Piedmont Sets a High Standard with the New Newnan Hospital

 

Amanda Mewborn is a Senior Healthcare Operational Planner in the Atlanta office of Perkins+Will.

Recently, Amanda Mewborn of Perkins+Will visited Piedmont Newnan Hospital to see how the new hospital is providing world class care to the Coweta County community located about one hour south of Atlanta.

Piedmont Newnan Hospital in Newnan, Georgia, about one hour south of Atlanta, is a showplace of the latest community acute care hospital design trends. The new 362,000-square-foot facility hosts a comprehensive array of services, including inpatient care units, emergency services, cardiac catheterization, imaging, surgical services and a comprehensive birthing facility with neonatal intensive care. The facility opened in May 2012 with 136 beds. Also on the 104-acre campus is Piedmont Medical Plaza, which contains physician practices, an ambulatory surgical center and outpatient infusion center.

The entry of Piedmont Newnan Hospital

The hospital was designed with four main intentions:

  • Promote flexibility in design so that as technology, clinical processes, and community needs change, the facility can easily support the new work flow
  • Improve the experience for patients and visitors through extensive use of natural light, simplified way-finding, and access to nature from all public spaces
  • Enhance the efficiency of the facility’s operations by improving staffing and maintenance costs
  • Prepare for growth of the facility in the future. The facility is designed to triple in size while only impacting three additional acres and without disruption to any existing spaces or entrances.

A Community Landmark

Entering the Piedmont Newnan Hospital campus, visitors are greeted with a grand, beautiful facility. The hospital can be seen on the right with the wall of glass, while the Piedmont Medical Plaza is located on the left side.

Piedmont Newnan Hospital has been years in the making. Newnan Hospital originally opened in 1925, and served the Coweta County community successfully for decades. In 2006, the hospital began having financial challenges, and in 2007, Piedmont Hospital committed to building a new facility for the community. Construction began in late 2008. Shortly thereafter, construction had to be put on hold due to the ailing economy and limited access to capital. Construction resumed in early 2010 with a renewed focus on cost savings that yielded a $30m reduction. The facility was completed in 2012, and the new Piedmont Newnan Hospital opened in May 2012.

While the hospital and Medical Plaza are certainly eye-catching, an impressive statistic to note is that 60% of the 104-acre campus was not disturbed during construction. The facility is surrounded by beautiful trees, trails and nature. Trees line the entrance from the parking area, providing a warm greeting to visitors from the minute they exit their vehicle. Trails from the campus are designed to eventually connect to a community-wide bike trail that is planned to connect to the city center. Outdoor dining areas line the central green space, providing a respite for both staff and visitors. Many of the roofs are green roofs to lessen heat gain and soften the views from public areas. The facility was definitely designed to bring nature inside.

 Building Interior Promotes Healing

When entering the building, the natural stone, warm woods and soothing colors strike you – it definitely does not have that “hospital feel.” The lobby features a two-story entrance lined on both sides with glass, a fireplace and comfortable seating. The flow of the building is natural and obvious upon entry.

Each floor with inpatient care units contains two 18-bed units. All rooms on a floor have the same set-up to promote standardization and ease of use. The nurse station in the center of the unit is enclosed with glass, allowing visibility to patients and natural light into the core of the unit. Decentralized nurse stations are located between patient rooms and have windows to facilitate patient visibility and monitoring from outside the patient room. All patient rooms are private, and include floor-to-ceiling windows. Gone are the days of patients looking at ceiling tiles, as the rooms are designed to promote natural light and visibility to the outside. It feels like you are in a tree-house when standing in the patient rooms – the views are gorgeous!

Inboard toilets are cleverly designed to reduce the risk of patient falls and staff injury, facilitating easy transfer of a patient from the bed or wheelchair. All doors to patient rooms are double, preventing beds and wheelchairs from bumping into walls and doorframes, and increasing patient comfort when transfers are necessary. New patient beds are able to weigh patients, perform respiratory therapy procedures such as percussion, play music, and speak in several languages.

In addition to a nursing station in the center of each 18-bed unit, decentralized nursing stations are located between patient rooms.

Many areas have concrete floors, as they cost about 25% less than terrazzo but have the same maintenance cost. Concrete only costs about one-third of VCT over a lifetime. The staff had to learn new things with the new materials used in the building. For example, the staff no longer has to wax the floors, as it is unnecessary with concrete.

Most spaces utilize natural light extensively and have outdoor views. Concrete flooring was used in many areas to cut lifetime costs by about one-third.

Services with like processes were grouped to achieve economies of space and improve operational flexibility. For example, surgery, interventional radiology and endoscopy services all have a common pre- and post-procedure suite to allow reassignment of space and cross training of staff. These design changes have enabled positive process changes. Within two months of moving in, the team was performing about 20 more surgical cases and 40 more gastrointestinal cases a month, and reduced the number of cases visiting the post anesthesia care unit (now only using three to five bays when seven bays were used in the old facility).

Piedmont Newnan Hospital anticipates saving $665,000 annually by reducing its energy usage by 20%.

Opening the Door to New Opportunities

As one staff member said, “We have been able to improve our quality and experience through the facility design.” The new facility is certainly enabling better care, as another staff member noted, “This facility has allowed us the freedom to do things we couldn’t have done elsewhere.” Specifically, the staff is looking forward to being the first in the Piedmont Healthcare System to begin using the new electronic health record. When assessing which hospital would receive the new system first, Piedmont Newnan Hospital was chosen because of the “perfect set-up” that will result in no problems with wiring the building to support the new technology or accommodating the new computer stations.

Green and Efficient

Piedmont Newnan Hospital was designed to not only improve the health of the community but the environment as well. Pending LEED certification, the hospital is anticipating energy usage reductions of 20%, saving the organization approximately $655,000 annually. Potable water usage has been reduced by 29%, saving approximately $25,000 annually. Most spaces utilize natural light extensively and have outdoor views. Site design leaves approximately 60% of acreage unspoiled as vegetated space for native fauna and flora.

 

Amanda Mewborn, RN, CPN, CPHIMS, PMC, DSHS is a senior healthcare consultant with Perkins+Will where she assists clients with improving operational efficiency, patient experience and quality. 

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New Learning Environment Geared Towards Success in Workplace

In this last column in a series on K-12 design, Barbara Crum, Principal and Market Sector Leader for K-12 at Perkins+Will, discusses a new type of learning environment that mirrors a traditional work place.

The 66,205 square foot building has been designed to meet the U.S. Green Building Council’s LEED Gold certification requirements.

The Center for Advanced Professional Studies (CAPS) in Overland Park, Kansas, provides high school juniors and seniors with unique educational programs that will connect these students to a career interest area of their choice, offering them intensive and integrated profession-based study within that field.

CAPS is an interesting story about a new type of learning environment, which poses the question, “What will it take to make students successful in the future?” As educators seek to engage students as active participants in their own education, this program provides opportunities in a stimulating “real world” environment that is both compelling and relevant, and one that will often include industry professionals working alongside students.

CAPS can serve 500 juniors and seniors each semester.

Understanding that what is relevant is ever changing, CAPS provides a framework for learning about known industries and careers while also providing an inherently flexible environment that will allow for future and yet-to-be-invented careers to be gracefully incorporated into the program.

The project goals, building space programming and educational curriculum were formulated simultaneously as a product of a collaborative workshop process led by Perkins+Will that included district administrators, educators, industry leaders and business professionals.

From Kansas biotech companies, to Garmin Industries, each participant in the process was critical to the vision for the project and each had a unique opportunity to lend their perspective on the direction of various industry “strands” that would be contained in the school.

Learning at CPAS is student driven; teachers facilitate the learning process through problem-based projects comprised of authentic and relevant work assignments.

Initially, those strands include: Bioscience, Business, Engineering and Human Services, each of which encompasses a variety of sub-pathways and each selected due to its particular relevancy in the Kansas City regional marketplace.

While academic, the look and feel of CAPS is decidedly not that of a traditional school. To reinforce the connection between coursework and real work, careful consideration was given to create an environment that mirrors a professional work place.

The examination of ideal environments of various career strands identified several common programmatic threads — large flexible spaces for “doing”, transparent project areas for intra- and inter- strand collaboration, and small group areas for real world meetings/presentations or individual work.

The planning for the building organizes all spaces on three levels around a centralized entry-level student commons that will support a variety of functions from informal gatherings, to science expositions, to community meetings.

CAPS philosophy includes students acquiring cutting-edge skills to be successful in the “Innovative Generation.”

Rising dramatically from one end of this commons, a large wood-clad amphitheater stair connects the entry level to floors above and provides an ideal amenity for large group presentations as well as a stage for the presentation of student work product.

The strands housed in CAPS are located on various levels adjacent to the commons. Located directly outside of each series of specialized classrooms and lab spaces, associated with any given strand, is a large and flexible project space that is visible from the classrooms through glass windows.  These flexible project spaces overlook the student commons and provide a multitude of functions in support of each strand, including informal gatherings, small group work, display areas and dedicated project workspace.

 

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Innovative School Designs Support 21st Century Learning

In this second of a series on K-12 design, Barbara Crum, Principal and Market Sector Leader for K-12 at Perkins+Will, discusses the concept of project-based learning and how it was incorporated into the design of Coahulla Creek High School in Dalton, Georgia.

Most of us went to high schools with the same design: long corridors lined with square or rectangular-shaped classrooms. On the rare occasions we may have collaborated with fellow students on a project, we had to drag bulky desks around to fit in a circle so we could face each other. We also learned pretty much in just one way — by having a teacher stand in front of the room and lecture us, occasionally making notes on a chalkboard.

Coahulla Creek High School opened in August 2011 with an emphasis on experiential learning. Its design supports that concept.

In addition to education focusing more on collaboration with classmates now, the thought in many forward-thinking schools centers around project-based learning — integrating the curriculum and making the learning more experiential.

An innovative school design goes a long way to facilitating this type of learning. At Perkins+Will we designed the new Coahulla Creek High School in Dalton, Georgia to incorporate the latest thinking with regards to school design and how education will be delivered in the 21st Century.

Classrooms can be reconfigured and subdivided as needed. Every classroom can be opened up into its own 4,000-square-foot project lab space.

Programmed with school administrators, faculty, students and the local community, the design addresses the shift towards project-based, hands-on learning with generous amounts of flexible space that allow for a more dynamic educational experience.

Coahulla Creek High School opened in August 2011 and this year has more than 900 students in the school, which is designed for up to 1200. The 260,000-square foot building is divided into three levels of class­rooms that each open onto their own 4,000-square-foot project lab space in support of their project-based curriculum.

The cafeteria and library are integrated to create an atmosphere like the combination bookstore/coffee shop where students like to gather to study and socialize.

Classrooms open onto this flexible space, which is configured with power, Internet access, smart boards and white boards to support multiple learning styles, collaborative learning and/or independent study.

This lab space is designed so that it can easily be reconfigured and subdivided into individual classroom space if and when curriculum and teaching methodologies change. The depth of the lab is the depth of a classroom plus the corridor, allowing these labs to be flexible in envisioned uses and in size configurations.

Students may never have their own Starbucks in school but this design acknowledges the nature of today’s student by arranging the cafeteria and library to operate as one integrated space, similar to the ubiquitous coffee shop/ bookstore that is frequented by students and study groups everywhere.

The core educational spaces are supplemented by an arts program that will include a black box theatre and outdoor art patios, as well as a full complement of athletic spaces that fit within the natural topography of the site. Sustainable features such as the use of natural daylight, bio-retention gardens and a green roof will also be utilized to enhance the students’ experience.

The school’s motto is High Touch, High Tech, High Expectations. The design of the Coahulla Creek High School is an integral part of its efforts to build expertise in designing rich inquiry-based experiences for students to work through in groups to effectively link common core standards, academic skills and new learning.

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A Total Transformation: Benjamin E. Mays High School

In the first of this new three-part series. Barbara Crum, Principal and Market Sector Leader for K-12 at Perkins+Will, discusses the transformation of Benjamin E. Mays High School in Southwest Atlanta. Perkins+Will won an Atlanta Urban Design Commission Award for the project in June 2012.

If you’ve ever been involved in a home renovation then you know that sometimes it’s easier and less expensive to knock a home down and start over than to substantially renovate it. The same holds true for commercial/institutional design and renovation.

Barbara Crum, Principal and Market Sector Leader for K-12 at Perkins+Will

But the opportunity to be able to take an existing school building and transform it into a state-of-the-art facility that an entire community can be proud of makes the extra challenges worth it.

Benjamin E. Mays High School, part of the Atlanta Public School System, was a 340,000-square-foot facility, constructed in 1981. The interior spaces were dark, cramped and uninviting. One of our goals was to incorporate a lot of natural light in all of the learning spaces and open up the school. Studies have shown that natural light is beneficial to learning with the added benefit of greatly reducing energy costs.

The entry lobby of Mays High School prior to renovation

The lobby of Mays High School after the 18-month renovation, transformed into a welcoming space filled with natural light

We demolished the entire entry lobby and relocated the main entry so now everyone enters through a glass-enclosed atrium, located between the academic building and the athletic/arts complex.  The academic wings can be closed off for use of the gym or theater after hours. Visitors, students and faculty first walk though a landscaped area under new canopies with inviting seating areas prior to entering a light-filled space.

A before shot of the cafeteria, a cramped and dark space

The new cafeteria, a much more inviting space for students and staff to eat lunch

The gym, auditorium and locker rooms were renovated and a new practice gym was construction. A new two-story media center was added as well as a new kitchen and cafeteria.

The media center prior to renovation

An after shot of the media center

The construction took a year and a half, during which the school was temporarily relocated. The grand opening celebration was held in January 2012 for the new Mays High School, named the #1 high school in the Atlanta Public School System by the Georgia Department of Education.

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Designing Refuge: A Hospice Case Study

In part four of this series on hospice design, Ila Burdette of Perkins+Will illustrates how a thoughtful hospice design benefits patients, caregivers and families while also attracting community interaction.

Willson Hospice in Albany, Georgia illustrates the latest hospice design trends we have covered in the past three columns. The new 34,000-square-foot facility includes a 15,000-sf administrative component for 50 home care staff who travel each day to reach patients in the surrounding 11 counties, as well as educational and meeting space for volunteers and community groups. The residential component for 18 inpatients is organized into three households, each arranged around a family living room.

Getting the Inside Right

Floor plan of the Willson Hospice in Albany, GA. The residential component includes housing for 18 residents, divided into three households, each arranged around a family living room.

Inside the building, the design is shaped for its users. Patient rooms feature extensive stained wood trim at headwalls, ceilings and millwork. Headwalls disguise medical outlets and switches by tucking them into the sides. Patient controls (fans, shades, thermostats) are all included. Beds are moveable, rolling out onto porches. Family members appreciate window seat beds with built-in drawer storage underneath, individual reading lights and corner glazing.

The front lobby of the Willson Hospice

Willson’s selection of family spaces includes living rooms immediately outside patient rooms, each outfitted with a reading inglenook, millwork for children’s games, a dining area and conversation area. Each living room also has ready access onto two outdoor terraces protected by sunscreens. Other spaces designed especially for family include a kitchenette with banquette seating, a dedicated children’s playroom, a quiet room, sunroom and chapel. The major gathering rooms are high-ceilinged, with tall window walls and exposed glulam beams supporting pine planks above.

A Healthcare Building and a Wildlife Sanctuary

From its inception, Phoebe Putney Memorial Hospital, the owner, intended Willson Hospice to not only to serve patients, but also to be an ecological oasis for its local community. The project’s success is evident in its designation as the only healthcare facility in the world recognized as a Certified Silver Audubon International Signature Sanctuary.

To best protect the site and its wetlands, the design team began by walking the property with a nationally known local ecologist who identified indigenous species and suggested building placement. They were able to preserve native atamasco lilies, dogwoods, pines and oaks. A one-mile walking trail loops the site perimeter, connecting the front courtyard, family gardens and outdoor chapel with boardwalks and a viewing platform at the bird sanctuary formed by a natural pond. The trail is signed with educational placards describing flora and fauna for bird-watchers and school children.

In order to be responsible stewards of the site, Willson Hospice restricted its building footprint and associated grading, and minimized site disturbance to only 14 acres. Its Natural Resource Management Plan includes measures to prevent erosion and storm water pollution, to conserve water and to enhance wildlife habitat.

An Open Invitation

Eagle Scouts building bluebird houses

The chance to visit Willson Hospice’s facility and site has dramatically increased interaction between the community and the health system, drawing a remarkable range of local groups to campus. The local Audubon Society holds chapter meetings and bird counts there; garden clubs and scout troops have contributed nature projects.

Other visitors include the American Chestnut Tree supporters, the Albany Rotary Club, the professional women’s club and the neighboring community college’s cross-country track team, which trains on the perimeter walk. Cancer support groups, local and state medical societies and the local Hospital Authority all convene there. Hospice has become a magnet for Albany’s special occasions, a place synonymous with beautiful surroundings.

Silver and Green

Willson Hospice is both a LEED Silver building and an Audubon International Silver Signature Sanctuary.  Its energy usage was reduced by 20.8%. Potable water usage was reduced by 21.9% by using ultra-low flow water closets, showers and faucets. More than 80% of spaces are daylit; more than 92% have outdoor views. Site design leaves 93.5% of acreage unspoiled as vegetated space for native fauna and flora.

Patient living rooms and terraces at evening

Rejuvenation

Roofs, driveways, dining nooks, thermostats, windowseats, rose beds and low-e glazing may not be the first tools hospice caregivers consider using to reach their worried clients. Paradoxically, however, the physical details of a particular place can be the most convincing evidence of the staff’s concern if the building does its job by extending their mission. A building and campus wordlessly and continually express welcome, reassurance, generosity of space and spirit. Hospice users often find we all need and appreciate the refuge of thoughtful design.

Ila Burdette AIA, LEED BD+C is a Principal with Perkins+Will where she leads the firm’s research and design of senior living projects, including hospices, continuing care retirement communities, assisted living, skilled nursing, and Alzheimer’s facilities. 

 

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Reaching Out, Ushering In: Transparent Buildings & Regenerative Gardens

In part three of this series on hospice design, Ila Burdette of Perkins+Will discusses the importance of the design of outdoor spaces at a hospice in supporting the work of the caregivers.

Welcoming hospices that sensitively house treatment programs for the terminally ill can architecturally support caregivers’ extraordinary work. Perkins+Will has found we can do even more when the design extends into the surrounding landscape.

Transparent Buildings: Reaching Out, Ushering In

When windows create strategic views into the landscape, interior spaces effectively grow into the site. Outdoor views help guests find their way around buildings, and also keep patients alert and oriented to time of day and season. An outside vista can encourage them to use gardens as outdoor rooms.

In addition to providing sunlight, large windows with views of outdoor gardens help keep patients oriented to time of day and season.

Conversely, strategically placed glazing can offer passersby outside the building a sense of what goes on inside. Major activity spaces that feature generous window walls can offer glimpses of a concert or a party or a meal. Well-lit glazed spaces glow, especially at dawn and dusk. Careful detailing can enhance the hospice’s transparency while preserving its energy efficiency.

Regenerative Gardens: A Place to Catch One’s Breath

Access to outdoor areas of respite is particularly important for every hospice patient, family and staff member. Tailoring gardens for each user group is rewarding. Quiet private gardens immediately outside patient rooms may link via walking trails to other meditative areas like outdoor chapels for those seeking solitude. Terraces, trellised patios and porches offer alternative dining areas for families.

Public memorial gardens are good gathering places for volunteers and donors, and attract the involvement of civic groups like Boy Scouts and garden clubs. Staff members, too, appreciate direct access to sunlight and fresh air, especially if it is possible to provide gardens adjacent to break rooms, artfully screened from accidental intrusion by families. With advance planning, each garden type can be organized to provide assorted levels of privacy and interaction.

This outdoor chapel is a wonderful, welcoming place for all types of activities.

Synergistic Goals: What Hospices and Sustainable Design Naturally Have in Common

Hospices dovetail beautifully with environmental sustainability. They are generally small, may be single-story, and are often freestanding, which means their mechanical and plumbing systems can more easily be independently designed for greater efficiencies.

Sustainable rating systems like LEED (Leadership in Energy and Environmental Design) rewards many strategies sensitive hospice planners already incorporate for patient comfort.  Day lit interior spaces and exterior views, for example, particularly benefit hospice users.

LEED also encourages site preservation, the conscious preservation of natural site features and native flora and fauna, the creation of areas of refuge for patients and staff, and the use of warmly textured rapidly renewable materials like cork, bamboo and linoleum, all initiatives that dovetail with palliative care programs.

This boardwalk is a safe, elevated place to walk through the wetlands on the grounds of the hospice. The educational signage allows visitors to learn more about the environment.

In Part Four next week, we’ll look at a case study that illustrates many of Perkins+Will’s techniques in creating a welcoming hospice and campus tailored to its users: Willson Hospice, this year’s AIA/American Academy of Health National Design Award winner.

Ila Burdette, AIA, LEED BD+C, is a Principal with Perkins+Will where she leads the firm’s research and design of senior living projects, including hospices, continuing care retirement communities, assisted living, skilled nursing, and Alzheimer’s facilities.

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Making Places to Talk is Critical in Hospice Design

In part two of this series on hospice design, Ila Burdette of Perkins+Will discusses how good design considers the needs of the patient and the family members to provide a variety of comfortable and appropriate settings for all types of gatherings.

Last week we explored strategies Perkins+Will uses in making friendly buildings to draw in all comers. Once users enter a well-designed hospice, the welcome is expressed in rooms tailored to make them feel at home. In fact, hospice programs include a little of everything, from quiet meditation rooms to multimedia conference centers, with secure medication servers and soiled utility rooms to boot. Thoughtfully selecting an appropriate mix of spaces and laying them out is an art that comes from understanding the users and their interactions.

A hospice needs a variety of seating to accomodate all the activities that go on. A sunny window seat is a restful place to relax or to comfort a child.

Programming: Places to Talk

Think of the variety of conversations inside a hospice. A window seat or inglenook is a good place to comfort a child, but is probably not the right venue for a physician to deliver confidential news to a family. Families telephone distant relatives and provide updates. Memorial services can be large, joyous, and noisy gatherings. Visiting teenagers may want to quietly read or rollerblade in the garden. Toddlers chatter in supervised acoustically buffered playrooms.

Some groups only gather in formal conference rooms during the day; others get together for midnight snacks around a popcorn popper. A range of space sizes and types, both intimate and large, with appropriate levels of privacy and separation, will accommodate various family and community gatherings. Chapels, music rooms, libraries, sunrooms, kitchenettes/ dining rooms, and quiet rooms all play different parts. Locating them so each works for its specified use is the first step, but we also often find that some are naturally clustered and can open into each other to provide additional flexibility in sizing.

This family room is a warm, sunlight place perfect for casual gatherings in a family-like setting and large enough to accomodate several people.

Laying Out Spaces: Perception is Key 

Hospice layout depends on the relationship between the patient room and the spaces devoted to families, who are an essential but unpredictable part of palliative care. Each patient bedroom is required to provide overnight accommodations for one family member, but extended families can include many members.

Families come in every flavor. They can be close or estranged. They may have everything or nothing to say to each other. They may stay 24/7 or visit for only 10 minutes. There are two common threads: all families are under stress from impeding loss, and all want to be within earshot of their ill loved one. No matter how much a daughter needs a break, if she fears she will not hear her father’s call, she will not step away from his bedside.

Family living rooms immediately outside patient rooms are heavily used and greatly appreciated, especially when they incorporate features like exterior views and a variety of conversation, dining and quiet activity areas. On the other hand, living rooms that are physically just around corner or down a short corridor may not be used at all if they feel psychologically remote. Household or pod configurations do a good job preserving this key adjacency, and simultaneously breaking down the building mass.

 

Every patient room is designed to have easy access to the outdoors and is close to the family living room so families can relax within earshot of their loved ones.

Personalizing the Patient Room: Making It Their Own

A good patient room enables individual control, de-institutionalizes necessary medical features and provides livable space and storage allowances to generously house patients and families together. Since patients may spend several weeks in a residential hospice, they appreciate every opportunity to make rooms their own.

Millwork should be extensive enough for keepsakes, flowers, photographs and family items. Headwalls that disguise medical outlets and switches, and the judicious use of millwork colors and materials keep rooms from appearing institutional. Overhead ceiling fans, double shades (screening and/ or blackout), and individual room thermostats afford patient control. If reading lights are attached to beds, not headwalls, patients can adjust the bed locations.

Our plans often include private porches entered through double doors from the patient room so beds can roll outside. Beds for family members built into window seats preserve crucial nursing space around patient beds so the room remains uncluttered by pullout beds; the window seats also provide welcome additional seating during the day as well as storage beneath.

This patient room is designed to disguise medical outlets and switches, give the patient control over lighting and temperature and provide a built-in bed for a family member that can be used as extra seating as well.

Next week in Part 3, we’ll discuss the ways hospice buildings can take advantage of landscaping to extend their programs outdoors.

Ila Burdette AIA, LEED BD+C is a Principal with Perkins+Will where she leads the firm’s research and design of senior living projects, including hospices, continuing care retirement communities, assisted living, skilled nursing, and Alzheimer’s facilities. 

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Connecting Communities and Caregivers: Hospice Design

In part one of this new three-part series on healthcare design, Ila Burdette, principal at Perkins+Will, discusses the unique challenges of designing a hospice and how design can be used to create a welcoming magnet for the community. Photos are from hospices designed by Perkins+Will.  

In the fast-moving world of healthcare design, Perkins+Will has been excited to explore the ways one particular building type, hospice, has emerged as a magnet of community affection. These small buildings, devoted to care for the terminally ill, have only been purpose-built in America since the 1980’s, although they spring from a European architectural tradition that is centuries old. (Think of medieval almshouses, orphanages, hostels, and hotels, even the castles of the Knights Hospitallers – all places where folks in dire straits received help.)

Ila Burdette is a principal at Perkins+Will in Atlanta.

Here in the United States, hospices link not only patients and caregivers but also families, donors, volunteers, visitors and the wider community. Their growing circles of health are re-invigorating traditional healthcare relationships, becoming flourishing generative spaces.

How Does a Building Convey a Mission?

Since the challenge of hospice is to encourage patients and their families at their most difficult moments, caregivers’ first task is often reassurance to dispel anxiety. A welcoming campus and generous building can be powerful tools in this work. As tangible demonstrations of the organization’s concern, buildings are intentional invitations to the neighborhood. When the designs are truly successful, they express the staff’s extraordinary mission and help knit the end of life back into its mainstream.

Designing a Welcome

How can a complicated healthcare building be made approachable? Our goal is to provide a sense of refuge by creatively selecting building masses and materials that are both intriguing and familiar. Breaking the overall facility mass into small pods dematerializes it, transforming it into a collection of friendly forms that feels like a sociable village, not a formidable treatment center. The building scales itself down to greet the user, like a tall adult kneeling to talk with a small child.

The administration building, a playroom and the chapel are clustered around the Western Courtyard at the Willson Hospice. This hospice was awarded the Annual Generative Space Award by The CARITAS Project.

Simple geometric shapes that echo local architectural styles create a sense of familiarity; for example, sloping and gabled roofs with large eaves recall barns and silos in rural areas. Warm textured materials like fieldstone, cedar and shingles impart natural color and help settle the building into its site, emphasizing its kinship to its particular place.

The family entry of the Ogeechee Area Hospice in Statesboro, Georgia

The literal approach to the building, the road leading to it, also shapes its personality. A winding drive that turns off a noisy rushed highway and takes its time meandering through moss-hung oaks to a hospice’s front door can give visitors breathing space to lay aside their distractions.

Another hospice contextually located in the center of a town, bordered by sidewalks where strolling neighbors exchange greetings, can be an immediate and active part of the local fabric, a good neighbor itself.

Still other hospices are located in wooded settings that afford glimpses from nearby streets; if the visual snippets are enticing, they coax passersby to visit and learn about the hospices’ mission. Whether and how a building reveals itself from a distance are clues that indicate its openness.

The Patient Pods at Hospice LaGrange in LaGrange, Georgia

Next week we’ll think about the spaces inside hospices, and the ways they are shaped by the multitude of conversations there, everything from midnight chats around popcorn poppers to memorial services to garden rambles.

Ila Burdette AIA, LEED BD+C is a Principal with Perkins+Will where she leads the firm’s research and design of senior living projects, including hospices, continuing care retirement communities, assisted living, skilled nursing, and Alzheimer’s facilities. 

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Pass T-SPLOST, Then Maximize Opportunities

In the final part of this series on urban design, Perkins+Will principal David Green discusses how the region can maximize its opportunities to improve transportation and the health, safety and welfare of its citizens if it passes T-SPLOST. 

We are voting on the transportation referendum on July 31.

It is almost certain that the result of the vote will have far less impact than is projected by either side of the debate. If it fails, we will continue to muddle through, as we always have, failing to fulfill much of our potential. If it passes we will surely make a mess of it, as we tend to do: the results will be less beneficial than promised, and we will most likely not learn much from our mistakes.

But this doesn’t have to be the case. While it is true that there is little opportunity in the failure of the referendum, there is much opportunity if it passes: if we can apply some key accountability measures over the next ten years. Some will argue that these measures are not allowed due to restrictions embedded in the referendum, but this is simply not true. In fact, the law requires that each of the recommendations below is included in the process.

This view from 1910 shows how visionaries anticipated Atlanta would look 100 years later, in 2010. They believed citizens would rely on mass transit, but were a bit off in their visions of dirigibles and boats as modes of transportation.

1. Clearly articulate measurable goals. The referendum as a whole, and each individual project should be required to have specific outcomes as targeted goals. The three categories are health, safety and welfare. As such each project should reduce unhealthy and unsafe conditions, as well as promote economic vitality. For example each project should reduce asthma and airborne particulates, increase pedestrian activity, and reduce vehicle-related injuries and deaths. In addition projects should have a clear budget that aligns with its stated goals. There are a number of measureable goals that could, and should, be added to the list above, and with technical tracking capabilities today this is a relatively simple process.

2. Set criteria for returns on our investment. Each project should have a measurable return on the investment, and each should be designed and funded relative to this return. Ultimately we want to utilize our resources (spend our money) in ways that are going to maximize the benefit to the greatest number people.

A street view of downtown Atlanta in the 1940s. The first streetcars in Atlanta, pulled by horses, started operation in 1871. The first electric line started in 1889 and ended in 1949, when trolleybuses took over.

3. Track project performance. Each project should be tracked to ensure that it is performing in the manner that was originally projected. The value in this process is that is allows us to understand what works and what doesn’t work. Without tracking performance, decisions will continue to be made based on faulty modeling and educated guesses. It also requires that we are truthful about the efficacy of projects, regardless of our position on various modes of transportation. It is the only way to provide true accountability across the board.

4. Modify projects based on items 1 – 3. Both current and future projects should be modified to respond to project tracking. If we see things aren’t working as planned, projects underway or completed should be modified (utilizing the methods above), and future projects should be redesigned or cancelled, as appropriate. This will require modifications to our current capital planning process, but it is the right thing to do.

It’s a little known fact that MARTA proposed a transit station at City Hall East in 1961. Now, 50 years later, we may finally see this vision realized.

This isn’t all that different from the way we run our own 401(k)’s. We set a goal for retirement, we have a method for measuring returns, we track performance, and we modify our investments when they aren’t meeting our goals. When we have less money, we make individual sacrifices so that we can keep contributing. There is no reason these principles should not be true for us as collective citizens, as they are for us individually.

On November 22, 1926, the Supreme Court told us to go forth and plan, but as we did, to make sure that every decision made benefitted the health, safety and welfare of the general public. This is pretty good advice, and we would be well served by following it. Finally.

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Two Conditions Must Change to Ensure Productive Transportation Planning

In part six of this series on urban design, Perkins+Will principal David Green discusses the two questions our region needs to ask itself as we deal with transportation issues and the upcoming referendum and the two conditions that have to change.

In this series we have discussed how, for the past 100 years or so, we have been struggling with issues of transportation; planning for the future, funding projects and trying to reduce congestion. We looked at the original context of the issues, from the constitutional and legal justifications to the initial strategies for implementation. And we reflected on what went wrong; why we are still grappling with these issues and, by most accounts, still unsuccessful. As a result, we should ask ourselves two simple questions: should we change this, and if so, how?

If the answer to the first question is yes, then the first thing we should to do is understand what we really want out of this process, how we want to live our daily lives. If we want to spend more time in our cars, get fatter and waste money, then the answer is simple: we just keep doing what we have been doing. We already know it works.

But if we want to spend less time driving, get healthier, and save money, then we have to do something else, reconsider the type of city we want to live in (and remember the Supreme Court said this is what we should do – keep people healthy, safe and prosperous). In order to do this successfully there are two broad conditions that have to change.

1. We have to work regionally. Unfortunately, the current situation in Georgia makes this very difficult. The trend is to further balkanize jurisdictions within each region, with many new small cities and towns. While this may seem like a good way to solve very local problems, it is moving us further from finding long-range solutions and fulfilling our constitutional obligations.

The issues and systems that bind us together are fundamentally regional (water, transportation, education, economic growth) yet we continue to try to find solutions in smaller jurisdictions. However, we have a system in the state that addresses this. It is a series of regional commissions that are charged with coordinating planning efforts throughout the state on a regional basis. The difficulty, however, is that they have almost no authority. In order to work regionally, we must give these commissions the authority to put in place planning criteria for each of the regions.

The state is currently reviewing and revising the operational structure of the regional commissions, and giving them more flexibility in how they operate within each region and giving local jurisdictions in each region more say in the process. This is a good thing, and it gives the system the flexibility it needs. Clearly, many of the issues facing the southwest region of the state are very different than the challenges the Atlanta region is facing. If this is to work, however, the regional commissions should be empowered to plan.

2. We should require testing and evaluation of the proposed transportation projects. The Supreme Court, in 1926, directed us to ensure that the methods we use to plan cities and regions are such that the resulting projects make us healthy, safe and prosperous. Yet the methods we currently use have either been proved to do just the opposite, or their affects on the population remain unknown.

For example, we know that the highway-arterial-collector system of roads creates an unhealthy, unproductive, unsafe environment, yet we continue to pay for and build them, based on ineffective modeling systems that were never scientifically constructed.

If, however, we find that walking creates healthy, safe and productive environments, and we want this, then we can look to recent research that shows people are significantly more likely to walk if the conditions make it comfortable to do so. And further, that the single most significant factor in measuring this is block size; smaller blocks provide an environment in which people are more likely to walk. But we have almost nothing in our current regulations that addresses this issue.

As a further example, it is now becoming clear that the cul-de-sac to highway pattern of development actually leads to a significant increase in pedestrian and vehicular deaths and injuries. The very model that was put in place to make our lives healthier, safer and more economically productive is doing just the opposite. Again, our constitutional obligation is to rectify this situation, and to do this we should provide a system in which projects are analyzed and tested to ensure appropriate results and minimize unintended consequences.

Imagine putting untested drugs on the market and waiting to see what kills us and what makes us better. This is essentially what we are doing with much of our planning efforts, with the same consequences, except in this case, even when we see the drugs are killing us, we don’t take them off the shelves; we order more.

We should be working regionally, and we should be testing projects to ensure they are doing what we want them to do.

Next week we will discuss very specific solutions and how they can be facilitated by the passage and implementation of the transportation referendum.

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