By David Weiss
Some structures are worth waiting for.
When architect Chuck Holmes, principal of the firm CDH Partners (www.cdhpartners.com), finally got the green light to make blueprints for DeKalb Medical Center at Hillandale (www.DKMC.org) in Lithonia, GA, he knew it would be an experience worth savoring.
“There are very few new hospitals built anymore in the state of Georgia. This is a major thing in my career and for our firm,” says Holmes. “We wanted [the new facility] to be state-of-the-art, with a high-tech look and an innovative infrastructure.”
The first planned all-digital hospital in Georgia, the DeKalb Medical Center at Hillandale (DMC) facility adds 100 beds, a host of new services, and sought-after health care talent to the resources of the not-for-profit DeKalb system. DMC joins DeKalb’s main Decatur campus, which opened in 1961 and provides quality health care to what had previously been a much-underserved demographic.
Gleaming out to drivers traveling nearby on Interstate 20, the six-level, 191,000- square-foot DMC resides on a 40-acre campus and represents a hard-won, $65 million triumph for its founders. “The community has been waiting over 30 years for this hospital,” notes Julia Jones, DMC vice president and administrator. “Georgia is a Certificate of Need (CON) state - you can’t just design a hospital and say, ‘Let’s build it.’
“We filed the CON in 2001 and had to justify it for the community. We presented to the state that there was a deficit of physicians, and our argument was that if we were going to bring physicians into this population, they also needed the tools. After 3 years of regulatory battle, the state agreed.”
The DMC team did not waste the opportunity to create a milestone health care facility for Georgia. The center would serve as the home for a wide range of diagnostic clinics, including radiology, ultrasound, mammography, fluoroscopy, EKG/EEC, nuclear medicine, and echocardiograpy, as well as comprehensive maternity and emergency services.
As architectural planning went into high gear, the founders wanted an exterior that would clearly reflect DMC’s futuristic attitude, as well as a hospitable interior - all built around a highly advanced technological core.
The approach to DMC brings visitors to a modern glass tower structure rising five levels above grade. Semicircular corners and the sweeping curves of a dramatic canopy, complete with cantilevered skylight, set the tone for the pleasing aesthetics waiting inside.
“When we began thinking about this new hospital 15 years ago,” Jones says, “our CEO at the time told us to envision a structure that would look and feel contemporary 30 years after it was built, and be expanded over time.”
Holmes and his team, which included Project Architect Doug Rogers and Project Manager Rick Stewart, specified glass and Dryvit’s EIFS (Exterior Insulation and Finish Systems) as the primary materials for DMC’s façade. “All of the exterior structures were designed so we could keep adding on,” Holmes states. “The EIFS is a synthetic, plaster-based stucco which we selected because it is easy to manage and maintain.
“The frame is a concrete frame. I developed a structural system where we had only one outside column within the wing, so it would have as much flexibility in the future as possible because we’re always going to be making changes to the facility. The energy sources of the building were also designed so they can be expanded, allowing DMC to eventually be a 250- to 300-bed hospital.”
Inside the facility, CDH’s history with DeKalb (it was the architectural firm of record since the late 1970s) would prove crucial in establishing a fast start to the program’s ambitious goals for healing and workflow. “Chuck has been the prime architect on this system for forever and a day,” Jones says. “What he brought to the table was a wealth of health care experience, but he also had to bring flexibility to think out of the box.
“Because most hospitals fully cater to the needs of physician and the staff when going through the design for new hospitals, the focus in those places had solely been function, not necessarily contributing to the emotional well-being of the patient. We had to work with an architect who would not just consider the workflow and function, but also bring elements that met our evidence-based design component.”
A philosophy enjoying increased consideration in health care, evidence-based design is also often referred to as the Planetree Model, named after the organization that conceptualized its framework in 1978 (see www.planetree.org for more information). “At DMC, evidence-based design means designing patient spaces to make them more healing and patient-friendly from mental, emotional, spiritual, social, and physical dimensions,” explains Jones. “Hospitals in the past were very functional for the ease of the staff moving from one place to another - and also very sterile looking, which is what they thought the patients wanted to see. A lot of surfaces were neutral colors, the hallways were just white, and you had smaller rooms.”
For DMC, strict criteria were attached to each architectural and interior design decision. “It had to pass the test: Is this something for the patients?” says Don Fears, director of strategic and regulatory planning at DMC. “We asked people who worked in our old facility to help design the spaces here. We were saying to them, ‘We’re talking about a newer environment - we’re looking at a blank sheet of paper for what you need to do.’ Along the way, we continually asked if their recommendations would be better for the patient or the staff, always orienting them towards the patient and their family.”
The influence of evidence-based design is everywhere at DMC, beginning immediately inside the hospital, where visitors are welcomed by a main lobby featuring an expansive, two-story atrium and a salt-water aquarium. Instead of the traditionally cold, sterile hospital feel, DMC’s ambience is intentionally modeled after hotels. Color and wall-mounted artwork abound in the public areas, with eye-pleasing curved surfaces built into such areas as carpeting, the “bistro” (aka cafeteria) banquettes, and nurse station dividers. Natural materials also appear as frequently as possible, with an abundance of hardwood flooring, as well as working stone fireplaces in the second-floor lobby and the third- through fifth-floor patient reception areas.
Generous amounts of space and natural light were provided wherever possible. “We created what we call a ‘theme of healing,’” says Holmes. “To do that, you want to have nice exterior windows, because psychologically it really helps the patient to see the outside. Allowing sufficient room for the family to be a participant with the patient is achieved architecturally in the waiting areas and the patients’ rooms, where fold-down beds and chairs are provided so that family can comfortably spend time overnight in the rooms with patients, if need be.”
Beneath the calming surface appearance, however, is a quick-moving technological plant that provides DMC’s staff with the firepower to heal faster and with increased safety as they accurately track a patient’s status across the hospital. “The technology we employ here is a paperless, all-digital infrastructure,” Fears says. “The heart of it is an Electronic Medical Record System which allows our physicians and clinicians to access charts simultaneously.
“It’s an incredible tool: We can keep track of what patients are allergic to and what they ate, access X-rays, or contact another physician online. As a result a doctor can prioritize his day by pulling up his patients’ records and start ordering from his office or home, so care can be initiated before he walks in. Insurance information can be pulled to initiate discharge planning and much, much more. So instead of waiting to get the care managed, everyone is doing their job the second the patient walks in.”
The DMC network’s hardware components were supplied by Cisco, connecting to Dell PCs and running Siemens’ Eclipsys clinical application software. Mobile Computers On Wheels (COWs) have secure, wireless connections and are mounted on carts made by Infologix. The network’s head-end is located remotely at the DeKalb main campus in Decatur, connected via a fiber-optic run of approximately 10 miles.
The building’s HVAC infrastructure is equally sophisticated, with the circulation of the cleanest air possible essential to faster healing. “We have a thermostatic control in each room, so each patient can make their space cooler or hotter,” Holmes says. “The pipes, penetrations, and duct work are routed such that each unit functions separately.
“From there, the rooms are connected to huge boilers and chillers which produce hot and cold water. Those lead to pipes that go to the air-handling system. Then you have filtration through banks of high-quality filters, and therefore air quality control on the chillers. The result is clean, noninfected air in every room, so one sick patient’s air won’t be transferred to another room.”
With patient safety, and especially iron-clad surveillance of the maternity ward, a necessity, security and emergency backup systems are extensive. “You have to have a very secure system so no one is stealing a baby, so that area has its own security system,” says Holmes. “There’s multiple, multiple remote cameras, and security people are equipped with several bands of monitors to watch with, with a great deal of conduit needed to connect it all.
“For this to be a state-of-the-art hospital, we believed it had to be able to function in a blackout. Therefore, there’s a lot more emergency equipment and systems here than at other hospitals. To provide emergency power, for example, there are large generators to take over immediately if needed. All of this capability stems from what we call the ‘energy plant’ of the building. It’s a mechanical room on the ground floor, located near the docking area and hidden from the public.”
In many areas of DMC, the most advanced aspects are not reflected in technology that has been installed, but the accommodations that have been made for future technology - whenever the need arrives. “The operating rooms are larger,” Fears points out. “Why? Because we don’t know what’s going to be in an operating room in 10 years. So we put more outlets on the walls, ceilings, or floor, and made room for more people to go in. The patient rooms are larger for the same reason: They’re about 200 square feet, whereas the typical CON facility room is 156 square feet.”
Design phases for the building and hospital department personnel moved closely in tandem. In the case of the network, for example, meetings took place early and often between the design team and Cynthia Davis, DMC chief information officer, and her technical team. “We worked closely with the architect to understand the business environment questions: ‘Did the caregivers need to be mobile or in a fixed space? What was their workflow?’ Once we knew that, we could build it,” Davis explains. “After the design was done, my network technical team met on a weekly basis, looking at design drawings so we could outline specifications to vendors and make sure the infrastructure was in place.
“Sixty days before the hospital launched, we began an enormous amount of applications testing to make sure everything worked, and were on-site 24/7 the first month as we trained the physicians and staff on the Electronic Medical Record System and Computerized Physician Order Entry system and integrating it into their workflow.”
With DMC charting the highest patient satisfaction scores that the DeKalb system has ever seen, it’s clear that having a team with heavy experience in architecture and technology is a healthy development. “The health care field is rewarding in that not every architect out there can do it,” Chuck Holmes observes. “Architects and contractors can’t just jump into it, you have to experience it and develop your knowledge.
“I’ve been working in this field for 29 years, and I know you have to keep yourself on the leading edge. There’s no mystery about the technology: From CAD to materials to diagnostic systems to materials, you simply have to stay with it and constantly ask, ‘What is new today?’”