The Heart & Vascular and Neuromedicine Hospitals: Part 2 – Design and Construction

In the last issue of OTSP, I described the circumstances surrounding the decision to build our two new hospitals, the UF Health Heart & Vascular Hospital and the UF Health Neuromedicine Hospital. By 2013, increasing demand for hospital services created operational gridlock and no remaining space to accommodate continued growth. Faced with the choice of building for the future versus hunkering down in the face of uncertainties in the health care environment, we embraced a vision of continued momentum and signature facilities that will enable us to fulfill the missions of UF and UF Health to serve our region, state and nation.

Thus, by January 2014, once a detailed business plan confirmed the financial feasibility of building new hospitals for neuromedicine and heart and vascular care, the decision was made by the UF Health Shands Board to proceed, and attention turned to design and construction. Early on, it was decided that these two hospitals would share a common infrastructure and would also be connected to the Cancer Hospital to take advantage of shared resources. Beyond that, the design started with a blank sheet of paper.

Design Process

To guide the design, we assembled a Hospital Design Committee consisting of UF Health leadership plus the chairs and division chiefs of the relevant clinical services – cardiology, thoracic and cardiovascular surgery, vascular surgery, neurology and neurosurgery. A key member of this team was Brad Pollitt, A.I.A., who is responsible for all facilities at UF Health Shands and who is the individual we should all thank for overseeing every detail of this enormous project so successfully from start to finish.

This Hospital Design Committee identified overarching principles at the outset and approved design elements as they unfolded. Its first order of business was to choose an architectural firm – Flad Architects, based in Madison, Wisconsin. A subgroup of the Design Committee visited Madison to meet the entire Flad team who would be working on this project. Subsequently, principal architects from Flad began to visit UF Health monthly to update us on their progress, present design alternatives to the Design Committee, and meet with staff in all of the relevant clinical and operational areas, in order to obtain their input as the design unfolded.

Together with Flad, members of the Design committee visited other institutions that had recently completed similar neuromedicine or heart and vascular hospitals. Trips to neuromedicine hospitals included Cedars-Sinai in Los Angeles and Massachusetts General in Boston. Trips to heart and vascular hospitals included Brigham and Women’s in Boston and the University of Michigan in Ann Arbor. We also visited Tampa General to learn about their experience with intraoperative MRI.

Lessons from these visits highlighted the importance of collaborative spaces in clinical care areas; availability of comforting and functional lounge areas for patient families with a variety of seating arrangements and USB ports and power outlets for phone and computer charging; adequate space for families in patient rooms; the use of light, color, art and other architectural elements to promote a healing environment; and a number of small clinical changes such as the design and location of the hand sink and nurse charting area. We were also able to validate space dimensions for the size of patient rooms, operating rooms and other clinical areas.

Along the way, Brad instituted a process in which a large number of individuals with different areas of expertise were organized into implementation and transition teams. Physicians, architects, nurses, engineers, administrators, contractors, equipment specialists and staff from diverse areas of specialization focused on the goal of designing an environment that will support outstanding medical practice and quality spaces where our patients can heal. Team members representing the specialized care areas of heart and vascular care, neurology, neurosurgery, operating rooms, intensive care units, acute care units, patient advocacy, radiology, supply chain, maintenance and every other group that is required to successfully operate a modern academic medical center were assembled.

Design meetings, attended by hundreds of staff members and representing thousands of hours, encouraged new ideas, best practices and exploration of new processes and captured the best examples to inform architectural plans. The transparency of the process was further promoted on our web-based Bridge site. Notes, drawings, plans and specifications from all meetings were quickly posted to the site for all members, even those who may have missed a meeting, to read and respond.

For those of you who had a chance to visit the new hospitals during the ribbon-cutting and opening events, I’m sure you will agree that we now have beautifully designed hospitals for patients requiring neuromedicine and cardiovascular care, for which we can thank the Flad team and all of our UF Health faculty and staff who worked with them during this process.

It’s one thing for the architectural design to be beautiful. Even more important, however, is whether the architecture ensures the desired functionality of the space — i.e., the ability to provide superb medical care and what our Design Committee calls the “perfect patient experience.” This is where the concept of “built around the patient” comes in. In all of our recent facilities at UF Health, we have tried to make sure that “form follows function.” For example, in the Harrell Medical Education Building, faculty first created a new medical school curriculum and only then did the design proceed. In this sense, the new medical education building was “built around the student,” being tailored for those specific curricular needs. Similarly, in designing the new hospitals, we first assessed the needs of our patients, and then worked with Flad to build spaces that fulfilled these needs.

Interior Design

We had a head start, in that we learned some lessons from the Cancer Hospital, which opened in 2009. Based on post-occupancy evaluations and a case study by the University of Virginia, Architecture as Medicine: The UF Health Shands Cancer Hospital, the design team understood that there were many elements to carry forward into the interior design of the new hospitals. Every room in the Cancer Hospital is private and designed with space for the patient, his or her family and the caregiver. Access to daylight and bringing views of nature into the hospital were important themes. The large windows in patient rooms, views from every waiting room and light at the end of every corridor were found to be tremendous satisfiers for patients’ families and staff. Other smaller details were also embraced by patients, such as their control of the window blinds, television and reading light from their bed as well as individual thermostatic control.

These ideas were all brought forward to the new hospitals. Thus, the architects created a healing environment in which soft colors in blue and yellow palettes enliven the space, but also feel warm and comforting. Distinctive and unique interior elements include a light wall in the atrium that accents the stair connecting the first and second levels of the building and a marine-inspired, colored glass wall that draws attention upward in the space, behind which is our meditation sanctuary. Corridors, circulation paths, waiting areas and staff walkways look out on the Garden of Hope, the natural landscape and water features that accent and provide respite in the outdoor environment. Natural light penetrates the interior on all levels, providing a sense of calm to patients and families who use the facility for extended stays and repeat appointments with care-givers.

When the initial design evaluation was complete, both the ICU and acute care rooms were built in a local warehouse at full scale that allowed a hands-on review. Hundreds of staff members visited these mock-ups to “test” the new rooms and give operational feedback. New ideas emerged such as a more robust patient handling/lift system, a fan for patient use and a larger TV/monitor. The concept of “Infotainment” was evaluated from the hospitality industry and incorporated as a way to provide timely information to the patient about his or her care as well as a broad selection of multimedia options, from entertainment to web access.

Staff engagement in this process went well beyond the patient room itself. Experiences about how people choose to wait, efficiency of functional design, and concepts like shared workrooms and team spaces were all discussed and incorporated. Repeatedly, the design team was able to incorporate new elements that helped design the building around patient and family need.

Thus, for example;

• The entry and walkway from the parking garage is designed for easy and private drop-off of transported patients from other settings, and for covered access to the facility during inclement weather.
• The building circulation was planned for easy wayfinding and navigation from the front door to the elevators, and onto dedicated floors for neurological and cardiac care. Wayfinding is enhanced from the elevators into the corridors on each floor by the direct views to the outdoors and across to the Cancer Hospital.
• The width of corridors support evaluation of patient movement and ambulation as part of their rehabilitation. Physician practice spaces are designed for special testing requirements for neurological and cardiac care, and support family participation in the exam and treatment process.
• The new heart and vascular and neuromedicine hospitals connect to the Cancer Hospital at the third level along an outdoor pathway, garden and eating area – where families can enjoy quiet moments and enjoy the views to the Garden of Hope below.

Exterior Design

The exterior of the building was designed to provide continuity with the Cancer Hospital, but also to speak to the future. The L-shaped design of the new neuromedicine and heart and vascular hospitals complements the Cancer Hospital in a manner that creates a central landscaping of lawns, gardens and water features, incorporating the existing Garden of Hope. Thus, the three hospitals, which total more than one million-square-feet of interior space, share more than simply a vernacular of materials and scale.

By using similar materials and massing, the architecture of the new hospitals continues to build upon and enhance the composition of the entire campus. Materials such as brick, architectural precast, metal panel, and glass were used on the Cancer Hospital, but have been deployed in the new hospitals in a manner that creates a fresh and modern appearance reflective of the medical care being provided within. The use of more contemporary forms and the addition of terra cotta as a complementary material was incorporated into the design of the facades, providing a richness and added diversity to the existing material pallet on site and the overall exterior expression of the campus.

The two-story base of the new hospitals, connected to the Cancer Hospital by way of a bridge over the main gateway to the hospital campus, has been designed to provide scale and texture at the pedestrian level, given its proximity to rails-to-trails and the central landscaping. Using the materials of brick set into precast, the new two-story base works in concert with the existing two-story base on the Cancer Hospital to complete the composition. The connector uses architectural precast and glass on its exterior to ‘lightly’ tie the two buildings visually together. When entering by road or walkway, the central landscaping welcomes all to the sheltered and serene environment within.

Construction

Once design was completed and financing was approved, construction commenced. On January 25, 2015, Dr. Fuchs joined us in his first groundbreaking ceremony as UF president. It is truly amazing to reflect upon how much was done since then in such little time to reach the point where the UF Health Heart & Vascular Hospital and the UF Health Neuromedicine Hospital will be open and receiving patients on Dec. 10.

Indeed, with the gridlock pressures on UF Health inpatient facilities, it was imperative that the project advance efficiently. Many projects suffer from delays in the “Design-Estimate-Reduce Cycle” due to lack of monetary controls at the front end. We chose to hire a construction manager, Skanska USA, early in the process so that estimates could be developed in real-time and effort would not be wasted in redrawing plans after each step of value engineering. This effort, as well as the process of releasing early design packages to allow site work, civil engineering and the foundation, frame and building-skin work to proceed while the internal design was completed, saved years off a traditional delivery process. In addition, delivery plans were developed to save time, such as bringing the OR deck on-line early. With 15 pieces of hybrid OR-type equipment, the installation schedule required detailed tracking. By delivering the OR deck six months early for installation, the opening was advanced to an earlier date. Overall, more than 300 companies and 8,000 people worked on the design and construction of these new hospitals during the 4.5-year duration of this project.

UF Health is committed to community sustainability issues. This building project was recently awarded Four Green Globes certification for demonstrated use of sustainable design elements, efficient energy utilization and incorporation of low-impact materials. One tangible example was the harvesting of trees that were to be removed to make way for the project. Wood from the trees was milled and used to create a large conference room table and several benches in our public waiting areas.

Landscaping

When UF Health first considered moving south across Archer Road a number of years ago, several factors came into consideration. Functional elements such as traffic congestion, access, floor-to-floor heights and utility infrastructure were evaluated carefully, as well as the need for a co-generation power facility for this part of the clinical campus. But another critical element that became an exciting opportunity was the site landscaping.

From the inception, this site was envisioned to be a restful place for staff, patients, their families and other visitors, whether being viewed from the building or experienced on the ground. With the addition of our two new hospitals, the final design of the central landscape could be completed. Two water features and plantings – from formal to more rustic – were incorporated. A gazebo and winding pathway bisect the park. More formal areas marked with a modern sculpture are juxtaposed against a natural limestone waterfall. Wi-Fi, soothing lighting at night and ample benches with shade encourage use and enhance the overall experience. Soon, the new UF Health Guest House on the South end of the property will begin construction. When complete, the “Rush Lake” area will be incorporated in this spectacular landscape of Florida flora, fauna and water that is designed around the needs of patients, visitors and staff.

Philanthropic Support

This project requires substantial financial resources and benefits greatly from a large number of supporters of UF Health Shands. There was an outpouring of individuals who wanted to help, which no doubt will continue. While the list is far too long to show every contribution, I would like to highlight a number of important gifts that we have received thus far, in alphabetical order:

• In honor of James Conti, M.D., many friends and colleagues contributed to the cardiac catherization suite.
• Numerous employees gave through Raising Hope at Work and named the Café.
• Sandy and Marty Fackler named the beautiful rooftop terrace.
• William and Ransom Friedman and friends of Albert Rhoton, M.D. named the walkway between the two hospitals in honor of Dr. Rhoton.
• Donna Giles and David Guzick named the garden walkway.
• Ed and Jen Jimenez named the Gift Shop.
• Flad Architects contributed to the 8th floor Executive Board Room.
• Charles Kahn named the 4th floor nurses station.
• The Mary K. Oxley Foundation named the atrium.
• Stephen and Patricia Pavlik named a procedure room in honor of Dr. Tomas Martin.
• Seth and Diane Schofield named many of the cardiac ICU rooms in honor of the many caregivers that Seth had as a patient.
• Lewis Schott made a gift in honor of Albert Rhoton, M.D.
• Carolyn Seeger named a procedure room in memory of James Seeger M.D.
• The SFI Foundation donated the beautiful sculpture in the Garden of Hope.
• Donna and Mickey Singer provided funds for the Sanctuary of Wisdom.
• Robert Stilley and Lynn Magar named one of the cardiac catherization labs.
• The UF Health Shands Auxiliary named the child play area.
• UF Health Shands Board members and hospital executives contributed to the 8th floor Executive Board Room.
• Fleury Yelvington and Barry Solomon named the reflection pond waterscape.

Concluding Remarks

Some key principles about the design and construction of a building include: “Once you’ve done your homework, proceed with confidence;” “Do not rethink what you already know;” and “Stay on course unless new data arrive and then make swift, efficient decisions.” While such truisms are easier said than done, it can be said that the design and construction of this project proceeded as smoothly and efficiently as it did because we adhered to these principles, especially in resolving the usual challenges of budgets, space allocation and the balancing of wants vs. needs.

In the next issue of OTSP, I will describe the process we used to decide upon the strategic repurposing of the space currently used by neuromedicine and heart and vascular patients that will be vacated once the new hospitals open on Dec. 10.

The Power of Together,

David S. Guzick, M.D., Ph.D. Senior Vice President for Health Affairs, UF President, UF Health