Apply evidence-based design principles to Frank Lloyd Wright-inspired architecture, and the result is the new 56,000-square-foot patient wing and surgery addition at Community Hospital in McCook, Nebraska.

Serving a modest population of 30,000 in eight surrounding southern Nebraskan and northern Kansas counties, the design is an unexpected yet delightful surprise in this rural prairie community.

The design, by HDR Architecture, features 19-foot ceilings, clerestory windows, fireplaces, stone and wood exteriors and interiors, an earthy color palette, and a scenic healing garden featuring butterflies, native plants and birds, a stone patio, fireplace, and fountains. The comprehensive care facility offers inpatient, outpatient, diagnostics, treatment, emergency, rehabilitation, clinic, and surgical services.

To learn more about this noteworthy project, contributing editor Barbara Horwitz-Bennett spoke with Community Hospital McCook President and CEO James P. Ulrich Jr., and HDR designers Cyndi McCullough, RN, MSN, EDAC, senior healthcare consultant; Robert Hailey, AIA, LEED GA, project manager and senior project architect; Kevin Ruff, project designer; and Amy Dishman, LEED AP ID+C, interior designer.


Out with the old, in with the new
James P. Ulrich Jr.:
In our old facility, the nurses’ stations were in the middle surrounded by patient rooms—which we lovingly referred to as the “pods.” From a nursing standpoint, it was nice. However, any kind of noise would bounce off the cone in the ceiling and go straight into the patient rooms. And the rooms were pie-shaped and had shared bathrooms, so access to the bathrooms wasn’t very good.

With our new patient wing, we wanted to have rooms that were more in line with today’s way of delivering care. This included a caregiver zone, a family zone—which was largely absent in the former hospital—and, obviously, a patient zone, which required more space than our previous rooms. We also decided to set up the support services to be much closer and accessible.

The pods were built back in 1974 and were beginning to require pretty heavy maintenance. We were having to consider a pretty big overhaul, so we decided to go with new construction to take advantage of the latest in design.

Ultimately, I think we did a very good job of providing surgery care for both inpatients and outpatients in an inpatient surgery unit. Today, at least 75% of surgeries are outpatient, whereas when the hospital was built, there were only inpatient surgeries, so the original space wasn’t designed with privacy in mind.


Enjoy your stay
The 19-foot ceilings, with natural light cascading in from the ribbon of windows just below, are an impressive feature that runs the length of the patient wing. Often, hospitals receive the usual complaints of the environment being stuffy and institutionalized; that’s not the case here. Patients may not like the fact that, in some cases (for health reasons), they can’t have salt on their meals. That we can’t do anything about, but the environment we can.

Amy Dishman, LEED AP ID+C: To create a hospitality feel, we chose a simple palette of colors and used carpeting in the hallways, fireplaces, and wood and stone accents. Since we can’t install water features in the state of Nebraska because of infection control, we’re doing more fireplaces.

Carpeting is often a hard sell for hospitals in terms of anticipated maintenance, but it makes a big difference with acoustics and indoor air quality. It can also reduce falling risks and reinforces the hospitality look, as opposed to the typical [vinyl composition tile] floor, which can make the space look sterile and institutional. Because we went with carpet tiles, they’re easily replaceable. It’s a seamless transition if you need to pop in a new carpet square.

In addition, the stone walls blur the lines between the exterior and the interior, and really help make that connection to the natural environment and the common vernacular of the area.


A tribute to Frank Lloyd Wright
Kevin Ruff:
There’s a Frank Lloyd Wright house in town, so his spirit was already in the community. In fact, McCook boasts one of the few Prairie-style homes west of the Mississippi River designed by the famous architect. While we didn’t want to replicate his design, we did decide to carry in the guiding principles that made his architecture so great.

For example, Wright replicated architectural elements with attention to detail. Similarly, we designed large bay windows in the patient rooms, which we repeated down the west façade. We took the time to detail out and look carefully at the proportions.

As another example, Wright did a wonderful job integrating his buildings into the landscape. Similarly, we continued the building’s stone base into the landscape, which provides additional seating and definition to areas of the healing garden.

Robert Hailey, AIA, LEED GA: And just as Frank Lloyd Wright used lots of local, natural materials and earth tones, a lot of the materials we used came from the Midwest region. In addition, we brought some of the features on the exterior of the building all the way inside, such as brick, stone, and wood elements.

Ulrich: That’s correct. The public corridor is lined with stone columns, and they mimic the stones on the lower part of the building exterior. The major communication stations are made from Brazilian hardwood, which is also on the outside of the building. The hardwood is used on the base with solid surface countertops and translucent resin panels, which are infused with regional landscape elements in between. 

Furthermore, the partitions that separate the public hallway from the outpatient waiting area (as well as the labor, deliver, and recovery [LDR] waiting areas) also use this hardwood on the top and the base, and sandwich the same translucent resin panels.

Hailey: In fact, when you light this transparent, decorative polymer material from behind, it glows, creating a very warm, attractive look.

Dishman: Another major element of the design is daylight, which is the one thing that patients, visitors, and staff compliment every time.

For example, at each end of the corridor on the nursing floor, we designed a 19-foot-high glass curtain wall with large, horizontal roof overhangs, which help bring filtered daylight into the long public corridor. This element helps bleed the lines of inside/outside.

High clerestory windows continue where the glass curtain wall stops and run the entire distance of the 300-foot-long north/south corridor.

Ulrich: Because it’s a one-story building, we had lots of opportunities to bring natural light in, and I think the designers did a fabulous job with that. The natural lighting absolutely pours in and it’s very luminous in the hallways.

Hailey: At the end of the hallway, we have two hospice rooms where we tried to provide a space for larger family gatherings and easy access to the healing garden. It’s a transformed, daylit space that lets your mind be at ease.

Ulrich: A lot of facilities provide just a living room next to the hospice room. In the new patient wing, we’ve also created an open-air, yet private area with further access to the healing garden, so families aren’t confined to a living room space.

The garden is a healing environment for the body, mind, and spirit. It’s an 18,000-square-foot place to escape to, right off the patient rooms and surgery wing. Families can actually go out there at night and comfortably sit around the fire in the garden
’s hearth.

Cyndi McCullough, RN, MSN, EDAC: Not only does the entire design have evidence-based design (EBD) research to support it, but you get this great feeling when you walk inside. It’s beautiful, it’s functional, and it’s efficient.

Ulrich: The acoustics in the new space are amazing. The space is also adaptable to the unforeseen ways that healthcare might change. For example, the bathrooms can handle bariatric patients, with an open space plan and a shower with no lip, allowing easy caregiver assistance, if necessary.

On the technology side, we have the ability to chart both in the patient room and outside the room at the decentralized nurses’ stations. We also have wireless Internet, so the doctors can work on tablets in the future.

McCullough: We went with standardized, same-handed rooms where everything is located and stored in the same place in every room. Everything caregivers need to take care of the patient is right there. Handwashing sinks are located where staff, families, and visitors can use them, away from the head of the bed where patients can see staff using the sinks.


Prioritizing privacy and security
In addition to the warm, non-institutional feel, it’s very private and secure at the same time, and privacy in a small town is especially important.

With key-card access doors, a lot of the public will never see the surgery area, LDR, or ER. For example, if you’re in labor and delivery, and require an emergency C-section, you never have to pass through a public area outside a secured zone. The same applies to an ER patient going from the emergency department to surgery for an emergency surgery.

We also separated the public corridors from the service corridors, so you don’t have to go to your CT scan or X-ray in front of all your friends and neighbors.

Dishman: One of the design strategies was to differentiate between front-of-house and back-of-house design. For example, the service areas are tiled, while the public space is carpeted. It acts as a wayfinding cue to let people know where they’re supposed to be and where they’re not.


Small town, world-class design
When we went through the facility master plan, we looked at some different EBD ideas. We did site visits and looked at different facilities, a couple of which were designed by HDR, which we really liked. HDR was very good about going through the different ideas we had and making them come to life. In some cases, they even took our ideas a step further.

McCullough: To us, it doesn’t matter whether it’s a 1,500-bed hospital or a 25-bed hospital, you still go through the same process and use research to support design decisions. But a rural institution is particularly challenged to recruit providers and staff, so you must create a facility that will attract them. Anything we can do to improve that is so important.

Ulrich: With our new patient and surgery wings, if we can get a candidate to set foot in McCook, our chances of having them sign a contract to provide patient care here absolutely skyrocket. Our biggest challenge is to make sure they can find McCook on Google or Mapquest.

From a dollar and cents standpoint, a critical access hospital like ours has a lot of requirements from the government, but we were also able to secure financing with some low-interest loans from USDA Rural Development. Working with the U.S. Department of Agriculture actually proved to be an advantage.

Our design is now being viewed by a lot of other hospitals. In fact, another hospital told HDR, “We want what McCook has.” That’s proof right there.