A river runs through it
Owner: Lake Health
Completion Date: August 2009
Architecture and Interior Design: Karlsberger, Columbus, Ohio
Construction Manager: Gilbane Building Company, Cleveland, Ohio
MEP Engineering: Karpinski Engineering, Cleveland, Ohio
Civil Engineering: CT Consultants, Willoughby, Ohio
Structural Engineering: Paul J. Ford & Co., Columbus, Ohio
Wetlands Consultant: HzW Environmental Consultants, Mentor, Ohio
IT/Communications: Smith Seckman Reid, Nashville, Tennessee
Snow Analysis: Rowan Williams Davies & Irwin Inc., Guelph, Ontario, Canada
Program Manager: Navigant Consulting Inc., Chicago
Photography: Scott Pease Photography, Aurora, Ohio
Total Building Area (excluding land): 297,500 square feet
Total Construction Cost: $102,000,000
Cost/Sq. Ft: $343
When the time came for Lake Health to replace LakeEast Hospital in Northeast Ohio, the decision was made to incorporate the latest life-saving technology, balanced with the healing environment guidelines of evidence-based design. The resulting four-story, 297,500-square-foot TriPoint Medical Center-accompanied by an adjacent 100,000-square-foot physician pavilion-stands as a unique juxtaposition of science and nature. Seated on a gorgeous 45-acre site complete with a pristine stream, TriPoint combines forward-thinking features like an electronic medical record (EMR) system and filmless digital radiology with a generous amount of natural light and five rooftop gardens. Lake Health President and CEO Cynthia Moore-Hardy and Senior Vice-President Steve Karns, along with Principal-in-Charge Bob Grundey, Project Architect Paul Schultz, and Director of Interior Design Susan Long from design firm Karlsberger spoke with HEALTHCARE DESIGN Editor-in-Chief Todd Hutlock about this remarkable project.
Steve Karns: In 2002, the Board of Trustees gave the go ahead to start the search for a replacement hospital for LakeEast Medical Center in Painesville, Ohio. Though the facility was fairly large, it was confined in an urban area and therefore had no room to expand. LakeEast was on 11 acres of land; the TriPoint site is 45 acres.
One early hurdle was that there was a little stream that ran across the property of which 100 feet had already been culverted. Our design for the parking area required more surface parking close to the entrance, so we made the request to culvert another 200 feet. The Corps of Engineers came in and did a study and found that it was a “pristine” stream, which was protected by the Corps of Engineers. It took about an additional year to work out this new culverting with the Corps of Engineers, but it gave us extra time to come up with the guiding principles of the project.
Cynthia Moore-Hardy: The stream was incorporated as a theme throughout the facility; it's present in the paving out in front of the hospital, and it “flows” all through the building. This actually fits in with the principles we came up with for the project. The hospital is part of The Center for Health Design's Pebble Project, and we used evidence-based research to guide the building's design, part of which was embracing the natural surroundings of the building. We made a concerted effort throughout the hospital to embrace nature, from the abundant use of natural light, through the artwork, to the views of the surrounding outdoors and rooftop gardens.
Bob Grundey: As soon as you enter the site, the drive winds through some manmade waterfalls and creeks, as well as the natural landscaping. To see that as soon as you come onto the site immediately establishes the connection to nature and healing. Instead of using a more traditional drainage system in the parking lot, we used bioswales and natural runoff to filter water through the ponds.
Paul Schultz: Our first challenge was to figure out where on the site to place the building. The site is beautiful, with lots of trees and a pristine stream running through the middle of it; we wanted to make sure to position the building to achieve the maximum views. The other thing that was very important to the client was to have the initial approach create a great first impression, very formal and very impressive.
Exteriors and public areas
Grundey: The “river” that runs through the building helps connect the exterior to the interior of the building, and also serves as a wayfinding tool. Several of the rooftops are green roofs with gardens, allowing views for staff and patients. We also brought in as much light into the building as possible, through floor-to-ceiling windows, which also allow for the great views to nature from all around the facility.
Schultz: We really separated the individuals coming into the building from the individuals leaving the building. It isn't especially welcoming or calming to those entering to see patients in wheelchairs or bandages as they enter the building. There are separate paths to come in, separate elevator banks inside, and another separate path to exit the building.
Grundey: This system also allows the patients, who typically aren't looking or feeling their best, to avoid running into neighbors or friends on their way out of the facility. This is a small community, and avoiding potential embarrassment in these situations was important. This wayfinding system reduces the anxiety of those entering, and also allows those leaving to feel more at ease.
Moore-Hardy: Much of our technology allows us to communicate more rapidly to each other-to share information about care or to contact physicians. Our telemetry systems and all of our monitoring systems are accessible at every decentralized nurses' station so the right person can have access to the information he or she needs at the time that he or she needs it.
Karns: We know that technology will continue to advance, so we are prepared to incorporate, for instance, more wireless technology into the EMR. We tried to incorporate a lot of technology features that will ease access to patient care, but also improve our patient safety.
Susan Long: Our approach to the project was holistic, carrying the exterior elements through to the interior, including the selection of furniture, artwork, and signage. The goal was to create a healing community responsive to the whole individual, through emotions, environment, and the experience. Pulling in nature was not only in the color palette, but also in the continuity of the use of the wood in the main entry, chapel, and patient areas.
The color palette is basically neutral so as not to distract from the beauty of the views to the outside. We kept it simplified and graceful, with lots of shades of blue used throughout.
From an infection control standpoint, solid-surface countertops were used, as well as resilient flooring in the patient rooms.
We wanted the furniture to not only be functional and durable, but also to keep in character with the architecture, pulling in nature and using easily maintained materials. The fabrics chosen have floral scenes or other patterns that tie back to nature. We arranged the furniture into small groups that are more personal and homelike than a simple row of chairs.
dey: It is a fairly compact floorplan. There is really only one central nurses' station, but even that is much smaller than what you might have seen in older facilities. Between each patient room, there are decentralized workstations, and at the end of each hall, there is an open, lighted space with seating. It's a fairly long corridor, so we looked at these decentralized nurses' stations as a way to reduce the nurses' walking time; they don't have to continually walk back to the main nurses' station. The utility areas also are decentralized, which further reduces steps; instead of having one big storage room, we created a few smaller storage rooms that we could place throughout the units. There are also some very nice staff respite areas, with great views and lots of light.
Schultz: The goal was to achieve a universal patient room. The only difference between any of the rooms is the number of outlets available. We chose to go with mirrored rooms rather than same-handed.
There are three distinct zones in each of the all-private patient rooms. These zones are differentiated by finishes and other visual cues: the patient space, the family space, and the caregiver space. The birthing rooms have a fourth zone, for the baby. The rooms all have large windows to let in lots of natural light and views to nature. Even the rooms in the ER are all-private and include natural light.
We also incorporated windows in the treatment areas, even the CT suites, which is definitely not the norm. In some of the other rooms where we couldn't put in a window, we used ceiling panels with nature scenes on them.
Long: Rather than hanging a piece of static artwork in each patient room, there is a digital art program comprised of 35 original photographs by local artists that circulate on the television. That is carried forward into the exam rooms, where the same images are used as computer screen savers.
Moore-Hardy: While we have fewer beds in the new facility than we did in the old one, we are delivering more efficient care now because of the private rooms. In the old facility, where there were more semiprivate rooms, if a patient needed isolation, you would need to block the other bed anyway. Here, we don't have those kinds of challenges.
Karns: We're very proud that the healing environment starts here right at the entry drive when you turn in. We stayed true to our guiding principles of design and incorporated them from the moment you arrive, and that thinking has led to a very successful incorporation throughout. HD
Visit http://healthcaredesi.wpengine.com/TriPoint to take a video tour of TriPoint Medical Center.
For further information, visit http://www.lakehealth.org/tripoint-medical-center.
Healthcare Design 2010 February;10(2):44-50