Practicing ArchitecturePracticing Architecture
Building the 21st-Century Hospital
The prototypical American hospital: monolithic, single-use, imperious. That form is no accident. For decades, hospital design has mirrored the generally accepted role of medicine and technology in society.
But with a new understanding of today’s healthcare challenges, that view is being questioned. Hospital design increasingly reflects the lessons of neighborhood-scale urban planning, siting, and health of the facility itself, as well as the surrounding community.
“The place where you go to the farmers market”
Dell Children’s Medical Center of Central Texas is a model of the way a hospital building itself can be a force for promoting health.
Dell’s designers at Karlsberger began by rejecting the conventional choices when it came to location. When they began planning, about 10 years ago, they had originally selected a greenfield site on the outskirts of Austin. But a group of community residents persuaded decision-makers that, for the hospital to do the most possible good in the community, it needed to be located in the center of town. So rather than debarking for a distant suburb, Dell chose to be part of a 700-acre, master-planned, mixed-use project designed for the brownfield location on the former site of an airport.
Even before any design elements had emerged, this hospital was already a force for better community health—by cleaning up a brownfield. The location decision also improved economic and social health in the Austin community. The completed hospital now anchors a much larger urban redevelopment that employs about 10,000 Austinites in an urban, transit-friendly location.
That foundation inspired other project leaders to make it a national sustainability model, says Michele Van Hyfte, manager of environmental stewardship at Seton Healthcare Network, which owns Dell and 10 other hospitals.
One of the development’s most innovative features is its highly efficient combined heat and power plant, which shrinks the hospital’s carbon footprint and promotes clean air. In addition, the grounds use innovative stormwater loops to help preserve clean water supplies. The hospital also contains a 3.5-acre healing garden and a series of interior courtyards.
“You’re starting to see a pattern of shifting away from the bright new building that’s detached, that could be communicating something very contrary to the mission of healthcare,” says Gail Vittori, co-director of the Center for Maximum Potential Building Systems, co-author of Sustainable Healthcare Architecture (Wiley), and a design consultant on the Dell project. “This really is a revolution in process.”
Dell met at least three of Vittori’s important criteria for a 21st-century hospital. One: It reduced consumption of fossil fuels and water. Two: It was built at a community scale. Three: It offers patients opportunities to commune with nature and the greater community. “Some hospitals are becoming the place where you go to the farmers market,” says Vittori. “It’s more about promoting health and wellness than just being [about] sickness and disease.”
The Dell model is now considered an inspiration. In 2008, the hospital was named the first LEED Platinum–certified hospital. A more recent addition—the 72-patient South Tower—was named the first LEED for Healthcare Platinum building.
The “revolution” spreads
More and more hospitals are following suit. Children’s Hospital of Pittsburgh (part of the University of Pittsburgh Medical Center), designed by Tsoi/Kobus & Associates, was at a similar crossroads in the early 2000s when it was considering a new location. It eventually chose a spot in the Lawrenceville neighborhood, in part for its transit-friendliness. “The uninsured that are in the city, sending them 30 miles up a highway into the suburbs just wouldn’t have been the right thing to do,” says the hospital’s Vice President of Operations Eric Hess.
The hospital also features plenty of bike racks, preferred parking for carpoolers, a four-story atrium, and a healing garden. Last year, Healthcare Business & Technology named it one of the 25 most beautiful hospitals in the world.
Pittsburgh Children’s took special care in another principle of sustainable hospitals: material choice. Hess says hospital leadership took it so seriously that they traveled to the Netherlands to learn more about the flooring material they chose, a synthetic material called Forbo that’s made using comprehensive life-cycle sustainability assessments.
The most progressive and sustainable hospitals also take great care in choosing healthy, sustainable materials, using recommendations from the Healthy Building Network (a healthy materials advocacy group), and Perkins+Will’s Transparency initiative (a database of materials harmful to human health), Vittori says.
Another sea change has come with respect to architectural form. The Corbusier-style towers-in-the-park model is beginning to break down. New designs favor smaller models or, at the very least, designs that promote delivering the greatest amount of natural light to the greatest number of patients and employees.
Chicago’s Rush University Medical Center, designed by Perkins+Will and completed last year, is considered a leader in this evolution. The hospital’s upper tower was designed in a “butterfly wing” shape, giving each patient access to sunlight. The hospital also contains four green roofs, providing park space and a connection to nature despite its urban location. The roofs are watered with captured condensation from an air handler. The system saves about a million gallons of water a year, says Jerry Johnson, AIA, of Perkins + Will’s Chicago office, the design principal on the job.
Johnson says that while the dramatic design of Rush’s upper floors actually resulted from the special attention paid to the way nurses travel throughout the hospital, another benefit is that every room gets sunlight and many have views of the green roofs as well. “It’s a very urban campus,” Jones says. “Just the idea of being able to look out the window into green space was very appealing. I think there’s a lot of therapeutic benefits to that.”
Ideas like these are still new in healthcare design, but they are gaining wider acceptance. In 2011, LEED for Healthcare amended its scoring system to better incorporate a broader view of health and health promotion. Private-industry leaders are taking notice as well: Kaiser Permanente has adopted this approach for all its facilities, says Vittori.
Building the case
But because the movement is so new, the health benefits of this revolution are just beginning to be understood. Because Dell, for example, opened only five years ago, little conclusive empirical data is available about the ways in which special design elements have improved patient health. Dell recently received data from a study on the health impacts of the building design, but Van Hyfte said it’s going to take months to comb through it.
Still, there is evidence that it is succeeding on the criteria that matter most to the hospital: patient and employee satisfaction. Human resources specialists agree that hospital itself is a great recruiting tool: People just like working in the building. That’s especially important for retaining nurses. Recruiting and training a new nurse can cost hospitals as much as $70,000, and the average annual turnover rate for registered nurses in 2011 was 14 percent, according to the American Association of Colleges of Nursing.
Patients seem to like it, too. Van Hyfte said the design of the hospital has helped it grown faster than projected, although it’s unclear to what extent that’s a result of design features. Construction of the additional tower was needed years sooner than planners expected.
“At the end of the day it’s about the patients that are in the building, the staff that’s in the building,” says Van Hyfte, “and the community that supports that building.”