Williston hospital design firm grows to No. 1

The steel is going up fast for the new Miller Building at the University of Vermont Medical Center, as workers push to enclose the seven-story structure by mid-December.

Dave Keelty, the medical center's director of facilities and planning, said the $187 million, 128-private-room project will spread out the bed population in the existing hospital. UVM Medical Center is currently between 30 and 40 percent private rooms. The Miller Building will get the hospital close to its goal of 90 percent private rooms. The hospital's total bed count will remain at 447, the same as it is now.

"It's very important for us to get to single rooms for a number of reasons," Keelty said. "Privacy, infection control, gender management."

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The co-CEO of Environments for Health Architecture in Williston, which designed the Miller Building, said a Canadian study showed that hospital-acquired infections drop by 10 percent in hospitals with predominantly private, rather than semi-private, rooms.

"Hospital-acquired infections are a huge health consequence and also a huge cost consequence," Dan Morris, said. "The levels are relatively low in organizations like UVM Medical Center, but they're never going to be zero."

Semi-private rooms are also inefficient, according to Morris.

"That's counter-intuitive but in many cases, semi-private rooms can only have one patient anyway because of roommate issues, or someone with an infection," he said. "It's inefficient because so often you have the second bed remaining open."

Semi-private rooms are expensive to staff, Morris said.

"You can't do procedures because there's another patient in that room so you have to juggle patients a lot," he said. "That takes a lot of nursing hours. By the time you add up the cost of hospital-acquired infections and staffing efficiency it covers the cost, in some cases, of a new inpatient wing."

Keelty said the beds in the Miller Building are coming out of the medical center's oldest inpatient facilities, more than 50 years old, where patients share semi-private rooms. UVM Medical Center is not buying new beds for the new facility, but rather using existing beds.

"The physicians and nurses do a wonderful job, but they really have a tough physical environment to overcome," Keelty said. "The equipment, family — it's amazing how when somebody visits everybody has to shuffle around just to get room for people to sit down. And there's no privacy. The doctor is giving you a report and the guy in the next bed is hearing everything."

Keelty explained that for every private bed in the Miller Building another private room is created in the older facilities, where beds will be removed from the semi-private rooms.

Keep your ego in check, please

Environments for Health Architecture, known by the shorthand, E4H, was founded by Dan Morris in 1990, with partners Jill Boardman and Jerry Switzer joining several years later. Boardman shares CEO duties with Morris.

E4H was recently named the top health care-only architecture firm in the nation by Modern Healthcare magazine. .

"At our staff meeting this morning I was cringing as we said, 'We are number 1 in terms of size,'" Jill Boardman said on Monday. "That's kind of an egotistic thing to say. It would be better to be the best. Let's say we're the best instead of the largest. But it is a milestone. For the staff it's exciting to be recognized as a leader in health care architecture."

Morris and Boardman are concerned about ego because they explicitly try to minimize its influence on their firm.

"A lot of our big competitors only chase big projects," Dan Morris said. "We pride ourselves on being a low ego architectural firm. Ego might get some architects some clients, but we think humility gets more clients."

Boardman said the company considers every project to be a "gift."

"Even if it's a small project, which might be $100,000, $100,000 is a lot of money," Morris said. "For that hospital that's the most important thing they're doing right now. They put their trust in us. We feel like we owe it to them to take it really seriously. If it's a $100,000 project or a $100 million project, we treat it exactly the same."

E4H's biggest project currently is a $305 million project for Eastern Maine Medical Center in Bangor.

Size matters

For most of its life, E4H was MorrisSwitzer Environments for Health, with offices in Williston, Boston, and Portland, Maine. The firm mushroomed from 55 people to about 130 people last year, and changed its name, when it acquired Ascension Group Architects in Dallas and partnered with DaSilva Architects in New York City.

Morris explained that his firm had to get big to keep up with the hospitals.

"Obviously there's a lot of consolidation happening in the health care industry right now," he said. "Independent hospitals continue to exist, but the vast majority are becoming part of some system. That system may have three or four hospitals in it, or it may have 30. The expectation in the industry is that consolidation is going to continue and those systems are going to become larger and larger."

As hospital systems grow across the nation they are looking for architecture firms that can keep up.

"It's more efficient for them to have fewer relationships so they try to have preferred vendors they work with," Morris said. "We felt that we needed to have a larger staff to be able to support hospital systems trying to serve the needs of not one or two hospitals, but of 30 hospitals."

Morris and Boardman had another reason for growing fast.

"We've been fortunate to have an extremely stable workforce with almost no turnover, which is great," Morris said. "The downside of that was at our limited size we had nowhere for staff to grow. If we were going to retain them we needed to grow to create career opportunities."

E4H currently has annual revenues "north of $30 million," Morris said, but the firm is not finished with growth. The partners say they are in conversations with four or five additional firms, one of which alone would double the size of the company overnight.

"We'll be nationwide," Morris said. "We'll have offices throughout the country."

Contact Dan D’Ambrosio at 660-1841 or ddambrosio@freepressmedia.com.