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For North Carolina, replacement beats renovation

May 26, 2011
by Terry Hatcher, PE and Timothy F. Winstead, AIA LEED AP
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State builds new state-of-the-art treatment facilities to take place of aging psychiatric hospitals
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During the late 1990s, in the midst of planning a single project to replace one of four psychiatric hospitals operated by the State of North Carolina, an ambitious idea emerged. Rather than address obsolescence one facility at a time, why not design a prototype facility and replace all four state-operated psychiatric hospitals? By 2001, the idea had started becoming a reality.

Of course, the problems were not uncommon. Just as in many other states, North Carolina Department of Health and Human Services (DHHS) administrators faced aging and inefficient hospital buildings (some dating back to the mid-1800s), which reduced the ability to deliver desired outcomes in a patient-friendly environment. Energy costs, maintenance headaches, security challenges and technology shortcomings only exacerbated the other challenges.

The hospital replacement strategy, supported and funded by the North Carolina General Assembly, called for the phased replacement of four existing regional psychiatric hospitals with three new state-of-the-art facilities. The design of each of these new regional hospitals consolidates patient care services using a treatment mall model. The prototypical design offers patients a safe open, day-lit environment that fulfils four key DHHS priorities:

  1. Enhancing the healing outcomes for patients

  2. Improving patient and staff safety

  3. Creating operational and energy efficiencies

  4. Delivering durable, adaptable facilities.

North Carolina anticipates that this investment will have a total design, construction, and up-fitting cost of approximately $423 million. However, it will also provide measurable return on investment through improved patient outcomes, reduced operating costs and closer integration with community-based service networks.

Shaping the therapy prototype, gaining consensus

Planning and design of the prototype facility began by establishing a leadership committee comprised of representatives from each of the four hospitals, DHHS administrators, behavioral healthcare experts, patient advocates, and the design team.

Workshop sessions helped to define the philosophical approach for therapeutic care and program requirements for each of the new prototypical facilities. Members of the leadership committee met regularly over many months, visited other facilities around the country and reached consensus around the use of a “treatment mall” concept featuring a “Main Street” lined with patient services and outdoor spaces.

The concept was advanced into an integrated flexible, scalable and affordable design standard, resulting in three new psychiatric hospitals designed to provide consistently high-quality environments for patients across the state-a landmark departure from the aging conditions of physical environment and therapy resources of the existing hospitals.

Designing a “linear village”

North Carolina's comprehensive reinvention and replacement program incorporates lessons learned from the experience of other states replacing aging facilities. Key features of the design program include:

  • An emphasis on community living within a regionally based campus-like setting and a strong connection to the outdoors

  • An abundance of natural light, with outdoor views and access to landscaped courtyards and outdoor seating areas throughout the facility

  • Patient care units (PCUs), occupied by 18 to 24 patients, located along the building perimeter. These PCUs are connected, allowing additional flexibility for the ebb and flow of different categories of patient populations

  • Patient rehabilitation and interaction occurring daily on a treatment mall, allowing patients to move from the patient care units to the mall as a part of their normal routine. The treatment mall is comprised of classrooms, dining areas, a gym, physical therapy, outdoor courtyards and other activity areas

  • The entire hospital functions as a linear village, providing multiple levels of independence and supervision

Beyond the treatment mall and PCUs, each hospital is supported with facilities for administration, clinical services, admissions and support services. Bed quantities were determined based on historical data projected forward, taking into account the shift toward community-based care for most patients requiring mental healthcare services. The hospitals target populations not effectively served in their local community, but that remain geographically proximate to their portion of the state.

Transforming the patient experience 

The first hospital opened under the statewide initiative was the Central Regional Hospital in Butner, N.C. The 432-bed, $130 million facility was constructed on a sloping green field site located across the street from the John Umstead Hospital, one of the two aging hospitals that Central Regional replaced.

Patients relocating to the new 470,000 square foot facility saw a dramatic change in surroundings. The older, multi-building hospitals were designed as secure facilities, characterized by fluorescent lights, windows with detention screens, institutional grade finishes and furniture, and limited access to the exterior environment.

The facility includes full-height windows with unobstructed views of trees, green fields and landscaped courtyards. Inside: increased freedom of movement, open and day-lit common areas for socialization, natural finish materials and comfortable furniture.

Patients particularly appreciate the easy access to amenities provided in the new building. They no longer have to be escorted or transported to other buildings to utilize the gym, learning resource center, or their therapeutic services.