Good Medicine

Good Medicine

While it may seem self-evident that a patient’s experience should be the central factor in the design of healthcare facilities, the average medical setting, however, is hardly salubrious. The typical hospital encounter, notes Turan Duda, principal of Duda/Paine in Durham, North Carolina, involves waiting in a sterile room with a television on and being seen in a clinical, often intimidating environment. “It does nothing to reassure you, to care for you, or comfort you—so part of the architecture can do those things,” Duda said.

That sentiment has spread across the healthcare field, due in part to the advent of evidence-based design, which considers the impact of hospital environments on patient care. Studies have found, for example, that spending time in a garden offers therapeutic benefits—the more soothing the setting, the more quickly patients are likely to recover. At the same time, patients today are far more informed about hospital choices than earlier generations. Statistics on readmission, infection rates, and procedures are widely available, making consumers ever choosier about facilities. This competitive market approach to healthcare means that hospitals and clinics need to make spaces as appealing to patients—read customers—as possible.

Duda/Paine’s design for the Duke Integrative Medicine facility in Durham is a case in point. Preventive medicine is—however slowly—becoming an accepted part of treatment plans, especially as insurance companies begin to cover procedures such as acupuncture and massage. The Duke project is the first facility built expressly to combine alternative medicine with traditional treatment options, offering acupuncture, acupressure, yoga, meditation, and a nutrition center.

The building, which won an AIA National Healthcare Design award in September, responds to its setting in the Duke Forest by using exposed wood for beams and columns meant to echo both the Gothic flavor of the Duke campus and the canopy created by the forest. The plan of the building includes “fingers,” projections into the wooded area to frame views and increase staff and patient comfort. “The arrival sequence and how you walk through the site was very carefully thought about,” Duda explained. For instance, the front desk includes a piece of sculpted wood that patients inevitably touch when they first enter. “Part of our mission,” he added, “was to make people more aware of their senses.”

That strategy has been echoed in San Francisco, where Anshen + Allen Architects, in collaboration with Stantec, have designed Laguna Honda, a new public healthcare facility for skilled nursing and rehabilitation, comprised of two residential towers and a central pavilion. The architects strove to give patients, many of them receiving long-term care, as many diverse settings as possible. Although they did not have the advantage of a nearby forest as at Duke, they used the notion of “household” and “neighborhood” to explore various scales. “That concept was articulated by the nursing staff at the beginning of the project,” said Jeff Logan, director of design at Anshen + Allen. “We tried to develop an architecture around it.”

The residential floors are organized around a household—a set of 15 patient rooms—with four to a floor making up a neighborhood. Each has a living room and dining room so that patients can dine with their fellow householders, while other options can be had in the larger setting of the third-floor cafeteria in the esplanade, which also includes a beauty shop, art studios, library, theater, and an aviary offering access to the natural world. “Even if you’re by yourself, you’re connected to life,” Logan said. “We were really trying to think about how that makes you feel better.” Other features include a wellness center with therapeutic swimming pools, as well as new green space for the 150-year-old hospital campus, making the project the first green-certified hospital in California, earning a LEED Silver rating.

Combining sustainable strategies with patient-centered services in an urban setting has also been central in Chicago, where Perkins+Will has led a ten-year redesign at Rush University Medical Center called the Rush Transformation. Much of the plan has been focused on how to make the center more responsive to patients’ needs. Last year, the firm completed the medical center’s Orthopedic Building, the largest of its kind in the Midwest. A five-story structure with a green roof that reduces stormwater runoff by 25 percent, the Orthopedic Building houses research, educational, and clinical facilities under one roof to encourage communication across departments.

A new hospital building, the centerpiece of the project, is being erected across the street. Its striking form corresponds to different programmatic needs, with upper floors, which are divided into four rounded wings, holding 386 hospital beds for acute, critical, maternity, and neonatal care. The bottom section houses diagnostic facilities, with imaging and examination rooms in close proximity for the convenience of patients and staff, along with the Center for Advanced Emergency Response.

Michael Hess, healthcare managing principal for Perkins+Will’s Chicago healthcare group, emphasizes the close connection between patient-centered design and the bottom line for medical providers. “Patient comfort is a key component, while demand and competition in many markets are significant,” he said. “So healthcare networks are always positioning themselves to capture more patients. Depending on the type of care or specialty, the environment and experience for patients and their families is very important.”

Staying ahead of the competition is getting tougher at a time of rapid technological change. A. Ray Pentecost III, director of healthcare architecture at Norfolk-headquartered firm Clark Nexsen and president of the AIA’s Academy of Architecture for Health, notes that the fast pace of revolutionary innovations—proton therapy, advanced imaging systems—is making traditional hospital buildings obsolete. Pentecost, an architect who is also a doctor of public health, explains: “The technological breakthroughs are so potentially paradigm-changing that when you build a facility that is supposed to last 30, 50, 100 years—if you can’t build it to accommodate those future changes, then you have a building that is almost useless.” While upcoming advances can’t be predicted, what’s certain is that spaces will eventually need to be reconfigured, so flexibility has become another watchword of healthcare design.

The dueling demands of patient-centered care and adaptable facilities are now guiding an overhaul of NYU’s Langone Medical Center, which has embarked on a ten-year design project—a collaboration of NYU, Ennead, and NBBJ—to reinvent its campus on Manhattan’s East Side. According to Vicki Match Suna, senior vice president and vice dean for real estate development and facilities at the medical center, planning for the project began with user groups that explored every aspect of the hospital, including clinical care, materials management, food and nutrition, patient and visitor services, information technology, and public spaces. Now in the schematic design phase, the team plans to erect a new, 800,000-square-foot acute-care building, the Helen and Martin Kimmel Pavilion, and connect it to the existing Tisch Hospital. The lower part of Kimmel will house operating and procedure rooms, while the adjoining tower will include patient rooms that can be easily converted from ICU to step-down rooms for patients with less acute needs.

Joan Saba, principal of NBBJ, notes that evidence-based design informed the team’s decision to use a standardized room layout and size. “It helps to minimize errors,” he said. “Be it a day-to-day event or an emergency, staff knows just what to do and they never have to reorient themselves.” All rooms will be single-patient rooms to avoid any concerns related to infection control or gender. Ennead’s Duncan Hazard, partner-in-charge of the project, added that Langone will be the first hospital in New York City to use the 2010 criteria from the Facility Guidelines Institute, which provides widely followed standards for healthcare design and construction.

As they work to put patients first, projects like Langone are facing tectonic shifts in the American healthcare landscape. According to AIA’s Pentecost, one of the main forces driving healthcare design today is dwindling insurance payments to providers—what he calls the “downward pressure on reimbursement” that has hospital administrators making cautious decisions about how their new facilities should be designed. Kenneth Kaufman, CEO of Kaufman Hall, a financial consulting firm for healthcare organizations, explained, “Everybody expects a much more demanding reimbursement payment environment, and will have to reorganize their cost structure in a significant way.” While that could mean cutbacks for primary care facilities—shifting resources to outpatient care and the use of technology to monitor patients at home—Kaufman suspects that there will also be greater emphasis on prevention and wellness initiatives. And these important nontraditional programs—which take healthcare well beyond the bounds of old-school hospital wards—can offer a world of opportunities to tap architecture’s power as a healing art.