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Driven design

Process improvement tools guide replacement project
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Virtua Voorhees replacement hospital

Project Overview

  • Project Name: Virtua Voorhees replacement hospital
  • Location: Voorhees, N.J.
  • Total floor area: 676,000 square feet
  • Number of floors: 7
  • Number of beds: 368
  • Project cost: $463 million
  • Construction cost: $342 million
  • Groundbreaking date: March 2008
  • Opening date: May 2011
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Project Team

Virtua Voorhees | Voorhees, N.J.

View "Virtua Voorhees | Voorhees, N.J." Gallery

  • Owner: Virtua
  • Architect, interior designer, MEP engineer, structural engineer and landscape designer: HGA Architects and Engineers
  • Project Manager: Hammes Co.
  • Construction Manager: Turner Construction Co.
  • Environmental Consulting and Civil Engineering: Dewberry
  • Medical Equipment Planning: KJWW Engineering Consultants
  • Signage Designer: ex;it


When Virtua, a health system based in Marlton, N.J., set out to replace its Voorhees, N.J., hospital facility, the system turned to a set of tools it has come to trust — Six Sigma process improvement and Lean design.

"We've done a lot of Six Sigma work in quality and safety, as well as cost, for the past 11 years. Six Sigma and Lean design are built into our everyday work here at Virtua. That's just the culture. That's the way we do things, in a very specific, detailed way," says Virtua CEO Richard Miller.

The Six Sigma and Lean approaches use data gathering and analysis to develop workflow and environments that promote efficiency and high-quality results. The health system worked with health care consultants Hammes Co., Brookfield, Wis., and the Milwaukee office of architecture, engineering and planning firm HGA Architects and Engineers to create the Virtua Voorhees replacement facility.

While Six Sigma and Lean directed the operational layout of the facility (see sidebar on page 15), HGA also used a carefully studied process that rated people's reactions to a variety of images including local landmarks and landscapes, as well as different types of building projects, to develop "design drivers" or guiding principles that influenced the hospital's aesthetic attributes.

Natural harmony

Virtua Voorhees was built on a 125-acre greenfield site that required water, sewer, gas and electrical upgrades.

According to Michael A. Solak, senior project executive, Hammes Co., about 60 percent of the site was usable land. "The remaining land is really left to its original state," he says.

The project team incorporated the existing landscape into the design of the hospital campus. Wetlands were respected and ponds were created during the project, with walking paths installed near forested areas.

The patient tower is slightly curved to help fit the 676,000-square-foot building onto the somewhat narrow site. The curved design also focuses views from the patient tower onto the natural wetlands.

The site inspired the materials used in the hospital's construction. The exterior of the building features simulated sandstone accented by phenolic resin panels of real wood veneer. These materials "create a real harmony, and something that's indicative of what was basically unearthed from the site," says Mark Debrauske, AIA, project lead designer, HGA.

Human scale

To make the large hospital easier to navigate, it is divided into separate areas for adult medical-surgical services, women's and children's services, obstetrics, adult emergency care and pediatric emergency care. Exterior sign­age directs patients and visitors to the appropriate entrance.

The entry lobbies and other main public spaces, such as retail and dining areas, are designed on a smaller, more human scale, to make people feel comfortable in the hospital environment.

Interior photo of the hospital waiting area with soft chairs and lighting

"[At a hospital], you're not necessarily looking for excitement. We want to reduce any anxiety and anxiousness by doing the antithesis of the large hotel lobby," says Debrauske. "The whole public aspect is pretty low-key, pretty calm — and yet a rich experience — because you're always connected to the exterior," he says. Large windows provide natural light and views that help people relax and orient themselves.

Courtyards give patients, visitors and caregivers direct access to garden spaces in the interior of the building's diagnostic and testing block. "If you've been at work all day, or you've been visiting your family member all day, you can poke your head out and breathe some fresh air for five minutes" without having to walk all the way to the front door of the hospital, says Kelly Brainerd, IIDA, interior designer, HGA.

The stone and wood materials seen on the building's exterior are carried through in the interior design. Granite is installed in each of the hospital's five main entrances, and the interior doors are manufactured of rift-cut oak.

The designers were mindful to include natural wood in places like the armrests of chairs in waiting areas and patient rooms, where people can touch and feel the warmth of the material.

Brainerd notes that advances in wood finishes ensure the surfaces can be cleaned with a diluted bleach solution and are "very durable for a health care setting."

Long-range design

The hospital has 368 private patient rooms. Of these, 72 are specially designed to accommodate the mother-baby experience. The rest implement a universal room concept that will enable the hospital to adjust each room's acuity level as needed.

"Changing the type of patient we see on a unit is really just a matter of staffing," says Michael Kotzen, Virtua Voorhees COO.

The patient rooms include a custom bedside cabinet with a bench that provides convenient seating for physicians and visitors. Custom over-bed tables feature trays for wireless keyboards.

According to Debrauske, the scale of the hospital allowed for such customization without adversely affecting the budget. "That was really a great opportunity for us to tailor this facility exactly to Virtua without adding any extra cost to the project," he says.

"The cost of health care is significant," says Miller. "You want to make sure you have a building that is sustainable for the long term." The size of the facility's site, the building infrastructure and the universal room design all are intended to help the hospital adapt to future growth and change.

The building, which is targeted for Silver certification from the U.S. Green Building Council's Leadership in Energy and Environmental Design program, is also environmentally sustainable.

'It works'

Miller credits the success of the project to careful planning and teamwork. "That's where tools like Six Sigma [and] Lean come into play," he says.

Process improvement tools that originated in manufacturing "can work very well in health care," says Miller.

"When you know how to use the toolkit, and you map out the strategy and design very carefully, it works."

— Amy Eagle is a freelance writer based in Homewood, Ill., who specializes in health care topics.

Sidebar - Six Sigma and Lean help drive quality and efficiency

Six Sigma management practices and Lean design principles influenced the design of New Jersey's Virtua Voorhees hospital in several significant ways, according to hospital leaders.

Six Sigma is aimed at improving quality by eliminating circumstances that can cause errors. Its methodology involves defining design goals, measuring current processes and analyzing alternatives. Lean design calls for the use of empirical data to eradicate wasteful practices and create more efficient systems.

To improve quality and efficiency, Virtua Voorhees "was designed with a lot of simulation and modeling around patient flow and clinician flow," says Richard Miller, Virtua CEO. Management engineers followed patients and caregivers at an existing Virtua hospital and diagrammed their movements in detail. Miller says this was done to identify inefficiencies in the existing building and "take those inefficiencies out" in the design of the replacement hospital.

Michael Kotzen, Virtua Voorhees COO, says the shadowing activity helped determine interdepartmental adjacencies. "That got us to some nonstandard layouts, not only in terms of how patients go through the system, but also how the work happens from a staff perspective," he says.

The pharmacy, which typically might be found in the basement of a hospital building, was given what Kotzen calls "prime real estate on the fourth floor" of the patient tower. This places the pharmacy halfway between the top and bottom floors of the hospital. Medical
equipment is cleaned and delivered from an adjacent fourth-floor location.

The design analysis also led to the decision to move from a central emergency department to two emergency departments, one dedicated to children and the other to adults. A separate entrance was built for the obstetrics department, where more than 5,600 babies are expected to be born this year.

"You really know when you start taking care of patients how well the design of the patient care model was done. And I have to say, we're hearing rave reviews about it, both from patients and staff," says Miller.

Sidebar - Patient peace and safety stressed in corridor design

At Virtua Voorhees (N.J.) hospital, the corridors of the patient units are not simple passages from point A to point B, but well-considered spaces in and of themselves. Designers worked to create a subdued, peaceful atmosphere in the corridors, to help patients rest and heal.

"It's imperative that we do everything we can to make sure it's very quiet in the corridor," says Mark Debrauske, AIA, project lead designer, HGA Architects and Engineers, who notes that noise levels play a large role in patient satisfaction. Quiet corridors are especially important at Virtua Voorhees because the patient rooms are designed to position patients closer to the door, to reduce nurses' walking distances and help staff members respond to patient needs quickly. Patient bathrooms are located along the outboard wall of the facility, which puts the bed nearer the entrance. "Moving the patient closer to the caregiver pushes them much closer to the activity center" of the unit, says Debrauske.

Carpet tile dampens noise on the unit. "Having that softer surface underfoot really helps with the acoustics," says Kelly Brainerd, IIDA, interior designer, HGA.

The antimicrobial carpet tiles have a tight pile that provides minimal resistance to wheelchairs and other rolling traffic. The tiles also feature a custom pattern and coloring designed for easy maintenance; they can be replaced as necessary without marring the overall appearance of the flooring.

The curvature of the building reduces the perceived length of the corridor, creating a space that feels more intimate. Indirect lighting adds a gentle ambience.

Richard Miller, Virtua CEO, says "patients have remarked on how quiet it is" at the hospital.

In terms of noise level, "it's difficult to discern the difference, unless you look in the rooms, between a full unit and an empty unit," adds Michael Kotzen, Virtua Voorhees COO.

Sidebar - Spec Sheet

Principal Design Materials   Carpet tile: Interface Inc. Ceiling: USG Corp. Composite wood panels (interior and exterior): Prodema Curtainwall framing: National Glass & Metal Co. Inc. Door hardware: Architectural Builders Hardware Manufacturing Inc. and Sargent Manufacturing Doors: VT Industries Inc. Flooring: Forbo Flooring Systems, Mannington Mills Inc. and Teknoflor Glass: PPG Industries and Skyline Design Lighting: Acuity Brands Inc., Cooper Lighting and Focal Point Manufactured stone cladding (interior and exterior): Arriscraft International Metal panels (exterior): Centria Paint: PPG Industries Plastic laminate: Formica Group and Pionite Decorative Surfaces Plumbing accessories: Chicago Faucets and Sloan Valve Co. Plumbing fixtures: Kohler Co. Resin panels: 3form Inc. and Designtex Roofing: Firestone Building Products Tile: American Olean, Crossville Inc., Daltile and Summitville Tiles Inc. Wall coverings and custom cubicle curtains: Designtex Window treatments: Hunter Douglas and MechoShade Systems Inc. Principal Furnishings   Cafeteria seating: Davis Furniture and Stylex Cafeteria tables: Versteel Casework: AllSteel Inc. and Gunlocke Children's furniture: Arcadia and TMC Furniture Inc. Conference tables, office desks, office seating, files and shelving: Allsteel Inc. Exterior furniture: Landscape Forms Lounge seating: David Edward, EKO, Gunlocke and Nemschoff Inc. Patient beds: Hill-Rom and Stryker Patient over-bed tables: AmFab Co. Patient room seating: IoA, KI and Krug Inc. Woodworking: THA Inc. Major medical equipment   Imaging equipment: GE Healthcare Sterilizers, lights and booms: Steris Corp. Infrastructure Boilers: AERCO International Inc. and The Fulton Companies Building management system: Johnson Controls Chillers: Ingersoll Rand Electrical equipment: GE Elevators: Quality Elevator Products Inc. Fire safety: Edwards, a UTC Fire & Security Company Generator and UPS: Caterpillar Inc. HVAC (misc): Ingénia Technologies Inc. Kitchen equipment: Jade Products Co. and Manitowoc Foodservice Nurse Call: GE Security Pneumatic Tube System: Swisslog Security: IDenticard Systems Television signal distribution system: Z-Band Inc. Video-on-demand system: GetWellNetwork Inc.

Information provided by HGA and Virtua

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