Play it again, Lamb: Former Administrator Skip Lamb donated this piano to Carilion New River Valley Medical Center, a model for hospital design in the new millennium.
Better By Design Virginia's newest hospitals are often its best. Modern facilities capitalize on efficient floor plans, better locations and patient-centered systems.

Skip Lamb spent the better part of 15 years pursuing his dream of designing a hospital that would improve quality and boost efficiency by focusing on patients. His dream came true with the opening of Carilion New River Valley Medical Center in March.

Lamb came by his convictions the hard way, after years of running Radford Community Hospital, a facility unable to expand in its residential neighborhood. After successive renovations, the hospital's layout had become hopelessly inconvenient. Patients were admitted on the third floor, wheeled down to the basement for surgery, then wheeled back to the third floor for recovery.

"The conclusion was pretty obvious to all of us," explains Lamb. "We had a lot of involvement in the decision making — physicians, employees, board members, administrators" before embarking upon the new construction program.

Above all, the facility no longer met its mission at a time when outpatient services are rapidly becoming the norm, and new technologies are dramatically changing inpatient care

"Hospitals have a very short shelf-life," notes Larry Sartoris, president of the Virginia Hospital & Healthcare Association. Hospitals built a half-century ago to state-of-the-art standards are hopelessly out of date today. The labyrinthine corridors that drew patients into wards full of beds and the heavy immovable equipment that made it necessary to transport patients throughout hospitals for X-rays and other tests are no longer necessary. In fact, they are signs of an inefficient facility.

Last year Virginia Business analyzed hospital data from the Virginia Heath Information Foundation and found that hospitals with new facilities generally charged less, discharged patients sooner and even had lower mortality rates. VHI is currently field testing and double checking that data, and scores for individual hospitals should be available in May. But in the meantime the aggregate trend appears to be clear: They just don't make hospitals the way they used to: They make them much better.

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New River Valley Medical Center is as far from the old hospital model as one could imagine. It is a two-story building that sits on 112 pastoral acres adjacent to Interstate 81. Its gray-brown stone walls and central glass atrium give the impression of a spa or a resort.

Within the atrium, a grand player piano — a gift from Lamb — offers continual melody. A waterfall tumbles gently over rocks, and the glass walls invite outsiders to become insiders.

The atrium is more than a source of light. It is also a "wayfinder," according to William "Chuck" Means, senior vice president in the Richmond office of Dallas, Texas-based HKS Inc., the architectural firm that designed the building. HKS also designed Winchester Medical Center in Frederick County, Mary Washington Hospital in Fredericksburg, and the soon-to-be-built Obici Memorial Hospital in Suffolk.

Means explains that atriums help orient visitors to large hospitals. They can see the upper floors and better visualize where they need to go.

Lamb says he "could not be more pleased with the outcome in terms of the physical structure and layout of the hospital. It's brought together the great capability of our employees ... so that we can offer the highest in patient care quality."

The outpatient areas are separated from the 97 inpatient rooms, says Virginia Ousley, who succeeded Lamb as vice president and hospital director. All inpatient rooms are located on the upper floor, while the lower floor is reserved for the busy service areas of the hospital. That means less walking for nurses and more privacy for patients.

It also reflects the $57 million facility's emphasis on patient-focused care. This means that services go to the patient's bedside, instead of the other way round, Ousley says. As much as possible, the design allows electrocardiograms, X-rays, and other diagnostic procedures to be done in the patient's room.

Outpatient facilities also are designed for maximum convenience. Similar services are adjacent to each other, and easily accessed from outside the building. For example, critical-care facilities are across the hall from the emergency room, and the diagnostics area — including the lab, X-ray room, ultrasound and cardiology — backs up to them. The obstetrics unit is adjacent to the operating room, in case there's a need for surgery. The lower level of the hospital also features a center for rehabilitative medicine with three pools and a small indoor track for use in cardiac conditioning.

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Replacement Hospitals often have several things in common, says Sartoris at the Virginia Hospital & Healthcare Association. Hospitals are migrating to large tracts of suburban land adjacent to major highways. Usually they are much larger than the facilities they replace, though they have fewer inpatient beds and greater outpatient capabilities.

Another brand new hospital that fits that pattern is Bon Secours Memorial Regional Medical Center in Hanover County. Opened in May 1998, its 74-acre campus, just off Interstate 95 and Interstate 295, also includes Sheltering Arms Rehabilitation Hospital, two medical office buildings, a radiation therapy center and a urology center.

The $60 million hospital holds 225 beds, compared with the 410 beds its predecessor was licensed for. Yet it draws patients, not only from its old neighborhood, but from as far away as Fredericksburg and Williamsburg, says Jim Goss, a Bon Secours vice president.

The hospital is designed around the concept of "family-centered care," he says, with a "care team" assigned to each patient. The team's responsibilities include helping the patient's family learn more about his conditions and to be prepared to care for him after discharge.

"We recognize as an organization that we don't just care for the patient," says Michael Robinson, the hospital's administrator. "When people are admitted to a hospital, it's either a time of crisis or a time of celebration. All of these events involve the family."

In design terms, that translates into private inpatient rooms that are larger than those they replaced. The rooms are equipped with window seats that double as beds for family members who want to spend the night. Nearby family waiting areas are equipped with showers, kitchenettes and conference rooms where family members can meet privately with physicians.

The hospital also set aside space for a community health information center, where patients and their families can gain up-to-date information about health topics, or watch a video of a procedure to know what to expect.

While some facilities work well together, others are best kept apart. Inpatient and outpatient services at Memorial Regional Medical Center, for instance, are on opposite sides of the building to promote easier access for outpatients and greater privacy for inpatients.

Though "quality" is hard to measure, utilization is not. After one year in business, emergency room visits were up 18 percent compared with the old facility. Outpatient visits rose 17 percent; surgeries increased 30 percent, and 37 percent more admitting physicians have joined the medical staff. Above all, Goss says, the new hospital is enjoying strong support from the community.

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While many new facilities try to blend gracefully into their surroundings, Augusta Medical Center in Fishersville makes no such effort. It's a modern midrise building on 250 rural acres. It's also a monument to the difficulties the hospital's directors faced when they decided to combine two small, independent community hospitals — one struggling, one modestly profitable — at opposite ends of the county.

The 5-year-old facility is licensed for 255 beds. But one reason the board decided to build an entirely new hospital was to facilitate outpatient services that the original hospitals were not designed to accommodate. The new hospital also is attached to a medical office building, which allows physicians and patients to circulate easily from one building to the other on two floors.

Efficiency and quality have improved in the new facility, says hospital spokesman Wayne H. Davis. Both in 1997 and in 1998, two nationally recognized surveys — one by HCIA Inc. and one by William M. Mercer Inc. — listed Augusta Medical Center as one of the 100 best hospitals in America based on nine criteria of performance.

Given that the competition included some of the finest hospitals in the nation, the honor was especially welcome. "It is very gratifying to know that it is not necessary to be situated in a large city or to be part of a big corporation to be one of the 100 top hospitals," said Chairman Jerry Biehn in a press release announcing the recent recognition.

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Hurricane Floyd blasted through Suffolk on the day groundbreaking for the new Louise Obici Memorial Hospital was to take place — 48 years to the day after the original hospital was dedicated.

Floyd forced the postponement of the ceremony, but he failed to dampen the mood of celebration in the Obici community. Located on a 62-acre tract just over a mile from Obici's current location, the new facility will serve the same community that the current hospital does on its 22-acre site near downtown Suffolk. It will continue to draw patients from Suffolk and the rural counties of Isle of Wight, Sussex and Surry.

From the outside, the new hospital has a traditional look that blends with other buildings in Suffolk. But on the inside, the building is designed to deliver modern medicine.

Obici's president and CEO, William C. Giermak, says the hospital's board deliberated for two years before embarking on the $74.6 million construction project. At 284,000 square feet, the facility will be much larger than the existing hospital, and it will have fewer inpatient beds: 124 beds instead of 220.

All inpatient rooms will be private, compared with the semiprivate rooms at the existing hospital. The new facility will neither add to nor reduce the kinds of services Obici now provides, Giermak says. "We will simply be better organized for our growing ancillary services."

Giermak anticipates a reduction in the number of full-time equivalent (FTE) employees after the new Obici opens its doors in 2002. "We should eventually be able to operate with about 4.1 FTEs per adjusted occupied bed compared to 4.4 now."

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Flexibility is the key to modern hospital design, says Bruce Tyler, president of the Richmond architectural firm of Baskervill & Son. "Many years ago, when you designed a radiology suite, you knew it would stay there. But with the changes in health care now, it could be obsolete in two to five years, depending on what new piece of equipment becomes available. You have to have open-ended design."

Baskervill & Son's projects in Virginia include the Gateway Clinic Building at MCV Hospitals in downtown Richmond, as well as additions to MCV's Stony Point Medical Complex, Richmond Community Hospital, Culpeper Memorial Hospital and other facilities around the state.

The need for flexibility affects the design right down to the electrical and mechanical systems, Tyler says. "In the pathology field, equipment is changing very rapidly," Tyler says. "And each new piece of equipment changes the requirements for the HVAC system, so the architect has to be very sensitive to these needs."

At the Virginia Hospital & Healthcare Association, Sartoris says that Virginia "will continue to have new hospital construction because new plans are required to deliver state-of-the-art health care as efficiently as possible."

These trends, together with healthy bottom lines at hospitals and relatively flat construction costs should be enough to keep hospital designers busy well into the next century.