Tip of the Iceberg:  How a 3-story addition is setting the stage for major changes on one healthcare campus

Everyone knows what we see on the top is only a fraction of what is going on below the surface. That is the case with the vertical expansion of the Critical Care Pavilion (CCP) at MetroHealth in Cleveland, OH. As the video suggests, there is a lot more going on underneath the surface that was designed and developed with a lot of care, passion, input, and thoughtful decision-making behind the scenes. And for good reason – the 75,000 sf CCP vertical expansion is the first in a series of major projects MetroHealth is taking on as part of its campus transformation project.

The vertical expansion includes two ICU floors and a mechanical floor above the existing Level 1 Trauma Emergency Department and the Surgery floor that serves the campus. One of the most notable aspects of the expansion is a federally funded Special Diseases Care Unit (SDCU) to handle the region’s threat of Ebola and other highly infectious diseases.

MetroHealth Hospital Interior

The vertical expansion includes two ICU floors and a mechanical floor above the existing Level 1 Trauma Emergency Department and the Surgery floor that serves the campus.

Building Constraints and Hard Stop Schedules

Taking on a vertical expansion project while the other departments of the critical care pavilion remain operational has the typical roster of challenges, including:

  • Existing floors are to remain fully operational 24/7
  • All systems upgrades will be independent to handle additional loads
  • Existing structure is to be extended to manage the cost
  • Planning is to include any code upgrades and opportunities for patient and staff satisfaction
  • The expansion should respect the design of the existing building
  • The project should respect the facility standards for materials, MEP and typical details

Another challenge is the schedule. Not unlike other health systems undergoing capital improvement projects, MetroHealth is looking to update its building stock as quickly as possible to ensure the best possible care and experience for staff and patients. Last year’s polar vortex exposed the vulnerability of the aging systems. Another extreme weather event could impact patient care. However, the big elephant in the room is the Republican National Convention in Cleveland in 2016. Everything has to be in place to handle any emergency scenario.

In conjunction with the fast schedule, there was also a very strict budget. As a public hospital, every project is under scrutiny from residents, officials and stakeholders in the area. All funding has to be approved, allocated and earmarked, vetted and verified.

Pushing the Limits, Maximizing ROI

While the vertical expansion has been an intense, fast-paced, all-hands-on-deck effort, it is just the tip of the iceberg of a full campus transformation plan led by Dr. Akram Boutros, president and CEO of the county’s health system. The transformation is estimated to cost $1.2 billion and could take between 8 and 12 years to complete. Dr. Boutros has a goal of reducing capacity by 30% while maintaining care at the highest level. In many ways, this current effort will set standards for future transformation projects.

Bringing his expertise from a recent completion of Parkland in Dallas, Walter Jones, AIA, and Sr. Vice President for MetroHealth, is constantly pushing the team, the clinical staff and the construction managers to think about the options on every level. Working with Walter, HKS (executive architect of the transformation project) and CBLH Design (local architects and exterior architecture), CannonDesign helped identify the key requirements for the expansion and acknowledged operational models that needed to be addressed. We developed a floor plan with shared support zones, decentralized nursing with touch points for multipurpose spaces located at key intersections, and an all-LED lighting strategy. Combinations of furniture and built elements were studied to maximize the budgets for both sides. Everything was reviewed and weighed against the budget, schedule, patient care, efficiency, design opportunities and best practices. We worked hard to eliminate redundancy, streamline the access to support zones and provide immediate adjacency to patients.

Ultimately, we carved the plan back to the original square footage and held to the budget. It was all resolved by talking through the absolute needs and getting consensus on how the decisions were going to be made. We had to get this process right because it will help with the next project and everything we can’t see below the surface now.

MetroHealth Patient Room Design

The clinical staff made decisions for every element in the room with the Patient Advisory Board assisted with patient and family amenities.

Fostering Buy-in with a Different Kind of Mock-up

As part of the design process, we developed a “standard” patient room, patient bathroom and typical approach to nursing support. The patient room (with bathroom) prototype was studied in cardboard mockups and then later, we created a mockup with digital finish images and actual equipment items. Constantly testing the assumptions, clinical staff made decisions for every element in the room. The Patient Advisory Board assisted with patient and family amenities. Once designed, a mockup was created and built as an exhibit space-like knock down room that could be disassembled and shipped to the Cleveland Convention Center. It was reassembled overnight and made ready for a stakeholder’s meeting with over 500 attendees.

Everything was designed using the best advances in materials, all while creating a calm, nature-inspired, fresh space. Some of the room innovations included:

  • Dual lights over patient beds for better illumination without shadows,
  • Bathrooms with linear drains and large format tiles for cleanability and reduced floor slopes
  • An offset drain at the hand wash sink to prevent bacteria laden splash back from water in the drain
  • Antimicrobial surfaces and materials that could withstand the cleaning protocol necessary to limit bacteria spread.

After the meeting, the mockup was broken down and shipped back to the medical center and is currently being used for training purposes. Additional spaces are being mocked up for other projects in the queue. These are all being done so that the designs and decisions can be tested before moving forward.

This project may be the only part we can see right now, but it is setting the stage for a campus transformation that will help MetroHealth strengthen its mission of serving the community. We know what is below the surface and we are defining the process to bring everything into view. The energy of this project is profound. Everyone from MetroHealth is eager and anxious, but ready to embrace change.  We feel privileged to be a part of that.

Diane Tate-Whatley, associate vice president, is an award-winning interior designer specializing in healthcare and commercial interiors based in CannonDesign’s Chicago office.

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