The story of Gundersen Health System’s La Crosse, Wis., campus renewal begins with the retreating glaciers that formed the Coulee Region 500,000 years ago.

Or so felt the design team from Ellerbe Becket (now AECOM) when it first considered how to approach the design of the project’s Legacy Building in 2007. The unique topography of this part of the country—the city sits along the Mississippi River in a valley surrounded by 500-foot limestone bluffs—was an important driver in determining what, exactly, this renovation and expansion would look like. While many healthcare projects turn to nature for design cues, here it makes particular sense for a health system that’s well known for its commitment to environmental stewardship and serves an outdoorsy community.

What the Legacy Building looks like, though, is also tied directly to the system’s goals for efficiency, cost control, and a better environment for the people who use it. Born out of necessity (a number of the La Crosse facilities dated back to the ‘30s and ‘40s and were no longer code compliant), the renewal project allowed Gundersen to improve operations while also bringing its main campus up to speed with its broader sustainability initiatives. The system’s Onalaska, Wis., campus was already operating as a net-zero facility, and CEO Jeff Thompson had declared a goal in 2008 for all of Gundersen to be net zero by the end of 2014. The Legacy Building was completed in January 2014; on Oct. 14, Gundersen hit its target and became the first health system in the nation to produce more energy than it consumed.

The lay of the land
But before it could get there, the design team had a lot of ground to cover. Kari Houser, director of construction and project management for Gundersen, worked with Matt Sanders, associate principal and senior design lead for AECOM (Minneapolis), to guide the whole team in a no-stone-unturned effort to better understand the region’s healthcare market forces, the latest evidence-based design research, staff workflows, and design best practices.

As the master planning process began in 2007, Gundersen defined its guiding principles. In addition to those already mentioned, the principles included a shift to all-private patient rooms, optimization of technology (the system went through a conversion to electronic medical records around that same time), a strong commitment  to patient safety, and improved wayfinding and accessibility.

“We wanted to put the patient’s and patient’s family’s needs first, at the center of every decision,” says Houser, “and we wanted a well-developed growth strategy. When you’re building new things, there’s lots of pressure for ‘more’ or ‘bigger’ than maybe what the real need is. So we wanted a very disciplined process to determine what we really needed.”

Gundersen hired consulting firm Kurt Salmon to compile market data that would paint a true picture of future patient prospects. The gist: not much growth on the horizon. “We weren’t going to see a major market shift or demographic growth,” Houser explains, “but they also told us what medical services would look like.” Their evaluation included details such as how many ORs were needed and what average lengths of stay might be.

At the same time, Sanders and his team were studying the campus and working on streamlining business and patient care services. A time-lapse study offered a simulation of the campus’s development from its start as a nursing home in 1905 through present day to help determine a replacement plan.

The campus was “a mess,” Sanders says, and Houser doesn’t argue. For one thing, the former entrance was 50 feet from a working railroad track that runs through the site. As for the buildings, “every architect who built on this site over the last 100 years had a new idea,” Houser says. “We literally have our 1917 hospital, our 1929 clinic, and they’re encapsulated in or sticking out from an amalgamation of facilities hodge-podged over 1.5 million square feet.”

Houser says she had one firm rule for the design: “I said, ‘Matt, I don’t care what new ideas you have, but whatever it is, you have to make all of this stuff that looks very different look less different.’”

The challenges to develop a more streamlined external campus that would be easier and more efficient to navigate (as well as more visually cohesive) were more than equaled by the challenges to improve adjacencies and workflows on the inside of the new Legacy Building. Critical care areas needed to be brought together to create a more universal platform for care. Surgery and interventional services, too.

“It all boiled down to both our values and the pressures that were being put on healthcare at the time,” Houser says. “The best value in terms of patient dollars was going to be replacing those beds. Sharing a hospital room is just not within today’s consumer-driven framework. And we did major workflow efficiency evaluations, looking at patient, staff, material, and equipment workflow and department adjacencies.”

All of these evaluations, studies, and number crunching converged in the master plan, completed and approved by the board in spring 2008. “There really were right sizes for the new spaces, constraints we defined early on. We put a lot of structure around those early decisions to make sure we didn’t overbuild,” Houser says.

How green is my valley
And then there’s that net-zero health system goal, another major component of the master plan. The sustainability goals were always comprehensive, in keeping with Gundersen’s longstanding commitment to the cause. But the team was challenged even further during the schematic design phase to shave kBtus per square foot (a measurement of heat energy expended) off the campus’s energy performance, with a goal of 115 kBtus eventually targeted for the Legacy Building from an original ballpark of around 200 kBtus. “It’s part of our mission, so we think it’s the right thing to do,” Houser says. “But it also saves us an enormous amount of money. It can pay for itself.”

More efficient lighting schemes and a highly insulated building shell with lots of glass—plus energy-efficient chillers, cooling towers, and chilled water pumps—all play a role in achieving the magic number. But the biggest piece of the puzzle is a new geothermal heat system installed in the staff parking lot about a block from the main campus.

A 300-ton heat pump was installed along with 156 wells, each buried about 400 feet beneath the lot. At that depth, the ground stays at a relatively constant temperature of around 48 degrees. Basically, the energy (heat) transfers between the earth and the water, which is then used to either heat or cool the hospital building, depending on the season. It’s a much more efficient method of temperature control over burning fossil fuels, and it will save Gunderson 70 to 80 kBtus per square foot annually.

The team investigated other options (solar, chilled beams, other types of heat exchanges), “but none of it really worked for us,” Sanders says. “We had to be able to measure its impact and cost. Everything had to be within a five- to 15-year payback.” The geothermal solution is projected to earn its $4 million price tag back in less than 10 years.  (For more details on Gundersen’s energy and sustainability efforts, go to

ding the current

The exterior design of the Legacy Building satisfied Houser’s request for something that would tie all the disparate campus buildings together and improve the patient experience from both a practical and aesthetic sense. “We never had a front door!” she says with a laugh. “Something like 60 to 70 percent of our patients are coming from a rural area outside La Crosse and Onalaska. And you’re looking at this big collection of buildings, and you have to go to one side for the clinic, another side for the hospital, and a whole different part of the building for the ED.” Now, she says, “[The designers] took a very thoughtful and intellectual approach to how the building would fit—not just with the buildings they’re attaching to, but with the community and the region.”

The exterior of the Legacy Building is defined by a sinuous façade of glass and locally sourced stone. The curves mimic the gentle flow of the nearby Mississippi River, while Sanders describes the stone as “an abstracted version of the limestone cliffs as you drive into the valley.” The interiors palette incorporates texture and subtle nature cues, such as in a cork material used on patient room headwalls.

The interiors provided another opportunity to resolve the patchwork sensibilities that had settled in through a century’s worth of renovations and new buildings. “If you were to walk across the campus prior to about 2006, you’d see that each department picked its own paint,” Houser says. “Every department head picked their own carpeting until they standardized the carpet—and then everybody got the exact same carpet. Neither of these directions was particularly charming.”

Houser took a focused interest in the interior design direction, launching a healing environments committee in 2006 that would address all the evidence behind creating surroundings that improve patient outcomes and experience. In 2007, the committee hired an in-house interior designer, who first standardized all the paint choices to one neutral background shade and more than 15 accent colors. When AECOM came on board for the Legacy project, the lead interior designer pared down the list even further. “From an owner’s perspective,” Houser says, “that’s a big deal. We’ve got two guys who are responsible for 1.5 million square feet of touch-up paint. They paint every day. It seems silly, but it’s a big deal when you have potentially 60 different paint colors.”

The building’s lighting is another point of pride for Houser, who says she and her team spent countless hours determining the right mix of direct and indirect lighting. “You don’t know bad lighting until you see really good lighting,” she says, adding that with the new building, “there are no dark spots or light spots. Everything feels good, and it’s not just because of the colors or the materials. A lot of it is the amount of natural light we were able to get into the building as well as how AECOM approached the lighting decisions.”

Greater good
With a deeply committed and hands-on owner, the project team was able to stay on top of all the competing priorities in order to deliver on its original guiding principles and then some. What ultimately tipped the scales for the system-wide net-zero energy achievement in 2014 was an investment of $30 million of Gundersen’s own money and a boost from $11 million in state and federal grants—but the La Crosse campus renewal project’s role was undeniably significant.

“Gundersen believes our responsibility is to the breadth of the population, not just within the walls of our hospitals or clinics,” said CEO Thompson back in May 2013, when the geothermal system was powered up for the first time, as reported by the La Cross Tribune. “It means the health and well-being of the whole community ... keeping the people and the economy healthy.”


Completion date: January 2014
Owner: Gundersen Health System
Total building area: 427,000 sq. ft. (new construction), 80,000 sq. ft. (renovation)
Total construction cost: N/A
Cost/sq. ft.: N/A
Architecture: AECOM
Interior design: AECOM
Engineering: AECOM/Ellerbe Becket
Construction: Kraus Anderson
Consultants: TKDA Engineering (civil engineer), Rolf Jensen and Associates (fire protection), Kurt Salmon (program analysis)
Art/pictures: Meltdown Glass Art & Design, ArtPartners
Carpet/flooring: Collins & Aikman
Ceiling/wall systems: Armstrong, USG, Ceilings Plus
Doors/locks/hardware: Ingersoll Rand
Furniture – seating/casegoods: Staples
Handrails/wall guards: InPro
Signage/wayfinding: CorbinDesign
Surfaces – solid/other: American Artstone Co., Rulon
Wallcoverings: MDC, Carnegie, National
Healing garden plantings: Plantscape Inc.
Fireplace: Modern Flames
Stone flooring: Cold Springs Granite
Terrazzo flooring: Twin City Tile & Marble
Epoxy flooring: Dex-o-tex