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Most people don’t expect to enter a three-story atrium with a light-diffusing fabric roof when they enter a hospital. Nor do they expect to find a piano, as they might in a hotel lobby. But that’s exactly what anyone entering Florida Hospital Waterman finds.
Florida Hospital Waterman in Tavares, Fla., takes a new approach to hospital design and construction. The design is aimed at making the hospital more inviting than many medical facilities and at enhancing the ability of the medical staff to care for patients.
“We wanted a facility that didn’t have the traditional health care look, in order to make patients more comfortable,” says Mike Hoffmeyer, a Dallas-based principal with RTKL Associates, the architects of the facility, which was completed in August, 2003. “We wanted to ease the anxiety that typically comes from going to a health care facility.”
Hospital executives decided to build the new facility — a replacement hospital — on a 122-acre parcel of land about 5 miles away from its previous location. The 420,000-square-foot Florida Hospital Waterman contains 254 beds distributed throughout six floors. It is adjacent to a 120,000-square-foot medical center.
In addition to gaining room and creating a more functional layout, an important goal in the design of Florida Hospital Waterman was minimizing the institutional look that is common for medical facilities.
Departing from the Past
Florida Hospital Waterman was not alone in its desire to minimize the institutional look. Across the industry, says Hoffmeyer, experts are striving to depart from the typical cavernous hospital with long, confusing corridors. The goal is a facility that feels more inviting for both patients and visitors.
Although the buildings are new, the hospital has a long history of providing health care in the area. Florida Hospital Waterman traces its roots back to the 1920s, when the Waterman family (of the Waterman pen company) donated a hotel in Eustis, Fla., to a group of doctors, says Richard Myles, facilities director for the hospital. Over time, the building, located about five miles from the current Florida Hospital Waterman, was converted to medical use.
The facility worked well for decades. But, like many hospitals, the previous Waterman facility had been added onto over the years, creating a confusing and less-than-functional layout. For instance, patients moving from the emergency room to the intensive care unit had to travel from the north side of the first floor to the south side of the fourth floor. “The way that the building was laid out, the departments didn’t function well together,” Myles says.
Perhaps the most noticeable design element in the new hospital is the atrium. At 20,000 square feet and with windows on all sides, it gives visitors views of the lakes and wooded areas surrounding Waterman. A piano, plants and fountain lend the atrium a look typically associated with hotels rather than hospitals.
All visitors to Waterman enter through the atrium, which functions as the hub and main waiting area for the building. From there, patients and visitors can reach the initial point of contact for every department.
One of the atrium’s most noticeable features is its translucent roof, which is made from a fabric similar to that used in bullet-proof vests. The material lets in light, yet is strong enough to withstand hurricane-force winds. The fabric also serves as a canopy at the building’s front entrance.
The emphasis on a welcoming environment extends to the patient rooms. All rooms, including those in the intensive care unit, allow patients to look outside through oversized windows. “Most views are aesthetically pleasing,” says Debbie Cameron, vice president with Dallas-based EQ International, a consulting firm that worked with the hospital staff to evaluate and plan for the technology at Florida Hospital Waterman. “The staff was really concerned about patient- and family-friendliness.”
For instance, patient rooms, all of which are private, range in size from 210 to 225 square feet — almost double the minimum requirement of 120 square feet, Hoffmeyer says. The larger rooms can accommodate more equipment when patient care requires it.
The larger size also makes a more comfortable environment for families that stay with patients, even if extra equipment is present, says Cameron. “A long time ago, caregivers often did not want the family in the intensive care unit,” she says. “Now, they want to integrate the family as part of the care-giving team.” The rooms also feature reclining chairs, so visitors can spend the night.
Technology and Equipment
While the design was important, Waterman is about more than just looking good. It also was constructed to enhance patient care and boost staff efficiency. For starters, the larger patient rooms actually help control costs, says Hoffmeyer. If patients can stay in one place, and have additional equipment brought to them as needed, the staff will spend less time moving patients. That’s easier on patients and frees up staff time.
Critical-care rooms feature high-tech beds that adjust to an upright position, making it easier for patients to sit up. Those beds provide such health benefits as reduced risk of bed sores. The beds also make it less likely patients will fall or that nurses will injure themselves helping a patient up.
The layout of the hospital also differs from traditional designs. Patient floors are divided into two wings made up of three groups of 10 patient rooms arranged around nursing stations. That layout allows nurses to see into each of the rooms. The three groups of rooms are arranged in a cloverleaf design, with each group of rooms representing one “leaf.”
“Because the nurses are more directly in contact with their patients, their time is used more efficiently in direct patient care,” says Hoffmeyer. At the same time, patients often are less anxious because they know that the nursing staff is right outside their door.
In addition, caregivers at each of the three nursing stations are within eyesight of each other. Nurses can easily see when one area needs help, and move to offer assistance. “Everyone can see each other,” says EQ’s Cameron. “It’s functional from a communication and visual perspective.”
Walls are muted shades of green, terra cotta, blue and purple. The walls, signs, elevators and decor in each wing are a different color, making it easier for visitors to find their way to their destinations.
Along with the hospital design, the technology used within Waterman facilitates communication between caregivers. This is critical, as a lack of or poor communication can result in medical errors, says Hoffmeyer. For instance, the hospital uses a picture archiving system that allows doctors or radiologists to pull up and study test results from remote locations. Medical staff can discuss their findings with their colleagues, even if they’re in another department or away from the hospital.
And nurses or doctors who are stepping in to care for patients that are new to them can easily access their records. Because they’re able to get up to speed quickly, the medical staff can provide better patient care.
In addition, the patient monitoring system at Waterman is capable of automatically recording and capturing patients’ vital signs, such as heart rate or blood pressure, says Cameron. This reduces the risk of clerical errors and allows the medical staff to spend less time on paperwork.
An automated medication-dispensing system ensures that only caregivers, who must provide a thumbprint or key in an identifying code, can access patients’ medicines. The medication for each patient is contained within a drawer designated strictly for him or her. The system records all withdrawals from the drawer, as well as the caregivers that withdrew the medicine, says Cameron.
Even though Waterman’s patient rooms and intensive care unit feature state-of-the-art technology, much of the equipment is contained within booms and walls, giving the rooms an open look. In operating rooms, wiring is contained within booms that hold the equipment. “There are no cables across the floor,” says Cameron. “It’s a nice, clean environment.” In addition, the use of flat-panel displays means the equipment doesn’t take up as much room as older models.
In critical-care rooms, medical gas outlets and monitoring equipment are housed on booms mounted to the ceiling. This allows the services to come right to the patient’s bedside and reduces the need to drape cords and tubes from the bed to headwall outlets and wall-mounted monitors. Ceiling booms provide staff better access to patients and make it easier to work around equipment. That can be critical when it’s necessary to resuscitate a patient. It also makes it easier for caregivers to move patients within their rooms.
To reduce the noise level found in most hospitals, the design team and medical staff equipped the nursing staff with pages and mobile phones, eliminating most of the need to use an overhead paging system, says Cameron. Now, public announcements are made only in emergencies.
Consistent design and use of the same materials, finishes and equipment throughout the hospital make it easier for the maintenance staff to do its job, says Myles. For instance, vendors were chosen to supply such items as fixtures, locks and medical equipment throughout the entire hospital. That makes it easier for employees to learn how to maintain the facility and equipment. In addition, the maintenance staff can operate with lower inventory levels because it doesn’t have to stock items from a variety of manufacturers, says Myles.
For example, of the 450 reheat coils throughout the building, 400 are the same type of unit. Comparing the new Waterman to the old, Myles says, “We have recognized over a 50 percent decrease in the number of actuators that we keep in stock for repairs.”
And, because patient rooms are identical, it’s easier for the custodial staff to work throughout the hospital, rather than only in certain areas.
The new facility also features a higher percentage of hard-surface flooring than the old facility did, Myles says. The current breakdown is about 75 percent hard surface, including vinyl composition tile, terrazzo and sheet goods, to 25 percent carpet. At the old facility, the breakdown was about 55 percent hard-surface flooring to 45 percent carpet. In addition, most of the carpet is tile, making it easier to replace areas that become stained or damaged.
The energy plant features two electric chillers and one gas-fired unit. As a result, the hospital can switch from electricity to gas during disasters, such as hurricanes. The hospital can also shift between the utilities to take advantage of price differences.
The hospital uses a state-of-the-art vacuum system that costs about 25 percent less to operate than the old system, says Myles. One reason for the cost difference is that the system requires less preventive maintenance.
Finally, a 5,500-square-foot child care center located on the campus makes it easier for hospital employees with children to balance work and family responsibilities.
To determine the most effective layout and design of the new hospital before construction began, the architect and medical staff did ongoing mockups of the rooms and equipment. The first trial runs were done in the parking lot of the old hospital. The design team painted the proposed layout of patient and supply rooms, as well as the nursing stations, on the pavement. Then the medical staff moved carts, patient beds and other supplies between the various areas. Hoffmeyer says the goal was to test the efficiency, circulation and communication capability of various designs.
Then the team built and equipped actual mock-up rooms and completed trial runs to test the workflow and function of the new room design. The nurses, doctors and therapists could see the proposed layouts of equipment, supplies and patients, and judge the functionality of different layouts. “The mockups really helped the user groups see how things would function,” Cameron adds.
As a result of the trial runs, about one foot was added to the size of the rooms, says Myles.
Even though the design and medical teams wanted a new design approach for Waterman, both still had to work within a budget. The hospital staff, along with experts hired for the project, thoroughly evaluated all potential purchases and negotiated pricing.
In addition, Myles partnered with vendors during construction, which allowed him up-front access to new technology. For instance, he worked with one company for all of Waterman’s low-voltage equipment, such as the access control and CCTV systems. “We were able to get economies of scale from a price perspective and got state-of-the-art products, as the manufacturer will use our facility as a show site for future clients,” Myles says.
As a result, the facility contains the technology the staff wanted to enhance patient care and operational efficiency, yet was completed for a reasonable amount of money. At about $180 per square foot, the cost to build Florida Hospital Waterman is below the median for similar medical facilities, says Hoffmeyer.
Equally important, the design and technology allows both patients and staff to focus on the true goal of Waterman: helping patients get better.
Karen Kroll, a contributing editor to Building Operating Management, is a freelance writer who has more than 10 years of experience covering real estate and facility issues.