UCLA’s $1.1 billion hospital to blend 21st century medicine with aesthetics
Open, light-filled areas will be used to greet patients
Managed care, telemedicine, outpatient surgery how do you plan the patient-focused hospital of the future, especially when that future is rapidly changing?
Administrators and architects at the UCLA Medical Center and School of Medicine face this challenge as they plan efforts to replace the 50-year old structure in downtown Los Angeles damaged in the 1994 earthquake. A second facility, a community hospital about 17 minutes to the west in Santa Monica, will also be rebuilt. (A cost-benefit analysis concluded it would cost twice as much money and time to upgrade existing facilities to current seismic codes rather than to build new ones.)
The planners’ vision is lofty: Gone will be the confusing clutter of banal medical buildings, multistory parking lots, and the institutional aura of the dense urban setting. Instead, patients and families will enter a bucolic, campus-like environment of lawns and gardens where light-filled structures provide a pleasant place in which to heal.
These creative and seismically safe facilities must also be built without disrupting current medical service, research, or campus access. Finally, the architectural design must take into account anticipated medical practices for the next century.
"We are constantly considering the demands of managed care, the increasing outpatient treatment, greater need of space for research, and the future ability to tap into the latest technology innovations, including fiber-optics networks for telemedicine and digital transfer of electronic patient records and diagnostic films," says Sarah Meeker Jensen, AIA, assistant vice chancellor in health sciences for capitol projects.
The chief planner for the construction of both facilities that will use light, form, and structure to heal, is world-renowned architect I.M. Pei, who will work with the Pei Partnership Architects founded by his sons.
"They were selected for their pre-eminence in architecture and their previous experience designing The Mount Sinai Medical Center in New York City," says Gerald Levey, MD, provost for the medical sciences and dean of the school of medicine. Pei is also known for his architectural designs of the entrance to the Louvre in Paris and the East Wing of the National Gallery of Art in Washington, DC.
But the architect’s pen is not on the paper quite yet.
"We wanted a planning mechanism where every constituency could have a voice, where consensus building could develop, and where the best ideas could be brought forward," Levey explains.
In the master planning process which is almost as massive as the project itself 225 physicians, nurses, and staff served on 10 committees.
"We solicited nominations for membership from every department chair and hospital management team," says Helene DesRuisseaux MPA, deputy director, who designed and implemented the planning process along with Jensen. "We wanted committees to represent all levels of employees from executives to the front line. We needed those who were familiar with daily patient care, as well as those who had the perspective to see the big picture."
The committees were organized around functional areas such as clinical planning, network planning, information systems planning, education planning, research planning, and financial planning. Two more committees were assigned the task of physical master planning at both the Santa Monica and Westwood Campus.
"The co-chairs of each committee served on the Master Planning Council so the work of all committees could be communicated, prioritized, and integrated into the overall plan," explains DesRuisseaux.
For four months, the committees met regularly to formulate a vision statement and to review information produced by other committees and to work out contradictions or gaps.
Because the process of master planning for the future hospitals will have an impact on several major constituencies, both in the hospital and in the community, a communications committee was formed to get the word out about what was happening.
The master plan was completed in August. After approval from the university’s regents, the architects will begin their work.
Guidelines for success
Meanwhile, a second tier of work groups, also a mixture of staff, nurses, and physicians, are examining critical issues surrounding physical planning. "Each work group will develop guiding principles that will form the basis for design," DesRuisseaux says.
Although the principles are still in the formulation stage, DesRuisseaux was able to discuss the following design parameters each group is facing:
1. Ambulatory interface.
With the rapid rise in outpatient surgery, this group must not only look at the flexibility of the design of the center but also how it will connect to the main hospital, both physically and organizationally. The team will also look at how staff and operations will need to be consolidated or relocated.
2. Clinical design.
This team is studying a variety of ways around which to develop clinical services. "Will services be centralized? Decentralized? A combination?’ This team has to decide," she says.
3. Modularity and standards.
With the trend toward higher acuity patients, the hospital of the future must be able to convert to ICU or trauma beds quickly, explains Michelle Karpf, MD, vice provost for the hospital system. So this team will create standardized specifications for room layout in ICU, acute, subacute, rehab, and operating rooms. It also will examine design of procedure, conference, and exam rooms.
4. Technology and systems.
With technology quickly outpacing the spaces in which it is installed, this team must plan for a facility that is wired for a future that will include electronic records, robotics, telemedicine, and bedside registration. "One parameter already recommended is interstitial floors above areas like the ICU so that computers and cables can be housed in their own climate controlled area," says DesRuisseaux. This mini-floor will eliminate climbing into the ceiling to add or repair technology, she points out.
5. Design committee.
In a heavily congested area of downtown Los Angeles, this team will examine parking accessibility as well as the flow of people inside and around the campus. It will consider underground parking, tunnels and bridges, landscaping public spaces, and exterior design of entrances, in addition to corridors designed to help patients and family find their way around.
"We expect to have five separate pavilions that let in as much light as possible, rather than long dark winding corridors," Jensen explains. Between each pavilion will be a garden area.
6. Support services.
This team will decide what services need to be in a hospital and what can be relocated to less costly off-campus sites. Karpf says the team is considering storage and supplies, laundry, dietary, laboratories for routine tests, and some aspects of pharmaceutical preparations.
7. Teaching interface.
This team will make sure the connection between academics, research, and practice is enhanced by the new campus by taking a close look at classrooms, consulting rooms, and technology needs.
"Medical education in the future will be characterized by increased use of small groups of six to 10 people," says Karpf. "Interactive and independent study will become more significant as information technology and distance learning techniques are enhanced."
What do patients really want?
After gathering the theoretical information from the committees, Jensen will put the principles to the ultimate test by conducting a series of focus groups for the following categories:
• regular adult patients;
• families of adult patients;
• pediatric patients and families;
• psychiatric patients and families;
• staff;
• physicians.
"Each group has its special needs, so we want to question them closely about what they’d like to see in the physical design," Jensen says.
Jensen believes she can already reassure patients about the most common complaint noted on past satisfaction studies: roommates.
"Patients don’t like having roommates," Jensen says. "They complain about snoring, visitors, etc. But in the new design, we will have only single rooms with a window seat that folds out as a bed."
Each floor will also have a small kitchen and lounge area where families can cook for themselves or their loved ones.
"Sometimes having home cooked food is just what a patient needs," she says.
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