It’s been a rough road in a lot of ways for Palomar Medical Center (PMC) in Escondido, Calif., which opened in August 2012 and touted itself as the “hospital of the future.” Costing just shy of $1 billion (partially funded by a voter-approved $496 million bond issue), it laid off 84 workers less than a year after opening, citing lower Medicare payments, declines in reimbursement, concern over a drop in patient satisfaction scores, and lower census levels. Six months ago, the project’s driving force—Michael Covert, who’d been Palomar Health’s CEO since 2003—announced he was leaving to run a network of six hospitals for Catholic Health Initiatives in Houston. PMC is still not fully occupied and continues to struggle under its debts.

But I couldn’t pass up the opportunity to tour PMC in person during the Healthcare Design Conference a couple of weeks ago. I’d written about the facility when it first opened, and I really wanted to see some of the design elements the team had described. Two features in particular—the bringing of daylight into even the deepest recesses of the hospital and the wavy green roof that served a clever dual purpose over the D&T wing—drew me to select this tour over the others.

And I wasn’t disappointed. The 740,000-square-foot building cuts an impressive figure atop a hillside with views of distant mountains and the city of Escondido. Led by project team members from Palomar, CO Architects, and DPR Construction, the tour began in the exterior courtyard, where the gorgeous local plantings have flourished and feel perfect for the setting. The hummingbirds that kept darting about seemed to agree (I’m going to assume the tour guides didn’t bring the birds in for effect).

Standing next to the aforementioned wavy roof, our guides explained how the undulations serve the purpose of allowing all mechanicals to be routed through segments of the ceiling over the D&T wing rather than in obstructive columns on the floor. The benefit: Less cost later for inevitable renovations and upgrades to that area, plus more flexibility. The lush greenery that tops the 1.5-acre roof reduces heat gain and glare in relation to the adjacent bed tower and provides a lovely view from the patient rooms as it blends into the mountain views beyond.

Views of green space and natural light were a high priority for improving the general well-being and productivity of staff, too. In 2012, when the team described the many light wells and pocket gardens designed to be seen even by surgeons working in the OR, it was hard to get the full picture just from photos. And while I didn’t get to enter an actual OR with a window when I was there in November, I did peer into pleasant little oases of green space surrounded by higher floors’ worth of healthcare activity, with a glimpse of blue sky above. I can imagine that if one lives and works in Southern California, it’s nice to be reminded of that whenever possible.

Despite its broader troubles, PMC reports that satisfaction scores (both from patients and staff) have improved from the sub-25th percentile to greater than 90th percentile in the new building. In the move from centralized to decentralized nurses’ stations, there’s been a 50 percent reduction in patient falls and 30 percent reduction in nurse calls.

For a more in-depth look at Palomar and professional photography to go with it, you can click here.