BY JENNIFER BOULDEN

Construction cranes, like this one on the UAMS campus, are becoming a familiar sight around the state. Arkansas is seeing a boom in healthcare construction as hospitals are taking on renovation, expansion or new facility projects.

Aging healthcare buildings around the state are receiving more than a half billion dollars of reconstructive surgery.

Across Arkansas, hospitals and clinics are expanding, updating, and in some cases, completely rebuilding their facilities in preparation for greatly increased healthcare demand in the coming decades.

Costs from some of the largest projects at major medical centers — St. Mary's Hospital in Rogers, Washington Regional in Fayetteville, Sparks Regional in Fort Smith, and St. Vincent and UAMS in Little Rock — plus smaller projects at Arkansas Children's Hospital and Baptist Health in Little Rock collectively total more than $600 million to be spent in the next couple of years. That's not including the additions, clinics, and critical care centers being built in many rural communities like Booneville, Danville and Heber Springs.

Steve Kinzler of the Wilcox Group, one of the local architecture firms contracted for UAMS' campus expansion, said that in his 30 years as an architect, healthcare construction has always been strong, but that it's predicted to be its strongest ever for the next 25 years.

UAMS chancellor I. Dodd Wilson, MD, characterized the $350 million UAMS, which includes a new hospital, as a "modest" project. "If you look at Northwestern about five years ago, they built one that was maybe twice the size of this," he said. "So it's not as if this is a huge project for academic health centers, but it's a big one for Arkansas. Just in plain dollars, not accounting for inflation, I suspect it's the biggest."

Kinzler said that of the 103 licensed hospitals in Arkansas, about half of them have been able to gradually expand, update, and "keep up with the Joneses."

"The other half has had a hard time doing this because it's very costly," he said, "So those are the ones that we're now getting phone calls from."

Part of the urgency comes from the much-discussed aging of the baby boomers, which is expected to create unprecedented levels of demand for healthcare as the senior population grows in both number and longevity. The anticipated wave has already begun, said Wilson.

"We are full most of the time," Wilson said. "The 29th of December, for example, we were packed. Ten years ago, we would have furloughed to a third to maybe 40 percent of our staff and closed maybe three or four of our hospital units just because we didn't expect that to happen that time of year. Things are different now."

Exacerbating that problem faced nationwide, Sparks director of marketing and communications Greg Russell said, is a more regional one. "We're located in what we call the 'cardiovascular valley of death,'" he said. "Our incidence of death from cardiovascular disease and stroke are among the highest in the nation, so we have to have the facilities to address that need."

Clark Ellison, spokesman for St. Mary's, said that above and beyond the baby boomers' entering the senior care market, the acute population growth in northwest Arkansas is "a huge concern" for the hospital. That growth necessitated a move from its landlocked, 171-bed facility to a new 200-bed hospital on donated land directly off the busy bypass. The new facility plans include space to expand up to 450 beds as the population growth continues.

Another driver is the emergence of new technology. "By some criteria, healthcare technology changes on average 6.4 times a year," Kinzler said. "We design a new hospital and before the doors open, it's obsolete. So we have to design them to be flexible and expandable as technology changes. That's the biggest design concern now for our clients."

Arkansas' "any willing provider" legislation is also contributing to the construction boom, some hospitals said, as providers are now able to care for out-of-network patients under the same terms as contracted providers. That translates into more reimbursement options for providers and possible increased revenue for facilities. "Hospital construction always follows the trends of their funding mechanisms," Kinzler said.



Private and Universal

Although outpatient services have been on the rise since the 1970s, Kinzler said the current trend is for hospitals to turn their attention to their increasingly outdated inpatient facilities.

Wilson said that the old University Hospital, built more than 55 years ago, has double patient rooms that are smaller than what the State Health Department now requires for a single room. "It's just not sufficient in any way for modern healthcare," he said. "We had to replace that."

The most requested feature their clients want, Paul Gregory, also of the Wilcox Group, said, is all-private, universal patient rooms. He said one of the reasons for it is that, with the increase in outpatient services, the patients who do stay in the hospital are sicker than they were before. "It's just better for them not to have a roommate and to have to try to control infection when there's someone else in the room," he said.

Other drivers he listed were consumer demand for privacy, and HIPAA. "A mandate that patient privacy must be maintained is kind of hard when there's a patient in a bed five feet away from you," Gregory said.

Kinzler added that while it would seem counterintuitive that choosing all-private rooms over semi-private rooms could save hospitals money, their clients have reported that over five years, operations and maintenance costs, are significantly lower. "Even when semi-private rooms are only half full, you have to heat and cool the whole room and when the patient leaves, the staff has to clean and disinfect both beds, everything," he explained. "It's more on the front-end, but all-private rooms are actually a better bargain in the long run."

The "universal room" concept of building spaces large and flexible enough that they can be easily converted to meet the needs of another type of wing down the road is also gaining ground as hospitals update their facilities.

"There's no right way to do it," Kinzler said. "Every group's got to decide what that concept means for them. They really are customized for their location and the unique needs of their patient population."

Wilson said UAMS is applying the concept for a number of areas in the new hospital, including the operating rooms.

He explained, "We put our cardiac interventional but non-surgical and our radiologic interventional all in the same suite with the OR so that in the future if the less invasive procedures become preferred because they don't involve making an incision, then we'll just change the number of rooms that are assigned to one area or another. It's very flexible."



Flow Charts

Wilcox Group architect Jason Landrum said that sort of intentional juxtaposition of departments is happening in a lot of the new construction.

"To some extent, we're beginning to see the traditional departmental separations get a little bit fuzzier," he said. "They're breaking down just to better suit some of the processes that go on in the hospital to make it more efficient and reduce procedure times."

By consciously designing floor plans to put related departments closer to each other, hospitals can promote a more intuitive and fluid passage of the patient through the system, saving time, cost, and increasing patient satisfaction.

Russell explained that because of the way Sparks had been added on here and there throughout the years, the ER and the ICU currently are located on opposite sides of the hospital's city block—one on the basement level, and one on the second floor. "It's kind of a trek, and it hasn't posed a problem for us yet," Russell said, "but having the departments directly connected (as they are in the new plans) will improve patient care. And it just makes sense."

Likewise, Wilson said UAMS' new ER room will be located just off the street, rather in its now rather awkward to reach location deeper in the campus. And Mercy Health of Northwest Arkansas is building a $20 million medical office building next to the new St. Mary's Hospital to more conveniently center patients' healthcare on the campus, reduce transit time between offices and departments, and foster a greater sense of medical community among the staff.

Kinzler said designers see this emphasis on the flow of care even within patient rooms. A growing trend is to place patient's private bathrooms on the exterior wall, so that physicians and nursing staff can more immediately access the patient upon entering the room.



Green, Lighted Projects

Although green, or environmentally friendly, construction is catching fire in larger markets, Kinzler said healthcare clients in Arkansas are more reluctant to sign on for what they expect will be a costlier building. But the industry is starting to change how it makes supplies, using recycled materials in things such as carpet and paint and finish materials. "The construction industry is heading that way, designers are heading that way, so we're offering those choices back to our client and encouraging them to consider them. Often, it doesn't cost the client any more and they are getting greener products."

He said Arkansas hospitals are particularly receptive to the kind of energy conservation that dovetails into other efforts, like making hospital rooms and waiting areas more hospitable to patients and families.

"As designers, we're always trying to get better daylighting and utilize that so you don't always have to have more lights turned on using energy," Kinzler said. "Green in Arkansas is really more conservation and providing as much of the healing environment as possible."

Almost all hospitals are lightening up, he said, as medical centers embrace these less institutional environments. Large windows that diffuse natural light, water elements, courtyards and other green space, muted tones and further efforts to "bring the outside in" are gradually transforming sterile rooms and hallways of old to make the atmosphere more inviting and less stressful for patients and their caregivers.

The effort, Kinzler said, is for the staff as much as for the patients. "Sometimes hospital staffs quite truly never see the light of day, so it's helpful for them to have a pleasant environment as well."

Wilson predicted the nicer UAMS hospital and related campus enhancements would directly increase not only how pleasant a place it was to work or stay, but how effectively faculty could teach and motivate the medical students.

"This will be a not overdone, but very nice facility where people can receive good care and where we can teach the residents and the students in all our disciplines in an environment that really supports the quality of care we want to be modeling," Wilson commented. "In my experience, people live up to the environment they're in."


Aging healthcare buildings around the state are receiving more than a half billion dollars of reconstructive surgery.

Across Arkansas, hospitals and clinics are expanding, updating, and in some cases, completely rebuilding their facilities in preparation for greatly increased healthcare demand in the coming decades.

Costs from some of the largest projects at major medical centers — St. Mary's Hospital in Rogers, Washington Regional in Fayetteville, Sparks Regional in Fort Smith, and St. Vincent and UAMS in Little Rock — plus smaller projects at Arkansas Children's Hospital and Baptist Health in Little Rock collectively total more than $600 million to be spent in the next couple of years. That's not including the additions, clinics, and critical care centers being built in many rural communities like Booneville, Danville and Heber Springs.

Steve Kinzler of the Wilcox Group, one of the local architecture firms contracted for UAMS' campus expansion, said that in his 30 years as an architect, healthcare construction has always been strong, but that it's predicted to be its strongest ever for the next 25 years.

UAMS chancellor I. Dodd Wilson, MD, characterized the $350 million UAMS, which includes a new hospital, as a "modest" project. "If you look at Northwestern about five years ago, they built one that was maybe twice the size of this," he said. "So it's not as if this is a huge project for academic health centers, but it's a big one for Arkansas. Just in plain dollars, not accounting for inflation, I suspect it's the biggest."

Kinzler said that of the 103 licensed hospitals in Arkansas, about half of them have been able to gradually expand, update, and "keep up with the Joneses."

"The other half has had a hard time doing this because it's very costly," he said, "So those are the ones that we're now getting phone calls from."

Part of the urgency comes from the much-discussed aging of the baby boomers, which is expected to create unprecedented levels of demand for healthcare as the senior population grows in both number and longevity. The anticipated wave has already begun, said Wilson.

"We are full most of the time," Wilson said. "The 29th of December, for example, we were packed. Ten years ago, we would have furloughed to a third to maybe 40 percent of our staff and closed maybe three or four of our hospital units just because we didn't expect that to happen that time of year. Things are different now."

Exacerbating that problem faced nationwide, Sparks director of marketing and communications Greg Russell said, is a more regional one. "We're located in what we call the 'cardiovascular valley of death,'" he said. "Our incidence of death from cardiovascular disease and stroke are among the highest in the nation, so we have to have the facilities to address that need."

Clark Ellison, spokesman for St. Mary's, said that above and beyond the baby boomers' entering the senior care market, the acute population growth in northwest Arkansas is "a huge concern" for the hospital. That growth necessitated a move from its landlocked, 171-bed facility to a new 200-bed hospital on donated land directly off the busy bypass. The new facility plans include space to expand up to 450 beds as the population growth continues.

Another driver is the emergence of new technology. "By some criteria, healthcare technology changes on average 6.4 times a year," Kinzler said. "We design a new hospital and before the doors open, it's obsolete. So we have to design them to be flexible and expandable as technology changes. That's the biggest design concern now for our clients."

Arkansas' "any willing provider" legislation is also contributing to the construction boom, some hospitals said, as providers are now able to care for out-of-network patients under the same terms as contracted providers. That translates into more reimbursement options for providers and possible increased revenue for facilities. "Hospital construction always follows the trends of their funding mechanisms," Kinzler said.



Private and Universal

Although outpatient services have been on the rise since the 1970s, Kinzler said the current trend is for hospitals to turn their attention to their increasingly outdated inpatient facilities.

Wilson said that the old University Hospital, built more than 55 years ago, has double patient rooms that are smaller than what the State Health Department now requires for a single room. "It's just not sufficient in any way for modern healthcare," he said. "We had to replace that."

The most requested feature their clients want, Paul Gregory, also of the Wilcox Group, said, is all-private, universal patient rooms. He said one of the reasons for it is that, with the increase in outpatient services, the patients who do stay in the hospital are sicker than they were before. "It's just better for them not to have a roommate and to have to try to control infection when there's someone else in the room," he said.

Other drivers he listed were consumer demand for privacy, and HIPAA. "A mandate that patient privacy must be maintained is kind of hard when there's a patient in a bed five feet away from you," Gregory said.

Kinzler added that while it would seem counterintuitive that choosing all-private rooms over semi-private rooms could save hospitals money, their clients have reported that over five years, operations and maintenance costs, are significantly lower. "Even when semi-private rooms are only half full, you have to heat and cool the whole room and when the patient leaves, the staff has to clean and disinfect both beds, everything," he explained. "It's more on the front-end, but all-private rooms are actually a better bargain in the long run."

The "universal room" concept of building spaces large and flexible enough that they can be easily converted to meet the needs of another type of wing down the road is also gaining ground as hospitals update their facilities.

"There's no right way to do it," Kinzler said. "Every group's got to decide what that concept means for them. They really are customized for their location and the unique needs of their patient population."

Wilson said UAMS is applying the concept for a number of areas in the new hospital, including the operating rooms.

He explained, "We put our cardiac interventional but non-surgical and our radiologic interventional all in the same suite with the OR so that in the future if the less invasive procedures become preferred because they don't involve making an incision, then we'll just change the number of rooms that are assigned to one area or another. It's very flexible."



Flow Charts

Wilcox Group architect Jason Landrum said that sort of intentional juxtaposition of departments is happening in a lot of the new construction.

"To some extent, we're beginning to see the traditional departmental separations get a little bit fuzzier," he said. "They're breaking down just to better suit some of the processes that go on in the hospital to make it more efficient and reduce procedure times."

By consciously designing floor plans to put related departments closer to each other, hospitals can promote a more intuitive and fluid passage of the patient through the system, saving time, cost, and increasing patient satisfaction.

Russell explained that because of the way Sparks had been added on here and there throughout the years, the ER and the ICU currently are located on opposite sides of the hospital's city block—one on the basement level, and one on the second floor. "It's kind of a trek, and it hasn't posed a problem for us yet," Russell said, "but having the departments directly connected (as they are in the new plans) will improve patient care. And it just makes sense."

Likewise, Wilson said UAMS' new ER room will be located just off the street, rather in its now rather awkward to reach location deeper in the campus. And Mercy Health of Northwest Arkansas is building a $20 million medical office building next to the new St. Mary's Hospital to more conveniently center patients' healthcare on the campus, reduce transit time between offices and departments, and foster a greater sense of medical community among the staff.

Kinzler said designers see this emphasis on the flow of care even within patient rooms. A growing trend is to place patient's private bathrooms on the exterior wall, so that physicians and nursing staff can more immediately access the patient upon entering the room.



Green, Lighted Projects

Although green, or environmentally friendly, construction is catching fire in larger markets, Kinzler said healthcare clients in Arkansas are more reluctant to sign on for what they expect will be a costlier building. But the industry is starting to change how it makes supplies, using recycled materials in things such as carpet and paint and finish materials. "The construction industry is heading that way, designers are heading that way, so we're offering those choices back to our client and encouraging them to consider them. Often, it doesn't cost the client any more and they are getting greener products."

He said Arkansas hospitals are particularly receptive to the kind of energy conservation that dovetails into other efforts, like making hospital rooms and waiting areas more hospitable to patients and families.

"As designers, we're always trying to get better daylighting and utilize that so you don't always have to have more lights turned on using energy," Kinzler said. "Green in Arkansas is really more conservation and providing as much of the healing environment as possible."

Almost all hospitals are lightening up, he said, as medical centers embrace these less institutional environments. Large windows that diffuse natural light, water elements, courtyards and other green space, muted tones and further efforts to "bring the outside in" are gradually transforming sterile rooms and hallways of old to make the atmosphere more inviting and less stressful for patients and their caregivers.

The effort, Kinzler said, is for the staff as much as for the patients. "Sometimes hospital staffs quite truly never see the light of day, so it's helpful for them to have a pleasant environment as well."

Wilson predicted the nicer UAMS hospital and related campus enhancements would directly increase not only how pleasant a place it was to work or stay, but how effectively faculty could teach and motivate the medical students.

"This will be a not overdone, but very nice facility where people can receive good care and where we can teach the residents and the students in all our disciplines in an environment that really supports the quality of care we want to be modeling," Wilson commented. "In my experience, people live up to the environment they're in."


February 2007