Case Study: Adapting to Change

Case Study: Adapting to Change A Deeper Look More than 15 years ago, a new healthcare organization sprung from a growing outmigration from Trenton, NJ, into its suburbs and three hospitals competing for a dwindling patient population. Two of the competing acute care hospitals in Trenton merged, forming Capital Health.

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Adapting to Change COMPETING TO SURVIVE

CHALLENGE Competing with more than two dozen U.S. News and World Report-ranked hospitals within a 50-mile radius, Capital Health, was finding it increasingly difficult to attract patients. They

SYSTEM OVERVIEW While health system consolidation happens more frequently in healthcare today, it was a bold step in the late 1990s. Three years post-merger, Capital Health maximized scaled economies and stable leadership to begin a dynamic, three-part plan to strengthen its Trenton hospital and provide access to suburbanites with a new ambulatory care facility in Hamilton and a state-of-the-art hospital in Hopewell Township.

needed a new hospital to expand their market

The climate was competitive, with over 10 regional hospitals in Mercer, Monmouth, Hunter-

reach

don, Burlington and Camden counties in New Jersey as well as neighboring Bucks County,

SOLUTION

Pennsylvania. Patients at these hospitals were transferring to tertiary hospitals in Philadelphia and New York, leaving New Jersey to support healthcare systems in neighboring

Located in a Certificate of Need state, where

states. Capital Health developed a business model based on enlarging the catchment

changes are difficult once a CON is approved, the

area and diversifying payer mix to sustain itself and grow to better serve the community.

design team worked closely to align plans and

The focus was to maintain Capital Health’s quality, keeping patients in New Jersey and to

program data with appropriate service lines. The

provide a unique healthcare experience that wasn’t available nearby.

design team was able to meet current and future growth criteria through a chassis design that provided a central spine for all utilities.

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Leadership directives included wanting to hear: “Wow, I can’t believe this is a hospital!” from patients and visitors.

THE PLAN TO EXPAND The plan featured three capital improvement projects, implemented over seven years. The first phase was a new outpatient facility in Hamilton, N.J. The second, a $100M transformation of the existing urban hospital into Capital Health Regional Medical Center. The third project was a new, 223-bed medical center in nearby suburban Pennington, NJ, transcending the hospital experience by emphasizing convenience, comfort and best practices for quality and safety. This replaced one of the two hospitals in Trenton (Capital Health–Mercer), which maintained a satellite presence during transition.

A valuable lesson in the Capital Health plan was adaptability. Over the seven-year implementation, initial parameters evolved for various reasons: new physicians, advancing technology, new processes and financial volatility. Managing change takes a team with the right project management, architectural design and construction expertise. If anyone fails to understand the common vision and understand the need for flexibility, the project will be compromised.

Development Manager Anchor Health Properties, which managed the Capital Health–Hamilton project, brought the same vision of consumer-driven experience to the new project. HKS and Array Architects served as the design team. Array brought a tremendous amount of institutional knowledge, having worked with Capital Health for over 25 years. Array also developed the certificate of need (CON) documentation for the new hospital.

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Implementation STEP 1: CAPITAL HEALTH–HAMILTON For the plan to become a reality, Capital Health’s first project,

A time-share system encourages a variety of specialists to

the two-phase ambulatory center in Hamilton, had to be a

practice at Hamilton. Physicians rent office and exam space

financial success. In the early 2000s, the healthcare industry

so patients can visit specialists alongside their primary care

began a national trend of offering hospital services in out-

appointments, producing stronger referral relationships. The

patient facilities. With Trenton’s suburban migration, Capital

integration of service lines is seamless. Patients know they

Health’s outpatient growth strategy followed the national trend

have one location for a range of appointments, tests and proce-

while also capturing suburban emigrants.

dures. A walk-in program coexists with the scheduled practice.

With 35,000 walk-in visits a year, Hamilton has successfully shifted the paradigm of traditional health care delivery. Over 90 percent of patients surveyed are likely to recommend and return to Capital Health–Hamilton.

STEP 2: CAPITAL HEALTH REGIONAL MEDICAL CENTER Capital Health’s plan called for two simultaneous construction projects: The new hospital in Pennington and a renovation of its Regional Medical Center in Trenton. A stipulation to issuing the CON for the new hospital was that its regional perinatal center (particularly, the Level III NICU) remain in Trenton.

Capital Health engaged Anchor Health Properties to devel-

Because Capital Health Regional Medical Center was crowded

op a modern outpatient facility on a conveniently accessible

with other programs, the NICU relocation from Mercer hospital

suburban property and to differentiate Capital Health from its

(a second, urban hospital in the System) required a $100 mil-

competitors. A building with great visibility and surrounding

lion transformation to utilize all existing space within the facility

scenic wetlands was redeveloped into Capital Health–Hamilton,

and increase capacity in key areas.

opening in 2005. Eager to present a new face to the suburban market, Capital Health and Anchor created a new kind of health care experience, creating an inviting structure to complement the new vision. The single-level plan incorporates natural materials, glass and landscaping. Amenities such as a café, lounge areas and water features enhance the experience.

A transformational renovation proposed by Array Architects was undertaken, allowing for an immediate ROI. Concentrating many of Capital Health’s tertiary services at Regional Medical Center, the plan included updating the Level II trauma center and emergency mental health services department; and adding inpatient rooms, a biplane operating suite, intensive care and

Most importantly, a variety of patient services were included to

intermediate units, a groundbreaking neurological emergency

offer multiple physicians and diagnostic testing on-site. With

department and the Capital Institute for Neurosciences. Finally,

Hamilton Physician Group (a practice of Capital Health primary

as part of the CON approval, the Level III NICU had to open

care physicians) as the centerpiece, the right mix of comple-

before the new hospital in Pennington.

mentary services: surgeons, ophthalmologists, gastroenterologists, cardiologists and ob/gyns were identified. The ambulatory surgery center, a joint venture between a Capital Health subsidiary and several physicians, has proved successful with over 500 surgeries monthly. The Center’s second phase

In addition to the NICU, the new regional perinatal center required a labor and delivery unit, intensive care nursery and a complex process of documentation for certificates of need and department of health approvals, shepherded largely by Array.

opened in 2007.

Adjacent to the building, a sleep medicine center and women’s services were added, bringing the total size to 74,000 SF.

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CAPITAL HEALTH REGIONAL MEDICAL CENTER

“[We have taken] one of the first steps of transforming the Fuld Campus into a truly regional hospital.”

- Al Maghazehe, PhD, FACHE Capital Health President & CEO

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Implementation

STEP 3: CAPITAL HEALTH MEDICAL CENTER - HOPEWELL The third step in the plan was a replacement hospital for the

orthopedics, radiology (with a separate women’s imaging

aging Capital Health–Mercer hospital in Trenton, which was

center) and more.

relocated due to declining population and aging infrastructure.

It was the less-accessible of Capital Health’s two urban hospitals. For the new medical center, Capital Health sought a convenient New Jersey location between the Delaware River and Route 1, along the I-95 corridor. Anchor Health Properties managed the site search and the hospital purchased a 165-acre property highly visible by both New Jersey and Pennsylvania commuters.

The campus consolidated Mercer services and offered new programs in an attractive setting. With 223 private rooms, the nearly one-million-square-foot facility has a glass atrium connecting the medical center with offices and amenities, including a spa, bistro, coffee kiosk and two gift shops.

The new Capital Health Medical Center–Hopewell offers advanced services, including the Capital Institute for Neurosciences; a center for digestive health; an oncology center; pediatric services (including a separate pediatric emergency department), a metabolic and weight loss center, a heart and vascular institute (including a chest pain center), a comprehensive breast care center, an acute care surgery,

The new medical center incorporates a birthing center with a Level II NICU sharing staff with the new regional perinatal center at Capital Health Regional Medical Center in Trenton.

To accommodate staff sharing, the obstetrics departments in both hospitals have similar floor plans and equipment placement for a universal room effect.

Capital Health Medical Center–Hopewell supports efficient medical processes. Operating rooms were designed to house new surgical technology such as a robotic surgery system. A unique hybrid operating room allows neurosurgeons to perform both endovascular and open neurosurgical procedures within the same room. All interventional spaces are adjacent to a central pre- and post-operating recovery space creating an interventional platform on a single floor.

Safety and quality were key to Hopewell’s layout, with separate corridors for testing and treatment procedures so that inpatients are sheltered from the public mall space. This promotes patient privacy and reduces infection and other risks. There are separate chutes for soiled linens, waste and

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Who We Are ARRAY-ARCHITECTS.COM recyclables centrally located on every nursing unit, leading directly to environmental services. Every room was designed and outfitted to prevent safety hazards such as falls and infections, and is designed same-handed, so nurses and doctors can standardize bedside care. Bathrooms are on the headwall and feature European designs with sloped shower floors to prevent falls.

Green building practices were used as a two-fold way of increasing long-term sustainability while promoting Capital

We Are Healthcare Architects We are a team of architects and designers with unique backgrounds, but we all have one thing in common - we share a strong desire to use our expertise and knowledge to design solutions that will help people in moments that matter most.

(LEED) rating system. In December 2012, Capital Health joined

This focus makes us leaders in our field. There’s a degree of compassion, empathy, and sensitivity that goes into every project that we touch. It’s designing a nurse station with sight lines to every patient. It’s building a Behavioral Health facility without corners, so that patients are safe. It’s translating the operational needs through the technical details to fine tune the lighting system in a neonatal unit so caregivers can match the lighting to each baby’s stage of development. It is a deeper understanding, honed through relationships spanning

only 28 hospitals nationwide to achieve LEED Gold certification.

decades.

The medical center was planned for a future 500-bed

Together, we discover optimal solutions with our clients. It is our four decades of specialization that allows for effective communication, collaboration and precision in the complex, changing world of healthcare.

Health as a cutting-edge provider. Roof gardens recycle rainwater and reduce heating and cooling requirements. Local building materials were used, on-site farming and woodlands preserved, and bioswales trapping runoff pollutants in the parking areas meet criteria set by the U.S. Green Building Council’s Leadership in Energy and Environmental Design

expansion, in two additional inpatient bed towers built without interrupting hospital functions.

The goal was developing facilities that provide access to highlevel services mostly restricted to large cities, particularly in neuroscience, digestive health and surgery (including orthopedics, bariatrics, breast, plastic and reconstructive vascular and acute care). Recruiting top physicians requires appropriate consulting rooms, views, wide corridors and updated technology.

While new facilities were essential to rebranding Capital Health, leadership knew the services and people are critical. With state-of-the-art facilities and services, staff produce optimum efficiencies for long-term stability and growth. Capital Health’s promise to patients and their families is a new kind of healthcare in peaceful, accessible environments that transcends the traditional patient experience.

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