Not only is the new 235,000-square-foot, 100-bed Northeast Georgia Medical Center (NGMC) Braselton notable for sustainability measures that have it tracking LEED Gold and a rigorous use of Lean design that’s streamlined clinical processes and operations. But what also makes the project a standout is the fact that it’s the first new hospital to be built in the Peach State in 20 years.

Originally a very small, rural community, the town of Braselton, Ga., sprouted from just 418 residents in 1990 to 7,511 in 2010—and it’s still and growing. Residents of the underserved community previously had to travel about 30 miles to the Atlanta area to seek medical care. But on April 1, Northeast Georgia Health System’s newest hospital opened its doors for business, housing 26 specialties including heart and vascular services, orthopedics, neuroscience, surgery, cancer treatment, and emergency services. Together, NGMC Braselton’s inpatient platform and large ambulatory presence are helping to build the organization’s brand as a small hospital with big programs.

The Lean journey
Starting with a clean slate on a greenfield site, NGMC Braselton set out to do things right and this meant serving as good environmental stewards, driving down energy use and maximizing operational efficiencies. It seemed that the key to achieving this was tapping into the latest strategies that Lean design add to offer.

From the start, clinical processes were established with measurable metrics tied to staffing and operations, sustainable concepts and lifecycle-cost savings, and improved patient outcomes and safety—all before the building design began. But it needed a team that would be able to carry it out.

“We did a lot of research to identify the thought leaders in their different fields and we did a wide search of architects as we were looking for a team that had direct Lean experience,” says Rudy Lonergan, director of facilities development for NGMC Braselton.

HGA Architects and Engineers was selected as lead architect and brought its Lean best practice models and time and motion studies to the table to provide data to support various approaches. Based upon that information, “We developed ideas on how the different departments would fit together within the overall building form, presented input, evaluated these ideas with the hospital, and engaged user groups,” says Mark Bultman, vice president, healthcare principal, and senior project manager at HGA (Milwaukee).

Ultimately, the major Lean initiatives that came out of the process include decentralized nurses’ stations and servers and efficient interventional and short-stay platforms to best flex and optimize treatment spaces. “The nurse is really deployed out to the patient much closer and can spend more time at the bedside,” Lonergan says. Also, “85 to 90 percent of the daily supplies that the nurse needs to care for the patient is there, so less time is spent hunting and gathering.”

Meanwhile, the interventional platform colocates surgical and procedure services in one common prep and recovery unit with universal rooms, and the short-stay platform is shared between the ED and imaging with universal rooms that flex back and forth based on census, according to Bultman. “The big idea behind the short-stay platform is colocating and leveraging shared spaces for staff,” he says. “This gives much flexibility with the space so that imaging prep in the morning can be an ED in the evening, for example. This achieves better value and 10 to 15 percent in space savings.”

In order to fine tune the design and construction process, the building team employed a number of mock-up strategies to get an idea of room size and needs and allow stakeholders and staff to walk through the space and record their feedback. Even prior to the mock-up stage, Turner Construction, head contractor on the project, used virtual design to help hospital leaders make key design decisions, such as choosing between a double-loaded corridor versus race-track design for the patient units. Thanks to these visualization tools, the team was able to discern that the criteria for patient observation, caregiver collaboration, and acoustic privacy were more effective in the race-track design than in the double-loaded model, so the race-track layout was selected with collaborative hubs interspersed throughout.

Silver to gold
NGMC Braselton originally set out to track LEED Silver, but after narrowing down a list of potential innovative, sustainable features based upon an in-depth research analysis and lifecycle costs, “We found that the points we could accumulate put us into the Gold level, possibly making us the first LEED Healthcare Gold facility in Georgia,” Lonergan says.

By achieving an overall 7- to 8-year payback goal from the project’s full $3.6 million investment, as set by the hospital’s CFO, the LEED documentation and processing ended up being a very small portion of the budgeted cost, according to Scott Seaman, executive vice president of project management firm LawlerWood (Knoxville, Tenn.).

Topping the hospital’s sustainable design list is an impressive 60 percent reduction in energy reduction, with the lion’s share of those savings coming from a geothermal system. The system delivers a 5.5-year payback for a total of $15 million in savings over the course of 30 years. The system “takes all the heat building up in the hospital and then recycles it to use it where it’s needed,” explains Jim Crabb, principal and CEO/president of engineering firm Perry Crabb (Atlanta).

Other green building highlights include radiant heating and cooling, metering systems, automated shading, LED lighting, green roofs, and elimination of almost all toxic finishes on the Living Building Challenge’s Red List. In addition, 98 percent of construction waste was diverted from landfill and the total recycled content of products used in the project exceeded between two and three times LEED’s minimum 10 percent requirement. “This required working closely with the waste/recycling firms to develop a plan to determine what can be recycled, how to sort/handle the recycled material, and who would receive it,” Bultman says.

A community affair
Because NGMC Braselton was Georgia’s first new hospital in two decades, the organization made sure to involve the community in the planning process. This included 11 community events, a series of public forums, workshops, and online surveys with participation from more than 1,000 community members, all in an effort to explore the ideal patient experience.

One design initiative that emerged from this input was the development of contextual ideas for the site and building that respond to the region—for example, the selection of native plant species and the use of materials such as locally quarried stone. Community education space was also added as well as amenities such as walking trails to connect surrounding neighborhoods to the site and promote wellness.

But perhaps the key to executing such a highly sustainable design with extensive community-
focused medical services was the building team’s commitment to fully guide the entire process by using Lean strategies, with a “keep your blinders on” focus that pushed other design solutions aside. “Lean really drove all the decisions,” Seaman says.

Barbara Horwitz-Bennett is a contributing editor for Healthcare Design. She can be reached at