Durham, North Carolina

Duda/Paine Architects

Category: Category A: Built, Less than $25 million (construction cost)

Project: Duke Integrative Medicine (Duke IM)

Client: Duke University Health System

Project Location: Durham, North Carolina

Architect: Duda/Paine Architects, LLP

General Contractor: Balfour Beatty Construction

MEP engineer: Newcomb & Boyd

Structural engineer: Gardner & McDaniel, PA

Landscape architect: Hughes/Good/O'Leary & Ryan

Photographer: Robert Benson Photography

Construction cost (not including equipment or soft costs): $11 million

Building area GSF: 27,000

Completion date: March 2006

Duke Integrative Medicine is considered to be the first facility designed solely for the combined practice of alternative treatments and conventional medicine. Both the facility and grounds express Duke Integrative Medicine's mission: To approach healthcare as a holistic endeavor that embraces the mind, body, and spirit. Just as the program itself integrates the concepts of Eastern/Western scientific medicine, alternative/traditional medical approaches, and prevention/treatment, Duke Integrative Medicine's design concept reconciles the dualities of man-made/natural, interior/exterior, and formal/informal.

Duke exhibits strong examples of both formal and informal planning strategies. On one hand, the Gothic-looking West Campus displays a rational and formal sense of order, with strong axes and clearly defined paths. In contrast, the Sarah P. Duke Gardens are informally picturesque, with meandering paths that continually reveal new views and follies. Duke Integrative Medicine's design blurs the distinction between interior and exterior, reflecting the redefined boundaries that characterize an integrated approach to healing. Three primary branches radiate outward from behind a curving entry loggia, whose vaulted colonnade refers to the Gothic language of the West Campus. As they reach toward the neighboring Duke Forest, they simultaneously invite nature in and offer a series of discoveries along the way-meditative corners, framed views, gardens, and fountains.

Duke Integrative Medicine serves many users: a patient population searching for a balance between traditional and alternative medical approaches; healthcare professionals from a wide spectrum of fields searching for a new paradigm of multi-disciplinary practice; and community members interested in learning about wellness and prevention. This focus on well-being and innovation by all guided the architects beyond a patient-centered perspective to what they describe as “human-centered healthcare design.”

To improve patient healthcare and staff performance, the design strategy focused on stress reduction through environmental design. One of the approaches used was “positive distractions.” Because the act of waiting can provoke anxiety, the two main waiting areas try to refocus the mind by engaging the senses. In the main waiting area, a bench-lined hall faces a water-wall that is flanked by a bamboo garden. In the library, overhead arches provide a visual meditation on structure and light. Changing textures underfoot draw thoughts to the act of walking. Views of nature throughout redirect attention externally.

A second device used by the firm was integrating programmatic richness and variety. Because the therapeutic process must be individually tailored, the architects provided for different levels of activity (from contemplative reading to group exercise) and privacy (from public gathering to solitary meditation).

Finally, the architects included natural light and views throughout, and operable windows in the offices.

Traditional medical settings often evoke negative feelings, and are perceived as sterile, cool, and clinical. In contrast, Duda/Paine created a warm, non-threatening environment dedicated to physical and mental well-being by interweaving the natural and the man-made in two distinct ways. The first was by creating a visually and physically permeable relationship between the facility and the landscape. The three main branches project into the landscape and create interstitial spaces that draw the landscape into the building, like interlocking fingers of building and garden. Glass walls break down visual boundaries between the exterior and interior, and encourage physical access to the exterior elements of the wellness program-a meditation pavilion, ornamental and functional herb gardens, walking paths, and seating areas. The second method was by the extensive use of wood in a healthcare setting. When used as an interior finish, wood imparts a perception of being warm to the touch and comforting to the mind. When used structurally-as in the exterior canopies, the reading room, and the central quiet room-it not only mediates between the built form and the wooded setting of the surrounding Duke Forest, but also suggests the organic origins of Gothic architecture: arching trees whose branches meet overhead, filtering light through their foliage.

In addition to many other sustainable design measures that allowed this project to become the first of its kind in the country to achieve LEED certification, the architects cite Duke Integrative Medicine's siting, footprint, and storm water management.

Choosing the existing Center for Living Campus offered many benefits-including proximity to the Duke medical community, an established infrastructure, and easy access to mass transportation-while still being appropriate for a mediation and spa program. Dramatic views of Duke Forest suggest an oasis at the periphery of an otherwise dense medical complex of hospitals, clinics, and teaching facilities.

The building is located on an existing parking lot. Since calculations indicated less parking required than existed, impervious surface area was removed as much as possible. Using a previously cleared and leveled site reduced the amount of tree removal and grading required.

The natural topography was used to its advantage, treating rainwater as a design feature for meditation and contemplation. By routing all roof drains into a central courtyard fountain, water bubbles up when it rains, then follows a meandering path through the site, down a river rock ravine, for a gradual and gentle release back into the site.

Healthcare Design 2010 November;10(11):192-194