“The old hospital was located in the middle of a residential neighborhood that was simply not a good location for a healthcare facility,” says Scott McQueen, GS&P principal-in-charge on the project. “It was difficult to access and could never really be expanded the way it needed to be because it was surrounded by houses. There was no question that a new facility was needed.”
More than ready to transition into a new facility that provided advanced healthcare in an efficient, healing environment, SJMS selected a site located at the entrance point to the city of Mount Sterling for its new 113,000-square-foot, 40-bed replacement hospital.
“One of the hospital’s key project goals was for the new facility to stand as a prominent gateway to the city of Mount Sterling,” says McQueen. “Unlike the former site, which was off the highway and fairly secluded, the new site was close to the Mount Sterling exit and could be clearly seen from the interstate. It was the prime location for their new hospital.
“One thing we did at the very beginning of this project—and we do this on every job—was set our guiding principles. These included easy access to the site, creating a family-oriented environment and serving the area beyond Mount Sterling. We then let those principles decide every solution for the hospital from that point forward.”
Before design work could begin, it was essential for the GS&P team to fully understand operational processes taking place within the existing facility. While analyzing the hospital’s working procedures, the design team solicited input from all patient and support departments, including registration, ED, radiology, surgery, pharmacy, lab and materials management. This multi-disciplinary approach not only provided the team with a greater understanding of the hospital’s current situation, but it also helped them to identify potential obstacles and opportunities for better efficiencies.
“We spent a lot of time in the old facility analyzing the hospital’s existing processes,” adds David Stewart, GS&P senior architect. “Process mapping how the hospital operated in areas such as patient and material flows really helped the individual departments have a better understanding of what the other departments were doing, and ultimately how one affected the other.
“After we completed our analysis, we worked closely with the hospital to start streamlining its overall process. Once we determined the most efficient way to lay out the new facility in terms of departmental adjacencies and other spaces, we were able to start designing the new hospital around those processes.”
Analyzing the Site
Following the process mapping and space programing phase of the project, a complete site evaluation was performed, and a conceptual design identifying the building locations, major access points, circulation and potential parking zones was developed.
Focusing on the facility’s new symbolic site as an iconic gateway to the city of Mount Sterling, the design team chose to orient the building toward the highway, allowing the hospital to be clearly seen from the freeway and surrounding areas. Saint Joseph Mount Sterling’s desire for positive community interaction was addressed by placing the hospital as a virtual billboard pointing to the city.
“After studying the color and context of the area, we were drawn to the spatial concept of a billboard and it’s interaction with the public,” says Stewart. “The hospital has been serving the community for close to a century, and orienting the facility this way promotes a conversation with that community.”
“The billboard concept was also about siting the building where it had a strong presence,” adds McQueen. “There was no other major building off that exit, so we designed the hospital to be a focus upon entering the city of Mount Sterling.”
To make the new facility stand out further in its prominent setting, the design team drew inspiration from the city’s downtown buildings and the architectural essence of nearby Lexington, using a color palette of natural tones and contextual materials.
“We visited several new and older buildings in the area in order to understand the broader context of the building’s exterior,” says Stewart. “We realized that the new facility would impact the overall community, and wanted to be sure that the design methodology took a thoughtful and sensitive approach.
“Mount Sterling is basically a suburb of Lexington. The historic Keeneland racecourse is located in Lexington and its building is a stone structure, so the horse farm theme runs strong in that region. We were able to demonstrate through design charettes that using red brick for the facility really wouldn’t fit in with the surrounding community, and were able to bring in materials that were more appropriate for the area.”
“When we were selecting the materials for the building’s exterior, we wanted to make sure they really stood out in that particular setting,” adds GS&P project team member Sejin Kim. “So we used contextual materials, giving the utmost consideration to how they blended with the neighborhood.”
To create a unified connection with the building’s interiors, a visioning session was conducted to identify an appropriate look and feel. The GS&P team focused on color and form, and how they could fuse those two components with SJMS’s core values of reverence, compassion, integrity and excellence.
Providing Flexibility and Expandability
As the two-story building started to take form, critical horizontal and vertical adjacencies were defined. The goal was to minimize travel distances and place related departments on the same floor. A critical element of this process was providing the hospital with two separate paths of circulation—one for the public, where all hospital services from administration to radiology could be accessed, and one for staff and materials that would cut through the rear of the building and eliminate cross-traffic.
“We laid out the facility so there would be a clear division between public and staff spaces,” says McQueen. “We also designed it so that no major departments were landlocked by another, which allows for easy expansion.”
“For any small hospital like this, the ability to expand is vital. One of the reasons the old facility had so many issues was because it couldn’t expand. The departments were essentially landlocked in the middle of the hospital. They would have had to move an entire department out of the way to expand.”
Adhering to SJMS’s key goal for the new facility to provide flexibility and expandability of programs, the design team laid out the building’s first floor so that all departments could easily grow. The circulation to and within each department was expressly designed to allow expansion in the direction of traffic without major impact to the existing layout. Additionally, departments such as the ED and radiology were placed in close proximity to one another to streamline patient flow.
Each of the first floor’s diagnostic and treatment centers was designed to have direct access to the building’s second floor, which accommodates all of the hospital’s inpatient care and includes an ICU, pharmacy, OB/LDR and lab space. Staff hubs located on this floor were arranged to provide clear wayfinding for patients and visitors.
Creating a Healing Environment
Just as expandability and flexibility were crucial considerations for the future of the hospital, equally important to patients and their families was a facility that minimized the stress often associated with the healthcare experience.
“A visit to the hospital can obviously be an extremely stressful event,” says Stewart. “A large number of studies strongly support that the use of natural light can greatly reduce anxiety and depression, and we made sure that we incorporated as much natural light into the facility as possible. If you walk down any of the corridors in the patient tower on the second floor, you’ll come to a large, non-reflective glass window at the end of each corridor that lets in plenty of light. Even the patient rooms themselves have sizable windows that provide views to nature and bring healing light into the space.”
“We also placed family zones in the patient rooms,” adds McQueen. This allows family members to participate in the care of the patient and offer closer observation, which is actually found to reduce the number of patient falls. In addition, all of the patient rooms are standardized, which also leads to patient safety. With standardized rooms, the rooms are not mirrored and all face in the same direction, so the bed is always going to be on the left side, and the doctor’s right arm is always going to be toward the patient. We’ve also incorporated those evidence-based design principles into every typical room that has multiple rooms such as the ER. The ORs and prep rooms for surgery are also standardized, so when a nurse hits a Code Blue button, it will be in the same space in each room.
“In a small hospital, the nursing staff don’t just stick to the one department. They get moved around a lot and have to cover multiple departments. So having some standardization across the board really helps because staff aren’t constantly looking for items. If a nurse is spending five minutes searching for supplies every time he or she goes into room, that is a complete waste of time. In short, standardization allows for more efficient use of time. And creating a more efficient work environment was a high priority on Saint Joseph’s list.”
Offering the city of Mount Sterling and its surrounding communities a new paradigm in healthcare, the Saint Joseph Mount Sterling replacement hospital includes comprehensive inpatient and outpatient diagnostic treatment centers; an emergency department; radiology, surgery and recovery suites; cardiopulmonary rehab; a café/dining area and chapel; and an easily accessible public spine, which serves the entirety of the hospital. The facility’s critical ability to connect and expand was successfully demonstrated when the addition of three major components during construction caused no significant impact to circulation, or to the originally designed department adjacencies.
“Additional funding became available midway through the project,” says Stewart, “so we were able to build out the MRI, a cath lab and a two-story MOB. It not only forced us to say to the hospital, ‘Yes, we can do this,’ but it also enabled us to show them how. Oftentimes, when we plan and design healthcare facilities with the future in mind, the client has to wait for our concepts to translate into truly functional solutions. This time, our design was tested in the middle of the construction process, and it passed with flying colors.”