“Kaiser Permanente’s integrated model of healthcare often uses larger hospitals with nearby specialty and primary care offices to deliver coordinated care and services to its members,” explains GS&P principal-in-charge and senior project manager Skip Yauger. “However, it was moving into markets where the population growth didn’t support that structure. So it sought a prototype for a small hospital that was much more integrated into the community, and could serve members in outlying areas.”
Keeping both its members and the environment in mind, Kaiser Permanente not only called for a design that provided a patient-centered, healing atmosphere, but also one with a near-zero environmental impact and access to the latest technology.
“We were charged with designing the 100-bed hospital of the future, which was quite different for Kaiser Permanente—and our approach was different, too,” adds GS&P project team member Michael Compton. “We typically have a program and make all the components fit the project. We then generate a narrative for how the user experiences that program after it’s established. With this project, we decided to diagram the approach spatially from the patient’s perspective. To understand what that might look like, we created a fictional patient and asked ourselves what that person may experience on a typical day within this particular Kaiser Permanente campus. So the project evolved out of what we understood the patient experience to be. And that quite literally drove every decision we made.”
Planned hypothetically for a site in Lancaster, California—which is situated in the Antelope Valley of the western Mojave Desert—the proposed small hospital would be situated in a mostly flat location covered with low desert vegetation. Centered on several key design drivers, the GS&P team began developing a design concept that not only worked with the topography of the location, but also allowed the hospital prototype’s buildings and services to be located in urban, suburban or rural environments.
“We recognized the need to reach beyond the Kaiser Permanente template hospital and search for innovation,” says GS&P senior designer Jim Kolb. “Central to our design approach was the understanding that a small hospital is not merely a small version of a large hospital—it has to operate in a fundamentally different manner to be economically viable. So our design solution focused on a number of key sectors of a small hospital.”
The principal design drivers measured in the competition included: technology innovation; flexibility and adaptability; sustainability; efficiency; and the environment of care. The design team evaluated each driver relative to quality, patient safety and costs, and devised a flexible, component-based design solution that could be adapted to any site.
Flexibility and Adaptability
Guided by the proposed location, the design team grouped the hospital and medical office buildings around a dry streambed known as an arroyo, which runs through the site. Dubbed the Arroyo Park by the team, this central space offers the hospital’s main public areas expansive views of nature. The building placement and landscape design shelter the Arroyo Park from the desert sun and wind, giving patients, family and staff—as well as the community—the opportunity to enjoy outdoor dining, exercise and community events such as local farmers markets and live performances.
“Kaiser Permanente stressed environmental sustainability as part of the competition,” says Compton. “Our design proposal—which features this central green space that runs between the hospital and all the medical outpatient buildings—helps achieve this by bringing healthy members to the campus before they ever have the need to see a physician.”
Fundamental elements of GS&P’s proposed small hospital of the future were designed as components that allow for incremental growth and application to other sites. For example, a seven-room strategy developed by the team demonstrated that 90 percent of all clinical activities could be accommodated through seven distinct room modules. These encompassed: universal care; standardized patient room; large patient room; interventional; small diagnostics; large diagnostics; and administrative office.
On the hospital’s first floor, a revolutionary universal care suite features emergent; urgent; non-urgent; observation; direct admissions; PAT; electrocardiogram; PFT; outpatient lab draw; and imaging services. This single department maximizes cross-utilization opportunities and allows scheduled procedures to be coordinated with predictable daily ED surges. The first floor plan also accommodates a rapid assessment suite in the ED that reduces patient-to-doctor time.
Similar economies were created in the interventional platform on the second floor, which combines the perioperative suite with the first floor patient tower. On this floor, the pre-op and PACU are essentially one large space, allowing rooms (and staff) to be used for multiple stages of prep and recovery as demand changes throughout the day. These innovative layouts ultimately reduce required full-time equivalent staff to achieve operational cost savings.
“One of the architect’s greatest strengths is the ability to help clients create efficiencies that can reduce staff and operational costs,” says Kolb. “Through this design strategy, we were able to reduce staffing by 10 percent.”
Patient floors were designed to accommodate six large patient rooms and 18 typical patient rooms. The large rooms can be used for rehab, bariatric, LDRP and extremely acute CCU. The typical rooms all meet the requirements for CCU, but can also be used for med/surg. This allows the units to be reassigned without construction. All patient rooms feature a nurse substation with observation windows and two sets of clean and supply rooms, which make for an average travel distance of 39 feet. In addition, internal departmental boundaries were reduced to help hospital staff maximize efficiency through a one-team approach. Flex zones between key rooms were incorporated into the design to permit future renovation and adaptation, while expansion was planned to the north and west, allowing the hospital to be sized in 48-, 96- and 192-bed increments.
Based on a solid understanding of Kaiser Permanente’s goals, GS&P’s primary sustainability strategies for the project included achieving an energy use intensity of 100, providing on-site power generation, reducing life-cycle costs and balancing human needs with those of the environment. Since energy efficiency begins with the site design, the team oriented the hospital and medical office buildings with their long axes to the north and south, reducing their exposure to the harsh morning and afternoon sun. The placement of the buildings around the central Arroyo Park also protects it from the prevailing desert winds.
Parking lots were designed to have 300,000 square feet of photovoltaic panels to collect solar energy and shade the pavement, reducing the heat island effect and generating 75 percent of the hospital’s annual energy use. Wind turbines located in the northeast corner of the site produce the remaining 25 percent. Strategies such as air-handling zones based on perimeter exposure, radiant ceiling panels and using run-around heat recovery coils at air-handling units make the building extremely energy efficient. The desert location of the site permits the use of solar hot water collection during the day and chilled water collection at night, and a central energy plant—larger than that of a typical hospital—houses some of the innovative technology components needed to achieve a carbon-neutral facility.
“This is the first carbon-neutral campus that we’ve designed for a domestic project,” says Compton. “This essentially means that the power is completely generated on site, and the campus isn’t pulling power from a utility grid, which minimizes the hospital’s environmental footprint.”
Environment of Care and Technology
In order to improve patient safety and satisfaction while also cutting costs, two of the project’s key design drivers included providing the best possible environment of care while incorporating the latest in technology.
“Kaiser Permanente was looking for fresh ideas on how technology and the environment of care could reshape its current medical delivery infrastructure,” says Kolb. “So we started to think about some of the things we’ve always wanted to do but never could. This project was all about innovation, and our approach was multiple big ideas instead of just the one.”
One of those big ideas came in the form of the myKaiser app. Available in the hospital’s high-tech rooms, the application’s interface allows patients to adjust room temperature, switch television channels and change the color of the room’s LED lighting. An interactive wall lets them display their own artwork or family photos, as well as engage in Skype consultations with a physician.
“Patients can often feel vulnerable, and that they’ve lost a certain degree of control when they go into a hospital environment,” says Penny Houchens, GS&P healthcare interior designer. “Our objective was to give them some sense of control. Our hospital design supports the idea of patients taking part in their own healthcare. By empowering patients in the hospital and making them active partners with their care providers, they’ll participate more readily in their care and recovery, and this will hopefully improve overall health outcomes.”
Yet another unique technological innovation locates micro-pneumatic tube stations at the bedside in each patient room. This, in combination with an automated medication dispensing system (robotic pharmacy), can eliminate six to eight nurse trips to the medication room per patient per day. The time saved can be spent at the patient’s side, reducing falls, lowering the rate of adverse events and improving patient satisfaction scores.
Further enhancing the overall healthcare experience, each patient room is provided with a generous family zone to encourage visitors. Glove boxes, sharps containers and other clinical clutter are easily accessible to staff, but otherwise hidden from view. Wider doorways, handrails and locating the toilet near the bed all reduce the risk of falls. Standardization around the seven room types offers maximum flexibility for room utilization in the short-term, and cost-efficient reconfiguration over the long-term.
Light wells and vegetated walls throughout the hospital bring natural light and views of nature to 90 percent of patient areas. Adjacent to light wells, nursing unit floors accommodate intensive, progressive and acute-care patients. The collaborative nurse station in the patient tower also provides staff with an airy and bright work environment.
“With every project we work on, we tend to refine the concepts of evidence-based design and push them a little further,” says GS&P interior designer Carolyn Blake.
“With this project, we had a landscape that featured boulders, cottonwoods and native plants to set the tone, which is very powerful and also very healing. So the interior design is intentionally a little more minimal because it’s focusing your attention to nature, which everyone has access to through the innovative use of glazing.”
“All of the shapes and motifs that we used were heavily influenced by the desert environment,” adds Stephanie Irwin, GS&P interior designer. “Natural materials and a mostly neutral palette with accents of bright colors relate the interior of the building to the surrounding landscape.”
Named a top-three finalist in Kaiser Permanente’s first-ever design competition, GS&P’s revolutionary small hospital concept provides an agile facility that can meet future changes, minimize environmental impacts, and improve patient health outcomes at a lower operating cost than larger Kaiser Permanente facilities.
“Our small hospital design was truly built on big ideas,” says Yauger. “We called on staff members in our offices across the country to challenge the current ways of thinking about successful healthcare design and delivery. Our final product uses cutting-edge technology to optimize and personalize every aspect of patient care, and provides a snapshot of the boundless potential for healthcare in the future.”