Tanner Medical Center / East Alabama

TANNER MEDICAL CENTER / EAST ALABAMA WEDOWEE, AL

ENTRANCE PHOTOGRAPHER Kieran Reynolds Photography COVER PHOTOGRAPHER Kieran Reynolds Photography

TANNER MEDICAL CENTER / EAST ALABAMA

OWNER: Tanner Health System Randolph County Health Care Authority LOCATION: Wedowee, AL DATE COMPLETE: August 2017

SIZE SQUARE FEET: 54,314 BEDS: 15

SMALL FOOTPRINT, BIG IMPACT Tanner Medical Center / East Alabama is a critical access micro-hospital that provides the best of modern healthcare to the Randolph County lakeside community and the eastern Alabama area. Centrally located in Randolph County’s seat, Wedowee, the “micro” footprint of the facility is right-sized to serve the community, with a scalable design for room to grow. By connecting to the existing medical office building serving outpatients on site, the new facility creates a streamlined location delivering quality care. The micro-hospital includes 24-hour emergency care, on-site lab and pharmacy services, diagnostic imaging, surgical services, inpatient beds, and inpatient rehab therapy.

ARCHITECT Earl Architects LLC PROJECT TEAM

CONSULTANTS

PARTNER-IN-CHARGE Rick Earl, AIA

INTERIOR DESIGNERS K2J Inc. & Earl Architects LLC

PROJECT ARCHITECT Scott Meade, AIA

STRUCTURAL ENGINEER Professional Engineering Associates

SENIOR ARCHITECT Dan Roberts, AIA LEED AP BD+C

ELECTRICAL ENGINEER Electrical Design Consultants, Inc.

DESIGNER Hillary Earl Crosby, Assoc. AIA

MECHANICAL ENGINEER Pruett, Ford, & Assoc., Inc. CIVIL ENGINEER Georgia & West, Inc.

CONTRACTORS RA-LIN and Associates, Inc.

INTRODUCTION

RETAINING HEALTHCARE IN A RURAL COMMUNITY America’s rural communities today are facing an unwelcome

In one of many pivotal decisions to fund the new facility,

blight of their very own, the rural healthcare crisis. Hospitals

Randolph County residents fully supported teaming with Tanner

across the nation are closing their doors at a faster rate

Health System, a system recognized by Truven Health Analytics

than ever seen before, creating ripple effects throughout

as one of the top 15 Health Systems in the nation. “Tanner

the communities they once served and crippling access to

has a track record in helping communities like ours, and we’re

emergency care, negatively impacting prospective economic

going to capitalize on their experience,” said Bill Caypless PA-C.,

development, and leaving a dwindling population in its wake.

Randolph County Healthcare Authority Chairman. Through

According to national news outlet CNBC, over the past eight

this affiliation, Tanner Health System now provides patients full

years, there has been approximately 83 hospital closures, with

access to over 300 medical staff personnel, including primary

the majority in the Southeast region. Unfortunately, Alabama

care and specialists.

has been no stranger to this trend, as they rank as one of the most affected states.

The national crisis hit home when Randolph County Medical Center closed their doors, leaving the 60+ year old facility, Wedowee Hospital, to shoulder the responsibility. Concerns mounted over the county’s access to emergency care during the “golden hour,” a term used to describe a patient’s much improved vitality rate if receiving immediate care in less than an hour after a trauma occurs. Although strategic plans were in place to handle such events, Wedowee’s aging existing facility struggled to meet the demands of modern healthcare and technology, while airlifting patients to the next county was heavily dependent on clear weather and availability of the helicopter.

TEAMING WITH TANNER HEALTH SYSTEM

SAVE A LIFE, SAVE A HOSPITAL In addition to teaming with Tanner Health System, the Randolph County residents diligently campaigned to vote “yes” towards a referendum to self-impose a 1-percent special purpose sales tax to support funding the new hospital. Community leaders and medical staff printed flyers, erected signs, and made T-shirts, taking their cause to the very people they intended to protect, promoting the adage, “Save a Life, Save a Hospital.”

After months of campaigning for the cause, voters took to the polls to voice their beliefs. The vote passed with a resounding “yes”, as 86 percent of the residents chose to stand strong to safeguarding their hospital from the somber fate countless rural hospitals had already faced. Through their financial backing, the residents protected Wedowee Hospital from closing, and in turn, protected the Certificate of Need (CON) until it was safely

In a proactive response to the Randolph County Medical

transferred to the new replacement micro-hospital facility. At

Center’s abrupt closing, the community’s leaders and its

the ribbon cutting ceremony, State Representative Bob Fincher

residents began rallying behind the idea of replacing Wedowee

congratulated its residents and stated the community’s vote

Hospital with a new facility in hopes to retain and attract the

of support was “a rare expression of faith and a willingness to medical staff present in the community, while also matching the invest in the future.” quality of a new facility to the quality of the care given.

RESHAPING RURAL HEALTHCARE THE MICRO-HOSPITAL MODEL Designing a community replacement hospital during a time when rural hospitals seemed to be targeted for closure provided the EA team an opportunity to take an in-depth look and re-assess the rural health architectural typology.

Implementing design cues from LEED, LEAN, and the Tiny House Movement, the “Micro-hospital” model emerged, and poised itself as an advantageous solution to serve Randolph County’s need for community-based accessibility to healthcare and a tailored level of personal care. In essence, the model is not a prototypical one-size-fits-all response but takes its shape through extensive research of the area’s current and projected needs. EA’s programmatic studies helped drive functional adjacencies and capitalize on efficient flow of patients and staff, creating a cost-effective approach to square footage needs and creating a scalable design for future growth. Tanner Medical Center / East Alabama brings the convenience of healthcare services to the rural community, while also providing a complimentary location for Tanner Health System.

TELEMEDICINE: MAKING THE CONNECTION Tanner Health System further strengthened the microhospital model in Wedowee through perceptively integrating the advanced and pioneering field of telemedicine, enabling the surrounding rural community to overcome distance barriers and gain access to medical specialists across the system’s vast spectrum of care. This innovative technology securely connects patients to clinicians to discuss exam results, recovery plans, treatment options, and electronically prescribe medications. Through this cutting-edge technology, patients benefit from faster consultations, improved quality of care, shorter hospital stays, in-room privacy, and bedside or in-office access to specialists.

HISTORY AND DESIGN NARRATIVE Randolph County of eastern Alabama has a long history with

one of the best in the area and is approximately 10,660 acres

deep roots, tracing its early beginnings back to 4,000 BC when

with a max depth of 135 feet. Today, Lake Wedowee brings

indigenous people were believed to have first occupied the

an abundance of tourism throughout the year, with activities

land. The Native American Tribe, known as the Muscogee Creek

including camping, boating, swimming, and its premiere

people and possible descendants of the earliest population,

attraction of fishing.

later established villages in the area. The Muscogee Creek people extended across the Southeast, with a presence

When designing the micro-hospital, it was important to

predominately in the flatlands of Georgia and Alabama, and

maintain the existing architectural language of the medical

excelled in hunting, farming, and raising livestock. European

office building on site, while also having both buildings come

settlers began to move into the area and in 1832, the county

together to form a cohesive presence. Borrowing inspiration

was created, with the town of Wedowee named as county seat

from the lakeside recreational culture, materials of architectural

shortly after. Wedowee is said to receive its name after the

stone and block are carried from the exterior into the interior,

Muscogee Creek Chief, Wiwa’towa, meaning “old water.”

with emphasis of wood-like tones, creating a modern lakeside lodge aesthetic. Familiar interior textures and finishes coupled

In its more recent history, Wedowee fulfilled its Muscogee

with local artwork bring positive distractions and tranquility

meaning when construction completed on the R.L Harris

and help promote an organically harmonious ambience

Reservoir of Tallapoosa River, forming Lake Wedowee in 1983.

throughout.

Known for its pristine clear waters, the lake is considered

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1 Administration Suite 2 Pharmacy Central Energy Plant Lobby Registration Dining & Gift Shop Area Emergency Department

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GROUND LEVEL:

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TEAM COORDINATION & CONSTRUCTION BUILDING FOR THE FUTURE When initially approached by the owner, Randolph County’s

the owner an opportunity to add an additional change during

discussion of building a new hospital had been over two

construction to expand their dining space. Upon including

decades in the making. Our design team understands the very

this additional change in the overall cost, the project was still

fine balance between managing a limited project budget,

delivered approximately $500,000 under budget.

while also designing a right-sized health care facility that will meet the current and future needs of the community. At Tanner Medical Center/East Alabama, we challenged ourselves to appropriately apply the budget to those specific areas that have the most significant impact towards enhancing the overall patient/staff experience.

Through the diligence of the design team, the construction cost for the micro-hospital came in under budget and provided

The project had a 14-month construction schedule, and was completed on time. Because the new micro-hospital was attaching to the existing MOB, special attention was given towards strategic phasing to maintain access to the site and helipad.

LEVEL 1 LOBBY ENTRANCE Entering into the lobby, warm rich tones of stone and wood carry from the exterior architectural elements into the interior space and accentuate the modern lakeside lodge community aesthetic. The lofty two-story glass-enclosed atrium graciously welcomes visitors with a reception desk and defined waiting space flanking either side, while providing access to natural daylight and views to nature as positive distractions. The lobby offers visual connection to the second floor balcony, aiding visitors in way-finding and orientation. The pitched wood-look plank and beam ceiling system and specialty pendant lighting further reinforce a familiar design language and vernacular materiality found throughout community.

Artwork inspired by the surrounding landscape is featured throughout the facility. The original pieces were specially designed to integrate into each space and were thoughtfully donated by a community of local artists.

PHOTOGRAPHER LEFT: Kieran Reynolds Photography

ABO VE: Tanner Health System

REGISTRATION & ED TRIAGE Registration is conveniently located adjacent the lobby, and shares functions with the 24-hour ED triage and registration.

This connection alleviates staffing conflicts as well as provides patients with an easily accessible and streamlined registration experience. Sliding glass registration doors enhance patient audial privacy, while also providing staff visibility of the wait area from their desk. Seating located outside the registration area and along the corridor serve as additional waiting.

As patients enter the dedicated walk-in ED entrance, nurses located at the adjoining ED reception quickly triage patients upon arrival. After hours, circulation from the ED entrance to the main hospital can be closed for the evenings, while the 24hour emergency department remains open.

PHOTOGRAPHER RIGHT/ABOVE: Kieran Reynolds Photography

DINING Public areas, like dining, contribute to the welcoming hospitality setting accommodating guests during their visit. At Tanner Medical Center / East Alabama, dining has become an integral part of the community fabric. The dining area serves not only the micro-hospital, but lends itself as a social gathering place for the surrounding residents. Construction cost for the facility came in under budget and allowed the owner to further expand their dining space to accommodate additional local diners. Design considerations include continuing accents from the lobby entrance through providing a voluminous clerestory space featuring finishes of stone and wood.

PHOTOGRAPHER ABOVE: Tanner Health System LEFT: Kieran Reynolds Photography

NURSE WORK AREAS Centralized nurse work areas are strategically located in the departments within the staff core areas to provide needed observation over patient areas and touch-down locations to complete necessary paperwork. Solid surface work tops possess inherent anti-microbial properties and are provided in both the staff and patient zones to assist in infection prevention needs.

Shifts in flooring finishes and accent cove lighting illuminating the staff core perimeter provide visual cues for designated staff zones, and in turn, assist in reducing stress in staff through ease of navigation.

PHOTOGRAPHER RIGHT: Kieran Reynolds Photography ABOVE: Tanner Health System

SURGERY & DIAGNOSTIC IMAGING The emergency department, imaging, and surgery services are strategically located to one another to provide alignment of services as well as fewer steps and less time for staff to circulate from one department to the next.

The emergency department offers separate triage ED waiting and walk-in entrance, a dedicated ambulance entrance, and universal designed exam and trauma rooms. The imaging department offers services utilizing state-of the art equipment including 64-slice CT machine, X-ray, and ultrasound. The surgery department includes pre/post rooms, PACU rooms, a surgical suite, and a minor procedures room offering a range of services and care to Randolph County.

PHOTOGRAPHER LEFT: Kieran Reynolds Photography ABOVE: Tanner Health System

PATIENT ROOM The patient room is right-sized to adequately support the needs of the patient, staff, and patient family, while also adjusting to the acuity level of the patient as needed, a vital component to the needs of a micro-hospital. Large windows provide access to natural light and views to nature. Interior finishes within the room continue the lakeside lodge aesthetic through familiar wood planking textures and tranquil blues. Future expansion capability was incorporated into the design of the inpatient floor, as horizontal expansion over the remaining first floor roof area allows the patient unit to grow by an additional ten beds.

PHOTOGRAPHER RIGHT: Kieran Reynolds Photography

RIBBON CUTTING CEREMONY Tanner Medical Center / East Alabama hosted over 400 guests for the Ribbon Cutting Ceremony. Attendants included members of Tanner’s Board of Directors, government officials, local community leaders, staff, and Randolph County residents. An outdoor reception kick started the ceremony, with all of the speakers eagerly congratulating the residents, local leaders, and Tanner Health System representatives on their successful role in making this long-awaited day a reality. Upon cutting Tanner’s signature green ribbon, guests excitedly entered through the main entrance. Staff greeted guests and provided guided tours throughout their new facility.

ENTRANCE PHOTOGRAPHER Kieran Reynolds Photography

Earl Architects 301 N Main St. 17th Floor Greenville, SC 29601 www.earlarchitects.com