How did Bradley Hospital in East Providence, Rhode Island-the nation's first psychiatric facility for children and adolescents-go from a crowded, outdated building to a new, state-of-the-art inpatient facility in only one year after breaking ground? It took an extraordinary effort put forth by the entire project team and the hospital's staff, all of whom remained committed to a single goal: building a future for Bradley's children.
Working within a tight budget and an aggressive timeline, the project team, including The S/L/A/M/ Collaborative (architects), PCI Engineers, ARCHITECTURE + (consultant) and Gilbane Building Company (construction manager), tripled the hospital's inpatient space with a 44,000-square-foot addition in just 12 months. The new building is the centerpiece of the hospital's $31.1 million modernization program.
The project team's first order of business was to conduct workshops with Bradley's staff about their specific challenges and thoughts on what would be the best kind of hospital for them. They learned that Bradley's staff is focused on active supervision and active participation with patients. To support this, the design provided a “sweet spot” where staff could stand and visualize all of the major corridors at once. In typical facilities this spot is marked with a staff station, but Bradley's staff deliberately sought to avoid creating a staff station at that spot. They were very committed to having an environment in which the staff station did not overwhelm the patient experience.
Key to the project was giving patients a variety of welcoming spaces to occupy. Along with a secure enclosed courtyard (figure 1), the addition features 60 private rooms (figure 2-one of the biggest upgrades from the previous facility) all arranged in “pods,” with shared facilities in between. Each pod, consisting of 7-8 patient rooms, has its own dedicated activity room, but also allows patients access to a shared great room (figure 3) and sun room.
Photography by Frank Giuliani
In addition to offering more space and privacy for patients, the building is designed to be welcoming and inviting, with walls painted comforting shades of yellows, blues and greens. The goal was to create an environment that was as homelike as possible while maintaining security. The courtyard allows the kids to have access to the outdoors in a secure, controlled environment that doesn't look institutional.
Dedicated spaces are provided for visiting family (figure 4), an important part of treatment. Finally, the new facility is wireless throughout.
Making it all fit
Bradley staff looked at literally hundreds of design options before they eventually chose to add two adjoining wings that formed the courtyard. The addition ties in to the existing hospital's ground floor, as well as at its first and second levels. There were difficulties lining up the buildings floor to floor, which the project team solved by installing ramps. However, the team still faced the challenge of too much program with too little money. Value engineering was completed in a timely way, given the short timeframe the schedule allowed from schematic design to finished construction documents.
That's where the team got a little creative: How could they build as little as possible while still giving Bradley a really top-rate children's facility? Using renovation as a budget-conserving strategy, Gilbane, S/L/A/M/ and ARCHITECTURE + placed the services that least required the amenities of the new space in the existing space. Thus, the inpatient facility is completely dedicated to patient space and patient activities, but there are no offices located in the new space.
Among other considerations, patients' very profound physical and mental disabilities needed to be addressed in the design. Due to the sensitivity of this population in their heightened need for safety, the project was extremely restrictive in terms of what could be done with windows, sprinklers, hardware, plumbing fixtures, light fixtures, etc. Moreover, a children's facility is quite different from an adult facility-with kids, there is more a need to accommodate larger groups moving around, thus requiring a little more space. With the expertise of Frank Pitts of ARCHITECTURE +, as well as careful attention to every detail, the project team delivered quality and safety.
Details were indeed critical. Every screw, every fixture had to be looked at from a behavioral healthcare perspective. Gilbane helped the group identify potential safety problems by first creating mockups of the design prior to construction. Reviewing a mock-up of a patient room, for instance, the team discovered a small gap at the top of the light fixture that had not been anticipated. They worked together to custom-create a water jet-cut trim ring to close the gap and they painted the ring to match the fixture (figure 5). Also, sprinklers have safety heads on them, and the windows, made of 1/2′ Lexan unbreakable glass, feature a specialized design incorporating the blinds inside the glass to avoid the need for cords.
Education before construction
Site security was a huge issue during construction. Gilbane drew on its mix of experience in building hospitals, detention centers, and educational facilities, while the architecture team worked closely with user groups and Gilbane to maintain hospital operations based on daily communications. Educating the trade contractors regarding the impact their actions and behaviors would have on the children was critical to gaining support from the hospital staff.
Because the children remained in their existing quarters while the new wings were being built, it was essential that the construction site remain fully secure at all times. Bradley staff developed a training video that Gilbane incorporated into its safety orientation for every worker on-site. There is also a school on the Bradley campus (separate from the inpatient units) where students were able to ask Gilbane staff questions about the construction on a regular basis.
In general, says Frank Pitts of ARCHITECTURE +, the design process is both “a dialogue and a dance”-a collaborative effort in which there are times when the design/construction team needs to lead and times when it needs to follow.
Flexibility for the future
From the earliest stages of the project, the team worked with Bradley to determine not only the hospital's current needs, but its long-term challenges. The team managed to endow the new addition and renovation with the flexibility needed to accommodate the long-term plan, setting the stage for future growth.
The next phase of the modernization project is currently underway, and will focus on the renovation of vacated space in the original building to enhance and expand Bradley's outpatient and partial-hospitalization programs. An on-campus residential home is also scheduled for renovation.
Denis Beique is a project executive at Gilbane Building Company, with over 32 years of experience in the construction industry. Specializing in healthcare and educational projects, Beique has managed some of the largest and most complex facilities in the New England area. For further information, phone (401) 456-5800 or email firstname.lastname@example.org. Behavioral Healthcare 2009 October;29(9):29-31