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A Hospital in a Garden
by Suzanne Van Gilder
More than 70 years ago, Alfred I. duPont established the Nemours Foundation based on a firm belief that “it is the duty of everyone in the world to do what is within his power to alleviate human suffering.” Today, Nemours is one of the nation’s largest integrated, pediatric health systems. In addition to clinical – and hospital-based primary and specialty care, the nonprofit is dedicated to improving the lives of children and families through research, education and advocacy. The organization includes more than 40 locations in the Delaware Valley and Florida. Of these, the new Nemours Children’s Hospital, located near Orlando, Fla., brings all the Foundation’s values into practice in one extraordinary setting.
What is exceptional about the facility is that its design does more than support the practice it houses – it is an integral part of creating and defining the operating model of the hospital. “Behind the Nemours Model of Care, which is our philosophy of how we want to provide services and care to our patients and families, we basically had a blank slate,” says Michael Cluff, AIA, who served as staff architect for Nemours and owner’s representative on the project. “It was a greenfield hospital, so our task was to create the ideal environment to fulfill that model. We knew we had to have a tremendous facility, in terms of design, finishes and medical equipment, to recruit great physicians. It all works together to support this world-class model of care.”
The 630,000 square-foot Nemours Children’s Hospital was one of the first entities to locate in Lake Nona, a real estate development strategically designed to be a “Medical City.” The well-supported theory behind the concept of a Medical City is that a cluster of healthcare, bioscience, research, and educational facilities in proximity to one another will foster collaboration and accelerate innovation. With its strong background of partnering with academic medical centers and research facilities, the Nemours Foundation recognized the potential of locating a hospital in such a nurturing setting. Yet it did provide a unique set of challenges to the design team.
“We had to create a very flexible environment because we didn’t know who the ultimate users were going to be. Layered on top of that, we didn’t necessarily know what services they were going to provide. Were they going to be heavily geared toward orthopedics versus oncology, or something else?” says Cluff. “The other issue was we were going to start with zero patients, and we didn’t know how quickly the volumes into our emergency department and into our hospital were going to grow. So we had to design the facility in a way that it could open in pods.”
Buildings That Heal
Nemours engaged two firms, Atlanta-based architecture and interior design firm Stanley Beaman & Sears, and Perkins+Will in Boston for the project. Because there were no established specialties, no cultural precedents and no defined patient population, the team used best practices and evidence-based design to develop the LEED GOLD certified facility. They also called in reinforcements. “We used a lot of national experts – physicians, surgeons and anesthesiologists from our satellite clinics in Jacksonville and Pensacola, as well as our sister hospital in Wilmington, Del. We also sought feedback from our patients and families. All of those insights helped us to design a very flexible institution that could grow,” says Cluff, who now supports the hospital’s master planning and facilities planning exercises. “And because we didn’t necessarily have that existing culture to work with, we were able to hire and recruit physicians, nurses and senior leaders that could build an operational model that would be supported by the facility.”
Despite all the unknowns, Nemours’ established Model of Care document defined how the organization would provide care across the continuum of pediatric patients, from birth to age 18. “It is what we used as architects and designers for the basis of how we organized the building,” says Cluff. “It stacks horizontally, sharing common functions on the same floor. So the orthopedic clinic is on the same floor as the orthopedic hospital beds, and orthopedic surgery and rehab gym. An orthopedic patient, depending on the acuity of the condition, could feasibly interact with all of those functions. We wanted to make sure everything is under one roof. At Nemours Children’s Hospital, patients don’t have to drive down the street or walk across a bridge to get to a specific function. Everything is accessible off the same floor. That was the genesis of the movement toward patient- and family-centered care.”
To remain flexible as physicians are hired and practices established, everything in the building is standardized. Every single hospital room, out patient exam room, emergency room department and operating suite are alike. “We had some ideas of the existing specialties that we had at our other Nemours clinics in Central Florida, but it wasn’t necessarily at the scale that we were planning,” says Cluff. Additionally, the quality of the facility and its proximity to world-class research centers and educational institutions makes it possible for the Nemours Children’s Hospital to recruit sub-specialties, as well as core pediatric practices. “When the CEO and clinical operations team arrived they had the flexibility to build operating models to accommodate the specific needs of mainstream services, as well as the one-off sub-specialties,” says Cluff. “For example, on Monday, Wednesday and Friday a specific exam room could be for orthopedics, and on Tuesday and Thursday when the orthopedic surgeon is in the operating room, that same exam room could be another sub-specialty.”
Since it was a greenfield facility, the Nemours Children’s Hospital started with no patient population. A secondary benefit designed into the layout of the building is the ability to open in pods. This helps the hospital to operate efficiently and staff appropriately. As practices are established and the patient population grows, additional pods are opened. The standardized design and layout facilitates easy growth. Soon the Nemours Children’s Hospital will celebrate its two-year anniversary of opening, and the patient population exceeds initial forecasting.
Public Spaces That Bring the Outdoors In
The comfort of patients and their families is as important to the Nemours Children’s Hospital’s model of care as are the well-organized buildings and super-star physicians. “We designed the facility to be uplifting and empowering for the patients,” says Cluff. “I strictly focus on healthcare design. Hospitals are the only building types that no one wants to go to. Ultimately you don’t go to the hospital for fun reasons. So we did a lot of research into design elements that provide comfort and positive distraction. Our research included visits to the Ritz-Carlton to better understand how hospitality can influence healthcare. A lot of energy went into making the environment something that supported being healthy and ultimately going home.”
The design team created the guiding principle of “A Hospital in a Garden,” which encompasses many of the aspects of evidence-based healthcare design – lots of big windows and natural light, soothing water features, dedicated fun areas to allow pediatric patients to feel like kids and interactive elements. There was also a directive to avoid themes of any kind. “So many children’s hospitals have characters or super heroes on the walls,” says Cluff. “We tried to use materials and design elements that are translatable. So that a two-year-old and a 15-year-old would both feel comfortable in the environment.”
Brenda Dietz, an interior designer and LEED AP with Stanley Beaman & Sears, helped design the interior spaces and specify the finishes for the Nemours Children’s Hospital. “Aesthetically, they wanted something that was timeless,” says Dietz. “That also translates into performance. As a firm, we are always trying to design so there is ease of maintenance. With every selection and every detail we consider the life of the product. For this project, we were concerned with trying to provide a 50-year palette. So we specified neutral materials that we knew were going to be there a long time, with the understanding that they could change out paints and carpets that have a shorter life.”
Within the public area, neutral terrazzo flooring anchors the space, while translucent resin panels are widely used to add pops of interest. A feature wall and welcome desk built from 3form in the main lobby include integrated LED color-changing technology. “They really wanted to embrace a timelessness. The materiality of these special elements allows Nemours to change the look and feel of the open atrium and lobby space,” says Dietz. “They can set the tone for holidays and special events.”
Engineered materials also play important roles in functional fixtures. Solid surface integrated sinks and countertops from LG Hausys HI-MACS are used throughout the facility because the seamless design is easy to clean and repair.
“The layout of each floor is standardized, so we use distinctive colors on every level as a means of way-finding,” says Dietz. “The progression is based on the hues of the setting sun. Stanley Beaman & Sears has in-house super graphic capabilities, so each elevator lobby includes a vibrant image that fades into a color. That distinction is carried throughout the level in accents, such as routed panels from Modular Arts, and translucent wall cladding with cut out seating.”
Natural, undulating patterns continue into the auditorium with Art Diffusion wall panels by Interlam. The product, made with routed MDF, offers designers a lot of options both in terms of aesthetics and technical specifications. Depending on the end use, the MDF can be specified as Arauco North America’s Premier fire rated product, Sierra Pine’s NAF (no-added formaldehyde) board, or as a moisture resistant substrate. Finish options include membrane-pressed 3D laminated films, performance lacquers or raw, sealed surfaces.
Wood ceilings add warmth to the facility. “We worked with Rulon for our wood ceilings throughout,” says Dietz. “This is a LEED project, and they were able to customize with FSC-certified veneer that was within the region.” White oak veneer carries through to the chapel, and ties into the exterior metal cladding.
Personalizing for Patients
To better understand what finishes and amenities were important to the end users, the design team created a preview center prior to construction with complete mock ups of patient rooms, exam rooms and nurse’s stations. The feedback they received from patients, their families and staff helped the designers create comfortable spaces. Some amenities seem obvious, like patient rooms with sleeping space for two parents and on-site laundry facilities. But often the more subtle insights were also the most important, such as the specification of HPL in the patient rooms.
High-pressure laminate, being a performance decorative surface, is used as a design element in the millwork and casework. Formica’s ColorCore solid color laminate is miter-folded into interesting shapes. Designs from Wilsonart and Nevamar are used widely throughout nurse’s stations and patient rooms. However, no material stands alone, so context within the palette is important.
Another distinctive element in the patient rooms is color-changing LED technology that allows the patient to “paint the room with light.” “When kids are in the hospital they feel like they don’t have control of their bodies or their environment. This technology gives them back a little control. It tells a story about the individual in the room,” says Cluff. “At the same time it becomes an ever-changing exterior design element with fun colors that shows that this is truly a children’s hospital.”
To showcase the lights and finishes, a patient room was set up in the preview center. “We had chosen a nice, shiny, high-gloss HPL. As architects we all thought it looked really neat and classy,” says Cluff. “Then one of the parents pointed out that the finish worked like a mirror, that it could be scary for little kids to see themselves hooked up to IVs and medical equipment. And that was absolutely right. We were thinking about how sexy the finish looked, and not about the practical implications of that decision. So before building out 100 rooms with glossy HPL, we changed the specification to a matte finish.” This seemingly small detail exemplifies the level of care that guided every decision in the design process. And the results are tangible.
The Nemours Children’s Hospital is a special place, where excellent design, a comprehensive model of care, and a location that provides access to research and education all coalesce. The institution attracts the best and brightest physicians, and offers world-class pediatric care regardless of a patient’s financial status. “All those factors add up to this amazing facility that has won several awards,” says Cluff. “And we are very proud of that. But ultimately we are proud of the services and treatment we are able to provide our patients and families.”
“We designed the facility to be uplifting and empowering for the patients.”
Michael Cluff, AIA, staff architect for Nemours