Cleveland gets no respect, no respect at all, as the late Rodney Dangerfield might have said. Widely known as “The Mistake on the Lake” (and variations thereof), the city has been the stuff of jokes since the heyday of vaudeville. The truth is, the city has many delights, including an “emerald necklace” of beautiful parks, a large and lively theater district, a magnificent orchestra, a livable commute, a supportable cost of living, and one of the most versatile and provocative architectural critics in America. Steven Litt's columns in The Cleveland Plain Dealer have long been the staple of Clevelanders interested in art, architecture, design, and urban planning. He is known for his versatility, trenchant analyses, and clearly stated opinions, not to mention his original take on things; his description, for example of the construction challenges posed by Frank Gehry's Weatherhead School of Management, a swooping titanium masterpiece, from the standpoint of the hardhats doing the building was a major inspiration for the broadening “Contractor's View”-type coverage of this magazine.

So, when the Cleveland Clinic announced the opening of its new Sydell and Arnold Miller Family Pavilion and Heart & Vascular Institute, with the adjoining Glickman Tower's Urological and Kidney Institute—a $634 million project that drew interest from all Plain Dealer readers awaiting Litt's reaction. He didn't disappoint. While praising aspects of the project's landscaping and patient-friendly interiors, he took the Miller building's designers—long-time healthcare stalwart NBBJ—to task for a glassy exterior he saw as “gloomy,” “monolithic,” and “bland,” and its expansion-limiting arc-shape.

“The buildings represented a huge opportunity to reinvent hospital architecture and broadcast a new image of Cleveland as a world capital of health care [sic],” Litt wrote. “Instead, we got a pair of buildings that look [sic] like the suburban headquarters of a large financial company.” Recently, HEALTHCARE DESIGN Editor Richard L. Peck sat down with Litt to discuss his views on the Clinic's projects, the state of healthcare design in general, and the seldom discussed impact of large healthcare projects on the urban environment.

Richard L. Peck: Your response to this signature Cleveland Clinic project, at least from the exterior standpoint, was quite negative. What was behind that?

Steven Litt: It's not my job as a critic to describe what a design or a healthcare building should look like. However, I do know that, if you're approaching a hospital and you're ill, every visual impression you have will be a huge part of your experience, whether you can articulate it or not. The approach to this building from the north is a visually daunting experience. It is a giant, curved wall of glass; it is opaque, and there is nothing to give you any sense of scale. When it is dark in the winter, with the sun cutting low and in your face, what you will see is a cold, deep, dark wall of glass. I believe these impressions should have been taken into account during the design.

Peck: You also criticized the apparent limits imposed by the building's arc-shape on future expansion. Would you elaborate?

Litt: Right now we have a quarter-circle, which implies that they would continue the circle into the streets around it, where there are some original Clinic buildings that now look quite strange in this context. I can understand a sentimental attachment to these old buildings, so why design their neighbor as if they're going to go away? Or will they? Subsequent planners and designers might find new uses for these buildings. These questions appear not to have been thought through.

Peck: Recently, you had an opportunity to go through our September Showcase issue. What were your impressions?

Litt: It's incredibly valuable to see all these projects in one place, and I see an enormous energy and astonishing amount of creativity in many of these projects. The majority of them are striving for a clean, contemporary look, and many making a great effort to bring natural light into the hospital. What I don't see is any particular signature look—in some cases the hospital could in fact be a beautiful office building or other commercial structure. I'm not sure whether that's intentional, whether healthcare buildings should look like other contemporary buildings, or whether there's something about them that really should be different.

Peck: There are some who say that healthcare architecture is a specialty unto itself, and that this is not a field for the “starchitect.” For example, we recently published the Cleveland Clinic's planned medical center in Dubai, designed by the experienced healthcare design firm HDR. Your thoughts?

Litt: Interestingly, the young architect assigned to that project (Alexander Wu) is something of a rising star in the field. He was chosen for his ability to give that building something extra. Anyone who compared that building with the new Clinic projects we just discussed would see the difference.

Peck: So are you saying that “stars” might be the way to go in this field?

Litt: Regardless of who the architect might be, this is a field that is ripe for exploration by architects who have that special ability to endow a building with a unique, memorable image that can become a landmark for a city, an icon for an institution—something deeply memorable and beautiful, something that moves people. I don't know why an architect couldn't bring this to a healthcare project in addition to all the technical requirements involved. Yes, patient care has to come first, but where is the rule that says you can't have brilliant, inspired, beautiful architecture in a healthcare setting? Is it because people are afraid it will cost more? Is it that doctors and hospital boards feel that they wouldn't have sufficient control over a brilliant architect? I suspect that, within the next 10 years, some hospital will figure this out and differentiate itself from the pack by hiring an architect everyone will recognize. The result will be lucrative to all concerned and beneficial to healthcare.

Peck: What is your view of the move toward evidence-based design in this field?

Litt: The fact that people are researching the influence of environmental factors on patients, physicians, nurses, and families will have considerable impact on the field. When you enter a hospital as a patient, you lose control of your body—entering a world that works 24/7, observes no natural rhythms or logic, and is not participatory. It's as though you've been eaten by a giant machine. I can say that as a former patient. I was admitted to the hospital with pneumonia for a seven-day stay about 10 years ago, and my daily contact with the sun through the windows of my room was unbelievably important to me. It connected me with the outside world, the world of healthy people, and it gave me hope. In a way, this connection seems so obvious and logical that people shouldn't have to spend a dime researching it, but it is fantastic that people are actually quantifying this—maybe it helps with doctors, who like to quantify things.

Peck: Let's take an aspect of this that is seldom talked about, at least in magazines: the impact of healthcare projects on urban redevelopment. I know you've followed this issue deeply over the years. Would you discuss this?

Litt: Talk to anyone today involved in city planning or urban design, and the overwhelming consensus is that American cities don't have the resources to carry out wholesale neighborhood revitalization. On the other hand, the leading medical centers and universities anchored in the “old neighborhoods” have figured out that, if they want to attract the best and the brightest to their staffs, they have to take responsibility for their immediate surroundings. Medical centers have not been the leaders in this yet, but they are getting more involved.

Medical centers are monocultures. There is no housing, no retail mall, no library, no post office—all the things that make a city are pushed to the edge. This is not true of university campuses, which are quite porous around the edges, so that they are not walling themselves off from the surrounding community. I think this porosity will be the next evolution for urban healthcare facilities. It will help reduce the perception of their being big, cold institutions turning their backs on their neighborhoods and, instead, by creating lots of pedestrian environments in the immediate locale—libraries, post offices, restaurants, and so forth—they will be bringing the life of the city into the life of the medical center. The Cleveland Clinic, for example, has begun to do just that in some areas of their campus, and that's a very promising development for the neighboring community. HD

For further information, contact Steven Litt at slitt@plaind.com.

Healthcare Design 2009 January;9(1):28-30