The first time Donna Chee visited Holy Cross Hospital to deliver a child, the parking lot was in such chaos that the only figure who seemed capable of offering guidance was the towering statue of the Virgin Mary in the front of the building.
"You saw the statue, and you were just, like, 'Oh, I'm in the right place,' " Chee said last week. She eventually found her way to the maternity ward, where she had her first child, Jasmine.
Last week, however, her route was easier -- even if the circumstances were more difficult.
The Silver Spring hospital recently completed a four-year, $90 million renovation and expansion. For hospital visitors and patients trying to park or locate a department, the project has produced a more orderly flow in and around the building, as well as additional private rooms.
Entering a bright and airy concourse filled with glass and blond-wood surfaces, expectant mothers head to elevators that take them directly to the maternity ward. That is a change, hospital officials said, from the mazelike search that maternity patients used to endure.
All of which made things easier last week for Chee, who had gone into labor prematurely. Chee, 33, a saleswoman who lives in Germantown, was escorted by a doctor through the neonatal ward. She and her husband, Isaac, 34, settled into a private room. And on Oct. 6, at 2:42 a.m., she delivered her son, Aiden, at 31/2 pounds.
"It's always a scary thing to come to the hospital," the mother said. The new arrangement and having a private room made things more efficient and easier on her nerves, she said.
"Oh, my God -- it looks like a hotel," said another new mother, Stella Prokopic, 31, of Olney. "It's a warmer atmosphere. You don't feel like you're in a hospital."
The changes are especially important to Holy Cross Hospital, which, like other medical centers, must attract patients who can pay. Maryland regulates the fees that hospitals charge for inpatient services, so hospitals must find ways besides fee increases to cover the climbing costs of providing those services. At the same time, demand is growing for hospitals to treat uninsured patients. Last year, for example, 2,000 uninsured mothers delivered children at the hospital.
To attract more patients, hospitals can specialize in certain medical fields or procedures, and they can offer such amenities as private rooms.
Holy Cross has built a reputation for its obstetrics and has a neonatal intensive care unit that can help premature infants survive after 23 weeks' gestation. Michael Hall, a spokesman, said Holy Cross delivers more babies than any other hospital in Maryland. In the past 12 months, the hospital delivered 8,500, he said.
"We do a very high percentage of the charity care that's done in this county," Kevin J. Sexton, the hospital's chief executive, said last week during a tour of the hospital. "I would say our strongest point is, we are a full-service community hospital."
Holy Cross officials said the only way a hospital can stay financially healthy is to control costs, such as through efficient purchasing of supplies and expanding services to attract more patients.
The renovation and expansion was the hospital's biggest since 1978, increasing its space to 687,000 square feet, about half of which is new or renovated. Two floors of rooms were added to the facility's east wing. The new emergency center, which includes a facility for treating injuries from biochemical attacks, opened last year. Twice as large as the previous emergency room, the center is divided into three wings for pediatric, acute and express care, which treats minor injuries. The project added 68 private maternity rooms and increased the number of beds in the neonatal unit to 46 from 32, officials said.
Other Montgomery County hospitals have expanded or announced building plans.
Rockville-based Adventist HealthCare, which operates Washington Adventist Hospital in Takoma Park and Shady Grove Adventist Hospital in Rockville, is expanding its facilities.
In April, the company broke ground on a $99 million project to build a four-story tower at Shady Grove Adventist that will add 144 private rooms, bringing its number of private rooms to 218, or about 84 percent of its capacity. In May, the organization obtained approval to create an emergency facility in Germantown to provide more access to patients in fast-growing areas of northern Montgomery County. And in July, the company announced plans to open an outpatient surgical clinic in Rockville.
William G. Robertson, Adventist HealthCare president and chief executive, said the hospital expansion trend can be attributed to the region's swiftly increasing population and to shifting demographics that skew toward elderly patients and patients in their childbearing years.
In addition, he said, new technologies require more space: The typical hospital room today, he said, is equipped like an emergency room was years ago. In addition, hospital buildings are aging. He said the newest hospital in the area -- Shady Grove Adventist -- recently turned 25.
In Frederick County, Frederick Memorial Hospital has plans to open a diagnostic facility in Urbana, close to the Montgomery County border, to reach the fast-growing community there.
"As soon as we find a site, we'll build something," Frederick Memorial Hospital spokesman Kenneth R. Coffey said.
Across the state, meanwhile, the number of hospital beds in acute-care facilities is expected to be about the same as last year, according to the Maryland Health Care Commission's fiscal 2006 report.
In 2000, the commission revised the method for counting licensed beds to provide a more realistic number of hospital capacity. The panel said Holy Cross has the largest number of licensed beds -- 365 -- of any of Montgomery's five hospitals. Holy Cross's number of beds has grown by about 7.4 percent since 2001 -- a rate faster than those of its competitors.
Holy Cross Hospital, founded in 1963 by the Congregation of the Sisters of the Holy Cross, retains some aspects of its Roman Catholic origins. The hospital does not perform abortions or sterilizations. Elements of faith continue to resonate in its devotion to providing medical care to the needy and in its programs that offer an array of spiritual counseling, in numerous faiths, to dying patients.
Officials emphasize that they do not push religious beliefs on their patients and that they encourage them to specify their own wishes for end-of-life care.
"It's a part of the atmosphere," Sexton said. "We do not have this notion that life does not end. We try to be proactive to get people to say what they want."