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University Hospitals Ahuja Medical Center opened in Beachwood, Ohio, with a seven-story inpatient bed tower in 2011. Their facility master plan included two expansion phases to increase inpatient beds from 144 to 600. However, when Phase 2 began in June 2016, project team quickly realized that details had to shift as soon as details had started to surface.
Since Ahuja opened, its emergency department had outgrown its space as many nearby hospitals discontinued offering emergency care services and as other practices like UH’s sports medicine program were formed from emerging needs within the community. Instead of adding another tower on campus to accommodate more inpatient beds, designers were forced to shift towards an ambulatory focus instead.
Completed in late June, the $236 million project added two new buildings on the existing Ahuja campus: Drusinsky Sports Medicine Institute–with multisport field house on its first floor and orthopedic exam rooms and dedicated men’s health center–and a 221,340-square-foot South Pavilion which houses expanded emergency departments, breast health centers and outpatient surgery, outpatient surgery as well as labor and delivery on its three floors.
“The second phase didn’t turn out as planned; instead it has evolved gradually to meet community needs,” states Percival I. Kane Jr., chief operating officer at UH Ahuja Medical Center. Healthcare has trended away from inpatient beds towards an ambulatory space and this trend can be found here too with almost everything added being of that nature.
Phase 2’s centerpiece is the Drusinsky Sports Medicine Institute, home of UH’s sports medicine program since 2014. Since that time, this institute has expanded to offer full team physician coverage for the Cleveland Browns as well as partner with over 75 schools throughout Northeast Ohio for students “from peewee to pro.” As their tagline states:
“We were integrated in the community but very dispersed,” according to Dr. James Voos, chair of orthopedic surgery at UH and head team physician for Cleveland Browns. “The new space enabled us to bring all aspects of the program together more effectively.”
“Our entire goal with this building was not for it to look like a health facility,” Voos explains, “but for it to resemble an arena.”
Addition of a Field House on a Medical Campus Driven by their vision to incorporate sports facilities into healthcare environments, HKS (New York), which served as lead architect and interior designer on this project, devised an original solution rarely seen elsewhere: an expansive field house as the centerpiece of their new expansion. “No other hospital we know of has one,” comments Lynne Rizk of HKS New York – their partner health practice leader said that this unique structure was unlike anything they had seen previously.
The design team considered several locations for massing the sports facility–directly attached or beneath the pavilion, in other corners of campus, or as a freestanding building. In the end, they decided on building the sports medicine institute as a separate building to set it apart visually while connecting it via second-floor skywalk with hospital pavilion.
“This building’s physical separation from the hospital was intentional to give an impression that you are entering a sports facility instead of an institution,” Voos noted.
Field house requirements gave this sports medicine facility an imposing appearance. Massive ceiling heights were necessary to accommodate half a football field, partial basketball court, batting cages, track and field surfaces and ballet bars (UH Sports Medicine provides medical services to the Cleveland Ballet along with Lake Erie Monsters ice hockey team which Kane claims remains as one of the few specialty sports surfaces they haven’t yet integrated).
Sports-inspired atmosphere pervades every level of this facility by emphasizing the arena as the focal point. On the ground floor, physical therapy lab opens directly onto the field through partitioned accordion glass walls for patients’ rehabilitation needs; waiting rooms on all floors offer views over this activity to keep patients active and engaged with rehabilitation activities taking place at ground level.
Voos states, “Our hope is for athletes to see other people working out and moving as it provides them with a psychological motivational tool to return out onto the field,” Voos explains.
Drusinsky Sports Medicine Institute was designed with an aim of being welcoming not just for athletes in pain or injury, but for healthy people as well. Kane refers to these people collectively as “patrons” rather than patients. UH identified that in order to reach its vision of men-centric healthcare delivery they needed to make extra efforts at recruiting male patrons as men are typically less likely to seek healthcare than women.
“Our goal was to be proactive about engaging this population, since men tend to avoid visiting doctors regularly,” Kane states.
The University Hospitals Cutler Center for Men on the third floor of the institute introduces a novel model of care by offering comprehensive men’s healthcare, including primary care, urology, digestive services, behavioral services and cardiovascular medicine.
To encourage men to come in for these services, the space was designed to feel more like a men’s lounge than a medical facility. For example, the waiting room features a pool table and foosball table as well as multiple seating options from comfortable lounge chairs to stadium seating overlooking the field.
Snacks and drinks are available for sale in an amenities nook called Skybox Lounge, which continues the industrial aesthetic established at Ahuja Hospital with white subway tiles, black steel furniture and natural wood finishes.
On this floor, guests won’t find a traditional reception desk; rather, patients will be met by a concierge as soon as they step off of the elevator and checked-in via kiosk to help navigate healthcare services within and beyond this facility.
Planning for Ambulatory Care Services
Though the sports complex stands as a centerpiece for campus, planning for Ambulatory Care Services required careful consideration from designers of the new South Pavilion as well. While originally envisaged as a bed tower design, ambulatory programs like emergency and outpatient surgery would necessitate horizontal adjacencies with existing departments.
Emergency departments need access to imaging directly; so one solution was placing the new pavilion on the south side rather than north of an existing hospital, providing better access without duplicating costly services.
The new Emergency Department on the first level of South Pavilion nearly doubles in size, adding 43 beds – 36 treatment rooms, five fast-track rooms and two trauma bays- while 22 original beds became short-stay observation units. According to Kane, “This change allows our overall hospital throughput to become more efficient as you’re no longer taking up beds that sicker patients may require just for overnight observation.”
By placing the expanded surgical suite on the second-floor pavilion, its location allowed for seamless connectivity to the existing hospital through a semi-restricted corridor and allowed it to add eight new ORs sized specifically to incorporate cutting edge technologies.
“We recently purchased six robots to assist with total joint replacement surgeries, which our prior rooms would not accommodate for,” Voos says. “These rooms were specifically built knowing new technology will be introduced into operating rooms.
Kane points out that Phase 2 expansion also included adding two C-section-specific operating rooms on the third floor of Steve and Loree Potash Women & Newborn Center; effectively increasing from 10 to 20 ORs across campus. Furthermore, nine labor and delivery rooms and a neonatal intensive care unit with 12 private rooms make up this center which features additional inpatient expansion space; they are the sole inpatient additions from this expansion effort.
Maximizing Green Spaces
Outdoor spaces were an integral component of the expansion project, not only providing views but also offering fresh-air respite spaces for patients and providers alike. After considering different massing options for each building in the expansion plan, designers ultimately chose structurally isolating both South Pavilion and Sports Medicine Institute from one another to maximize green spaces and window coverage surrounding both structures.
Rizk describes that, to preserve daylight and create an appealing courtyard space that could offer respite for staff members, they pulled apart by approximately 40 feet the buildings. “By doing this,” she adds, “we didn’t block existing windows and could maintain daylight levels while creating an attractive, landscaped courtyard that offers respite for staff.”
Windows along the second-floor corridor that links all buildings on campus offer stunning views of the surroundings, such as landscaped retention ponds with walking trails at the northeast corner. Patients and visitors can access this green space from within existing hospital cafeteria; initially slated as site of Phase 2 expansion by designers until realizing how crucial this green space was to staff and patients alike.
Rizk notes, “they didn’t want to give up any greenspace, so now it is kind of sacred land. To honor their wishes we opted not to build there.”
At each facility, expansive windows offer patients and providers ample natural sunlight as well as stunning views of the outside world.
“Most staff spaces at Voos’ hospital are windowed,” Voos remarked, noting how operating rooms feature large breakrooms with windows that let in natural sunlight – perfect for taking a breather during long shifts in an operating room.
Lessons in healthcare master planning Recognizing that much has changed in healthcare since designing Ahuja hospital’s greenfield site 12 years ago, Voos and his team approached Phase 2 with future flexibility as their main priority. “We didn’t want to build just for today; rather we wanted a building that will still meet needs 10 years from now,” Voos noted.
Kane points out that the imaging department in the sports medicine institute currently houses one MRI machine but was designed with additional capacity in mind, according to Kane. Furthermore, new operating rooms (ORs) were constructed larger than necessary so as to accommodate bigger equipment later – only four out of eight initially opened their doors; another four are shelled over. Furthermore, South Pavilion construction included stub columns to support weight on vertical expansion plans.
Phase three could add even more ambulatory programs and services to the Ahuja campus as its needs evolve. Sitework such as drainage has already been prepared for Phase 3 expansion; any future additions likely require parking garages as existing parking capacity has reached capacity.
Rizk cautions not to view the master plan as the ultimate blueprint. Although we used many elements from it when evaluating programs for subsequent phases, when reviewing such large and complex endeavors it is crucial that one takes a step back, looks at the larger picture, and ensures there will be room for future growth without impeding upon existing plans.
Brooke Bilyj is a freelance writer and owner of Bantamedia in Cleveland. You can reach her at brooke@bantamedia.com.
