In 2001, two Moon Mayoras projects were featured in the Washington/Oregon Healthcare Construction Review. Three Rivers Community Hospital, located in Grants Pass, Oregon and owned by Asante Health System, is a modern facility designed to replace two aging facilities built in the 1960s. The approximately 196,000-square-foot facility cost approximately $34 million and took just shy of two years (23 months) to construct. The Washington/Oregon Healthcare Construction Review also featured Legacy Health System’s Legacy Meridian Park Hospital, located in Tualatin, Oregon. Moon Mayoras designed a $22 million expansion and renovation to a variety of departments in the 101,060-square-foot facility while maintaining hospital operations. The publication text for each project reads as follows:
Three Rivers Community Hospital
Three Rivers Community Hospital in Grants Pass, Ore., may be a prototype for all hospitals in the future because it’s going to be so outpatient and public friendly, said Douglas A Mayoras, AIA, ACHA, principal with Moon Mayoras Architects, Inc. the project’s architect. This new three story, 196,000-square-foor facility is designed to replace two facilities owned by Asante Health System. The two facilities have been in operation since the 1960’s and a comprehensive study showed that a new facility would be more viable in terms of both patient care and costs.
Three Rivers is very outpatient oriented. Upon entering the facility, patients and visitors are greeted by a fantastic lobby. A dining are, a resource center and gift shop area are also located in the lobby. Outpatient functions, such as patient registration, presenting, imaging and emergency services are accessible from this 300-foot-long, 30-foot-wide, two-story atrium area on the first floor. The emergency services department is located at the north end of the lobby and separated by a pair of controlled doors. A dedicated patient elevator at the ambulance entrance transports a patient directly to the critical care unit (CCU), surgery and/or a patient room. There is also direct admittance from the emergency room.
The surgery department is located on the second floor. “Surgery literally in the middle of the building,” Mayoras said. ” It’s kind of the heartbeat of the building and it’s centrally located because so many things intersect with it. So, we put it right in the middle to make it equidistant.” Critical care, short-stay and birthing areas are among the services surrounding the surgery center. Three triage positions; seven Labor/Delivery/Recovery/Postpartum (LDRP) rooms; and four Post-op/C-Sections rooms are located within the family birthing center. The LDRPs provide an extended window element that creates rhythm and interest to the bay-like east façade.
Three waiting areas on the second floor are suspended over the first-floor atrium. The outpatient waiting room is very open, while the surgery waiting room is slightly more private, although still in the middle. a CCU waiting area is at the far end of this second-floor lobby area and is the most private. All through these lobby spaces are two-story expanses of glass that provide breathtaking views of the mountains beyond. The third floor, the inpatient area, offers privacy and provides a tranquil environment for patients with extended stays.
Expanding Three Rivers in the future can easily be done. The 98-bed facility is built on 18 of 44 acres of purchased land, providing ample room for expansion. The amount of land and design of the facility allows it to be doubled in size. “We left them enough space to duplicate their chassis. When I say chassis I mean they can duplicate approximately 150,000 square feet,” Mayoras said. The option of adding 17 beds is already in place through the use of built-in shell space. When the need arises for more beds, the space is already there. All that needs to be done is tenant improvement build-out for beds.
The utility services, the central power plant servicing the facility would only need an additional boiler and generator to provide adequate service if the building were to be doubled in size. As an additional feature, “we located the central plant 120 feet away from the building and made a link, so [it] will never have to be moved again,” Mayoras said. Originally, the facility was to be placed on a 10-acre parcel that did not allow for growth. Instead, the owner chose a different site that would accommodate expansion. Three Rivers is designed to be a 50-year hospital, meaning it should not need to be replaced for 50 years. Ultimately, the chosen site will allow this to happen.
After the site as chosen, the team utilized a fast-track approach to constructing the facility. “The concept of fast tracking allowed us to start the project at a time of the year that was advantageous as far as weather conditions,” said Jerry Grogan, director of healthcare construction with Andersen Construction Company, Inc., the project’s construction manager/general contractor. “We wanted to take advantage of conditions to minimize cost.” Site development during a time of good weather provided the subcontractors with positive conditions and made their work much easier.
Grogan said the most apparent and unique facet of the Three Rivers project was teamwork. “We had an excellent owners representative to work with, Craig Harti, and our design team members were excellent,” he said. He said part of the reason for such stellar teamwork was communication, which wasn’t easy due to the geographical distance separating the parties involved on the project. “We found some tools to deal with that,” Grogen said. “An Internet-based software, Constructware, allowed the entire team to work off of one project management database. This facilitated instantaneous responses to questions on the project, which just added to the chemistry that was developed to make it all happen.”
Legacy Meridian Park Hospital
Adding top-quality space in terms of both performance and style does not necessarily have to be be done at great expense, as Legacy Meridian Park Hospital has proven with its recent facility upgrade. Established in 1973 to serve one of the fastest growing areas in the state, Legacy Meridian Park Hospital needed to expand its services for the growing community. The project involved renovating, expanding and adding to the operating room (OR), cardio/outpatient area, intensive care unit/intensive medium care unit (ICU/IMCU), short-stay and family birthing units. Each of the five components was added to the portion of the building where that function was already located.
A lot of site work was needed to allow for successful growth. “The hardest part of this job was getting the site planning of this worked out,” said Doug Mayoras, AIA, ACHA, principal in charge for Moon Mayoras Architects, the project’s architect. “We did the master plan and set up a diagram for [the hospital] to grow.” The first area to have site issues was the OR. There was very little room to perform the construction to add two MIS operating rooms and a new angio/catheterization lab. Not only was the site difficult to build on because of a lack of space, but it is also located next to the engineering building. This meant pin piles had to be strategically placed to hold up the elevated structures to avoid interfering with the utilities that filled the ground.
Construction of the combination 32-bed ICU/IMCU had similar issues with the size of the site. “The unique thing about the ICU was we broke it down into eight pods for each discipline, so there’s a nurses’ station for eight pods,” Mayoras said. The pod configuration allows for more intimacy between the staff and patients. “You have a work counter immediately outside each room so the charting is done adjacent to the room,” he said. “Each pair of rooms shares a soil room, so there’s a maximum efficiency because the staff doesn’t have to leave the rooms to dispose of items or wash their hands.”
Huge rooms offer state-of-the-art care provided by equipment booms. “It creates maximum flexibility. There’s nothing on the floor in there so [staff members] can move the bed around freely,” Mayroas said. But utilizing such efficient configuration came with a price, and not necessarily in dollars. “When we did these pods, the building got stretched out quite a bit,” he said. “Originally in the master plan, we had it in a much tighter box, but when we went to this pod it really extended the box and changed it almost to these two little boxes where the corners overlap.”
In addition to dealing with site issues, the design team had to deal with the campus architecture as well. A neo-classical, white stucco look with a lot of “ins and outs” was used in the layout. These “ins and outs” provided a sort of saw-tooth design that allowed for the construction of numerous burms. “The landscape is what puts the richness on the campus,” Mayoras said.
“It was a multiphased project and that’s what complicated it,” he added. Justin Cook, project engineer with Baugh, the project’s general contractor, agreed that the phasing was a difficult aspect of the project because not only were there as lot of phases, but “just about all of the hospital expanded.”
The phasing allowed work to be done on the new portions and once that work was done, the staff could occupy the new spaces, allowing renovations to commence. Cook said the most challenging aspect of the phasing was working on the imaging department because it could not be shut down. To overcome that obstacle, renovation of the imaging department was broken down into three smaller phases. “The phasing was efficient,” Cook said. “Once it got going, it worked out to everyone’s advantage.”
Because there was so much construction going on in an existing facility, Baugh provided an onsite safety coordinator. Cook said the job of the coordinator was to deal solely with safety issues. A lot of work was done using partitions and temporary spaces to prevent non-construction personnel from entering an area under construction. Despite conducting a large amount of construction, the project was successful due to careful planning and phasing. The strategy helped work within budget constraints while still providing Legacy Meridian Park Hospital with a beautiful, state-of-the art facility.