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Austere settings fade away in favor of inviting design

Rochester Business Journal
February 8, 2013

Local health care facilities are marching steadily away from the cold, ward-like environments of the past.
The buildings' improved designs reflect changing patient and employee expectations, the growing presence of information technology in medical settings, and mounting pressure for the health care industry to focus on efficiency.
A typical hospital nowadays "never stops growing, never stops changing," says David Gardner, president of Henrietta-based Gardner Plus Architects PLLC, where 95 percent of the work is for health care clients.
Area health systems have begun poring over how to chart their future from a design perspective, in efforts ranging from drafting master plans to modernizing long-term care facilities.
Amid ongoing renovations at their main facilities, hospitals continue to expand their footprints through ambulatory surgical centers and state-of-the-art medical office buildings.
"A major trend that we are seeing is a move away from expanding within the traditional hospital setting," says Trevor Harrison, managing partner at Pittsford-based HBT Architects LLP. "Our firm is working on a variety of projects that indicate the desire to locate primary care and certainly some administrative and support functions in off-site locations. This frees up spaces in the hospital for more specialized and intensive care.
"It also supports patient satisfaction surveys, which typically indicate a higher level of satisfaction at off-site locations," Harrison adds. "The hospital is not going away in any sense, but we see these facilities as becoming more specialized."
Patients' expectations-whether that means a quiet, private room or having amenities commonly found at hotels-also figure into new buildings' designs.
"In the last five or six years, there is much more of a focus on the patient experience," says Robert Donahue, vice president of corporate and ancillary services for Unity Health System, which has undertaken a $160 million expansion of Unity Hospital, slated to wrap up in April 2014.
He adds: "I don't think anyone can predict what those (patient) needs will be 10 (or) 20 years down the road, but we've given as much thought as we can to the design of this to give us as much flexibility as possible."
Among the local medical office buildings that exemplify state-of-the-art design is Unity at Ridgeway. Opened in 2010 and owned by Rochester-based Broadstone Real Estate LLC, the four-story building in Greece houses various outpatient operations for Unity, including a diabetes center, cardiac rehabilitation and a pain-management practice.
"We have found that, at least in our experience, ... developers are doing these (medical) buildings more and more now than hospitals are doing them," says Joseph Istvan, principal at Rochester-based Bergmann Associates Inc., which designed Unity at Ridgeway's core and shell. "So developers seem to be attracting the hospitals in terms of the lease-back types of arrangements ... and the financing."
Energy efficiency was an important factor in the building's design. A geothermal system provides heating and cooling for the property, and other features include motion-sensing lighting, low-flow plumbing fixtures, instantaneous water heaters and a "cool" roof to reflect solar energy.
"And it has a very high energy-efficient envelope in terms of the roof, the walls and the windows," Istvan adds.
The property's proximity to the Erie Canal partly inspired the aesthetics for the building, for which the tenants' fit-outs were done by Gardner Plus Architects. Both the interior and exterior, for instance, have stonework that resembles materials used to construct the historic waterway. Light-colored wooden arches and large pendant lights give the hallways a hotel-like feeling.
"Again, the trend (for materials) seems to be a lot less clinical (than what) you tended to see in hospitals and medical office buildings in the past," Istvan says. "It's tending to be a lot more inviting and inclusive to the patients and folks that are visiting the building."
The emphasis on hospitality in health care building design relates to patients' desire to be treated as guests nowadays, he says. A warm, inviting atmosphere can influence which provider a patient chooses.
Projects for health care clients at HBT Architects include Rochester General Health System's ambulatory surgery center at the Linden Oaks medical complex. The 38,350-square-foot facility, currently under construction, will have six surgical suites and two procedure rooms when it opens in the fall.
The architectural firm also has worked on RGHS' Riedman Campus, formerly the headquarters of ESL Federal Credit Union. The latest construction at the Irondequoit property involves a new employee wellness center, which HBT designed to be "not just about treadmills and spinning classes," Harrison says. The facility will have a wide range of programming, he adds.
Medical professionals' rising expectations of their employers have seeped into the design of health care buildings. Modernized workplaces and convenient parking contribute to satisfaction on the job, Harrison says.
Unity Hospital's ongoing expansion also typifies trends in health care building design. Now in the 33rd month of the 47-month project, the expansion includes adding roughly 80 beds, both licensed and unlicensed, and reshaping "virtually every element of the hospital from an inpatient med-surge perspective," Donahue says.
In the last year, a 75-seat auditorium, cafe for staff and visitors, acute dialysis department, administrative suite and boardroom have opened on the Unity campus, he adds.
Gardner, whose firm has worked on the Unity expansion since its planning stage in 2005, says the patient-room design now incorporates zones that simplify work flow. The first zone has room for the caregiver; the second zone has the patient bed with plenty of room for administering care, while the third has space for visitors.
Information technology's increasing presence in medicine has profoundly influenced the design for the expansion, Gardner says. Electronic medical records represent only the tip of the iceberg when it comes to developments on the horizon for high-tech medicine, he adds.
The traditional nurses' station with patient rooms in building wings has become outdated because of IT, notes Gardner, whose firm recently completed a master plan for Canandaigua-based Thompson Health. Medical professionals now are working closer to patients.
"They're working immediately outside the patient room in terms of having access to computers, having access to cardiac monitors," Gardner says.
Hallmarks of modern design are visible at Unity's acute dialysis department, Donahue says. The space, for instance, has clear sight lines to all of the patients, easing care delivery.
Information technology improvements at Unity include a new state-of-the-art nurse call system that aims to shorten bedside response times. It uses wireless phone technology and gives patients two call buttons on the pillow speaker to choose: one that calls a nurse for a medical issue and another that calls an aide for help in getting to the bathroom.
"So what it does is it gets the patient in contact with the appropriate care provider instantaneously" and allows the hospital to run reports on response times, Donahue says.
Without question, efficiency and hospitality will help shape the future of medical building design, Harrison says.
Patients will likely want more privacy and serenity, as well as less austere surroundings, when seeking care, "whether that's warmth of (design) materials or ... access to staff ...," he says.

Sheila Livadas is a Rochester-area freelance writer.

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