Oculus | Center of Excellence

Center of Excellence

Jim Crispino and Aran McCarthy, Winter 2009/2010 Download PDF

Francis Cauffman Architects transforms a community medical center in Pennsylvania into a major regional – and sustainable - institution

A community’s wellbeing and the health of its environment are intimately interrelated. For the Geisinger Health System, this is a guiding principle. When administrators set out on a much-needed expansion to its Wyoming Valley campus, they put sustainability at the forefront – for the long-term health of area residents, the region’s economic wellbeing, and the welfare of the land.

Environmental and community responsibility is an integral part of Geisinger’s mission. Founded in 1915, the physician-led system offers health care, education and research for a service area that covers 20,000 square miles and a population of 2.6 million. The health system owns 39% of all LEED-registered healthcare projects in the state of Pennsylvania and provides more than $15 million in uncompensated care to needy patients every year.

Most recently, Geisinger’s approach earned the attention of President Obama, who has held up its health system as a model, saying: “We have to ask why places like the Geisinger Health system...can offer high-quality care at costs well below average, but other places in America can't. We need to identify the best practices across the country, learn from the success, and replicate that success elsewhere.”

It was in 2000 that Geisinger announced a plan to transform its Wyoming Valley campus, located in Wilkes-Barre, PA, from a community medical center into a regional institution. Prior to implementation of the $121-million plan, the majority of the structures on the campus were 20 to 30 years old and unable to meet the needs of a growing community. Different departments were scattered around the site, circulation between them was difficult and hard to navigate, and the services were limited.

Planning for the Future – and Beyond

Wilkes-Barre is situated in Luzerne County, which is home to more than 320,000 residents, making it the most populous county in northeastern Pennsylvania. Although the region is served by more than 20 colleges and universities and encompasses several major employers such as Proctor & Gamble and Bank of America, there was a pronounced need for additional facilities in the area, especially a trauma center. Demand for intensive care services was expected to grow approximately 40% by 2020.

Explained Lissa Bryan-Smith, Chief Administrative Officer for the Geisinger Regional Ambulatory Campus, “We knew that the region did not have a tertiary or quaternary hospital, and we knew that Geisinger could fill that role. However, we needed to build new facilities – the kind of facilities that would attract outstanding physicians and convince our residents that they did not need to go outside the region for top-notch services.”

To do that, the architects of the master plan, New York-based Francis Cauffman, earmarked new “centers of excellence,” or sites for specialty care (cardiovascular, cancer, and birthing centers, for example) that served as the nodes of a sophisticated and efficient healthcare complex. These “centers” are standalone buildings that are each staffed with a coordinated team of physicians and equipped with state-of-the-art technology.

The first center of excellence was the Heart Hospital (2002), followed by the Silver LEED-certified Critical Care Building (2008) and an addition to the Henry Cancer Center (2009). The Critical Care Building (CCB) alone increased the campus by 50 percent and added considerably to its capacity. It houses an expanded 32-bed emergency department, a helipad, 12 high-tech surgical suites with robotics, and a 24-bed intensive care unit. It also contains a Level II-accredited trauma program.

The development of the Wyoming Valley campus means that Luzerne’s healthcare is finally catching up with its transformation from coal-mining region into a diverse, modern community. The state’s mining industry began in the mid-18th century, and the population of Wilkes-Barre exploded after the discovery of anthracite coal there in 1800, which earned it the nickname “The Diamond City.”

So it was no surprise that, while planning for the CCB, the design team found a series of abandoned coalmines under the original building site. Ultimately, the design team moved the project rather than shoring up the mines, because the health system wanted to build the CCB as swiftly, efficiently, and cost-effectively as possible. The new site, located on a mountainside, posed its own set of problems. The design team literally carved the CCB into the geography of the campus.

Sustaining a Region and Its People

In addition to the challenges of the site, it was difficult to create an acute care facility that was also “green.” Critical care facilities operate on a 24/7 basis, and emergency departments require inordinate amounts of energy to support around-the-clock, high-tech operations.

To achieve a LEED Silver rating for the CCB, the design team used systems that were known to be efficient, such as the high-performance variable air volume system. Light levels were reduced to 1.8 watts per square foot, which resulted in a 19.1% reduction in energy use while maintaining work-appropriate light levels. In addition, 40% of the materials used in construction were from regional sources and 85% of construction waste was recycled or diverted from landfills.

These energy saving techniques resulted in an immediate savings of about $100,000 in energy costs annually. Geisinger also focused on employing local subcontractors; in the end, 60% of the 33 subcontractors were local. Surprisingly, the design team achieved the LEED rating without any additional costs to the budget.

Planning for the future is also important to keeping costs down, so the design team built the CCB with long-term sustainability in mind. Inside, the CCB’s infrastructure has the extremely high level of flexibility that is typically found in research buildings, but is not common in hospital buildings.

Beyond cost concerns, the design of the CCB reflects the new “soft-touch” style of healthcare design. Great expanses of glass allow for natural sunlight to penetrate throughout the building’s interior, so that many of its rooms have views to the outdoors and the valley. The hospital features a serenity room for visitors of all faiths and ample teaching space for Geisinger’s two new residency programs. A local artist was commissioned to create artwork for the building, adding inviting, tranquil scenes of the area’s natural landscapes.

Bryan-Smith describes how “the process did not go in a straight line. We actively sought feedback and changed the design to incorporate suggestions from the community. Whereas the original buildings on campus were built for the health system, our recent buildings are built for its people. In the end, they are also more sustainable – not only because they save energy – but also because they are a long-term investment in the lives of our patients and our region.”


James Crispino, AIA, is president of Francis Cauffman Architects, based in the firm’s New York City office.

Aran McCarthy, AIA, is a principal of Francis Cauffman Architects

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