A healthcare institution can be a troublesome neighbor: utilitarian in design, voracious in resource use, and insular toward its surroundings. Historically, notes Jean Mah, FAIA, LEED AP BD+C, a principal at Perkins+Will in Los Angeles, hospitals were isolated because infectious diseases and marginalized populations were their chief concerns. “Hospitals were places that the poor went,” she notes. This quarantine model hasn’t kept pace with contemporary epidemiology, demographics, or market forces driving facilities to exurban sites. Today’s hospital is more of a critical node than an isolated citadel. “Healthcare’s not about sickness,” Mah says, “so much as about healthy people and communities.”
Ron Smith, AIA, LEED AP, vice president for healthcare at HOK in Houston and president of the AIA’s Academy of Architecture for Health, interprets hospitals’ regenerative opportunities broadly: “If you take the definition of regenerative medicine as regenerating damaged tissues and organs in the body by stimulating previously irreparable organs to heal themselves,” he says, a hospital can “stimulate a part of the community that is not working or is underperforming.” By shaping facilities to contribute to the communities they serve, architects become partners with healthcare providers in regenerative design.
Lighter footprints and walkable sites
Several related schools of thought—environmental medicine, evidence-based design, and active design—share a general premise: that patients’ well-being responds not only to one-on-one interventions but to the quality of environments. Robin Guenther, FAIA, LEED AP, sustainable healthcare design leader at Perkins+Will, puts it succinctly: “You’re not going to have healthy people on a sick planet.”
Guenther, co-author (with Gail Vittori) of Sustainable Healthcare Architecture (Wiley, 2007) and a member of the LEED for Healthcare Committee (LEED-HC), sees a philosophical shift. A few years ago, “green hospital” was almost a contradiction in terms; hospitals’ mission to provide high-quality care overrode concerns about resource conservation. Now, she says, “healthcare understands that delivering high-quality patient care isn’t a passport to waste and excessive energy use. It’s not a get-out-of-jail-free card. The industry is recognizing that sustainable design is not about deprivation; it’s about doing more with less and fundamentally connects to healthcare’s core mission to ‘do no harm.’”
Health promotion, she believes, also includes accountability for carbon footprints, graywater management, purchasing patterns, and combating sprawl. (Epidemiologists correlate sedentary behavior with obesity, diabetes, and cardiovascular disorders—identified in the Active Design Guidelines, published in 2010 by four New York City agencies and the AIA New York Chapter, as “diseases of design.”) “Do hospitals contribute to the sprawl when they leave their downtown sites and build their expansive new campuses at the intersection of two arterial interstates?” Guenther asks. “Or are they just following the populations they serve?”
Situating buildings among footpaths, gardens, and transit enriches a neighborhood more than surrounding it with parking. The world’s first LEED Platinum hospital, Dell Children’s Medical Center of Central Texas, set a strong precedent by choosing a brownfield site at central Austin’s abandoned airport over a suburban location. Kaiser Permanente is supporting local food procurement in Oakland and South Central Los Angeles. Spaulding Rehabilitation Hospital is moving from central Boston to the former Charlestown Navy Yard, anchoring waterfront redevelopment and opening amenities to the public; it is also designed for the higher water levels anticipated by 2050.
Even in the Motor City, reports Uma Ramanathan, AIA, a principal at Boston’s Shepley Bulfinch, design is addressing sprawl’s bodily consequences. Her firm’s Specialty Center for Children’s Hospital of Michigan will incorporate a running track and clustered conference rooms that convert to exercise and outreach spaces, a boon to a region with widespread obesity and diabetes and a large uninsured population.
Retooling for recovery
In Newark, N.J., revitalization combines community synergies with institutional triage. “The State of New Jersey asked Catholic Health East (CHE) to buy Cathedral Health System, a three-hospital system,” says James Crispino, AIA, president of Francis Cauffman’s New York office. “We helped reposition the hospital when CHE needed to close two [in order] to make one healthy hospital for the city of Newark, which the state and city agreed to support.” The plan’s initial phase gives Saint Michael’s Medical Center a new four-story tower, expanding clinical spaces and offices amid Newark’s wider project to upgrade transit, build 3,000 housing units, demolish Baxter Terrace (“the most dangerous project in the city,” Crispino says, “very much in Pruitt-Igoe mode”), and add commercial development.
Newark’s recovery from its 1967 riots remains an uphill struggle, a far cry from creative-class success stories such as university-medical complexes in Pittsburgh and Cleveland. Still, the city has Rutgers, the New Jersey Institute of Technology, and Seton Hall for intellectual capital. “They’re focused on retention,” Crispino says. “If the workforce isn’t there, maybe you can train them and keep them” with accessible and affordable medical education. “At the end of the day, it’s as much about the quality of your life in the city of Newark as the redevelopment of a medical center.”
Perkins+Will’s Mah cites a hospital in Rio Negro, Colombia, that incorporates a cathedral, thereby becoming the spiritual town center. Healing any community, suggests Frances Halsband, FAIA, of the New York firm Kliment Halsband Architects, requires deep, nuanced local assessment. How deep, only a proverb can say: “To make an apple pie from scratch, plant an apple tree.” But the necessary assets may already exist. “Start with what’s there. Find out if there’s already an apple tree growing on that site,” she says.
Find out about two regenerative design projects in Providence, R.I., by Kliment Halsband and !melk at www.aia.org.