A construction manager adds a valuable perspective to the design team
Psychiatric Healthcare facilities are changing in both purpose and design. Gone are the days of locking up patients in an institution and forgetting about them. Today's psychiatric facilities are designed, built, and managed with the intent of rehabilitating patients so that they can return to society and function successfully.
As a result, new and renovated psychiatric hospitals are employing a community-design approach. Residential units are connected to a "neighborhood," which then connects to a larger "downtown" area. There are common treatment areas but individual living quarters so patients are gradually exposed to more social opportunities as they move throughout the facility.
The language used to describe these spaces is changing from "hallway" to "street," "unit" to "house," and "ward" to "neighborhood" to reinforce a normalized environment. For example, at Worcester Psychiatric Hospital in Massachusetts the plan for the new facility (currently m the design stages) is to allow patients and staff to interact inavariety of settings throughout the facility to encourage individual growth and development.
The new psychiatric hospital being built on the Saint Elizabeths' campus in Washington, D.C., follows a similar design concept. Designed by Einhorn Yaffee Prescott Architecture and being constructed by Gilbane Building Company, the new hospital will integrate residential, treatment, and educational areas in an environment that reflects outside world experiences to better prepare patients for a return to the community. Patient treatment will take place in "malls" to encourage socialization.
At Greystone Park Psychiatric Hospital in Morris Plains, New Jersey, patients also receive their care m treatment malls. The 400-bed hospital, completed in October 2007, features on-site cottages that can house up to 60 patients to prepare them for the transition to more independent living.
It's on Paper-How What?
Psychiatric hospital projects demand a particularly sensitive understanding of patient, staff, and visitor needs, both from a design standpoint but also during construction. Owners can get the most benefit by involving the construction manager (CM) early in the design process to ensure that everyone on the project team is aware of the design and field construction standards for this type of an environment.
The CM looks at the project from a different angle, particularly when it comes to the cost impact of the neighborhood concept. For instance, most new psychiatric hospitals use residential-style finishes as opposed to the traditional institutional finishes in order to improve patients' quality of life and to mirror real-life experiences. Those finishes will impact the budget, however, and it's important for owners to recognize how their decisions will affect the bottom line.
In addition, the modular structure of the neighborhood design, with residential clusters around downtown areas or treatment malls, can contribute to escalated costs over traditional healthcare buildings. Facilities using the neighborhood concept have greater exterior wall area as opposed to a typical hospital, which is more rectangular-shaped and has several floors. Single-patient rooms, which are becoming the standard for new healthcare facilities and aid in making patients feel more independent, also increase the amount of area needed per patient and add to the cost.
Thus, it comes down to what a good CM can bring to the table during the construction process for these unique facilities. Most owners will build only one psychiatric hospital in their careers, so they don't typically have a history to reference. The CM can bring that history to the design and planning process, along with answers to the day-to-day questions about running the construction project, such as: What do we need to think about? What have we forgotten? How will we protect patients during construction?
Safety and Security
When building a psychiatric hospital, particularly an addition to an occupied area, safety and security are paramount both for patients and the construction team. Construction tolerances for completeness, detailing, and cleanliness are a lot more stringent when building these facilities.
For example, at Saint Elizabeths one important requirement was that the walls be sealed all the way up to the underside of the slab above, to prevent access to the room and cross-talk from one room to the next. Sealing the walls meant that there would be limited accessibility to the wall cavity should a problem arise in the future, so extra care had to be taken to keep the wall cavity as clean as possible during construction. (On a typical construction site, debris can get into the wall cavity, and because of the decomposition of debris, there is a potential for mold-hence the reason for extra precautions.)
Since the new Saint Elizabeths includes a civil hospital and a forensic hospital in one building, workers have to follow the security measures used for working in a prison. Although the new building is not connected to existing structures, it is on the same site. Therefore, the team has to record anything brought onto the site in the morning and make sure it is taken off the site or securely stored at the end of the workday.
The importance of separating the construction area from the active hospital cannot be emphasized enough. When the Saint Elizabeths project started, the drawings did not include a temporary perimeter fence, even though the new hospital was to be built less than 50 feet from the existing hospital and patients would be walking around the grounds. Gilbane met with the hospital staff to discuss options and ended up installing an 8-foot chain-link fence around the entire project site, staging areas, etc. The fence had to be recessed and cemented into the ground to prevent movement and improve security. Items such as temporary security fencing might seem insignificant, but they affect a project's total cost and need to be identified early. This is why having a CM involved from the beginning is important.
In addition, Gilbane met with staff at the D.C. Department of Mental Health to modify the company's existing safety orientation to include all of the necessary security measures. Many of the security requirements for the construction team were similar to those to new staff members at the hospital.
Perhaps the most overlooked part of new construction for psychiatric facilities is the actual move itself, another area where the CM plays a vital role. At Saint Elizabeths the owner is taking a proactive approach by enlisting the help of Gilbane's transition planning and management (TPM) group.
Because psychiatric hospital patients can be sensitive to change, a move into a new facility or even just a newly renovated room can present challenges. It helps to plan the move long before it actually happens so that staff and patients are as comfortable as possible with the new surroundings. At Saint Elizabeths, TPM was brought in when the hospital construction was only 25% complete to help establish a "move committee" with the hospital staff.
The move committee develops objectives to help the patients better adjust to the transition. Setting up patient tours in advance, showing patients the construction progress, and allowing patients to bring something meaningful with them from their old space are important ways to minimize the effects of the move. The TPM team conducts a "day in the life" exercise to get patients and staff used to their new space. At Saint Elizabeths, this exercise will focus on getting everyone used to the new building's layout and how patients will move from their rooms to the treatment malls.
A lot of factors need to be considered when building a psychiatric hospital, particularly given the changing attitudes regarding treatment. These facilities have evolved from institutional to healing environments with open designs, outdoor spaces, and a focus on recovery.
At the same time, patients still need to be closely monitored and accessible. Construction teams have to be aware of security concerns at all times, both for themselves and the safety of patients. Owners also must consider the impact of construction on patients, as well as the effects of the relocation and new surroundings. It is a delicate balance that can be achieved with a knowledgeable and experienced architect and construction team.
BY DENNIS CURL, LEED AP
ABOUT THE AUTHOR
Dennis Curl, LEED AR is a Senior Project Executive and the national Healthcare Center of Excellence Principal for Gilbane Building Company.
Dennis Curl has nearly 30 years of development, design, and construction experience in the healthcare market. To contact him, e-mail firstname.lastname@example.org.