Patient experience and safety drives building construction decisions for the new academic hospital

The new academic psychiatric hospital building for The University of Texas Health Science Center at Houston (UTHealth Houston) is the result of collaboration and consensus building over the better part of a decade.

The state-of-the-art facility, named the John S. Dunn Behavioral Sciences Center, was unveiled on Wednesday, Feb. 2, during a ribbon-cutting celebration. The 253,000-square-foot facility includes 264 new inpatient beds. Sitting adjacent to the UTHealth Houston Harris County Psychiatric Center, the two facilities have a combined 538 beds, making it the largest academic psychiatric hospital in the nation.

It is also the first hospital of its kind to be constructed in Texas in more than 25 years, and was built in partnership with the Texas Health and Human Services Commission and the Texas Medical Center.

The new facility is intended to be to be a new standard of care in Texas, and UTHealth Houston leadership took an active role to ensure patients remained at the center of the mission, even during planning and construction of the building.

People with mental health disorders are among the most vulnerable in society, and every building detail, down to the type of screws used in construction, were meticulously thought out and vetted in an effort to create a safe and beautiful place for patients to heal.

The Texas Legislature approved funding in 2017. UTHealth Houston and the design firm Perkins + Will spent 2 ½ years on planning, design, and getting approvals for the project. Vaughn Construction worked for another 2 ½ years on construction during the COVID-19 pandemic. 

“The patient was the priority throughout this project,” said Cynthia Crespo-Bonaparte, safety manager of the hospital and clinic safety program within Environmental Health and Safety at UTHealth Houston. “There were people with different expertise working together to make decisions. You have to be patient with one another and listen to ideas, but it was never about us. We kept the safety of patients, staff, and visitors at the forefront of discussions, and those discussions got down into the nitty-gritty of the building.”

The nitty-gritty included security screws, so called because they cannot be easily removed with common utensils. The safety of patients is in every detail, including door knobs, clothing hooks, hand rails, and furniture design. All are ligature-resistant, designed to prevent the opportunity for patient self-harm.

The hospital has 11 units with 24 beds in each unit. Nurses, physicians, and psychiatric technicians were consulted to help design the units to ensure patient and employee safety.

Based on staff feedback, each unit has a long, central nurse station that is open to the large central room. From the station, staff can see almost every angle of the unit, including down the two patient room hallways. Therapy rooms have glass walls to provide visibility, and frosted to give patients privacy.

“We put considerable thought into how to build the nurse stations so they remained accessible, but also safe. The desks are built deeply, so someone cannot reach across to harm a nurse while they are working,” said Carina Ayers, director of Clinical and Information Technology at the UTHealth Houston Behavioral Sciences Campus. “We actually brought in a short and a tall nurse to test the position of the computer monitors. We wanted staff to be able to see the screen and patient activities without having to continually adjust the computer angle or seat position.”

Considerable thought was also put into patient experience in the new facility.

“You have to look at everything from a different light,” said Ginger Smith, senior facilities construction project manager at UTHealth Houston. “Every patient room door has a special hinge on it that allows it to swing in or out. A patient cannot lock themselves in a room, and yet you can allow them the privacy to close the door.”

In the bathrooms, soft foam panels are used instead of a traditional shower curtain. Magnets hold the panel in place to allow for privacy while maintaining safety.

IT found ways to space out phones in the units to give patients added privacy to connect with their loved ones, and a new program was utilized to allow TVs to have moderated content. This include the ability to control content by parental rating or by channel, giving patients and therapists greater choice. 

“The patient experience is so important to healing,” said Derek Drawhorn, associate vice president of IT Infrastructure at UTHealth Houston. “Patients can get agitated if they don’t have anything to do or don’t have anything appropriate to watch. Small details like the quality of television make a real difference.”

With a goal of including longer-stay patients in the facility a Therapy Mall was added to the design to provide spaces for group and expressive therapies such as music and art therapy. There will also be a hair salon and a boutique where patients who are on a behavior management program can redeem the points they earn for snacks and other items.

The facility boasts two enclosed courtyards with a walking trail, and the spacious cafeteria has outdoor seating options. Attention to detail in the courtyards was a priority for the UTHealth Houston safety team. Safety Specialist Cedric Peace researched what trees to plant to avoid potentially poisonous seeds.

The same attention to detail was applied to make sure patients, staff, and visitors remained safe during an emergency.

“There’s a lot of glass and light in the building, but we wanted to make sure it was also safe in the event of a hurricane,” Peace said. “The windows can withstand Category 3 winds. They are actually called ‘missile-proof windows.’”

The safety team was also intricately involved in the design of the fire alarm and sprinkler systems and thinking through how to evacuate in case of a fire. Former Safety Manager Jennifer Laine was instrumental in the decision to have an additional stairwell added to the design to allow visitors to evacuate without entering a patient-care area.

The team also connected with the Houston Fire Department to ensure firefighters are aware of protocols unique to the building, and hosted tours during different phases of the construction to help the fire department be familiar with the building’s floor plan.

Construction during a pandemic

Building a state-of-the-art facility during a global pandemic presented its own challenges, but it also created opportunities.

The Dunn Center Building project was the first of its size to be self-managed by the UTHealth Houston facilities team. In the past, The University of Texas System has managed the inner workings of a project, including change orders, and managing the general contractor.

Surprisingly, there were advantages to building the hospital during the pandemic, as construction continued with strict COVID-19 protocols managed by contractor Vaughn Construction.

“We were one of the few projects that didn’t stop in the Greater Houston area because of the pandemic,” Smith said. “Because of that we were able to staff up as other projects were stopping. In some cases, depending on the scope of work being done, we could have two or three staggered crews working instead of one.”

Vaughn was able to bring in subcontractors sooner and at competitive pricing, ultimately leading to the project completing at $6.8 million under budget. Those funds were reallocated to enhance the building.

“From the savings, we were able to add a fourth floor to the south tower of the facility, which added another 24-bed unit to the building,” Smith said. “We were also able to add therapy and clinical office space.”

The university was able to spend additional savings on enhancing the atmosphere of the building, including adding warm faux wood finishes to halls and elevators, as well as large photographic murals.

“We hired a photographer to go out and take photos of the Greater Houston area, and we turned those into beautiful murals inside the units,” Smith said. “The wood finishes and murals add a warm feeling that really benefits patient experience. It de-institutionalizes everything. The thing I love about this facility is when you walk in, you would never know it is a behavioral health center.”

The pandemic prompted additional installation of video conferencing equipment, some of which were impacted by supply chain issues.

“COVID-19 kicked in hard and heavy in the middle of our timeline for installing new tech, so we had to shift and change,” Ayers said. “We weren’t sure when equipment would be delivered, so we ordered various options and borrowed equipment from other UT System schools. Then, we tested and evaluated the technology to make sure it would meet our needs.”

Those efforts resulted in technology that allows for improved instructional opportunities.

“The Dunn Center Building has rooms set up to be able to record a psychology session, with consent of the patient,” Ayers said. “Instructors can play the session back for students, or be able to review the student’s patient interview skills in real time. These are incredible instruction tools to be able to train the next generation of mental health care providers.”

Special thanks:

Special thanks to all of the UTHealth Houston teams and outside firms that assisted in making this project a success:

• Safety, Health, Environment, and Risk Management
• UTHealth Houston Facilities Project Management Team including Julie Lucas, Ginger Smith, Brady Smyth, and Robin Murtishaw, who collectively managed and delivered this highly successful project on time and well under budget.
• Deborah Parker, Infection Control Practitioner
• UTHealth Houston Harris County Psychiatric Center Facilities Team including Gerard Marchand, Alan Dumas, and Richard Carmona
• Tim Burr, Director, Performance Improvement, Business Intelligence, and Reporting
• Norman Dorsett, Department of Health and Human Services inspector
• Design team: Perkins + Will, Smith & Company, Shah Smith & Associates, Smith Seckman Reid, Genesis Planning, Martinez Moore, and Kevin Turner with human eXperience for his knowledge and dedication to behavioral health facility design.
• T. Vaughn Construction team for their partnership, knowledge, and expertise in the completion of this project.