By Lee Buckner, BBH Design

Experience shows that building a replacement hospital can be more efficient, and sometimes less expensive, than refurbishing or updating an existing facility. Yet replacing a hospital in today’s constantly-changing health care environment presents the complex design challenge of adapting to future technologies and health care delivery methods. Construction efficiency and adaptability are especially important to remote communities with limited resources, where most rural hospitals are approaching 50 years old and contending with inadequate or inefficient space.

To provide guiding principals for facility replacement, the U.S. Department of Health and Human Services (HHS), which operates the Critical Access Hospital program, commissioned a study to develop two prototypes for 25- and 15-bed facilities. BBH Design, a North Carolina architectural firm, worked with HHS and the Health Resources & Services Administration (HRSA) to establish guiding principles to aid small and rural hospitals in replacement facility planning, design and construction. This prototype complements federal efforts to improve rural hospitals’ operational performance, including establishment of the CAH program and increased efforts by  the U.S. Department of Agriculture’s Community Facilities Program and the Federal Housing Administration’s Section 242 Mortgage Insurance Program to reach out to these providers.

The resulting healthcare facility design (prototype) is a decision-making tool for rural hospital leaders to estimate space requirements and costs associated with a replacement facility. A project of this magnitude should be considered a major economic advantage for the local economy, and encourages the hospital to consider a process that combines national perspective, insight, knowledge and expertise with qualified local and regional resources to provide a practice-ready facility to serve a community for the next 50 years. And while it was commissioned specifically for CAHs, the design concept can be adapted to a hospital of almost any size.

The approach uses modular design, including modular mechanical and electrical systems housed in a central spine, a universal space approach with high floor-to-floor heights to allow for conversion of internal space to other potential uses, universal room models and provisions for future expansion and convertibility.

The central spine serves as a mechanical circulation and distribution channel, providing such needs as electrical service and carrying all infrastructure components horizontally and vertically throughout the building. This structure allows for flexibility for incremental growth of patient beds and clinical, administrative and support services, either by adding stories or expanding horizontally, with minimal disruption to operations.

The use of modular techniques and systems will allow for shorter construction times, whether for packages of complete clinical suites or semi-moveable components. This will also reduce construction cost, allowing more funding to go toward equipment purchases.

The prototype is based on an all-private universal patient room concept designed to enable conversion of acute patient rooms to intensive, critical care, isolation or labor-delivery (LDRP) use. Nursing units are designed to accommodate 25 beds but, as with all prototype elements, the system allows for adaptation for fewer beds or for expansion.

The prototype was designed under certain budget and services assumptions and incorporates features that may not be necessary in every facility. As with any approach designed for more than one user, it will have drawbacks; hospital leadership may have to make compromises. Building for future needs may initially be more expensive than designing a “tight fit” for current needs, and designing for the long term may mean that features and departments may not all be ideally located in the short term. On a whole, however, the prototype should help smaller hospitals affordably and quickly meet current facility needs while enabling convertibility and adaptability to accommodate change for the next fifty years.

Lee Buckner is a partner at BBH Design in Research Triangle Park, N.C. He can be reached at (919) 460-6700 or at lbuckner@bbh-design.com. Portions of this article were originally written by Mr. Buckner for the April/May issue of Healthcare Building Ideas.Print this article
View the Critical Access Hospital Prototype Study