When Mercy Health (Cincinnati) decided to replace two older hospitals on the west side of Cincinnati with one centrally located facility, the provider also saw an opportunity to support an anticipated evolution of services in years to come.

For starters, the organization sought to expand its network by adding a center of excellence in cardiac care (including an open heart surgery program) and a family birth center, services that weren’t available at its former Mt. Airy and Western Hills hospitals.

Patti Meszaros, director of facility planning for Mercy Health & Catholic Health Partners (Cincinnati), says the healthcare provider also knew it had to be adaptable to the changes going on in healthcare and the types of patients that are going to present themselves.

“We are seeing an increased focus on care in the outpatient setting and we expect that in the future, patients admitted to the hospital will have a higher acuity level,” she says.

The answer to creating that flexibility—and more—was found in the site itself.  

Lay of the land
“[The site] looks fairly simple, but it was pretty complex when we started,” says Mic Johnson, lead designer on the project and now design principal at Architecture Field Office (Minneapolis). “It had a drop of 110 feet across the slope, and that posed certain problems related to how to stack the building.”

The project team, which included AECOM (Minneapolis) and Champlin Architecture (Cincinnati), decided to nestle the facility into the landscape, which allowed support services—including mechanical, loading, materials management, and staff parking—to be located below grade and out of sight.

Then, rather than stack hospital services vertically, the team designed a 140,000-square-foot base to accommodate the owner's desire for operational efficiency and future flexibility, resulting in an interventional platform that locates surgery, imaging, and the ED on one level. The large building footprint also allows for future expansion of those services without requiring a major overhaul to the facility, with the ED expanding to the east and surgery to the south, and imaging growing in place. In addition, the building’s two bed towers, which sit atop the diagnostic and treatment (D&T) base, could expand vertically or horizontally to the north.

“It’s a very simple idea: You grow in all other directions except for where patients arrive,” Johnson says. “Mercy can change and alter the size of the hospital without changing its primary functions. That was a big thing.”

Designed to last

With flexibility an overriding goal for the project, West Hospital includes an adjacent MOB, which allows physicians to provide care in both the inpatient and outpatient setting. In addition, the procedure spaces in the D&T base (including imaging and surgery) serve both the inpatient and outpatient population. Additional shelled space in the hospital allows for future growth of the critical care unit and the birth center as well.

The universal procedure rooms are sized to accommodate traditional surgical procedures, robotic surgery, and image-guided surgery. “As surgical and imaging techniques advance from open procedures to minimally invasive procedures, these rooms can be converted with minimal impact,” Johnson says.

Brett Oberholzer, principal of Champlin Architecture, says the ability to create prime adjacencies, including emergency, imaging, surgery, cardiac catheterization, and surgical ICU, all on the same level creates a better patient experience. “It’s jarring for patients to be moved around and shifted from floor to floor,” he says.

It also improves the work environment for staff. “A side benefit of the single-level D&T is that there’s no implied hierarchy of importance of ailments and procedures,” he says. “The staff feels like they are equal parts of the same patient care team.”

The design team also spent a lot of time addressing the layout of patient rooms, conducting multiple mock-ups and gathering feedback from staff. One conversation focused on what type of door to install on inboard toilet rooms, with the team and staff assessing how much pressure was required to open a door, handle locations, and ease with which patients could reach the door. In the end, a sliding wood door was chosen, which offered flexibility in how the staff could use the space and move equipment around while also allowing more space to accommodate family members.

Bedside charting stations were also designed so staff members have face-to-face contact with the patient. In the med/surg areas, additional walk-up nurse stations are 42-inches tall and can accommodate multiple employees, providing space to do charting outside the patient rooms.

Outside in
Concurrent with construction of the 645,000-square-foot hospital, Mercy Health decided to launch a new brand statement, with the site again providing inspiration. Ohio was a center of pottery production from the late 1800s until mid-1900s with to its abundance of waterways and raw materials, particularly its rich clay soil. Drawing on that history with art pottery, the design team decided to create a bold look for the exterior through the use of blue and green colored brick tiles. “It was a way for us to begin to think about how to connect this building to Ohio and to this place,” Johnson says. (For more on the facade, see “Making Of An Exterior At Mercy Health West.”)

Meanwhile, the hospital’s large horizontal footprint resulted in an enormous roof, leading the design team to think about how it could be incorporated into the local landscape, too. That brainstorming led to the development of a 2.5-acre green roof—one of the largest living roofs in the state of Ohio. Designed by Close Landscape Architecture (Minneapolis) with Meisner + Associates/Land Vision (Cincinnati), the roof features a mixture of 65,000 native plants, and every patient room has a view to the feature.

The project also focused on daylighting by installing skylights in the D&T platform and mechanical wells in the rooftop to bring natural light into surgery areas, workstations, and staff hallways. Even the lab floor, which is two levels below the main entrance, isn’t left in the dark, thanks to a series of windows along the west side of the building. “Because of the slope of the site, we’re able to get natural light into every level, including the lowest one,” Champlin’s Oberholzer says.

And to ensure the interiors wouldn’t fight with the exterior views and lively color palette outside, Kim Williamson, principal/interior design director for AECOM (Minneapolis), used a neutral palette with strategic pops of color to help with wayfinding and create a more hospitality-like setting. For example, the dining room features orange accents to contrast with the overall exterior blue/green palette of the hospital. In the patient rooms, the nearly floor-to-ceiling windows and complementary blue and green furnishings help to blur the line between inside and out.

Going forward

Mercy West’s new look, future-thinking layouts, and operational efficiencies are being used as a model for the organization as it pursues renovations of its older existing hospitals in the region and cons
truction of new care centers.

For example, a new freestanding emergency department and health center in Cincinnati, which opened in July 2013, features a similar façade treatment but in a different color palette and pattern, making the Mercy Health connection but in a context that fits its more urban location.

A bed tower addition at Mercy Health’s Jewish Hospital will focus on bringing more natural light and views of nature into the interior, as well as adding a courtyard on the urban campus. West’s application of sliding doors on patient toilet rooms is also being extended to the medical surgical wing at the Jewish and Anderson hospitals.

“We’re taking all the best practices from our previous experience and we’re building on it,” Meszaros says.  

Anne DiNardo is senior editor of Healthcare Design. She can be reached at adinardo@vendomegrp.com.

For a source list relating to this project, see "Mercy Health West Hospital: Project Breakdown."

Photo: Sarah Crouch

For insight on Mercy Health West’s green roof, read “Room To Bloom At Mercy Health.”