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When Providence Health System completes the $143 million expansion of its Holy Cross Medical Center in Mission Hills, CA in 2010, it will be one of the largest, most efficient and environmentally friendly healthcare facilities in Southern California. It will also be one of the busiest.

“We are in dire need of space for patient and diagnostic services,” said Waldo Romero, director of facilities services for Providence Health System Southern California Region. “This expansion is of the utmost importance for the community.”

Indeed, with 1,450 employees and 500 medical staff, the 186,000-SF, 255-bed Providence Holy Cross Medical Center is already the second busiest private trauma facility in Los Angeles County, according to hospital administrator Kerry Carmody. Its expansion is urgently needed to take up some of the slack created by the closure of several other hospitals in Los Angeles County in recent years, including the 155-bed Granada Hills Community Hospital in 2003 and the 209-bed Sherman Way Campus of Northridge Hospital Medical Center in 2004.

The four story tower addition to Providence Holy Cross Medical Center qualified for Leadership in Energy and Environmental Design (LEED) certification for various sustainable design elements.

Los Angeles County lost 10 percent of its hospitals between 1997 and 2002 and nine additional acute care facilities have closed since then, according to a study published in the July 2006 issue of the Journal of Health Economics.

Several hospitals closed because they could not afford to comply with California’s new seismic retrofit requirements, some of which take effect by 2008, while others could no longer afford to operate for financial reasons.

While there is an obvious sense of urgency behind the expansion of Providence’s Mission Hills facility, its administrator, facilities managers, doctors, and support personnel have taken the time needed to design a facility they believe will set new standards for efficiency and sustainability in Southern California.

The four-story tower addition on the south side of the hospital will house an expanded women’s services department, including labor and delivery rooms and a neonatal intensive care unit, as well as general acute care services. It will also include surgery, recovery and endoscopy rooms; an intensive care unit; a spiritual care chapel; lobby areas; and dining facilities.

The building also qualified for Leadership in Energy and Environmental Design (LEED) certification for various sustainable design elements, including:

• Landscaping, site paving, and roofing to reduce the “heat island effect,” lowering outdoor temperatures, thereby increasing comfort and reducing energy costs.

• Water-efficient irrigation.

• High-performance glazing and increased insulation to reduce energy costs and provide a more comfortable indoor environment.

• Energy-efficient central plant.

• High-efficiency “super” T8 fluorescent lighting.

• Low-emitting materials to improve indoor air quality.

• Construction and demolition waste recycling.

• Construction-phase indoor air quality plan.

The tower addition also qualifies for design incentives from Southern California Gas Company’s Savings by Design program for employing energy-efficient mechanical, lighting, and building envelope strategies.

In addition, the new tower will feature many additional attributes geared toward improving employee efficiency while benefiting patient healing. These include:

• Identical patient rooms to increase patient and staff safety.

• Separation of staff and patient circulation for efficiency and comfort.

• Centralized lobbies, entries, and cafeterias that promote wayfinding.

• High quality interior finishes that offer a comforting residential look and feel.

• A fourth floor that could be built out at a later date, depending on Providence’s needs and budgetary abilities.

Designing a hospital expansion of this magnitude was a unique challenge for Providence’s facility managers. Working in concert with the Pasadena office of HMC Architects proved effortless; teams worked through the design process easily and with a higher degree of input than the client ever expected.

“In my past experience, the architect tells you ‘This is the building’ and ‘This is how it’s going to be.’ HMC wasn’t like that,” said John Ramirez, director of facilities and support services for Providence Holy Cross Medical Center.

HMC, in fact, spent eight months gathering information from Providence facilities managers, doctors, nurses, and other support personnel before beginning the actual design work for the hospital addition.

“The first thing we do is host work-shops that are geared toward establishing the client’s project vision and guiding principles,” said Joe A. Kragelund, AIA, HMC’s project director, adding, “Our methodology is not so much about telling them what the project will be, but walking them through team building exercises. We try to extract information and help them assemble it into a format that makes sense.”

HMC worked closely with Providence to establish separate “user groups” that could offer their input on specific aspects of the hospital addition. These groups, which included facilities managers, department heads, doctors, nurses, and other support staff, focused on a variety of design issues that would need to be addressed to maximize the efficiency of the tower addition. User groups were organized to address specific issues involving:

• Utilities, including low voltage utility systems, such as fire alarms, nurse call systems, telephone networks, and pneumatic tube systems

• Vertical and horizontal pedestrian traffic, such as the interaction between patients, hospital staff, environmental services, and delivery personnel

• Materials storage and environmental services

• The medical/surgery unit

• The intensive care unit

• The operating room

• Women’s health

• Labor and delivery

These user groups typically met twice a month for eight months to identify specific changes and improvements that they would like to have incorporated into the tower addition.

“Our goal is always to fix what doesn’t work, and to leave what does,” said HMC’s Kragelund. He also noted that all recommendations made by the user groups were approved by the hospital administrator and cross checked with the original guiding principles and project vision set forth during the initial meetings with Providence doctors and staff.

Ramirez said the design process was complicated by the fact that the new tower was being added to an existing facility, rather than being built as a standalone addition. “This meant we had to go through the process of looking at the existing facilities to see if they would support the structure of the new building,” Ramirez said, adding, “A lot of what everybody sees is the front, the new building, the colors, the finish. But the back side, how you process the materials, the patients, how you move the goods, that is just as important as the public or community image.”

Consequently, after reviewing the requirements of the new structure, the utilities user group recommended that new wiring and utilities be installed so that the new facility could support the existing facility in the event of a power outage.

“When some utilities fail, our goal is to ensure that those two buildings will support each other,” said Soria. “So while the south tower is attached mechanically or ‘utilitywise,’ it will be independent. It’s going to have its own chiller and its own emergency generators. Previously, there was no backup system like that,” Soria said.

The user groups recommended a number of other improvements over the existing facility as well, including:

• Rooms with greater working and storage space. “The existing building didn’t program enough room for storage, for nursing stations or utility rooms, for restrooms, or for lockers,” Ramirez said.

• More electrical and data outlets for equipment, facilitating maneuverability from one section of the hospital to another and increasing flexibility. “Right now,” Ramirez said, “we don’t have the connections to take care of intensive care patients in med-surgery rooms. The rooms must be able to accommodate all the equipment, including Internet connections, IT systems, medical equipment connectivity, a PCA pump, and a ventilator.”

At the time of this writing, the tower addition to Providence Holy Cross Medical Center had just been submitted to California Office of Statewide Planning and Development (OSHPD) for review. According to Carmody, the hospital’s administrator, preliminary indications were not only that the facility would be built on time, but that Providence would need to build out the fourth floor soon after the tower is completed.

“In 2006, our average daily census has been above 90 percent of capacity, which means we’re basically full each day,” Carmody said, adding, “There are no additional beds being built in the San Fernando Valley at this time. We’re building this addition to meet that community need.”

Based in Ontario, CA, Pam Maynard, CID, is a Principal and serves as the director of interior design at HMC Architects. Corazon Roush, Associate, AIA, AICP, is a senior healthcare planner in HMC’s San Diego office. They can be reached directly at pmaynard@hmcarchitects.com , and croush@hmcarchitects.com , respectively. For more information about HMC, please visit www.hmcarchitects.com.

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