The Genesis Heart Institute in Davenport, Iowa, is home to a unique collaboration between a hospital and one of its major physician groups to provide their shared patients with a convenient, life-affirming facility focused on overcoming heart disease. Genesis Medical Center and Cardiovascular Medicine, P.C. (CVM) needed a facility that would allow them to merge cardio-diagnostic services in a relationship as close as federal regulations would allow while maintaining separate office space and presence for CVM physicians. Capitalizing on the strong educational component prevalent in cardiac care, space was also needed for medical and community education.

 

The design team from the Madison, Wisconsin office of Flad & Associates spent seven months with doctors, nurses, technicians, and administrators to create an approachable, beautiful building for the new Heart Institute. Every aspect of the 80,000-square-foot, $11 million diagnosis and treatment center, from its location on the campus to the colors on the walls, is focused on implementing today’s trends in healing design and medical care. Opened in October 2001, the Institute houses cardio-diagnostics, the Phase II and III/IV rehabilitation program, a 174-seat auditorium, physician offices, foundation offices, and a clinical trials group.

 

The new building was first conceived for practical reasons – it is cost-effective to move many parts of patient care out of the expensive hospital space and consolidate diagnostics and rehabilitation facilities. Just as important, there is a psychological benefit to patients recovering from heart disease in a new setting, away from the acute treatment areas in the hospital. Sited on the campus and connected by a glass-walled skywalk, patients are already familiar with the area, reducing the stress and anxiety associated with starting a new phase of care after a cardiac event. Added impetus for creating the Institute was to satisfy physicians' desire to be close and convenient to hospitalized patients while maintaining a busy clinic schedule.

 

Both patients and providers expect high-tech, but neither wants a facility that feels cold. The designers “softened” the technology so patients feel comfortable, not threatened or overwhelmed. The Heart Institute uses many design elements like light, color, and spatial relationships to create an atmosphere that promotes well-being and optimism, helping patients and their families focus on healing.

 

Welcoming patients and reducing stress begins with making it simple to find the Heart Institute, especially for patients from out of town. The building’s simple rectangular shape is enhanced by a gently curving glass curtainwall that forms the lobby at the main entrance. White aluminum sandwich panes that bisect the form externally link the new Institute to the rest of the campus architecture, and create a visual landmark for patients. The three-story glass face of the lobby greets visitors, giving them a glimpse into the building even before they enter, and easing anxiety. Patients literally see what they’re getting into.

 

This striking lobby, with glass on one side and brick on the opposite wall, creates a dramatic but peaceful space that acts as a transition between the outdoors and the treatment areas. Three 17-foot-tall sculptural glass light fixtures double as works of art, filling the lobby with a rainbow of soft colors and warm light when illuminated. Waiting areas are large and light filled, with the glass curtainwall on the south and west sides bringing sunlight deep into the facility. Furnishings in warm, natural tones are grouped in small clusters, creating intimate settings for patients in the open area. The interior design and finishes avoid any hint of a white, sterile environment often associated with hospitals.

 

The center corridor bisects the diagnostic floor. Half the space is occupied by Genesis, the other by CVM. Identical equipment and very similar planning will allow the floor to be fully integrated with no renovation should laws be revised to allow for alternative ownership. Because of their close relationship, patients may not be fully aware of whether CVM or Genesis does their diagnostic work. The shared waiting area for both groups prevents patients from being "in the wrong place," and separate but adjacent registration desks direct patients to the correct group for testing.

 

Forty staff members provide diagnostic services including nuclear medicine, echocardiography, stress testing, Holter monitors, and pediatric echocardiography. Physician offices are located near the support staff with whom they regularly work, and physicians now have a five-station interpretation room where they can access hospital charts via computers. A separate reading room has four stations for reading echoes and computers. Because the CVM physicians also perform testing for Genesis Medical Center, they simply walk across the center corridor to see patients. Equipment can be shared, precluding patient inconvenience during equipment downtime.

 

The prep rooms located between stress testing rooms have improved patient flow by freeing up the test rooms quicker because they aren't used as changing rooms. The nuclear medicine rooms and cameras are conveniently located across from the pharmacy stress lab. An oversized pediatric echo room is placed away from the rest of the diagnostic area for quiet, and is large enough to accommodate staff and several family members. Inpatients’ access to these diagnostic areas is provided through a separate entry to the department via the walkway. The nurse station is open and communal, with ample space for paperwork and computers.

 

CVM occupies the third floor with a clinic that has brought together 14 physicians from two separate clinics. It has dramatically improved their operation, which serves 150 to 200 patients a day. Each physician has a private office – quite a change from formerly shared office space. Nurses, too, are enjoying operational changes in their work areas. Occupying the center portion of the 20,000 square feet of space on this floor, the nurse area features partial-height walled workspaces arranged in pods to provide individual privacy and quiet for each nurse at his or her desk.

 

One of the most effective elements of the third floor plan is the design of scheduling stations at the four corners of the nurse area. Previously, patients were escorted to the nurses’ desks to make the next appointment, causing the nurse to clear his or her desk of confidential documents and interrupt work unexpectedly. Now, nurses and patients meet in this nearby “clear” space stocked with any papers necessary to recap the visit and prepare for the next one. Nurses have praised this approach, allowing them to give undivided attention to patients away from the hubbub of their desks, while also freeing exam rooms quickly. Patients appreciate not having to walk long distances in a large clinic, as everyone they need to see is located within adjacent spaces.

 

Dictation areas, medicine cabinets, and EKG alcoves at the exterior of the central area are conveniently located across the hall from the 20 exam rooms placed around the perimeter of the floor. Each physician has three exam rooms, dictation space, and a nurse in one area. Adjacent to the reception area is a patient education room that doubles as a staff education room that also offers a private, comfortable space for a waiting patient and family members.

 

The 9,000-square-foot cardiac rehabilitation gym on the first floor is sunny and cheerful thanks to a full wall of south-facing windows. Bold colors and shapes create an uplifting and invigorating space. The design was intended to motivate patients who may spend many hours in this gym as they regain their health. Up to 16 exercising patients can be on monitors, with planned growth for 24 when new equipment arrives. Twenty-four patients can participate in the Phase III/IV classes.

 

A generous waiting area with lockers, two meeting rooms, and kitchenette takes on a coffee shop atmosphere as patients gather before and after their classes. It is important to provide these socialization and group teaching spaces because heart disease cannot be conquered alone – it takes the support of medical professionals and fellow patients to keep patients, especially newcomers, engaged in the lifestyles changes that will support their recovery.

 

“Patients consider the first floor of rehab ‘their’ space,” says Manager of Cardiac Rehabilitation, Charlette Evans. “They like the windows and the living room style environment because it's so welcoming." She describes the psychological importance of participating in rehab in an outpatient setting. “As patients graduate from the acute phase to recovery, they must take more responsibility for themselves. To see others’ success is motivating.”

 

The main corridor leading to the administrative offices contains several patient interview rooms for pre- and post-rehab visits. The medical director of the Heart Institute, a surgeon, can see patients on site without either party making separate appointments at another location. The gallery corridor is 12 feet wide and 60 feet long, and doubles as a test area. Wide enough for patients to walk a “loop,” the carpet has visually appealing red stripes that aid rehab staff in conducting an important measurement of recovery: how far a patient can walk in six minutes.

 

A generous donation from a local family funded the 174-seat Adler Center auditorium, named in their honor. Although envisioned primarily for health and medical education, community groups use the space, too. A fully equipped audio-visual facility, it is often used three or four times a week, and will have the capability to link to the cath labs and ORs in the hospital. Plans are underway for the auditorium to eventually have broadcast capabilities to facilitate sharing of medical knowledge and innovation.

 

Steve Fish, Administrative Director of Cardiac Services for Genesis Medical Center, describes the Heart Institute as a place that gives patients hope, no matter what their stage of confronting heart disease. “It's a place with a sense of solidness and permanence, telling patients that we will be here with them as they return to health. It's also a reflective place in the face of a life-threatening situation. The warmth and supportive nature of the design reassures people that they can be successful.” For physicians and healthcare providers, he adds, it is an oasis. Crossing the skywalk from the critical world of a hospital offers a virtual walk outside before entering the calm and uplifting environment of the Heart Institute.

 

Architect/Landscape Architect: Flad & Associates, Madison, Wisconsin

Design Team: Fred Peterson, AIA (Principal-in-Charge/Project Manager), Susan Olson, RA, Bill Bibo, RA (Project Architects), Kirk Keller, AIA (Medical Planner), Louise Uehling (Interior Designer)
Structural Engineer: Flad Structural Engineers, Bill McWilliams, PE
Mechanical, Electrical, Piping Engineer: Affiliated Engineers, Madison, Wisconsin

General Contractor: Estes Company, Davenport, Iowa
Photographer: Bob Harr, Hedrich Blessing
 
Throughout seven decades of continuous practice, award-winning Flad + Associates has combined a specialized blend of service, design talent, and high technology solutions. The firm maintains offices in Wisconsin, Florida, California, Washington, Connecticut, Missouri, and North Carolina. Its extensive client list includes everything from Fortune 500 companies to smaller start-up companies. Fully 75 percent of its annual design fees are from repeat clients.