the care center. Most modality rooms feature illuminated wall images installed with warm wood frames. The CT, MRI, and nuclear medicine camera areas feature custom sky ceiling images. The company also custom-fabricated the focal point of the imaging center, a large sky panel located over the gowned waiting space.

Sutter Medical Foundation engaged artist Cathy Mullenberg to provide a signature piece of art in the main entry to the women's center.

Art played an integral part of the project as well. Jena Siedler, graphic designer with Boulder Associates Architects, and graphic designer David Hemsi collaborated with the team to create environmental graphics in the form of art panels arrayed along the entry hallway to help guide patients from the building entry to waiting and reception areas. The selected images successfully convey the intergenerational and cross-cultural importance of women's imaging. Nature photography was used throughout the suite, providing a calm focus for patients. Sutter Medical Foundation also engaged Cathy Mullenberg, a fabric artist, to provide a signature piece of art in the main entry to the women's center. Her watercolor quilted fabric piece of the silhouette of a woman has become a focal piece for the center.

Improving workflow

In addition to seeking an innovative space for women's imaging, Clay Frederick, senior project manager for Sutter Health Facility Planning and Development, challenged the architect and contractor to deliver the project in an innovative manner that would add value for Sutter Medical Foundation. As part of this challenge, he asked that the team examine tools for improving the way it worked. As a result, the team employed Lean design and construction principles during design and construction, including: the use of commitment logs to manage work; the one-day “Super DD” exercise to rapidly advance the design from criteria to detailed design; collaboration events where the team worked together in a Toyota-style “big room”; and the use of BIM.

The Lean processes and tools employed by the project team early on continued to play an important role throughout construction. Regularly scheduled “big room” team meetings included everyone from the building owner to the end users. This allowed decisions to be made quickly, and fostered a collaborative team environment. A six-week look-ahead schedule allowed upcoming constraints to be
identified, while commitment tracking held everyone accountable for promises made to remove those constraints. Owner program changes challenged the team to come up with innovative solutions to improve or mitigate impact to budget and schedule. The team effort of continuous improvement over the course of the project ultimately culminated in substantial cost-savings to the owner, and an overall reduction of the construction schedule by three weeks.

Warm color tones and wood-look flooring provide a pleasing environment for patients during mammograms.

The project also featured a unique collaboration between owner and subcontractor. A casework manufacturer used a CAD/CAM software package to create custom perspective views of proposed casework in the care center. A meeting was held to review the perspective casework views and then make revisions. The approved drawings were later used to fabricate casework for the imaging center.

The designers also pioneered BIM-based tracking of soft costs for Sutter Medical Foundation by hosting medical equipment, voice and data equipment, furniture, artwork, and signage in the virtual model. Lori Serruta, project manager, and Vince Clephane, superintendent, with Unger Construction, joined the team early on and provided invaluable confirmation of existing conditions through thorough field investigation.

The Sutter Diagnostic and Women's Imaging Center, Roseville showcases both beautiful design and extraordinary attention to the specific needs of women in a healthcare setting. But it is the innovative process through which that design was achieved and executed that truly sets this project apart. The use of technology, key planning processes, and simple human collaboration made for a project that was delivered ahead of schedule and under budget, while also meeting the client's objectives. This critical emphasis on interaction, input, and collective decision-making transformed the team into one intent on delivering a state-of-the-art, person-centered healthcare environment that elegantly serves each and every patient. HCD

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