?What kind of facility do we need in the next five to 10 years, for our kids and grandkids and even further??
That question, according Jeremy Armstrong, chief executive officer at Marion?s St. Luke Hospital & Living Center, was pondered and discussed for months by the hospital?s board and administration.
Their answer? To undertake a $6.5 million renovation and expansion of its 57-year-old facility in an effort to accommodate the needs and expectations of today?s health-care environment.
The start of construction, which includes the addition of about 10,000 square feet of space as well as major structural changes throughout the existing building, will begin with groundbreaking in spring. The project is expected to be completed in about a year and half.
Armstrong said he feels good about the fundamental decision to renovate and add on to the existing facility rather than build a new one.
?We?ve come up with what we think is a good plan,? Armstrong said. ?For us, we like the fact that we?re right here next to the clinic, right next to the Living Center, and we could have everything right on campus.
?If we had the space (to expand) on site, we were going to stay on site,? he added. ?We knew we could do it, so we?re going to stay on site.?
Armstrong said the St. Luke board has three ?primary reasons and a lot of little ones? for pursing the project.
The biggest reason is infrastructure.
?The building was originally built in 1952, and it?s reached what we call the end of it?s useful life,? Armstrong said. ?The thing is just worn out.?
In addition to ever-increasing expenses for its maintenance, the building is not compliant with current health and safety requirements.
For example, the St. Luke Living Center (the hospital?s long-term care unit) is mandated to have fire sprinklers installed by 2013. Armstrong said it?s inevitable that hospitals will need to follow suit in the near future.
A second objective is to accommodate the handicap-accessibility requirements of the Americans with Disabilities Act.
?If you?re taking care of an inpatient who?s in a wheelchair in our facility, you have to wheel it to the bathroom in the (emergency room)?that?s the closest handicap-accessible bathroom that we have,? Armstrong said.
?In the ?50s they didn?t even think about needing bigger access for wheelchairs and that kind of thing?but these are some real issues we?re dealing with right now.?
A third issue is growth and efficiency.
?We could grow (physical therapy) significantly, but we just don?t have the space to offer,? Armstrong said. ?We do have space in the sense of empty inpatient rooms, but it?s not functional for the staff that we have.?
As for efficiency, Armstrong cited housekeeping as an example: Supplies and equipment are stored in five places around the facility because no one or two spaces are big enough to store it centrally.
Armstrong said the new floor plan is designed in such way that the same amount of staff time should be sufficient to care for the new facility even with the additional square footage.
adding new space
New space will be added to the current structure on the northeast corner and the south end. A new mechanical room will be developed on the northwest corner to accommodate new electrical and plumbing systems.
The largest addition, situated on the northeast corner, will provide significantly more space for the physical therapy (PT) department?including an in-ground hydrotherapy pool?but also will accommodate other therapy services.
?One of the challenges I see whenever I?m walking around, especially going back to PT, is we?ve got people who are out in the hallways doing their exercises and stuff,? Armstrong said. ?It?s not the optimum way to treat people.
?This (project) will give us the space?and the equipment, frankly, because we don?t have room now for the equipment we would like to purchase and offer from a rehab standpoint for our patients?to be able to take care of them within the department.?
The area will provide space for treatment tables, a couple of private exam and consultation rooms, a new location for the lab and additional office space.
?We?re able to spread things out a little bit and give people more privacy to have their procedures done,? Armstrong said about exam rooms.
A new main entrance will provide immediate access to the PT area.
?The idea behind that is you want to keep the outpatient departments as close to the main entrance as possible,? Armstrong said. ?We don?t want our PT patients having to wheel clear to the other side of the hospital (where the current PT area is located). We want to keep it convenient.?
Meanwhile, the new space on the south end of the building will accommodate the needs of the operating room. Even though the hospital does procedures in that area only once or twice a week, state regulations require additional room.
?As you can imagine, back in the ?50s the rules were very different than they are nowadays,? Armstrong said. ?The requirements for air circulation and infection-control standards by default force us to have about twice as much space in our operating department as we currently have.?
The OR area will include separate rooms for major and minor procedures?and new recovery space for people who undergo them.
?A big change and benefit is that patients will be able to prep and recover from their procedure within the department itself,? Armstrong said. ?We?ll no longer have to wheel people from an inpatient room back to the OR.
?There?s a lot more privacy with that,? he added. ?People who are coming in for their colonoscopies, or whatever else they?re having done, are going to walk in and leave right there. Nobody else is going to have the opportunity to see them.?
Renovating existing space
The hospital?s current space will be renovated in three phases. Phase 1 will include redoing the outpatient rooms.
?We?re going to have four outpatient rooms (that) will look almost exactly like the inpatient rooms?the only difference is they don?t have access to an outside window,? Armstrong said.
?The state says if the room doesn?t have natural light coming in from an outside window, they cannot be considered an inpatient room.?
The outpatient rooms will be used for a variety of procedures, including IV-infusion therapies and chemotherapy treatments.
Phase 1 also includes a new nursing station situated to have easy access to outpatient rooms and inpatient rooms, the emergency and operating rooms, and to the main entrance.
?That?s important because we wanted to keep everything centralized in one place,? he said.
Phase 2 will include redoing the business office, medical records, some administrative space, and redoing the kitchen and dining area?not just for employees and people visiting patients, but for the general public.
?We will offer like a salad bar or something where people can just walk in and serve themselves,? Armstrong said.
Phase 3 involves inpatient rooms. The newly renovated facility will offer five instead of the current 15.
?There?s been some concern that we?re bringing it clear down to five, but we need to use space better,? Armstrong said.
He said that each of the new rooms can accommodate two beds in response to temporary crises such as a flu epidemic.
?We did some studies that show over the past three years that we would have been able to consider each of these (five) rooms a private room and meet our patients? needs as a private room 97 percent of the time,? Armstrong said.
?Five rooms is really a good fit for us. Each room is costing us $120,000 to add on, so it was a big deal for us to get this right.?
Armstrong said the space presently used by physical therapy may be made into a conference room, additional storage or to meet some other departmental need.
COST and benefits
While St. Luke Hospital & Living Center is a tax-supported institution through Hospital District No. 1 of Marion County, the proposed project will not affect the current mill levy. Instead, $6 million will be generated through revenue bonds, which will be paid back with future revenues of the hospital, Armstrong said.
The remaining amount?between $500,000 and $650,000 needed for bond-issuance fees, debt reserve and additional bond security?will come from cash.
A third funding component is a capital campaign directed by the St. Luke Foundation called, ?A Healthy Investment in Your Future.? Funds raised via public donations will be used solely for remodeling, construction and equipment needed for the facility, and for an endowment.
So far, the capital campaign has been internal. St. Luke employees raised more than $108,000 among themselves during November. In late December, St. Luke Hospital Auxiliary pledged $125,000 to the project, payable over five years.
When the campaign goes public later in 2010, the overall goal will be to reach a $2 million target.
What do planners see as the indicators of a successful campaign?
?No. 1, we need to establish an efficient, stable health-care system now and into the future,? Armstrong said. ?It is not going to do St. Luke and this town any good if we put up a facility and then decided in a year or two that we?ve bitten off more than we can chew and can?t afford to pay for it.?
Armstrong said a successful campaign will also mean securing a facility that has the capacity to handle present and future health-care needs, improve physician and staff recruitment and retention, and continue as a major attraction for residents and prospective businesses.
?One of the two things I hear whenever a business comes into town is: ?Tell me about your education system and about your health care,?? Armstrong said about the impact of an improved and modern facility on economic development.
As for the immediate financial impact of a successful hospital, Armstrong points first to the 100-plus jobs with annual payroll of about $3.1 million.
?Economic experts says a dollar entering the local economy turns over five times in its impact?that?s a financial impact of $15.3 million each year,? he said.
Another positive impact may be just as significant, he said, but is harder to measure in dollars and cents.
?Whenever folks come into town, I brag about the projects that the school has done,? Armstrong said referring to the recent construction of a fine arts center and gymnasium/indoor swimming pool by USD 408 in cooperation with the city.
?We?d like to continue that process and hopefully have people brag about our health-care facility they way they brag about our schools,? he said.