Novant Health - Haymarket Medical Center
A New Paradigm in Hospital Design
In 2006, Prince William Health System selected GS&P to develop the master plan for Haymarket Medical Center to serve the growing and diverse northern Virginia community. The comprehensive plan informed the phase I development of the campus consisting of an ambulatory care center, a freestanding emergency department, an ambulatory surgery center, and a medical office building.
When Novant Health (NH) acquired Prince William Health System in 2010, they called upon GS&P to complete the master plan with the design of the second phase of the development, a 221,000-square-foot, 104-bed hospital comprising a 20-bed emergency department, a 10-bed observation unit, four operating rooms, an eight-bed intensive care unit, and women’s services.
“This project was extremely important to Novant Health because it represented the first major move for them in Virginia,” explains senior healthcare principal Paul Braun. “They wanted to effectively demonstrate their commitment to the community as well as fulfill obligations made when they acquired Prince William Health System.”
A Thoughtful Integration
Built into the master plan were elements that supported the cohesive integration of the hospital and the phase I structure. GS&P was instrumental in leveraging the phase I development to the fullest extent by seeking and receiving approval from the Virginia Department of Health to allow the hospital to share services with the existing ambulatory care center.
“We developed the campus master plan with the foresight of the hospital becoming an integral part of the ambulatory care environment,” says Braun. “We started out with the phase I ambulatory care center, and as we were planning for that building, we set up zones on the site for inpatient and outpatient care, starting with low-acuity care and wellness at the ACC.
“The master plan not only gave us a jumpstart in terms of the planning and design of the phase II development, but it also provided a highly efficient way to approach the creation of systems of operation.”
Blending seamlessly with the existing architecture, the integration of the phase II hospital with the phase I ambulatory care center not only maximizes patient convenience but also increases operational efficiency—two key goals for Novant Health.
Focusing on Patients and Caregivers
Along with integrating phases I and II of the master plan, GS&P was charged with helping to develop a hospital prototypical design toolkit that reinforced Novant Health’s care delivery model. The design team worked closely with NH to define specific elements of the toolkit, enmeshing solutions from several resources provided by the client with GS&P’s own analysis and design interpretations.
“Developing a prototypical design toolkit is an effective way to approach not only the planning and design of a hospital, but how healthcare can move to the next level in terms of creating a system of how they operate, and seeing that system evolve and improve as they go along,” explains Braun. “It helps Novant realize what their mission and vision is, which is to ‘deliver the most remarkable patient experience in every dimension, every time,’ and helps that vision become a reality.”
One of the client’s main initiatives was to design prototypes that would allow caregivers to be at their patients’ bedside 80 percent of the time.
“We focused heavily on the patient-caregiver relationship with the nursing unit design,” says senior architect Kristen Bell. “We designed the space so nursing is decentralized at huddle stations that give both physicians and nurses ample space for collaborating on a patient’s care plan.”
Each huddle station is central to six patient rooms. Nurse servers are located at each pair of patient rooms, offering “just-in-time delivery” for both medications and supplies. Documentation stations are located in each patient room rather than at a centralized nurse station.
“We arranged medicines and services so that nurses aren’t running around trying to find the tools they need to take care of their patients,” notes Braun. “The nursing staff has reported that they’re happy they don’t have to spend time hunting for supplies and materials anymore—they’re all right there next to the patient.”
Maximum Throughput Efficiency
Reinforcing Novant Health’s mission and vision, the hospital’s emergency department was designed with patient convenience, comfort and safety in mind.
“The ED was planned and designed around the concept that there are both ‘vertical’ and ‘horizontal’ patient treatment rooms, so it’s set up in two separate zones,” explains Braun. “One is for the vertical type of patient—those who need emergency care but it’s non-life-threatening. Vertical treatment rooms are sectored around an area where patients wait while their tests results are being run. They’re set up in a very efficient manner, located next to another waiting area so that a patient isn’t occupying a treatment space when they don’t really need it.
“The horizontal treatment rooms are in the second tier once you come into the ED, and that’s where more of the acute and critical type of activities occur. Those rooms are located adjacent to an observation area where patients requiring additional time for evaluation have a more comfortable environment, with a bed instead of a stretcher, and access to individual patient bathrooms. So it’s a very fluid arrangement of functions.”
Also maximizing throughput efficiency, a dedicated elevator (located next to the critical area of the ED) goes up one floor to the ORs, allowing patients who require emergency surgery fast access to the surgical suite. Those who arrive with life-threatening conditions are a swift elevator ride away from the intensive care unit located on the third floor.
The Need for Speed
Speed-to-market while still maintaining the highest level of quality was another key driver for the project. Braun explains:
“We were tasked with completing the project in a record six-month time frame. We committed to that schedule, but as we were going through the process, the client needed to further develop their prototypical standards and we were given an extra month to complete the construction documents. We met that target and designed 221,000 square feet in seven months.”
Similarly assisting the schedule was the timing of construction, with commencement of the actual work starting three months prior to completion of the construction documents.
“It was very much a fast-track process,” says Braun. “We started our design in December 2011, and they began site work in May of the following year. So we were about four or five months into the design and were able to support construction starting within that time frame.”
Beating the Budget
Completing the design of the hospital within budget required out-of-the-box thinking and innovative design strategies that fostered a close collaboration between the GS&P team, Novant Health and general contractor Brasfield & Gorrie. This collective team effort ultimately resulted in significant project savings.
“Our first responsibility was to the project budget,” notes senior architect Derek Mott. “Novant was committed to achieving their vision within their budget parameters. Brasfield & Gorrie brought some suggestions on how to reduce the cost of the hospital’s exterior skin while still meeting the owner’s objectives.
“One of the key things we did was reduce the amount of brick on the structure while adhering to the property’s covenant that required a certain percentage of brick be used. In excess of that prerequisite, we substituted a different type of masonry—a decorative concrete block—at higher elevations on the upper floors so that it wouldn’t necessarily be material that you interfaced with as a patient or a visitor.
“Between using the most economic material at a higher elevation in the building and reducing the amount of curtain wall in favor of storefront glazing, we were able to save around $750,000 on the exterior skin. Not only did total construction costs come in under budget, but the contractor was able to return a surplus to the owner.”
A Benchmark for Energy Efficiency
Designing a hospital that would serve as a benchmark in the industry for energy efficiency was a top priority for Novant Health. To accomplish this, the design team implemented energy-saving strategies and efficiency measures whenever possible, and in cost-conscious ways.
“Energy modeling was performed during the early design phases, taking into account solar orientation and heat gain factors,” says project coordinator Brad Sucher. “We had to make sure the orientation of the building was at proper angles, and that everything operated efficiently. We used a good portion of the energy modeling to prove those results.”
Additionally, GS&P’s engineering team worked closely with the client to design the hospital’s mechanical and electrical systems for optimum energy efficiency. The building achieved an ENERGY STAR rating of 80 by utilizing energy-saving strategies, and building in controls such as occupancy sensors, energy-recovery systems, heat pump chillers, critical valve resets on air and hydronic systems, variable speed pumping systems, and lighting control systems.
Novant Health also set a directive for the team to utilize sustainable, local materials as much as possible.
“The stone used on the exterior was locally sourced from Manassas,” says Mott. “We focused on materials that performed well and were economical, and made sure we had low-VOCs inside; something that’s becoming a standard in hospital projects.”
A Testament to the Power of Teamwork
Setting new standards for speed-to-market design, patient care, and operational efficiency, Haymarket Medical Center was conceptualized, produced, permitted and constructed within just 24 months, with square footage costs well below the national average for this type of occupancy and construction. The design team successfully created the benchmark prototypical hospital Novant Health was seeking through teamwork, collaboration, communication and dedication.
“When I think about this project, the first thing that comes to mind is the teamwork and commitment that was involved,” says Mott. “From the very beginning it was clear that it was an interactive and constructive team approach between the owner, the design team, the engineers and the contractor. Everyone was in it together, and that set the tone for the entire project.”
Recipient of the 2014 Washington Building Congress Craftsmanship Award, the project’s success was confirmed by Carl Armato, president and CEO of Novant Health, at the hospital’s opening ceremony.
“Novant’s CEO announced that Haymarket Medical Center was the highest performing hospital in the entire Novant Health system, and that their goals had been realized,” says Braun. “He also noted that he really liked GS&P’s planning and design.
“We’ve since been hired to design another hospital for Novant Health in Charlotte, North Carolina, and we’re going to take this prototype to another level, pushing the envelope to look at ways of providing higher levels of patient care within a more efficient type of environment. As part of this process, GS&P has completed a post-occupancy evaluation of Haymarket Medical Center to examine ways to continuously improve the design, with a specific goal toward patient satisfaction.”