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It all starts with a story

October 31, 2011
by Jonathan F. Douglas, AIA
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Florida VA hospital uses story-based narratives to evoke positive patient experiences in design of new mental health addition
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Story-based narratives are frequently used to plan museums, interpretive centers, and even destination resorts to help inform and educate the guest about a place or subject. The process introduces a single methodology, as well as key themes and messages to educate and inform desired actions through planned sequences of events. 

Storytelling can help to connect teams quickly, gain insight and understanding into the project, and communicate how the unique aspects of a place, both physical and geographic, inspire different experiences created through design alternatives. In mental health facilities, designs based on a narrative engage the senses, break down barriers and establish a meaningful sense of place.

With these goals in mind, the Department of Veterans Affairs retained VOA Associates and Ellerbe Becket LLC in 2008 to help plan and design inpatient and outpatient improvements at the VA hospital in Bay Pines, Fla. The goal was to resolve inpatient psychiatric deficiencies, as well as address workload-driven gaps in outpatient mental health to support the VA's Capital Asset Realignment for Enhanced Services (CARES) initiative.

As part of the design's initial scope, the VOA/Ellerbe Becket team developed a master plan to locate the new mental health center in anticipation of a multi-phased project based on funding availability. The VA was able to obtain funding for the first phase in 2010 and started construction in May 2011. Subsequent phases are expected to be completed as further funding becomes available, with completion of the entire project scheduled for 2014/2015.

The $92 million facility will be a multi-story, 156,000 square-foot addition to the main hospital building. It is a mixed facility that provides residential rehabilitation, acute inpatient mental health services and outpatient mental health services.

Turning a concept into a design objective

In 2010, the outpatient mental health programs that will be located in the new building had nearly 150,000 visits (an 18 percent increase over the previous year), according to the VA. It is estimated there will be 211,784 annual visits by 2029 (42 percent patient increase from 2009). The new center increases the number of inpatient acute psychiatric beds from 33 to 40. In 2010, Bay Pines averaged 125 mental health admissions per month and the trend continues to grow.

As a result, the design team employed storytelling to help create compelling experiences that would build human connections based on emotional, physical and intellectual experiences. Utilizing stories to express the user experience enabled simple barriers to connectivity (such as inadequate way-finding, lack of accessibility, crowded circulation paths, and long wait times) to be anticipated, and eliminated.

The design team's use of narratives started with an understanding of the surroundings. For example, it meant recognizing what opportunities existed to establish overall orientation, arrival sequence, and context based on a defined user experience and established through a visioning process.

In addition, construction of the new campus utilized a regionally popular architectural styling called “Mediterranean Revival,” which was applied to the standardized prototype hospital, as well as support facilities.

To develop and establish the site plan, numerous site studies were conducted during the planning phase to analyze the immediate environment, operational connectivity, and the patient and family experience. Originally, the north side of the existing hospital was thought to be the best location for the new center, facing the immediate entrance to the campus.

But after further study a site was chosen near the southwest corner of the main hospital (Building 100) due to important operational efficiencies provided by establishing connectivity to the main floors of Building 100, and Building 1, the historic building next door. The location also orients the building to views of the water, while maintaining visibility from the main circulation drive around the campus.

Creating a “warm and inviting” neighborhood

While Building 100 is a modern building that was constructed in the 1980s, the adjacent historic Building 1 is on the National Register of Historic Buildings for its rich Mediterranean revival style dating from the 1930s.

This context provided a variety of visual references that were used in the exterior design of the new Mental Health Center while still allowing the design team to establish a clear unique theme and architectural character.

As one approaches the building, the complementary scale and articulation of the building establishes a warm inviting sense of arrival and consistency with the surrounding landscape. At the main entry, a vertical tower reminiscent of a beacon of light symbolizes hope and reinforces the entry location leading the patient forward to a covered drop off and porte-cochere.

Existing mature oak trees along with new landscaping underscore the natural beauty of the site, provide shade from the sun, and establish informal gathering spaces. Central areas like the new plaza and courtyard along with the trees and expanses of green lawn are keys to creating a good first impression of the Center.

Clear and direct way-finding in conjunction with a complementary scale and architecture with the surrounding buildings establishes an inviting image supporting the VA's mission.

At the building's main lobby, the higher volume space with light filled windows shaded from the direct sun with accents of natural wood establishes a warm, comfortable setting. On this main level, the public lobby is a clearly defined passage that connects patients and visitors from the drop-off area, through the main lobby and a main north/south “street” ending in an outdoor courtyard.