Health-Care Case Study

Project: Mission Trail Baptist Hospital
Location: San Antonio, Texas
Architect: Earl Swensson Associates (ESa)
Owner: Vanguard Health Systems

The Client: It is somewhat tongue-in-cheek when Landon Lawson, project director for Vanguard Health Systems, quips that “Vanguard is the vanguard of outcome-based quality health care,” but the company is certainly part of what is driving the big philosophical changes in health-care design. “Our sole focus is health care,” Lawson says, “and it is really evolving from sick care to caring for health. We implement evidence-based practices to move from a fee-for-service model to a fee-for-value model.” With 28 facilities in five distinct markets (Arizona, Illinois, Massachusetts, Michigan, and Texas), Vanguard cultivates locally branded health systems that meet the needs of the people in the region.

The Project: The Mission Trail Baptist Hospital (MTBH) is a 214,000-square-foot, 110-bed replacement facility that was recently completed in San Antonio, Texas, as a part of the Baptist Health System, a group within Vanguard. Architects and designers from Earl Swensson Associates (ESa) collaborated with the project owner and care providers to develop a patient-centered, family-friendly hospital. In addition to applying best practices for evidence-based health care, there were three design criteria that informed the specification of materials throughout the project: LEED Gold certification, regional harmony, and creating a facility that is both light and quiet.

The Sustainability Approach: Part of MTBH’s vision is to be “good stewards of our resources.” “For us, it was important to incorporate LEED principles into the hospital by focusing on the things that really made sense, versus just how we can get points for X, Y, and Z,” Lawson says. This included features that were innovative for the general public, such as electric car charging stations, a smart phone app called SnapWalk that allows visitors to scan a QR code and get directions within the facility, and lighting strategies that give functional options to bright overhead fixtures. It also guided the specification of interior finishes. “We selected several designs of high-pressure laminate (HPL) for different applications in the project,” says Angela Rinehart, interior designer for ESa. The construction of HPL differs from traditional laminates. In addition to a decorative layer and substrate, HPL includes several layers of saturated kraft paper that give the material superior impact resistance. This significantly increases the durability and life of the product. “Overall, we try to be very aware of the origin of the products that we use. Not only are the products manufactured in Temple, Texas, but they are sourced within 500 miles of San Antonio. Plus, it has recycled content, so it qualifies for several LEED credits.”

The Materials: Mike Jones is a project manager for SWA Millwork, the fabricator that built many of the fixtures for the MTBH project. “We mainly produce nurse stations and reception desks,” he says. “And we receive a lot of specifications for decorative laminate because it offers so many different colors and designs. Woodgrain is usually the choice in a hospital setting because it feels homey, but if you were to use real wood or veneer plywood, it just would not last as long.” The laminates were specified with a Class A fire-rated particleboard substrate. And because the doors and drawers get a lot of use, the casework was built with concealed hinges. The public-area doors in the hospital are done in wood-grained HPL, a comforting design reminiscent of anigre with dark, gold, and reddish hues. The design is carried over into panel systems along the walls, casework, and accents within the patient rooms and nursing stations. Laminate in a warm, straight-grained amber cherry color is used to soften the stark, white functionality of the back-of-the house doors, desks, and casework. And a lighter Asian sand design accents the nurse’s work alcoves and nursing stations. This design also moves out into the corridor to the coffee shop and servery providing a very cohesive look.

The Indoor Environment: Another aspect of the MTBH’s vision is to maintain a healing environment. A growing body of research in evidence-based health-care design supports the idea that the physical environment can relieve patient pain and stress, affect well-being, promote healing, and reduce medical errors, infections, and falls. An important component of this is designing health-care spaces that feel less institutional and more familiar. “A big focus for us with the MTBH project was to be as hyper-local as possible with the south Texas culture,” Lawson says. “So that plays a big role in the design elements that went into the facility.” A physician-led art committee sought out photographs, paintings, and quilts done by local artists. “Angela Rinehart sat on the art committee as well,” Lawson says, “so the selections of the finishes worked in concert with the artwork to achieve the general theme we were going for.” The warm wood tones of the HPL and the strong neutral foundation of the solid surface set the tonal palette.

MTBH takes its name from the unique history of the area. “We had a local artist do a mosaic tile layout of the San Antonio River in the meditation garden that sits between the medical office building and the hospital,” Lawson says. “It depicts each of the missions along the way and shows where MTBH now sits along that trail.” Weaving these earthy elements throughout the interior of the facility and the grounds gives patients a sense of place, rather than a feeling of being removed from society because they are sick.

The Lighting Approach: MTBH considers a patient’s family to be partners in the care of the patient. To this end, spaces are designed to be simultaneously open and private. Several devices are used to achieve this seemingly contradictory objective. The first is natural light, which streams into the public spaces in the facility through abundant windows and vaulted ceilings. Translucent materials were used to create areas of separation without blocking the light. “We ordered 4 x 8 sheets of resin panels in a bear grass pattern, basically tall grass with different variations of length and height, and cut them to size at our shop,” Jones says. The design was also added to some of the nurse stations to counteract the institutional feel of the back-of-house environment. “The panels are aesthetically gorgeous,” Rinehart says, “but they really serve a function to help keep the spaces more intimate for patients and family. As hospitals become more like hospitality spaces, the look of organic materials like HPL, stone, and grass really help to counteract the institutional feel, and that is one of our goals.”

The Result: All these details add up to serve the first tenet of the MTBH vision statement: “The patient is at the heart and center of MTBH. We exist to serve patients. Each one of us at MTBH is a caregiver and plays a role in our healing mission.” That philosophy carries through to the facility itself and the team that carefully developed the healing environment.

Renovation Case Study

Project: Our Lady of Consolation Nursing & Rehabilitative Care Center
Location: West Islip, New York

The Facility: Our Lady of Consolation Nursing & Rehabilitative Care Center was originally constructed in 1975. More than 20 years later, the facility has expanded with 80,000 square feet in additions. It has witnessed several major upgrades designed to improve the health-care built environment for its patients, as well as the unique rehabilitation services provided to its in-house residents and local community members.

The Renovation: In early 2017, Our Lady of Consolation Foundation Board sought out to enhance two areas within the facility that served all residents, visitors, and employees. In order to create a more comfortable and welcoming area for the residents and their guests, the facility built a new coffee shop called the Founders Café. Intentionally renovated with materials that would keep the space bright and cheerful, the layout also included a removal of the solid corridor walls replaced with decorative glass paneled partitions to enrich the pleasant, open, and airy atmosphere.

It was also important to the Foundation Board to have a new space entirely dedicated to employees. The chapel, dining cafeteria, and large group lounge room underwent a conscientious renovation, transforming it into a multifunctional space where employees could quietly enjoy their meals, socialize, and rejuvenate during breaks. To achieve the bright, airy, and functional appeal desired for the space, the café and multiuse employee area utilized high-pressure laminate for the casework, tables, and counter walls, while solid surface bedecked the countertops.

The Results: Since the project’s completion, the Foundation Board has received positive feedback from the residents, staff, and visitors, and there has been a boost to employee morale.