The design of the NewYork-Presbyterian David H. Koch Center was guided by a mission to improve the patient, family, and staff experience through every touch point of the care journey. Completed in April 2018, the building on Manhattan’s Upper East Side delivers on that and more. Showcase jurors lauded numerous thoughtful details incorporated throughout the 734,000-square-foot ambulatory building that provides treatment of digestive diseases, cancer, and other conditions.

One outstanding example of that effort is found in the approach to procedural care, with flow maps of the patient and care team experience developed to help improve efficiency. A notable feature of the resulting design is 100 percent private prep/recovery rooms, where patients can change, store belongings, prepare for surgery, and return for recovery. Also celebrated were solutions such as a private vehicular drop-off area adjacent to the main lobby that allows patients a more quiet, calm arrival experience; clinical floors organized with perimeter circulation for clear public wayfinding; and a fully integrated and diverse art program.

But beyond experience, the project impressed with its approach to operations/efficiency, future flexibility, as well as sustainability and resiliency. Designed for a minimum of LEED Silver certification, the building uses numerous sustainable strategies; but when Hurricane Sandy hit New York during design, resiliency features were then added to ensure the building could be responsive to community needs during a severe weather event. The project also boasts 18-foot-6-inch floor-to-floor heights, removable façade panels on clinical floors, and a long-span structural system to reduce columns—all to ensure the facility was built to adapt to countless future needs.

The project was submitted to the Design Showcase by Ballinger, HOK, and Pei Cobb Freed & Partners. Here, lead designers Erin Nunes Cooper, associate principal at Ballinger; Christine Vandover, senior interior designer at HOK; and Henry Cobb, founding partner of Pei Cobb Freed & Partners, share their thoughts on how some of the jury’s favorite elements were achieved.

Healthcare Design: Our jury was very impressed by the amount of thought put into the patient/family experience and reducing stress where possible—specifically in the procedure areas. They applauded elements such as the all private prep/recovery spaces. Tell us about your process for understanding the experience, identifying pain points, and then solving them via design. 

Erin Cooper: At the outset, the healthcare planning and design team recognized the visionary nature of the project and determined that a traditional approach to planning would be insufficient. A visionary process to complement the visionary goals was needed. The team transformed the way planning takes place with stakeholders, engaging with all stakeholders in multidisciplinary groups, from surgeons, to nurses and caregivers, IT specialists, materials management, central sterile processing, family focus groups, and everyone in between. Instead of departmental user group meetings and floor plan reviews, the planning process started with a clean slate. Stakeholders were not asked what types of rooms they needed or how many. The team began with “what are your touch points with the patient?” and “what is needed to be more effective and efficient at treating the patient?”

Our process included detailed flow mapping in the early phases of the project. The entire team looked at this building as an opportunity to transform the patient, family, and care team experience. Before the design team began drawing, we mapped existing flows and looked for operational improvements for the care team, and touch points for the patient. We analyzed survey data from patients and families to determine how they arrive, when they arrive, and how many family members accompany the patient. The survey revealed the need for multiple modes of arrival to the building, and information on the visitor needs and expectations. We envisioned an ideal patient experience, and we asked ourselves some challenge questions: What would it look like to provide surgical services without waiting? How can we accommodate families in a more inviting way?

The private prep/recovery spaces are a design solution intended to improve the operational efficiency, the care team experience, and the environment for patients and families—a triple win. All of the prep/recovery positions are private rooms, dedicated to the patient and their family for the duration of their stay. The rooms are fully enclosed with sliding glass doors, instead of the more traditional three walls and a curtain. Patients change, prep, recover, and check out in their assigned room. The room provides a secure storage space for a patie­­nt’s belongings, as well as a private waiting space for the patients’ family members during the procedure.

Patients even prep and recover with the same care team.  Family members may stay in the room during the procedure, or take advantage of food service and lounge offerings in common areas of the building, knowing that they will return to the same room to be with the patient after the procedure. In addition, three prep/recovery rooms are dedicated to each procedure room, which allows for greater consistency and continuity of the care team for each patient.  Dedicated rooms also make it easier for caregivers and clinicians to find family members for face-to-face updates and instructions on follow-up care.

In a bold move, the care teams committed to eliminating the central nurses’ station in its entirety. Instead, a single Central Command Center is located at the juncture of the procedure platform, which monitors all activities between the procedure platform and prep/recovery zone. Decentralized stations are located at each pair of prep/recovery rooms. The result is that all caregivers are able to spend more time either in the patient rooms or at the decentralized stations in close proximity to the patients.

How did that process differ from a more traditional approach? What allowed you to pursue this so thoroughly?

Erin Cooper: What stands out is the dedication and commitment of the client, who allocated appropriate time prior to and during design to address these issues. We approached the project in parallel tracks: Our design team was working on design concepts in the background, while we pursued operational planning and programming. This allowed for a feedback loop between design and planning. We did not show floor plans in user meetings until later in the schematic design process so that we could focus on experience. We led multidisciplinary workshops, in which key decisions coalesced around a pressing need for more and better space, and an acknowledgement that the current state is not the way of the future. The desire was to create spaces that are better organized for all users—patients, family, and staff.

We then emphasized the organization of key rooms that are repeated throughout the building, (e.g. prep/recovery, surgery, exam). We used the 3-D printed model pieces to roleplay the activities in the rooms so that we could understand them thoroughly as well as obtain consensus on template rooms. We facilitated role playing sessions using a collection of 250 3-D printed model pieces as miniature figurines of people, equipment, and furniture. Participants moved the 3-D pieces to simulate 22 procedure types, establishing typical room types that would form a template of repeating elements in the building. The group was able to eliminate some room arrangements on the spot, and hone in on the details of the most promising solutions. The result was a templating strategy for identical prep/recovery rooms and exam rooms throughout the building. Three templated procedure platforms were developed to encompass surgery, endoscopy, and interventional radiology procedures.

Functional mock-ups were built of each of the key room types to validate the design decisions and room geometry. The mock-ups were constructed in an empty floor of a neighboring building and consisted of hard walls representing the room dimensions established during the 3-D printed roleplay sessions described above. Equipment and cardboard mock-ups were placed in the rooms, and the design team used color-coded paper to indicate each outlet, data port, and medical gas outlet on the mock-up walls. The multidisciplinary teams returned for mock-up workshops and rearranged the paper indicators to finalize the room details. In prep/recovery rooms, clinicians of varying heights verified the visibility of the patient and monitors from the decentralized care stations.

Christine Vandover: It was a complex project, with three different design firms and an array of consultants working collaboratively to deliver a project with a unified design intent. It was critical to the project’s success for us to bring all consultants on board from the earliest stages. Even an art consultant and graphic design consultant were brought on in the beginning, which was important to creating a cohesive, well-branded space.

Another unique element was the team’s approach to facility tours. Instead of visiting existing healthcare spaces, we challenged ourselves and the client to learn about the customer experience from those outside the healthcare industry. We went to a diverse set of projects, had scorecards that our clients used to give feedback, and we really considered the experience from start to finish—from hospitality to food service. This process gave us freedom to think outside the box and integrate spaces and amenities that we might not otherwise have considered.

As the project progressed, we wove architecture, medical planning, and interiors together through regular and constant communication. We wanted to function as one firm to create a singularly unique space. From regular in-person meetings to weekly charrettes, this collaborative spirit was key to making the project a success.

This building is incredibly flexible, serving as an example for many who are striving to achieve that very difficult balance between answering desires for future flexibility and being mindful of the budget today. How did your team approach this? 

Erin Cooper: We built on our prior experience of returning to previously completed projects to make modifications when medical equipment technology evolves. For the David H. Koch Center, the team wanted to find a sweet spot in designing for future flexibility with appropriate pre-investment. We consulted clinical and industry experts, including major imaging and medical equipment vendors and asked a series of questions: What is on the horizon? What equipment or procedures haven’t been invented yet but could find their way here in the future? Will equipment get bigger?

The answers to the team’s questions varied, yet there were some common threads around the expectation that more and more sophisticated equipment will be incorporated into the outpatient care environment of the future. As new equipment technology is developed, some types will grow in size and capacity while others may become smaller yet require more power, more cooling, and the transfer of massive amounts of data. This resulted in designing:
• Higher floor-to-floor heights of 18-feet-6-inches on clinical floors
• A long span structural system with fewer interior columns, allowing room sizes to change in the future with fewer structural impediments
• An organized zone of removable façade panels on each clinical floor for large equipment delivery such as MRIs
• Placement of vertical elements at the edges, such as columns, elevators, stairs, and shafts, to maximize internal space and accommodate future changes
• Identifying strategic zones of flexibility
• Provisions for additional future booms in operating rooms.

In addition to being flexible, this building is also incredibly operationally efficient, even at 700,000+ square feet. One jury member called it “very practical.” How did you achieve this via programming, building stacking, circulation, standardization, etc.?

Erin Cooper: The building practicality and efficiency was achieved through multiple strategies.

As a vertical building in a site-constrained urban environment, the building stacking considerations were essential for operational efficiency. A procedure patient, after checking in at the lobby, may proceed to one of three procedure floors and have all of their care on that single floor. Meanwhile, the care team and materials come to the patient or their procedure room through a combined network or horizontal and vertical circulation infrastructure. We considered on-stage/off-stage circulation in both vertical and horizontal organizations. We prioritized horizontal adjacencies where it mattered most for patients and optimized the vertical adjacencies to best connect the care team and materials to the patients.

Procedure and prep/recovery rooms are located on each procedure floor (5th, 6th, and 8th floors), along with the necessary support spaces. Program elements that did not require horizontal connectivity are centrally located on the 7th floor, also known as the sandwich floor due to its position in the stack between the procedure floors. This floor contains central sterile processing, with a dedicated elevator to deliver case carts directly to the clean core of each procedure floor. A soiled lift moves instruments from the procedure floors directly to decontamination.

Another area of the sandwich floor contains shared staff support functions, conference rooms, and lockers and lounge for all procedure staff. Staff change on this floor then travel to the procedure floors by dedicated stairs and staff elevators that support clean flow. Providing convenient access to the stair and elevators was a priority. Staff return to the sandwich floor for breaks in the staff lounge with food service offerings. This centralized approach reduces duplication of functions on each floor, gives more space to the procedure and prep/recovery rooms, and provides a more collaborative environment for staff.

A standout element of the design is the wood screen in the building glazing, creating a cool undulating effect that helps the facility become a landmark while also serving practical purposes for sunscreening and reducing glare. How did this idea come to fruition?

Henry Cobb: To accommodate state-of-the-art clinical and administrative spaces while allowing for future flexibility, the building occupies the entirety of its site on almost every floor, leaving few opportunities to shape the building volume. This circumstance gave rise to two interrelated goals that inform the design: first, to celebrate the generosity and accessibility of the building’s public spaces and, second, to articulate the building envelope in such a way as to give appropriate expression to the mission of the hospital it serves.

An all-glass facade was suggested by the fact that the exterior edge of the building is primarily circulation space. The insertion of a wood screen into the triple-glazed assembly and application of a frit pattern on the inner surface of the outer pane together give the curtain wall its distinctive character, achieving richness and variety in the glazed surface in a form that is readily constructible and highly sustainable, without intruding into the usable space of the interior.

The sole exception to the strict rule limiting the depth of the building envelope occurs in the double-height space between the street-level entry and the clinical floors above. In this space, the glass wall is recessed to create a lofty outdoor porch overlooking the avenue. The generous scale of this porch makes it the single most important architectural gesture in defining the character of the NewYork-Presbyterian David H. Koch Center as a major institution in its city, while the transparent glass wall behind reveals the entire interior to the street, giving the building an exceptionally welcoming demeanor.

Erin Cooper: The programming and efficiency drivers led to a dense program arrangement with little soft space and minimal opportunities for exterior articulation on the clinical floors. The wood screen and undulating frit pattern of this building were influenced by the notion that the patient experience begins long before the patient arrives and enters the building.

The building has a strong and recognizable presence. The façade design, with its wood screen and transparency at the lower register of the building is a gesture of generosity, to patients and to the community. The use of wood provides a sense of warmth, and the spacing is experienced as a screening feature from within the building, at a much different scale than when viewed from a distance.

This project represents a shift in thinking about improving clinical spaces and experience. What did you learn by completing this building that you’ll apply to ongoing work?

Erin Cooper: I learned the value of incorporating a variety of modes of engaging with stakeholders throughout the design process. By complementing conventional diagrams, floor plans, and written narratives with the 3-D printed role playing, we enhanced the level of engagement with multidisciplinary teams.

The tactile experience of moving the pieces revealed key functional relationships early in the design process streamlined decision-making. We unearthed conflicts earlier and we were able to develop design solutions promptly. We were able to take standardization further than we expected through this level of engagement. As we incorporate more virtual reality experiences in ongoing work, the value of using a blend of tools and selecting the most effective tool to communicate with stakeholders is essential.

This project embraced the inclusion of the family in the patient care experience. This is continually relevant in ongoing work to accommodate any definition of family by design spaces that offer a range of choices for family members to take part of the process while upholding privacy and dignity for patients.

What’s your favorite design element and why?

Christine Vandover: My favorite part of the design is the casual dining on the 2nd floor. It was designed to create community and to emphasize the connections between food and health and wellness. NewYork-Presbyterian saw the impact that a good dining experience can have on an organization and people and committed to bringing in a food service operator who had a fresh perspective on what they served. For example, bone broth is available at the coffee bar. How cool is that?

From a design perspective, it’s a generous, light-filled open space that gives visitors diverse choices of places to dine, socialize, and work. It feels warm and inviting. There’s strategically a quiet family lounge on this floor, adjacent to the coffee bar. It’s a unique space for healthcare, but one with a great impact. It’s enclosed with glass for acoustic purposes and has end block wood floors and ceilings that overlook the treetops on 69th Street. It’s a calming and healing space that gives families a quiet environment to contemplate their health or that of a loved one.

Erin Cooper: The radiation therapy rooms on the 4th floor. What a wonderful opportunity to have these spaces elevated, where patients, families, and staff circulate along light-filled corridors instead of a subterranean environment.

Jennifer Kovacs Silvis is editor-in-chief of Healthcare Design. She can be reached at