View to a Dream
Cover Story
Written by Jill Rose   
Saturday, 01 November 2008
View to a Dream - Inside Healthcare - RedCoat Publishing
Stanford Hospital’s design reflects its leaders’ plan to promote holistic care, enable fast technology installation, and create a highly desirable place to work.
Finding creative solutions to health problems and providing a healing environment for patients is all in a day’s work for hospitals across the country. Unfortunately, most hospital buildings don’t reflect that mission, forced by space and money constraints to follow decades-old patterns of windowless hallways and crowded public areas.

The design for the new Stanford Hospital breaks that pattern in a major way. The new hospital, now in the final design stages, will physically embody the hospital’s two main focuses: treating patients as a whole and continuous adoption of new technology. Along the way, it will break new ground in sustainable design.

­­­­“We want people to have the best technology available but feel like they’re in a comforting place that treats them as a whole person,” explained Martha Marsh, CEO of Stanford Hospital and Clinics in Stanford, Calif.

The new hospital, located adjacent to the existing structure on the Stanford University campus, will be 1.3 million square feet and house 600 beds. Construction will begin in 2010, and the bulk of the project will be completed by 2013 to meet California’s new seismic requirements. Dr. George Tingwald is director of medical planning for the project; he is working with New York-based Rafael Viñoly Architects on the design.

Practical landscaping
The new building is built around a large landscaped courtyard with seating areas for patients and families, providing not only a unique visual, but also a practical element. “We want gardens to be the first thing people see, not sterile halls,” said Marsh. “It’s also important for wayfinding. Each of the four main buildings are located around the courtyard, and there are large windows. So when people are walking, they can see where they are because they can look outside.”

The first floor of the hospital contains the entrance lobby, the ED, and imaging centers. The second floor comprises operating rooms, interventional suites, and surgical intensive care units. The third floor is a garden level with a combination of landscaping and mechanical systems. Above that float the patient rooms (all private) in a pavilion configuration.

This unusual design serves two purposes. The green roof technology, which Tingwald points out is fast gaining popularity in California, absorbs water flow during rain, reducing the need for drainage. It also decreases the amount of heat gain from the sun, Tingwald said.

Second, because the mechanical systems are located close to the high-technology-use areas of the hospital (ORs, imaging, etc.), air needed to cool those areas has less distance to travel. “We put those systems in the middle of the building to reduce the amount of air that has to be moved through     duct work,” explained Tingwald. “This will mean significant savings on energy costs.”

Because the building’s green design literally incorporates greenery, patients and families will have a unique space in which to visit or relax. The view from the garden level includes much of the 8,000-acre Stanford University campus and, beyond that, the foothills that separate the San Francisco Peninsula from the Pacific Ocean.

“We have a unique physical setting, and part of the design concept is to use that to create a healing environment,” said Shelley Hébert, executive director of public affairs. Although such an environment just makes good sense, hospitals today have evidence to support their efforts.

“Especially in the acute-care environment, there are measurable outcome differences from the environment,” said Tingwald. “People can be released sooner, have better outcomes, and have a better experience.”

Trading spaces
It’s hard to imagine any building that would benefit more from flexibility than a hospital, a building that frequently needs to accommodate new types of equipment and must be prepared for a huge patient influx during a disaster, natural or otherwise.

Building in flexibility is easier said than done, but the design of the new Stanford Hospital makes huge strides in that direction. The second level of the hospital, especially, is designed for change. By locating the highly technical areas together and making sure the mechanical systems are more changeable than fixed, these spaces can be rearranged without knocking down walls.

“If we need an interventional suite more than an OR, or we need additional ORs, or something new we haven’t considered, we can swap spaces,” explained Marsh. Added Tingwald: “Can we plan a new type of hospital that really responds to that level of flexibility? Once the building plans are more complete and the building is on its way, I think people will notice that it’s really a new type of hospital.”

Fast expansion in the case of an emergency situation is also part of the design. Each ED bay is oversized, so that by simply dividing these in half, the capacity of the ED is instantly doubled. Taking advantage of the area’s mild weather, triage areas can be quickly set up outside, adjacent to the hospital. This is especially important to Stanford Hospital, as it’s the only Level I trauma center between SFO and San Jose.

“The entry court to the ED will be walled and landscaped,” said Tingwald. The regular use for this area is short-term parking and patient drop-off. “But in the case of a disaster, that area can be used for triage. It will have electrical and the potential for showers and emergency equipment so we can use that outdoor space as a triage and treatment zone.”

Consider the orchestra
Although many hospitals are looking at making their organizations more green, and perhaps having new construction meet LEED standards, Stanford Hospital’s approach is, like its approach to healing, more holistic.

“We’re looking at building design and energy use and, simultaneously, the healing environment,” said Hébert. “We’re not just sustaining the environment, we’re sustaining the people—not only the patients, but also the people who visit the building and work in it.”

Indeed, Hébert said, architect Rafael Viñoly believes that just as you wouldn’t design a concert hall without keeping the needs of the orchestra in mind, neither should you design a hospital without considering the workers.

Those workers are not only getting a superb new place work, they are also empowered by management and highly involved in the hospital’s improvement efforts. Most of those improvements are centered around patient satisfaction, said Marsh, although the hospital saved $14 million last year by modifying the way supplies are evaluated and purchased.

“We’re now looking at our labor supply, which in a hospital is about 50% of the total budget. We want to look at how we can be more cost effective and efficient. This is not about cutting care—we believe we can improve the care as well as the quality and efficiency if we’re more effective in what we do,” Marsh said.

Here, again, a holistic approach is key to success. Marsh said it’s essential to approach these types of programs systemically. “Otherwise, you get savings in year one, but the costs pop back up in year two. To make sure that doesn’t happen, we have to be focused on sustainability of our accomplishments.” 
 
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