Beyond the state of the art
Cleveland Clinic Abu Dhabi Hospital Abu Dhabi, United Arab Emirates
Project Inception:August 2007
Completion: January 2011
Operator and Management: Cleveland Clinic
Master Architect: HDR, Inc. (San Francisco)
Design Architect: HDR, Inc. (San Francisco)
Principal-in-Charge and Director of Design: Alexander Wu
Principal Project Director: Harold Nesland
Design Principal: George Vangelatos
Lead Medical Planner: Gabriel Oproescu
Interior Architect: HDR, Inc. (San Francisco)
MEP: Ted Jacob Engineering Group (San Francisco)
Structural: Magnusson Klemencic Associates (Seattle)
Civil: HDR, Inc.
Landscape: HDR, Inc.
Images: Courtesy of HDR, Inc.
Total Building Area (sq. ft.): Approx 2.1-2.2 million
Cost: Approx. US $1.5 Billion
The term “hospital of the future” is tossed around quite a bit these days, but the new Cleveland Clinic Abu Dhabi (CCAD) Hospital, United Arab Emirates, looks as if it might be the real deal. HDR Architecture, Inc., selected as the Master Architect to design the project, was awarded the project through an International Design Competition, beating out many large and prestigious firms and big-name architects. Scheduled for completion in 2011, the 360-bed hospital and clinic is located on the coast of Al Sowa Island, adjacent to the new Abu Dhabi Financial District, part of a master plan that brings healthcare, education, and commercial development envisioned as the new heart of Abu Dhabi. HEALTHCARE DESIGN Managing Editor Todd Hutlock spoke to Principal-in-Charge and Director of Design Alexander Wu about this massive, visionary project.
Alexander Wu: “The Cleveland Clinic Abu Dhabi (CCAD) Hospital project is probably the most significant hospital in the world. It is one of the largest American-managed hospitals in the world. The outpatient clinic at CCAD is about the size of most general hospitals in the United States.
“HDR was selected on September 1, 2007, and we started the project in October 2007. It's the most aggressive schedule that I've personally been involved with; the first patient must be admitted in January 2011. We've had more than 150 HDR architects and planners working around the clock through eight different offices, and we've just completed schematic design. There also were thousands of hours put in at the Cleveland Clinic, consulting with all the doctors and clinicians. The January 2008 groundbreaking was a huge ceremony, and the foundation work is happening right now.”
“I've never worked in Abu Dhabi before, but it is one of the most wonderful places I've ever visited because of the people, the openness, and their stewardship for welcoming people and encouraging interaction.
“There needs to be a great respect for the culture in the project's design. Having a prestigious name like Cleveland Clinic attached will draw lots of patients from outside of the UAE because there is such a demand in the region for state-of-the-art healthcare. What we've done differently in our approach is incorporate areas such as prayer rooms and a respect for different locations for ingress and egress for women and men. Even though we have a separation of spaces, those spaces are not demanded. Basically, we are giving the patients and families a choice.
“This has added some unique features to the hospital. The understanding is that in the UAE, the culture sets itself aside because of the family unit. There are unique cultural differences. For example, female patients will most likely not come alone, but rather with a family escort. Most of the time, if she doesn't come with a male family member, a group of family females will come together. In the patient rooms, there is a patient zone, a family zone, and a staff zone. Compared to the United States, there is more generous space for family zones incorporated into the design. Much research was undertaken to support these sorts of differences to support the culture.
“Also, because of Cleveland Clinic's role as a leader in healthcare, we also have to respect and understand their clinical approach to supporting patients. What do you do as a practitioner when there are eight people in the exam room? How do we support that flow without getting in the way of healing patients? We really took a scientific approach on how to support the issue, but also you have to plan an efficient hospital. So, for example, there are spaces that have overflows to welcome members of the family into gathering areas within a typical patient floor. So there are places where the families can retreat and interact outside of the patient room, but also offering some separation within a patient room. The culture is really inclusive with the larger family aspect in the healthcare process.”
“Because of the vision to create the hospital of the 21st century, there are concepts used in the patient floors that are focused on evidence-based design ideas based on findings in Western hospitals, but we took it step further by also incorporating the Disney concept and also applying the culture of UAE to the mix. There are multiple offstage areas so we don't disturb the patients and corridors for support facilities on an inner core that remains out of sight. The common corridors are generously sized to accommodate the extended family traffic, and all of the offstage volumes are neatly tucked away in the center. We worked extensively with clinicians from Cleveland Clinic—literally thousands of hours—and they pushed us to design a facility that will help improve clinical outcomes.”
Hospital versus hospitality
“We wanted to blur the line between hospital and hospitality. The UAE is a bit ahead of the United States in hospitality design. Part of evidence-based design is about patients being able to control their environment—the lighting system, shading system, everything should be at the fingertips of the patient. If you look at five-star hotel design, it has some of those same attributes. We've been able to pull ideas from a number of different building types. I'm hoping that passers-by will look and want to know ‘What is that building?’
“There is also a VIP level in the patient tower that features slightly larger rooms, and four Royal levels. This is again a unique cultural space. They are of course very beautiful and luxurious, but also very respectful to the Arabic culture in terms of its design, with arabesque patterns and spaces for family.”
“This is one of the most beautiful sites in Abu Dhabi, directly across from a five-star hotel, with a very short bridge across to the mainland. It will be located on Al Sowa Island, adjacent to the new Abu Dhabi Stock Exchange. The master plan of the island envisions it as the heart of Abu Dhabi. There is another island east of our site that will have a high-density residential development. Different from other parts of the region, Abu Dhabi isn't just putting up condos and hotels; they are looking to create revitalization through education, medicine, and finance. Cleveland Clinic Abu Dhabi will be an anchor downtown. Healthcare is one of the most effective catalysts for urban renewal, but with many cities around the world, it is an afterthought. With this project, it has been a forethought.”
“The concept was modeled after a European hilltop village, with the staggered heights. I started with the central piazza with the reflecting pool, and then decided to stack the building programs. The highest building is the patient tower; the smallest building is the administration building. The patient tower rests on top of the ICU unit, which is on top of the D&T block. It follows a continuum of care for efficiency in operations. The public indoor gallery links to the administration building. On the west side, along the water, there is a ‘canyon’ and the clinic block that sits inside of the gallery.
“The architectural notion was to create an iconic design. We also understood that because this was a hospital, we had to follow strategic planning procedures. We took an orthogonal approach so we could have a high level of flexibility. We wanted to be able to grow into different programs; the 360 beds can actually expand into 490 by expanding into one of the orthogonal building blocks without making considerable changes.
“On the patient tower, there are two curtainwalls, creating a kind of ‘respiratory system’ for the building. There is an outer curtainwall and the hospital inside, which has its own separate storefront. Conditioned air will come out of the bottom of the patient tower through the two curtainwalls and out through the rooftop. This creates a constant buffer to protect the building from the radiant heat of the sun; it gets brutally hot in Abu Dhabi about seven months out of the year. We're going to use 100% outside air and exhaust the air out; that conditioned air will create a cooling layer that will reduce load factors per floor, using less energy. This will count toward the Architectural Innovation portion of LEED qualification; we should be able to achieve LEED Gold certification.
“The exterior design is very clean and iconic. The hospital is an all-steel structure, which is uncommon in Abu Dhabi. It also has one of the largest cantilevers ever done in a hospital; the patient tower extends about 60 feet over the ICU and the D&T block, with a truss holding that up without columns.”
Onward to infinity
“The gallery's long span, connecting the hospital to the administration building, represents infinity. There is a reflecting pool in the plaza, representing the infinity of the sea. The message represents our aim for the project to be infinite in its stewardship for healthcare. We want to create that journey inside.
“To that end, the gallery also houses all of the community and retail space. Because of the large volume, there needed to be a place for everyone—patients, family, and staff—to wait and also to reduce some of the impact of the patient flow in our patient areas. This provides a place for everyone to enjoy and wander through, taking this journey. There is also an outdoor terrace level on top of the D&T block.
“On the gallery space, the glass changes to show a white color band; in addition, it is wrapped on top of the roofline. To reinforce the ‘infinite’ message, we changed that to a channel glass. This will create an iconic design that will be seen anywhere, and also helps to maintain the same language through the building structures.
“Because it is such a large space, direct wayfinding is very important; the large patient tower is meant to act as the village clock tower. From the gallery or the executive building or any other area, visitors will know where the front door is. There are also colored hubs to help with wayfinding that were purposefully set no more than 100 feet apart. The reflecting pool is actually a large light well that projects light into the parking decks below.
Thinking beyond the state of the art
“In addition to being influenced by evidence-based design principles and the hospitality industry, we are also bringing in ideas from, for example, the airline industry and its use of controlled spaces and amenities right next to the bed—or seat—such as lighting and fans. We are researching ideas from the automotive industry, as well; for example, cars today have pop-up refrigerated compartments, so we're examining ways to bring such at-hand amenities and choices to the patient.
“We truly feel that this project will be the future benchmark for healthcare. I don't want to be too bold, but we're really trying to change environments to the point of changing the very language of the hospital. Maybe it should no longer be called the ‘waiting room,’ for instance; we don't want people to wait there. Every time I hear the term, I think, ‘That's the last place I want to go.’ We want people to have a deinstitutionalized emotional response to the hospital.
“We have also looked at the future of technology. One example is Smart Glass; when a doctor enters his or her office, the glass storefront wall becomes private, and when he or she leaves, it turns transparent, offering light throughout the clinic. We may have a kiosk at check-in that will be able to take patients exactly where they need to go through the use of LEDs in the walls and the floor. There are Smart Wall systems that will allow for faster and more efficient response to alarms than just the traditional audio response. Technology will always be there, but the success lies in the culmination of all of these different factors, including the future of illnesses and demographics.
“Our goal upon completion is that CCAD will be five years ahead of the state of the art. This isn't just a statement about technology; technology will always change and we have to prepare for that with flexible planning. We need to look forward into other areas, such as how education will change healthcare. For example, you can't mentor a nurse through a PDA or the Internet. We created a system where we initiated collision spaces between staff. This is the first time in history that we have four generations of patients, visitors, and workers in one place. Architecture needs to respond to that.” HD