Healthcare Case Study: Making Room To Heal
By Heidi Schwartz
Published in the November 2008 issue of Facility Executive
Ventnor Avenue, Park Place, and Boardwalk—most people recognize these names as part of the real estate trading game known around the world as Monopoly. But these are not just made up avenues and streets; they are part of the infrastructure in a real city that has had its share of ups and downs.
A thriving family resort back in its early days, Atlantic City, NJ gained fame as the summer playground of vacationers from the Philadelphia, PA area. Amusement venues, grand hotels, wide stretches of beach, and one of the longest boardwalks in the U.S. attracted tourists from up and down the East Coast, but by the mid-1960s, the city's fortunes started to slide.
To rejuvenate the fading community, amusements of a different kind were introduced in 1976. Casino gambling was legalized that year as part of a civic revitalization effort, and as a result, the prime real estate along the streets and avenues made famous by the board game went through a significant redevelopment.
One stabilizing element to remain throughout the area's dramatic transformation was Atlantic City Hospital. Founded in 1898 as a 10 bed facility, it got its start in a converted home. Since those modest beginnings, the hospital has grown into the 560 bed not-for-profit AtlantiCare Regional Medical Center (ARMC), which now spreads across two campuses. This world-class healing facility is populated with numerous centers of excellence offering specialty treatment institutes, wellness programs, and other neighborhood services designed to meet the needs of a fluctuating, yet demanding, patient base.
Curving forms and natural light are incorporated throughout—like in this stairway from the lobby to the second floor (center, far left)—along with a collection of pieces (center, left and right) from local artists. (Photo Credit: Jeff Clapp, Creative Director, Group C Media, Inc.)
Mainland Or Downtown?
The most recent addition to the ARMC collection of properties is the George F. Lynn Harmony Pavilion, which is across from Caesars Atlantic City Hotel and Casino on Pacific Avenue. Named in honor of AtlantiCare's former CEO, the seven story patient tower is a $129 million expansion that adds 198,000 square feet to the hospital's facilities on the island (the other campus is just a few miles away on the mainland). In addition to the expansion, ARMC is renovating 23,000 square feet of the original 1959 vintage building.
Several contrasting factors dictated the priorities of the project, which set out to offer modern emergency healthcare services to a diverse community in an environment that would exude and support a sense of harmony and stability. At the head of this challenging project was Margaret Belfield, RN, MSN, vice president and administrator for ARMC City Campus.
Belfield joined ARMC in 1999 as the administrator of the city campus, even before the Harmony project was underway. In addition to serving in administrative leadership roles at several hospitals across the country, she had a background in critical care nursing—making her the ideal person to head up the Harmony Pavilion project that would break ground in September 2005.
Even before the addition was built, "there was a lot of community pride regarding this hospital, even though the facility was getting very old and tired," recalls Belfield. "As the only hospital on the island, there was a lot of pressure: we could either rebuild (because the rooms just weren't contemporary for the patient) or abandon the island and move to our campus on the mainland. The addition of shopping, the Sheraton Convention Center, and new casino towers in the immediate area led to the realization that the island would be the right spot to build a replacement hospital."
A Chat With Margaret A. Belfield
How did your background as a critical care nurse prepare you to run a hospital? As a nurse, you have a tendency to look at a building as a patient. There's plumbing, HVAC, and other systems that all work together, just like a body. And the first time you lose a chiller in a building when it's 90?F out, you start to recognize its meaning in an entirely different way. Even a simple leak could turn into something major.
What did you learn from this project? We originally didn't want to spend the money on mock up patient rooms. I didn't think we had to. But it really saved us in the end, because we got some phenomenal feedback. The clinicians changed where they were putting things, because it didn't make sense once they got in the mock room. It was well worth it.
What is your favorite aspect of this project? Since I come from a critical care background, the Emergency Center is near and dear to my heart. There's also the art program and the family rooms, which both bring warmth and comfort into environments that are typically cold and sterile. The artwork actually increased donations to our foundation. Along with that, I love my grand piano in the lobby. It has brought a lot of pride and it's fun. Besides, no one expects to see a piano in the middle of the Atlantic City hospital. Come to think of it, that piano is probably the least expensive and most appreciated pieces of equipment here.
What changes have occurred in the healthcare industry during your career? The life safety inspections have gotten so much more demanding and sophisticated, justifiably so. All of the disaster preparedness planning is so important, and so is the compliance with life safety and regulatory pieces
Planning for the project began back in 2004. Naturally, the first step was to gain enough community support and funding for the project. Belfield breaks down the details as she explains, "It took a real coalition of people to get this project off the ground. We knew we needed to make it very special. And since this is a safety net hospital (it accepts any patient, including the uninsured), we could tap into our community and government to raise the funds. Some of the money came from AtlantiCare; $15 million came from Atlantic City itself; partial funding for the pedestrian bridge and the heliport came from federal and state governments; and our neighbor, Caesars, bought our little old parking garage. In return, they agreed to give us free gated parking forever in their garage. They also gave us some money towards the building." In addition, the Harrah's Foundation contributed $1 million to ARMC's Special Gifts Campaign to help provide new and enhanced services.
The generous support of so many contributors led to many requests for a seat at the table in terms of planning for the project. Belfied says this added to the excitement, even though achieving a consistent consensus was a little tricky. Three separate committees were formed—healing arts, community advisory, and oversight—in order to expedite each phase of the process.
Finding A Theme
To help gain a cohesive consensus for the project, Belfield called in Aesthetics of San Diego, CA, to select a theme and the feeling for the project. Intense brainstorming or "visioning" sessions (which included all members of the construction team), gave Belfield the framework to start the design process.
During these exercises, "The woman from Aesthetics [a San Diego, CA-based multidisciplinary firm specializing in evidence based healthcare design principles] actually asked us, ‘What did the building need to feel like? What should patients and families feel?' Going through that exercise was a little awkward for some people in the construction team, who were a bit out of their element," she says.
"It was a bit odd," confirms William Kissinger, director of facility services and facility management with Crothall Services Group of Atlantic City, NJ. Kissinger confesses, "We all had to get up and speak about what we felt too. We'd throw out words and concepts, and everything was jotted down."
This free flowing exchange of images and ideas allowed the team to isolate different elements that would satisfy specific goals, such as optimizing windows and natural lighting in an urban environment dominated by tall casinos. "We wanted to bring the outside in with some of our design features," says Larisa Goganzer, who took the role of director of special projects in September 2005 after leading Maternal Newborn Services and the building of ARMC's Center for Childbirth at the hospital's Mainland Campus in Pomona, NJ.
Eventually, the group agreed upon 12 essential concepts the new building needed to convey. And when asked to boil those things down into one simple phrase or thought, the group was able to arrive at a consensus—harmony.
Belfield explains, "We wanted people to walk in and get a sense of harmony, despite the fact we're in a tourist environment with noises and lights 24/7. All decisions regarding the space had to create harmony. We reminded the builders and architects by saying, ‘You were at the visioning; does that feel harmonious?' It was our joke, but that brought it back to our original intent."
Nowhere To Go But Up
Ongoing meetings and community feedback played an essential role in the project right from the start. "It started out as a four story building," Belfield notes. "But the board noted the site was landlocked and told us the minute we opened those four stories it wouldn't be enough. So the construction team started shelling the first two floors, and by the time the planning was complete, those two floors were finished."
Kissinger recalls, "As the steel got higher, it was becoming somewhat dangerous for the emergency choppers to come in. And because the project would essentially box in the old helipad, we had to build the infrastructure (including the elevator shafts) from the top down."
Belfield adds, "We actually got the life safety systems approved for the inside of the building and the elevators, because we needed to open from the new helipad on the top of the building down to the Emergency Center on the ground floor."
"Our goal was to have it open before Memorial Day 2007," Kissinger says, "and the first helicopter landed within 10 minutes of opening that Friday evening. We received 12 flights and saved 12 trauma patients' lives that weekend."
As the project moved along, an "owner" was assigned to each floor of the building. After being trained in "Architecture 101," the owner—someone from outside the building trades and typically with a clinical background—would oversee construction, inspect the site, and verify the progress of the project based on the floor plan. Even though it was a new set of skills for these people, they responded with enthusiasm. "Then when they moved in," Goganzer adds, "they felt much more like they were a part of it."
August 2008 marked the completion of the multi-phased opening of the ARMC City Campus, and in that short time, response from the community has been very positive. Even the casino crowd is impressed.
"There's a positive buzz at community groups or cocktail parties," says Belfield. "The casino executives now say, ‘You've set the standard with the Harmony Pavilion, and we need to meet that.'"
So while casinos and hotels may come and go in Atlantic City, it's a good bet the Harmony Pavilion has permanently secured its spot just off the Boardwalk.
This article was based on an interview with Belfield, Goganzer, and Kissinger.
Name of Facility: AtlantiCare.
Type of Facility: New.
Function of Facility: Hospital.
Location: Atlantic City, NJ.
Square Footage: 204,570 square feet.
Budget: $129 million.
Construction Timetable: September 2005 to October 2007 (with final phase opening August 2008).
Cost Per Square Foot: $485.
Facility Owner: AtlantiCare.
Facility Manager: Margaret Belfield, administrator and vice president, AtlantiCare Regional Medical Center (ARMC) Atlantic City Campus.
Architect: Granary Associates.
General Contractor/Construction Manager: LF Driscoll Co.
Engineering: Highland Associates (Electrical and Mechanical); O'Donnell & Naccarato (Structural).
Designers: Francis Cauffman (Interiors); The Lighting Practice (Lighting).
Landscape Architect: J. Adamson.
Furniture: KI; Softcare from the Nurture division of Steelcase.
Flooring: Armstrong (vinyl); Aztec (epoxy based terrazzo).
Wallcoverings/Textiles: Vycon; Maharam.
Surfacing: Marlite; Corian by DuPont.
Security System: Controlled Access (CA).
Smart Cards: Access/Vision.
Fire Alarms: Honeywell.
Safety Equipment: Rich Fire Protection (sprinklers); Honeywell (strobes).
Exit Signs: Sure-Lite.
Lighting Fixtures: Gotham; Peerless; Lithonia.
Ballasts: Advance; General Electric.
Lighting Sensors: Torx.
Lighting Control Products: Leviton; Pass & Seymour.
Building Management Systems/Services: Honeywell.
HVAC Equipment: York Chillers; Marley Cooling Tower.
Power Supply Equipment: Siemens.
Backup Power: Cummins.
IT Infrastructure: Cisco; Clearcube; Dell; SpaceLabs; Vocera.
Office Equipment: HP; Canon; Avaya.
Roofing System: Carlisle.
Windows: National Glass.
Window Treatments: Standard Textile.
Signage: DMR; Sierra Graphics.
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