From its inception, the NewYork-Presbyterian David H. Koch Center in New York wasn’t going to resemble your typical healthcare project. First, there was the owner’s vision to redefine its ambulatory care services, moving all outpatient procedures from the existing main hospital at Weill Cornell Medical Center to a new freestanding location across the street that would embody a patient-centric experience.

“It would be a very purpose-built ambulatory center,” says Joe Ienuso, group senior vice president of facilities and real estate at NewYork-Presbyterian.

Then there was the size. At 734,000 gross square feet and 320 feet tall, the massive structure ran the risk of resembling any one of Manhattan’s large-scale office buildings.

“The problem is how to take a volume like that and transform it into something welcoming and relaxed rather than overbearing. That’s the source of this design, the effort to solve that problem,” says Henry Cobb, founding partner at Pei Cobb Freed & Partners (New York).

Finally, based on the size and complexity, the owner decided to enlist three design firms to oversee specific aspects of the project, with HOK (New York) serving as architect and interior designer for the public spaces; Ballinger (Philadelphia) focusing on medical planning as well as the interior design of clinical spaces; and Pei Cobb Freed & Partners collaborating on the façade architecture and lobby design.

“The partnership brought the best out of each firm and led to a cohesive building,” Ienuso says.


Setting expectations

To guide decision-making early on, the project team outlined six planning principles, including providing a patient-centric and operationally efficient setting for advanced ambulatory procedures, a coordinated network of care, and a technology- and equipment-rich setting.

One decision made in that process was to use a templated design on all the procedure floors, including surgery, endoscopy, and interventional radiology, to create efficiency for patients and staff. For example, fixed elements, such as walls, doors, ceiling boom locations, and scrub sinks are consistent in these rooms, so clinicians and support service teams are familiar with the layout of the procedure rooms on all floors.

Additionally, the team established a clarity of language on project goals with a visual design spectrum to help define the aesthetic terms, from modern and minimalist to contemporary and Zen, to better capture exactly what the client was seeking, says Amy Beckman, principal at HOK and senior project manager.

To gather input from users, the team held more than 36 work sessions over six months during pre-schematic and design development phases. Numerous 3-D printed models of medical equipment in miniature were created so multidisciplinary teams could roleplay procedures from start to finish. This process helped to determine the location of room elements and discover and resolve conflict points before the designs were finalized, says Erin Nunes Cooper, associate principal and director of project management at Ballinger.

“Using the models was a simple but effective way to bring the rooms to life, building excitement for the project with stakeholders and involving them early on in key design decisions.”

In 2014, construction kicked off on the 734,000- square-foot building. The NewYork-Presbyterian David H. Koch Center opened in April 2018 with 11 dedicated floors, including three procedure floors, six clinical floors, and support space. Portions of floors one to three house the 20,000-square-foot Integrative Health and Wellbeing center, which opened in June 2018, while the 212,000-square-foot NewYork-Presbyterian Alexandra Cohen Hospital for Women and Newborns is expected to open in July 2020 on the upper six floors.


Not a standard box

The building volume and basic organization for the patient floors had already been determined for the Koch Center when Pei Cobb Freed & Partners was added to the project team line-up to deliver the façade and lobby design. Because of its location within a dense, urban area, the building had to occupy the whole site on York Avenue between 68th and 69th streets to fulfill the building program, meaning the firm couldn’t rely on setbacks or other conventional architectural solutions to help make the large building feel “less aggressive,” Cobb says.

The architecture firm turned to triple-glazed windows as a solution, deciding to clad the entire building in glass to provide a sense of transparency, while adding an obeche wood screen insert and a frit pattern on one layer of the glazing to give the overall building a sense of warmth and play. From the outside, passersby see wavy lines running from top to bottom of the 225,000-square-foot curtain wall from the fritting. Inside, the wood screen allows sufficient transparency for daylight to penetrate the corridors, which run along the perimeter of the procedure floors, while also creating a sense of privacy.

“It transforms the experience of the building both inside and out,” Cobb says. Furthermore, patients arriving will make the connection between the architectural feature from both the inside and outside. “It has the effect of humanizing this huge institution because it introduces clarity,” he says.

To deliver a welcoming setting on the ground floor, Cobb says it was important to create a grand public space that was inviting and serene. “When you have inescapably a very large building volume, you have to create an entry space that’s commensurate,” he says.

Measuring 40 feet high and 200 feet long, the lobby can be accessed by foot off York Avenue or via car at a drive-through drop-off underneath the building. “It was extremely important to the hospital that there be the ability to arrive at this building in a way that allows you to step off those congested streets into a much more controlled and protected environment,” Beckman says. “The drive-through was a commitment of a significant amount of space at the ground plane that otherwise could have been interior space.”

Inside the lobby, designers utilize a warm, neutral materials palette, including wood ceiling elements and stone columns and flooring materials, that’s repeated throughout the upper floors at varying scales—for example, granite flooring in the lobby is carried into waiting spaces (called sky lobbies) on the upper floors and the wood ceiling element in the lobby is repeated in some of the treatment spaces on the oncology floor.

“It’s unexpected and helps make those places feel special,” says Christine Vandover, design principal at HOK and senior project interior designer for public spaces.


Crafting an experience

In addition to creating an unexpected setting, the design team also needed to deliver a new patient experience that would reset expectations for ambulatory care by reducing waiting, improving communication with staff, and providing a sense of choice for patients and families throughout the building.

“We choreographed the ideal patient experience, from before they arrive in the building to when they leave,” Cooper says. “That informed the layout.”

To help patients navigate the building as quickly as possible, Ienuso says technology has been developed to enhance the process. Upon entry, patients are greeted by patient ambassadors who assist with registration via digital kiosks in the lobby. Patients are then directed to elevators to access their floors, where staff members have been alerted to expect them. Team members then greet patients when they arrive at their destinations.

Clear onstage and offstage circulation areas allow patients and families to travel along light-filled perimeter corridors. A typical clinical floor houses a small waiting area, 12 flexible procedure rooms, and 36 private prep/recovery rooms, which replace the more traditional open-bay PACU and serve as a home base for patients and their families throughout their stay. Here, patients can change and store their belongings, undergo their pre-procedure assessment, recover, and receive discharge instructions, all in the same room.

Small details, such as hooks for hanging coats and purses and furnishings for family members and guests, further signal to patients and their families that they’re “welcome and wanted here,” Beckman says. The setting also reduces stress for family members who know exactly where to return to find their loved one after surgery, allowing them to choose to wait in the room, in a lobby lounge, or at the café on the second level.

“The design plays a role in providing avenues for patients and families to have agency and choice in their care and their experience in the building,” she says.

On the care side, three prep/recovery rooms are dedicated to each procedure room, allowing for greater consistency and continuity in the care team assigned to each patient. Using a decentralized model, the floors feature small staff stations located outside pairs of prep/recovery rooms, and in lieu of a central nurses’ station, a single command center is located at the juncture of the procedure platform where staff monitor all activity between the procedure platform and prep/recovery zone.

In support of the project’s planning principles, a single, shared staff lounge is designated on the seventh floor for all clinical and support staff, with access provided via separate clinical elevators and a stairway. The solution eliminated the need to designate square footage on every floor for staff lockers and lounges and delivered a desired collaboration zone. “It was a clear design decision,” Cooper says.

Another departure from traditional models is the location of infusion and radiation oncology on the fourth floor. The department includes three radiation therapy vaults as well as 14 infusion locations, ranging from private rooms to more communal lounge settings. Similar wood materials and fabrics found in the lobby and public spaces were utilized in the treatment spaces to support a relaxed, soothing setting.

“I think there’s something fundamentally different between bringing a patient with a cancer diagnosis down into a subterranean level, which is the typical care experience, to here in this building, where we’re bringing them up,” Cooper says.


Coming together

After nearly a year in operation, Ienuso says it’s not unusual for him to overhear a patient say they want all their experiences with NewYork-Presbyterian to be like the one they had at the Koch Center.

“That’s a real statement about how all these elements of care have come together in a way that the patient knows they’ve just had a great experience,” he says. To that end, the organization is considering incorporating some of the building materials as well as technology systems into other projects.

Cooper attributes the project’s success to the owner’s goals and a collaborative design effort by the project team. “We had a unified vision at the macro level, and the individual design solutions at the micro level were responsive to one another’s areas of focus,” she says. “Overall, it was a great way to approach the project.”

The high degree of collaboration made another big difference, Beckman notes. “If you look at the building from the exterior to the interiors and move throughout the different spaces, you won’t recognize authorship of one firm in one area.”

Anne DiNardo is executive editor of Healthcare Design. She can be reached at


Project details:

Project name: NewYork-Presbyterian David H. Koch Center

Project completion date: April 2018

Owner: NewYork-Presbyterian

Total building area: 734,000 sq. ft.

Total construction cost: N/A

Cost/sq. ft.: N/A

Architect: HOK

Medical architect: Ballinger

Consulting architect (building envelope and lobby): Pei Cobb Freed & Partners

Interior designers: HOK and Ballinger

Engineers: Syska Hennessy Group (MEP, fire protection); Thornton Tomasetti (structural); AKRF (civil); Mueser Rutledge Consulting Engineers (geotechnical)

Construction manager: Turner Construction Co.

Lighting: Cline Bettridge Bernstein Lighting Design and HOK

Medical equipment, IT, AV, Security: Shen Milsom & Wilke (with NYP Clinical Technology Projects)

Acoustics: Cerami and Associates

Materials management: CT + Associates LLC

Vertical transportation systems consultants: Van Deusen & Associates

Food service: Jacobs, Doland, Beer

Environmental graphics and wayfinding sign consultant: Poulin + Morris

Art: Salon 94

Furniture dealer: Waldner’s Business Environments

Fabric/textiles: ArcCom, CF Stinson, DesignTex, Geiger, Maharam, Skai, Wolf Gordon

Curtain wall: Okalux, Permasteelisa

Materials: Kaswell, Danzer, Bendheim, Decoustics, Topakustik, Lindner, Hanover