Ashtabula Regional Medical Center’s New Patient Tower Expands Care In Rural Ohio
For the past 120 years, Ashtabula Regional Medical Center (ARMC) has been the only full-service hospital in Ashtabula County, Ohio’s largest county, a rural community occupying the state’s northeast corner.
Having started as a one-room, wood-framed general hospital in 1904, the organization has an outsize presence there now as the largest employer in the region, the primary provider of inpatient and outpatient healthcare services, and the only place to go for patients who need the services of a catheterization (Cath) lab or behavioral medicine unit.
New specializations, clinics, and improvements have materialized over the decades as needs and opportunities have evolved. But it’s been a while since the main hospital underwent any major construction—actually, not since President Gerald Ford was in office.
Now, 50 years later, ARMC cut the ribbon on a brand-new 115,000-square-foot patient care tower in June 2024. The $86.5 million expansion project, led by Bostwick Design Partnership (Cleveland), architecture and interior design firm on the project, doubles the hospital’s footprint.
“We spent several years with the ARMC leadership, programming and planning for the appropriate replacement and expansion of key departments,” says Michael Zambo, principal, health and wellness leader, at Bostwick Design Partnership. “After a deep dive into the community’s needs, we focused our efforts on spaces that will have the most impact on local health and well-being.”
Addressing rural population healthcare needs
Ashtabula county’s population is affected by the same social determinants of health as many other rural areas, including a relatively high poverty rate, lower levels of education than state/national averages, and a lack of public transportation and broadband internet service.
Leonard Stepp, president and CEO of ARMC Health , which owns the hospital, says the organization has focused much of its attention on improving healthcare access over the past several decades, opening family health centers and other outpatient and specialty facilities throughout the region.
During that time, the main ARMC hospital building had to wait for any serious attention. In 2021, funding was approved for a new four-story patient care tower that would allow the health system to bring some much-needed improvements to the campus, such as upgrading MEP elements, rightsizing operating rooms (ORs) and exam rooms in the emergency department (ED), opening up access to daylight, and restructuring departments for more efficient operations.
Additionally, inpatient rooms could be converted from double occupancy to private layouts, while a redesigned entry experience would provide something the campus sorely lacked: a sense of arrival.
New hospital entrance
Before the addition, the hospital’s architecture didn’t present a particularly welcoming (or obvious) front door. “Visitors would go down a side road, get to a canopy, then walk through a double door straight to a small elevator lobby,” says Logan Carroll, associate with Bostwick Design and project architect on the ARMC project. “You kind of trickled your way into the building.”
Now, a solid concrete wall “floats” above the new 1 1/2 -story lobby space, creating a billboard of sorts to guide the way through a landscaped approach that leads to entrance. The traffic flow has been redesigned and improved to clear up congestion issues at drop-off, better accommodating valet service and city buses.
Textural vertical waves add interest and a sense of height to the concrete façades on the new building. Ample glass brings light into the interiors and visual lightness to the massing.
Inside, the design team picked up some aesthetic cues from the old building—wood paneling and patterned glass—and elevated them to create an inviting, cohesive environment. For example, large-format graphics on glass that depict nature photography aid in wayfinding and support a focus on biophilic design in the new tower. Light-colored wood looms large in the new lobby and other key areas, while woodgrain-patterned sheet wall protection carries the theme elsewhere.
“We wanted to introduce soft kinds of textures within the actual finishing materials to make it feel more organic,” says Carroll.
Fixing flow for hospital patients and clinicians
The new tower allowed the design team to convert all inpatient rooms to private occupancy, complete with private bathrooms and defined caregiver, patient, and visitor zones, improving both efficiency and the patient experience. Half the rooms benefit from floor-to-ceiling glass to maximize natural light; the other half look out over the adjacent Ashtabula River and the woods around it.
“Anytime we could give somebody that view, we did,” Zambo says. “All the waiting rooms, for example, are organized on the east side of the building so they can take advantage of the wonderful view.”
ARMC and the design team also dove deep into strategies to reconfigure departments to improve workflows, upgrade technology capabilities (such as telemedicine in the patient rooms), and establish the hospital as a destination for 21st century care.
The new ED features universal exam rooms; the ORs are now prepared to take on future equipment enhancements (including a recently acquired Da Vinci Surgical System) and are supported by private pre- and post-op bays.
“The connection between the ORs, ICU, and ED is much better,” says Zambo.
Specifically, an elevator now connects each department, allowing patients to quickly receive the care they require. Previously, these departments were scattered around the hospital, requiring patients to be transported through public corridors.
Addressing staffing in rural healthcare facilities
Workflow optimization, technology enhancements, and other improvements (such as ample staff lounge and locker space) play a big role in tackling another challenge facing ARMC and other systems like it: staffing.
“Healthcare is a very tough industry, and labor force is a challenge,” says Stepp. “We don’t have a vast talent pool and recruitment can be challenging, especially in rural areas.”
ARMC is looking to hire more specialists who can cover the “spectrum of expectations,” Stepp says, so that patients can get more comprehensive care without having to shuttle between multiple locations.
And for recruiting purposes, he says, “a brand-new facility is a nice draw. It’s a welcoming environment, it has all-new technology, and it speaks to the financial health of the facility. We’ve been here for 120 years, and we’re looking forward to being here for 120-plus years more.”
That message is one ARMC hopes resonates with the community at large, as well. As part of the campus renewal efforts, the organization has cleaned up the nearby bank of the river, is repaving all of the surrounding parking lots for a consistent experience and look, and plans to create more parking.
“They’re really taking a comprehensive look,” Zambo says, “and it all comes from the patient perspective. From the very beginning, this group always found a way to make decisions that prioritized what the patient needs.”
Kristin D. Zeit is a contributing editor at Healthcare Design and can be reached at [email protected].
Ashtabula Regional Medical Center Patient Care Tower project details
Project location: Ashtabula, Ohio
Project completion date: June 2024
Owner: Ashtabula Regional Medical Center
Total building area: 131,554 sq. ft. addition; 17,060 sq. ft. renovation
Total construction cost: $89.5 million
Cost/sq. ft.: $602
Architect: Bostwick Design Partnership
Interior designer: Bostwick Design Partnership
Construction manager: Independence Construction
Structural engineer: Barber Hoffman
MEPT Engineer: Karpinski Engineering
Civil engineer: Langan
Design-assist contractors: United Architectural Metals (curtainwall), Lake Erie Electric (electrical), TH Martin-HAVE (mechanical), Summit Plumbing (plumbing)
Art consultant: By owner
Medical equipment planner: VOC Associates
Large-format wall graphics: Henry Domke
Carpet/flooring: Interface, Mannington (resilient sheet flooring); Interface (resilient tile flooring); Patcraft (tile carpeting)
Ceiling/wall systems: Armstrong Ceilings, Turf
Doors/locks/hardware: Enterprise Hardware (supplier/installer)
Fabric/textiles: Maharam
Furniture—seating/casegoods: American Interiors (OFS/ MillerKnoll/Nemschoff)
Handrails/wall guards: Construction Specialties
Headwalls/booms: Skytron
Lighting: Skytron
Surfaces—solid/other: Corian and Silestone, Formica
Wallcoverings: Construction Specialties Acrovyn, Pionite, Formica
Decorative Glass Glazing: Agnora Glass, Skyline Design
Project details are provided by the design team and not vetted by Healthcare Design.