Fabian Kremkus

Photo credit: Beth Coller

In this series, Healthcare Design asks leading healthcare design professionals, firms, and owners to tell us what has their attention and share ideas on the subject.

Fabian Kremkus is a team leader in the healthcare, interior design, and civic and cultural disciplines at CO Architects (Los Angeles). Here, he shares his thoughts on using technology to move healthcare toward net zero.


  1. Using modern central-plant technology to move healthcare toward net zero

To help address hospitals’ energy consumption and operational carbon, CO Architects and partners such as tk1sc’s engineering team are leveraging equipment technology to design future healthcare facilities as close to net zero as possible. California is leading the country in all-electric legislation—and some healthcare projects are responding. For example, CO Architects’ current UCI Health-Irvine (UCIH-I) project adjacent to the University of California, Irvine, campus features an all-electric central plant that uses uses heat-recovery chillers and heat pumps. This design eliminates gas-fired boilers, enabling operation without burning any fossil fuels. As the grid is getting greener, this facility takes full advantage of California’s energy infrastructure. Additionally, we’re challenging heat-pump manufacturers to create higher-capacity systems for easier integration in large projects.

A UCIH-I design feature that reduces embodied carbon is using the lightest possible structural steel framing system while also complying with California’s strict seismic standards for facilities that have in-patient care. We chose a buckle-restrained brace (BRB) system, which uses appreciably less steel compare to side-plate moment-frame systems. The structure is the most significant contributor to the embodied carbon footprint of a building. Therefore, the UCIH-I team strived to save weight and increase structural efficiency as much as possible.

The lessons learned here is that you need a fully integrated design team consisting of the structural engineer, the architects, the contractor and steel fabricator, and the medical planner from the outset to integrate a BRB system into the building. The disadvantage is less future flexibility—the bracing might limit interior layouts.


  1. Biophilia strategies that contribute healing environments

As we know through evidence-based design, access and connections to nature improve healing outcomes. In addition to prioritizing soothing outdoor views for patients and staff through features such as full-height glazing (reducing lighting energy), we see naturally lit pre-op and recovery units as a trend in patient-care design. Another design priority is including interior color palettes that use natural tones combined with earthen materials such as stone and wood to blur the line between indoors and outdoors.  Landscaping and plantings can also be purposely chosen for soothing sights and scents. At UCIH-I, the site is planned to prioritize access to the exterior and pedestrian flow, including a central plaza, elevated terraces devoid of cars, strategic plantings, shade canopies, benches, informal seating, a meditation area, café, and dining terrace. The project’s location also allows recovering patients, visitors, and staff access to acres of outdoor space adjacent to the San Joaquin Marsh nature preserve, uninhibited by any vehicular circulation.


  1. Using design to give back to communities

As a profession, designers of healing environments are hard-pressed to ignore challenges that exist on a global scale, from wildfires in Maui to the war in Ukraine. In response, healthcare design professionals should look for opportunities to use their design skills to give back and make a difference. For example, our firm is working with nonprofit Sail to Shelter to repurpose retired yacht sails into emergency relief shelters.


  1. Building features to promote community engagement

Particularly for healthcare projects in underserved areas, designers should consider forward-thinking design solutions, including public areas that engage the community by accommodating events: vaccination programs, nutritional education, art displays, and famer’s markets to name a few. Large healthcare providers are also adopting these features at their facilities, regardless of location. California has a high percentage of residents who lack health insurance. To help destigmatize the act of seeking healthcare, we’re incorporating features such as central plazas, which serve as flexible public spaces that can host community events. They also help galvanize neighborhood involvement and support for healthcare projects by eliminating barriers, making the community feel like a partner in the process. As designers, we need to consider how we can engage the public to better accommodate events that bring people together both outdoors and inside.


  1. Pandemic preparedness driving design approaches

Healthcare spaces and their designs will continue to be impacted by changing demands and ever-evolving challenges such as pandemics and natural disasters: earthquakes, fires, floods, and hurricanes as prime examples. It is incumbent on us to design facilities that can accommodate sudden influxes of people. Also, the pandemic escalated demand for telehealth services and also stimulated rethinking of how facilities must be designed to accommodate the next pandemic. Among those preparation strategies, clients are asking for air systems that use entirely outdoor air to address airborne infection transmission, exterior areas with utility access for triage tents, exterior waiting areas for inpatient and outpatient settings, and more acuity-adaptable patient rooms to minimize patient movement and exposure.


Want to share your Top 5? Contact Managing Editor Tracey Walker at tracey.walker@emeraldx.com for submission instructions.