Healthcare Case Study: Moving Forward
By Anne Vazquez
Published in the May 2010 issue of Today’s Facility Manager
Maintaining the exacting standards required in a healthcare setting calls for knowledge, diligence, and the right equipment for the job. From the facility management (FM) standpoint, this goal involves providing a safe and comfortable environment. When the new Gateway Medical Center in Clarksville, TN, opened in mid-2008, Mike Holzkamper, director of plant operations and security there, was more than ready to meet these goals.
This state of readiness was largely due to improved wayfinding that benefits all types of occupants, as well as a building management system (BMS) that equipped Holzkamper and his staff with the ability to operate the 510,000 square foot facility with greater ease than in the past.
The previous Gateway Medical Center was located several miles away in a building constructed in the 1950s. As the primary healthcare facility in a rapidly growing region (providing care in 33 specialties), the time had come for the facilities to be drastically overhauled. And it was decided by hospital leadership not to upgrade the existing facility; instead a new hospital would be built.
“There had been many additions and renovations to our old building,” says Holzkamper, who has worked at the hospital for 20 years. “It was not a modern day concept. In our building now, there is much more efficiency in the way the departments are laid out and how people travel through it.”
Beyond wayfinding, other prohibitive conditions included restrictions on facility growth, small patient rooms, and aging technology. Moving to the 60 acre parcel of land it now occupies provided Gateway the room to expand in the future. Meanwhile, patient rooms were outfitted with amenities to make stays more comfortable and designed to accommodate the latest medical technologies.
That focus on aging technology also applied to the building systems that Holzkamper oversees. Therefore, including state of the art mechanical and electrical systems and an upgraded BMS were major pieces of the project. This would not only ensure the hospital provided an optimal indoor environment for patients, but it also equipped the FM staff with the tools necessary to operate this complex facility.
These new capabilities involve an integrated BMS that enables the FM team to identify, diagnose, and solve any problems one or more building systems may be having. As Holzkamper points out, the system has provided a way to monitor and address operational issues (planned or not) in less time and with more flexibility.
“It saves time and money,” he says of the BMS. “When we have a comfort failure, we can go to one of our computers and look at all the building systems to see what’s going on before we physically travel to the system to try to fix it. This has increased the satisfaction of both our patients and staff.”
A Comfortable Place
In designing the new hospital, the project team was striving to provide the most comfortable patient experience. In considering programming options, the architectural firm Gould Turner Group of Nashville, TN reviewed several hospitals around the country. Ultimately, the new facility was modeled after a Texas hospital that addressed the main issues with which the Gateway team was concerned. These included ease of navigation through the building and room for future growth in an organized fashion.
As a result, all primary outpatient services were located directly inside the main entrance in a large rotunda. And emergency services were located adjacent to the main entryway.
Beyond the circular rotunda, the building’s footprint mimics a “T” shape—a configuration repeated above, on all five floors of the hospital. (The top of the “T” runs along the face of the hospital, where the main entrance is located.) Departments that handle heavy traffic, such as operating rooms and radiology, as well as support services, such as kitchen and dining areas, pharmacy, and FM were sited on the first floor.
The entire site concept was developed with identification and access of wayfinding as a primary driver. This was especially important, since Gateway provides the gamut of healthcare specialties, and this new building would bring several of the hospital’s departments back under one roof. These additions included outpatient rehabilitation, the breast health center, and the business office, explains Holzkamper.
The hospital contains 270 beds, 12 operating rooms, a fully equipped imaging department, and an emergency room with 38 exam rooms. For patient rooms and some common spaces, bringing in natural daylight was a priority. (The Center for Health Design has reported that patients in brightly lighted rooms have a shorter length of stay, and those exposed to increased intensity of sunlight experience less perceived stress and had 20% less pain medication costs.)
The windows at Gateway are capable of keeping out solar heat in the summer months, and in patient rooms, these were outfitted with blinds between the panes. Cleanliness is improved by siting blinds between the glass, and the blinds also give patients more control over the amount of light entering their rooms.
To safeguard patient spaces—along with the rest of the hospital, one component of the physical security program is an electronic card system for employees. This not only limits where visitors can go in the hospital, but card access is also customized to determine where employees travel.
Says Holzkamper, “We can also allow an individual in for a certain part of the day, and after hours, we can shut his or her access off to those spaces. We have complete control of our secure and sensitive areas with this system.”
A Chat With Mike Holzkamper, director of plant operations and security, Gateway Medical Center
What are your responsibilities at Gateway Medical Center? I am the director of plant operations and security. I am responsible for the day to day operations of the hospital. As part of that, my job involves making decisions on what products and services we use. I evaluate vendors for our contracts—for elevator and fire alarm service, for instance—to decide which ones will be best for the hospital. Every day is different; there’s something new every day.
How long have you worked at Gateway Medical Center? How long have you been in the facility management profession? I’ve worked for the hospital for 20 years with nine in my current position. I’ve been the industry for 20 years overall.
What changes have you seen in the facility management profession during your career? One major change has been the significant focus on being more energy efficient. We’ve always looked for ways to save on utilities costs, but now we look at how to save all the way around.
In terms of building materials, we now specify the use of paperless gypsum board for all facility projects. It’s standard for this hospital. In the past, many facilities were building with drywall and then wallpaper along outside walls. The resulting moisture provides a perfect place for mold to grow. Now we specify paperless gypsum. We don’t use wallpaper anymore either; we paint instead.
Getting It Done
Construction began on the new Gateway facility in August 2006, and for the next 22 months, Holzkamper served as the hospital’s liaison on the project. This role included communicating with the construction management firm, BE&K Building Group of Charlotte, NC. “There was a project manager overseeing the process,” he explains, “but as the liaison, I was there several times each week. In the beginning stages, it was once or twice a week, but as construction progressed, I spent more time on-site. I also attended the monthly meetings, which became weekly meetings later in the schedule.”
As moving time neared, Holzkamper brought Gateway department heads into the meetings to make sure their spaces were outfitted to their specifications. “We [included them in those meetings] in order to address any problems or changes before we began the physical moving process from the old building,” he explains. The building was completed and ready for occupancy on schedule.
From his vantage point, Holzkamper points to the BMS as one of the standout features of the new Gateway facility. The ability to troubleshoot and fix equipment issues, along with access to much more operational data than previously available has been a boon for him. “This system is tied into all the utilities plus all the internal comfort systems. It monitors our incoming electric and water, and it collects data about our chillers and boilers—as well as the auxiliary equipment,” he says.
Holzkamper continues, “The old hospital wasn’t very energy efficient. And emphasis in planning this facility was that it would be efficient, with the goal of saving money and energy. We had a BMS in the old building, but it did not have all the capabilities we have now.”
For instance, the previous BMS did not allow for scaling back equipment operation automatically. “We’d turn on a system, and it would run all the time, no matter the demand,” Holzkamper says. “The new system backs off when a system doesn’t need to run at full capacity.”
Speaking on the BMS’ role in infection control measures, Holzkamper says, “There is at least one isolation room on each patient floor; some areas have two. These rooms are tied into the management system, so if there is a problem with the air exchangers [in an isolation room], the system alerts us automatically. We check these things on a monthly basis, but it helps to have the system tied into those isolation rooms.”
Nearly two years on, Holzkamper and his team are enjoying the benefits of a streamlined facility layout as well as the control their BMS affords them. This helps him in his work presently (“We don’t have as many calls daily on our comfort items from the patients and staff,” he shares), and it is expected to aid operations when the need for expansion arises. “Everything was designed with future growth in mind, from the parking lots to service areas to nursing units,” says Holzkamper. “The 60 acre campus allows for a 30% future facilities expansion.”
The back side of the hospital is where a major expansion would most likely occur. “If we decide to expand, we can build along that side, transforming the ‘T’ shape of the building into an ‘H’,” explains Holzkamper. “We could have five new floors along the whole length of the hospital.”
If the past decade is any indication, Gateway will put that potential space to use in the coming years. Population growth in Montgomery County, in which the city is located, has increased an estimated 18% since 2000 (from 134,768 in 2000 to 160,120 last year).
In anticipation, the 2008 construction included putting in utilities infrastructure large enough to accommodate such an expansion. “We’re only using part of the 60 acres,” says Holzkamper. “We have built an MOB [medical office building] since we moved in, and we have room for two more.” With the long-term planning in sight, the day to day operations at the new Gateway are under control.
This article was based on an interview with Holzkamper. To learn more about the new Gateway Medical Center and its facilities, visit www.TodaysGateway.com.
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Name Of Facility: Gateway Medical Center. Location: Clarksville, TN. Function of Facility: Acute inpatient care hospital. Type of Project: New construction. Facility Owner: Community Health Systems. In-House Facility Manager: Mike Holzkamper, director of plant operations and security. Construction Timetable: April 2006 to June 2008. Square Footage: 510,000. Budget: $200 million. Cost/Square Foot: $392. Architect/Interior Design: Gould Turner Group (including interior design, Tracy Rives). General Contractor/Construction Manager: BE&K Building Group. Electrical/Mechanical Engineer and Lighting Designer: TLC Engineering Group, Inc. Structural Engineer: Structural Design Group. Landscape Architect: Littlejohn Engineering. Other Consultants: MechTech Inc. Services.
Furniture: Steelcase. Flooring: Armstrong; Forbo; Louisville Tile; Mannington; nora; Shaw. Carpet: Bentley. Ceilings: Armstrong. Paint: Pittsburgh Paints; Sherwin-Williams. Acoustics/Sound Masking: 3M. Building Management System/Services: Trane. Security System Components: Lenel. Fire Alarm Components/ Safety Equipment: SimplexGrinnell. Lighting Products: Lithonia. HVAC Equipment: Trane. Power Supply Equipment (including back up power): Kohler. Roofing: Cornell Roofing. Signage: Signcraft, Inc. Windows: Wausau Window and Wall Systems. Window Treatments: Standard Textile. Elevators: Dover.
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