Journey under the sea
Type of Facility: Children's Hospital
Completed: March 13, 2006 (new construction); renovation construction to be completed August 2007
Hospital Administration: Ruth Benfield, Vice-President of Psycho-Social Services, Children's Hospital and Regional Medical Center
Architecture: HKS, Inc. (Ronald W. Dennis, AIA, Principal-in-Charge; Jeffrey Stouffer, AIA, Principal Designer; Bob Martineck, AIA, Principal Project Manager)
Owner's Representative: David Victor, AIA, Seneca Real Estate Group
Construction Management: Dave Scalzo, Sellen Construction
Interior Design: HKS, Inc. (Cindy Williams, Senior Interior Designer)
Landscaping: Coy Talley, ASLA, Talley Associates
Mechanical/Electrical/Plumbing Engineering: CDi Engineers (Mechanical/ Plumbing); Sparling (Electrical)
Structural/Civil Engineering: CPL
Medical Equipment Planning: GB&A
Environmental Graphics Consulting: HKS Environmental Graphics
Photography: Ed LaCasse
Total Area (sq. ft.): 172,000 (new construction); 80,000 (renovation construction)
Total Cost: $70.7 million
Cost/Sq. Ft: $298 (new); $241 (renovation)
The Melinda French Gates Ambulatory Care Building at Children's Hospital and Regional Medical Center in Seattle was designed with the goal of improving the patient journey from start to finish. That journey, however, starts at the bottom of Puget Sound with an octopus named Candy. The new building—named in honor of the founder and co-chair of the Bill & Melinda Gates Foundation—consolidates more than 30 different clinics into one 168,000-square-foot building, housing 105 exam rooms, more than 30 procedure/scan rooms, and more than 350 physician/staff offices. The building offers perhaps the ultimate in flexibility, as the clinic space changes daily based on need. HEALTHCARE DESIGN Managing Editor Todd Hutlock spoke to Principal Designer Jeffrey Stouffer, AIA, of architects HKS, Inc., about the project.
“The model of care for the facility was developed prior to the design beginning based on an operational model of care study, a series of meetings with the medical staff, nursing staff, clinic administrators, and the executive team. It was an inside-out type of effort with all different types of operational models explored. They came up with the concept that, number one, all of the clinics needed to be consolidated, and number two, that they wanted them mainly on two floors and as flexible and modular as possible. They were separated into two groups: clinics that met four days a week or more, or clinics that met less than four days a week. The clinics that met more than four days a week or that had specific equipment were given dedicated space on one floor, and the top floor was all flexible and modular clinics.
“The clinic spaces change daily. They may have a neurology clinic that meets one day that needs five rooms, but then the craniofacial team may need 25 rooms. The signage is even flexible—the staff go around and change the signs according to what clinics are meeting that day. So everything is modular.
“In addition to the clinics, we created a high-intensity ambulatory care area for all sedated procedures. Those were being done in 21 different locations throughout the hospital, but now they are being done in just three places, all of which are received, prepped, and recovered in one place. We were able to consolidate that into one major location, and it acts as overflow for the Emergency Department at night. We were really able to maximize the flexibility and utilization.”
“We started the design with the parents. We wanted to hear from them on what their experiences had been, what would make their patient journey better, and how the environment could influence those journeys. Then through a series of very intense meetings with medical and nursing staff and the directors, we created the model that was actually built. The organization and location of the clinic came directly from the meetings with the parents.
“The clinic is directly adjacent to a parking garage, which was designed prior. We designed the garage with the same floor-to-floor heights as the clinic. Visitors enter on each floor from the garage directly into the central three-story atrium with two colorful glass and steel whales floating overhead, so wayfinding is very clear. There are also greeters at each level right at the entrances. The atrium is the major wayfinding spine for outpatients. Almost all of their services are located off of the atrium. All of the entrances are at the end of the atrium. The number one stress for patients is parking, and number two is wayfinding. We felt like we greatly reduced both of those stress factors.
“There is also seating in the atrium for pharmacy, day surgery, and procedural-area waiting. There is a pathway through there, but it is also waiting space.
“Children's Hospital and Regional Medical Center is on a hill, so on one end of the campus, you enter at level one. The main entrance at the clinic level is on level six. The fourth floor was the only one that goes all the way through the hospital, which is where all the major clinical activity takes place. Because of this, we wanted to create a separate circulation system for the visitors and families, so we used level five as the visitor and public access across the campus. It also opens to the main atrium. We tried to put as many public services as possible on that floor, such as the cafeteria and the gift shop.”
“Another goal was consolidation and to reduce travel distances. Many of these patients would have to see multiple physicians in one day, and would have to wait and move across the campus to multiple locations. Most of the parents would have other children in tow, as well. Now, if a patient has to come for multiple visits, they are at least in the same area, or ideally, the doctors will come to them so they don't have to move. The flexibility of the clinic spaces allows this to happen.
“Parents also requested a place of escape so they could go outside with their other children and still be close to the clinic spaces. We created an outdoor courtyard and activity area between the parking garage and the clinic. It was resultant space that had to be there anyway, so we made it into as positive a place as possible. There is a restaurant-style beeper that allows the families the freedom to move around the grounds. The space was designed as a series of outdoor rooms, if you will. As you move away from the main entrance, the rooms become more private and reflective.”
“Originally, waiting space for the clinics was in the atrium, but staff told us that they wanted patients and families inside. We thought of it like an underwater theme, like an aquarium. The circular lights in the ceiling were designed by a local artist to look like sea anemones to accentuate the feeling of being under the sea. We also broke up the waiting areas into smaller family groupings, with some more geared toward younger children and others geared toward adolescents.”
“We designed the patient spaces integrally with the staff. The rooms were all mocked-up to allow staff to really test out the major repeated spaces. Some of the unique features are the marker board in the exam rooms so that the physicians can explain procedures to the family. We lowered it so that kids can see it better. We also have a bench rather than chairs in the room so that kids can lay on their parents' laps for physical closeness and comfort, as well as providing more room than a group of chairs would. Another positive distraction in these rooms is the repetition of the sea creatures in the floor and on the wall sconces, which were created by an artist.”
“We created a lot of positive distractions throughout the building. We used sea-creature-themed artwork and lighting, most of which was designed by artists, to act as a positive distraction. We even put sea creatures in the floor materials. Within the clinic, we punctuate the ends of all the corridors with a medallion of a sea creature in the floor. This is reinforced by a similar creature in the art on the wall and accented lighting in the ceiling. This aids in wayfinding, as well—you can tell someone to go to the corridor with the turtle in the floor and turn left.
“The building theme spotlights the creatures of nearby Puget Sound. The beauty of it is all of regional artists used are brilliant, and there was a lot of custom photography done specifically for the hospital of creatures from Puget Sound—that's not ‘canned’ art, it's actually from the region taken by a local photographer. (For more on the building's artwork, see the Art Corner on page 48.)”
“We've gotten tremendous feedback from staff and patients. Appointment times have been reduced from three months to three weeks, and their goal is to get that down to just one week. Thanks to the consolidation, physicians see each other more often and can have informal discussions. Patient satisfaction has also gone up, and the ‘frequent flyer’ parents are very pleased. They said, ‘You listened to us. You really listened to us.’” HD