Imagine entering a healthcare facility quite unlike anything you have ever seen before. From the exterior you can already tell that something is different. It seems…smaller. The concept of a hospital that can meet the needs of patients, covers a smaller footprint on the landscape, and has less impact on the environment, is something that Kaiser Permanente (KP) sees as the way of the future for healthcare design.  As a result, the “Small Hospital, Big Idea” competition was conceived. The contest sought to probe the minds of creative and innovative designers and thinkers around the globe to come up with their interpretation of a small hospital.  After months of work the project submitted by Mazzetti Nash Lipsey Burch (M+NLB) in partnership with Perkins+Will NY, tied for first place.

 M+NLB focused on making sure each design decision engaged the whole project team to ensure all aspects and viewpoints were considered. “Our approach to this competition was to start by making sure we had a clear understanding of KP’s goals and objectives with ideas that most effectively supported them.  A major part of our approach was to develop a prototype that incorporated a palette of optimized universal strategies that could then be applied to a specific site, in our case Lancaster. This would facilitate a flexible model that could be applied to almost any site that KP would want to build a facility, and would allow unique strategies that took the most advantage of site specific considerations,” says Arash Guity, PE, LEED AP, CEM, chief environmental performance engineer, M+NLB. 

In the first round, the firm created multiple teams with different architect partners and submitted numerous designs. As the lead on their particular project, Perkins+Will worked with M+NLB to create a design that was sustainable, developmental, and practical.

“The competition’s vision was to really open up the idea of imagining a different healthcare delivery system and the role of the small hospital in this re-imagined system. We took that at face value and began by looking at the future of healthcare delivery at the macro level. We looked at what the range of built environment as well as technological interfaces would be that defined healthcare in the future and we then situated the small hospital within that construct,” explains Robin Guenther, FAIA, LEED AP, sustainable healthcare design leader, Perkins+Will. Using this as the springboard to expand the idea, the team designed the small hospital as an inpatient and outpatient facility that would collocate specialty ambulatory care or specialty medical offices on a small acute care chassis.

Creating the front door of the hospital gave the team an opportunity to explore the welcoming attributes of different types of buildings including retail, university, and hospitality and extract from them the qualities that would extend beyond what is conventional or usual for a hospital front door. The aim was to redefine the function of a hospital lobby and incorporate a wellness and health management interface.

Michael Bardin, AIA, LEED AP, senior project designer, Perkins+Will, points out that the design team saw the importance of concentrating on the needs of the surrounding community. “The hospital needed to be adaptive to a lot of different contexts. The components in the hospital could be employed or deployed à la carte depending on the specific circumstance or market needs and we conceived of it as a kit of parts that could respond very specifically to local needs,” says Bardin.

The design challenges of this smaller edifice affected not only the function but also how it would translate architecturally as well as the selection of interior and exterior materials. For this project Perkins+Will worked with a high desert environment. This dictated particular attitudes, choices, and understanding of the needs of the community. The inspiration was tied into the surrounding ecosystem and the patients that would be served in the hospital.

“The idea was to plan a very intuitively navigated building. Walking next to the courtyards a person can recognize that, particularly in the shaded courtyards, you don’t need to be indoors. There are exterior stairs and a whole series of exterior/interior experiences that are embedded in the design for an experience that feels quite radically different from a typical hospital building,” says Guenther.  The glass-enclosed courtyard with habitat-sensitive landscape architecture and navigational paths is open to the interior and public spaces, reinforcing the sense of a relationship with nature. The rooftop garden with canopies for shade serves as both a respite and communal space for staff, patients, and visitors.

The design team was very aware that KP is a health system with an established and recognizable organization to their architecture and therefore adding this hospital of the future to the portfolio would mean designing a structure that was not so drastically different that staff would not recognize it as a place to work or that it would not adopt certain standard work practices. “It was familiar enough but also transformative. The challenge was to not simply design a completely drastic departure from their way of doing business. We needed to design something that can transform people’s experience of being there without being extreme,” says Guenther.

Another design approach was to purposefully address some of the failures or shortfalls that are commonly noted in hospitals, for example, feeling disconnected from nature, the inability by patients to control their environment, private space in which to communicate with caregivers or to communicate with family, and limited areas for respite or consultation for staff or family. Bardin explains that the challenge was to tackle each of these and find a way incorporate the solutions to these issues without being lured back to the image of a “large” hospital or creating something that is a complete departure from other buildings that people would have seen.  

In keeping with KP’s intention to have more connected care for their patients, and to encourage caregivers to work across discipline boundaries, the design integrated a two-story shared lounge space at the center of the diagnostic and treatment block to serve as a gathering social space for the care providers. “It is a completely glass-enclosed informal gathering space that does not replace small staff respite spaces on the unit. It also functions as a place that staff can use to navigate through the building with a staircase that gives access from the first floor up to the third-floor roof deck,” says Guenther. This central staff area, positioned off stage near the staff entry, allows a flow of discourse in an informal but controlled setting.

“One of the other things we tried to focus on was the way people experience technology in hospitals, not just the function of the technology but on how specifically either mobile technology or building management technology could be integrated into people’s experiences in a way that  reduced stress,” says Bardin. The team identified the stress points in hospital visits such as filling out paperwork, or anxiousness about a family member’s health status while they are in the hospital. By providing technology that accommodates advance check-in or a handheld device to give updates on their loved one’s condition, it would allow the family members to visit the cafeteria or get a breath of fresh air and alleviate the anxiety and strain sometimes associated with hospital visits.

“Our overall vision was to devel
op a design that was the most efficient in its operation, though not overly complex.  We made a concerted effort to make sure that all ideas eliminated unnecessary components and features, ensuring a high level of reliability and efficiency. A major component of our approach was to make sure that we could look past the potential barriers and obstacles that are frequently encountered in developing a progressive design.  For each potential barrier (undeveloped technology, codes, or regulations), we identified a plan to address them and even started the process of challenging them.  We put together a comprehensive plan of what needed to be done to address the barrier and exactly how we would need to do it.  We also made sure that we had a back-up plan if we were unsuccessful in removing the barriers and obstacles,” says Guity.

The focus on creating a total health setting with this design while also reducing the burden on the environment encouraged the team to put their most innovative ideas on the table while still adhering to KP’s vision. With winning designs now chosen, KP plans to open the first of the small-scale hospitals in 2018.