When Major Hospital in Shelbyville, Indiana, was built in 1980, 70 percent of care went to admitted patients; now more than 75 percent of services are delivered in an outpatient setting. With patient volume expected to increase 17 percent by 2020 and the current facility landlocked on a downtown site, Major Health Partners (MHP) recently finished construction of an $89 million replacement hospital, MHP Medical Center, 3 miles away.
The new facility, funded through patient revenues and donations, meets today's care model and provides flexibility for the future. Despite more than doubling the square footage of the old hospital, the new building significantly reduces energy usage. With the central plant in the flood-proofed lower level, outpatient services on the first floor, physician practices on the second floor, inpatient care on the third floor, and the hardened shell of the mechanical penthouse, MHP Medical Center is built to withstand disasters and continue serving the community.
The 305,000 square feet of new construction ties into the existing 47,000-square-foot Benesse Oncology Center. Indianapolis' Messer began construction in October 2014. When the building reached substantial completion last October, administrators began moving into the new space. Patients and hospital services move this month.
The design of the new hospital concentrated on four major goals, including a patient-centric focus. Kathy Clark, Senior Director of Healthcare Operations Planning for the project's architect, Indianapolis' BSA LifeStructures, led an operational planning process with the hospital's clinical directors. "We worked quite a bit on what our community needs and how we want to deliver care in the future," said Linda Wessic, MHP's COO. "We felt we could best meet our community's needs if we really advanced our outpatient - or ambulatory care - services."
Although plans started with just 12 outpatient surgery beds, "The unit (now called the Ambulatory Care Center) grew to 38 beds when we looked at our demographics and pulled our analytics and metrics regarding our patient population," Wessic said.
To help patients and visitors navigate the new building, "We have a public concourse like you'd see in an airport that runs the length of the building, about two football fields long," said Richard Fetz, MHP's Executive Architect. "All the departments plug into it."
An interior corridor parallels the public concourse. "The patient at that time has entered into a care area so it provides a more personal experience," Wessic said.
Many features ensure cleanliness and infection control. For instance, in the Emergency Department (ED), instead of cubicle curtains that need constant cleaning, "We put a sliding glass door that has a blind in between the two panes of glass," Fetz said. "You just flip a button instead of pulling the curtain for privacy."
Throughout the hospital, "intentional adjacencies" make operations smoother, leading to better care, Wessic said. For example, "We didn't have enough volume to warrant a decentralized CT scanner in the Emergency Department, but we designed our Imaging Department right next to the ED and positioned the CT scanner room to be very efficient in terms of its flow from the ED."
Energy Savings in Every Corner
The second design goal focused on energy efficiency and achieving a 95 or higher Energy Star rating. To start, the building envelope features three inches of spray foam insulation. "It provides a continuous thermal barrier," said Doug Hundley, Jr., Principal and Senior Mechanical Engineer for CMTA, Inc., in Louisville. "We conducted a building pressure test to confirm we didn't have any major leakage points and we passed our goal by quite a bit. It's a very tight building."
In addition to ample natural light, the entire building uses LED lighting and occupancy sensors. "We were one of the first hospitals to be all LED," Fetz said. "The fixtures last forever and they can easily dim - but the nicest thing is that LED hardly puts off any heat."
In fact, "We achieved lighting intensity of 0.6 watts per square foot," Hundley added. "You're allowed 1.2 for energy code, so we have a 50 percent reduction." That translated into a 50-ton decrease in cooling capacity requirements, he said.
CMTA also incorporated energy recovery for minimum outside air throughout the building. "That equated to 100 tons of cooling capacity reduction by recovering 70 percent of the waste heat in the general exhaust air," Hundley said.
The system uses a total heat wheel spinning through two air streams. "It captures the heat and moisture in one air stream and transfers it to the other," he explained. "In the winter it can take 6-degree air and heat it to 55 degrees; in the summer it will take 90-plus degree, 60 percent relative humidity air and cool it down to 78 degrees."
To further increase efficiency, a heat pump chiller allows the hospital to turn off boilers throughout the summer. "We sized the chiller so that in the summer months, all the waste heat normally sent to a cooling tower and rejected to the atmosphere is used to generate hot water," Hundley said.
Instead of traditional steam boilers, the building uses high-efficiency condensing boilers. "Multiple smaller units come online as the demand grows for heat or domestic hot water," said Jeff Williams, MHP's Vice President of Facility Operations. "They were sized and staged so that if we experience an extreme cold or hot period, we can bring another unit online vs. having a big unit run all the time when it's really out of its efficiency curve. That's all controlled by our building automation package, which is one of the ways we really maintain our energy efficiency throughout the year."
In addition to mechanical systems, designers thought outside the box for energy savings. "When they designed the inpatient care unit, they asked the care team, "˜Do you want showers in all your patient rooms?'" Wessic related. "We all said, "˜Of course we do!' Then we went back and looked at our numbers and found that a very small percentage of our patients were able to shower without considerable help. We decided that with the energy costs saved by eliminating showers, we could bring on a clinical tech to help patients with their hygiene needs, do it in a safer manner, and maybe even provide a patient experience that would be a differentiator."
ADA and isolation rooms in the new facility include their own in-room showers, but for others in the new inpatient unit, the central spa offers a large soaking tub, a large shower with room for two people and assistive devices, and a massage therapy room.
Standing Up to Disaster
The third design goal ensured readiness for natural disasters. With the new medical center in a tornado alley, "We wanted to do what we could to make sure in any catastrophe the community could count on our hospital being there to serve them," Williams said.
Although building code requires emergency generators to back up critical hospital systems, "We sized our generators to back up the entire building," Williams said. "If we experience a disaster in the middle of summer and lose local power feeds, our generators will not only run our hospital, but continue to cool it."
The team also built IT systems to survive. The data center sits in a separate building about a quarter mile away. "We were able to harden it so it's like a bank vault," Williams said. "It was an existing building and we literally gutted it, constructed a steel room inside a steel frame building, and hardened that room to withstand virtually anything from a tornado to a vehicular strike. We also have a redundant fiber optic loop so we have a resilient IT system, which is critical for hospital operations going forward."
For the medical center's mechanical penthouse, "We created reinforced concrete block masonry walls with an insulated steel panel system on the exterior to harden that portion of the building," said Derek Selke, BSA's Lead Architect. "That protects the mechanical systems so the hospital can continue to function even if it's hit by flying debris."
To prevent flooding issues, designers opted for a service elevator rather than a loading dock. "When Columbus, Indiana, experienced a big flood, all the water came in the loading dock ramp that went to the basement," Fetz related. "If you have a loading dock, it's like an interstate ramp for water, so we eliminated that. If we get a big downpour that exceeds our drainage ability, water will flood away from the building. We didn't provide any holes for water to get into the basement."
As one of the last steps of construction, crews installed a protective covering on all the exterior glass. "It's an 8-millimeter film designed to prevent the glass from shattering during a weather event where flying debris strikes the building," Williams explained. "It keeps the glass in the frames and protects the integrity of the building."
The final design goal focused on flexibility. "We could predict what healthcare needed to be two or three years down the road, but because we're building a facility for 30 years, we used products that allow us to restructure or reorganize without major construction," Wessic said.
For instance, admissions and other areas feature moveable walls. Patient rooms include a rail system in the caregiver area for mounting supplies and technology. "In a lot of hospitals they screw it to the wall, then you get a new brand and it doesn't fit," Fetz said. "We mounted them all on a rail so they can move them to their heart's content."
The building's lateral structural system incorporates shear walls. "That eliminated a lot of steel and opened up the floor plan for easier renovation in the future," Selke said.
In addition, "We designed the building to expand in place," Fetz said. With all the main departments on the first floor, "We have the ability to expand to the north and they can all grow."
With all four primary design goals met, the new medical center finished on schedule and slightly under budget, with final construction cost at $250 per square foot. The remaining physician practices will move to the new facility by March, then MHP will demolish the old hospital and donate the green space to the City of Shelbyville.
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