Encouraging a strong leadership role for senior executive groups is a critical component to forming a successful project team. Healthcare projects are complex and require a diverse array of professionals to come together in the quest to create the most successful project possible. Leadership that can inspire consensus and focus the team on the overall project goals will provide the foundation for achieving the best possible results.

All architects strive to balance the desires of hospitals and their healthcare systems in design decision making, but it presents a unique challenge to respond to the needs of the traditional players while integrating the desires of an individual stakeholder who can unilaterally shift the entire project. As healthcare architects, we often face client relationships that are “two-headed”—one being the hospital itself with administration, nurses, and physicians all championing their interests, and the other being the healthcare system or governing board who must balance the requests of your project with the other investments being proposed within their system. Not so often are we faced with a “third head.”

A proposed cardiac center in a Middle Eastern country, currently being developed by Ellerbe Becket's offices in San Francisco and Dubai, has such a client triad. The project has strong leadership at the hospital level, with a senior executive group representing staff physicians, nursing staff, and administration. The government agency responsible for the construction has enthusiastically supported the project throughout the initial stages of design. In addition to these traditional players, a senior government official is sponsoring the project. The sponsor is in a position of power that allows him a level of individual control that we rarely see in domestic projects in the United States, where consideration by committee and decision by consensus tend to be the norm.

The project sponsor has a strong personal interest in cardiac care. He has had personal and family experience with cardiac hospitals, and brings a strong set of ideas and a passionate interest in the success of the project.

The proposed cardiac center will consolidate services currently distributed across an existing hospital. The new building will be sited within a harsh, interior desert landscape. During the initial concept design phase, we worked hard to take a strong initial scheme to our opening meetings, taking all this into account. We developed a conceptual site and building master plan that responded to all environmental, site, functional, and programmatic considerations that we could identify.

The harsh desert environment, for example, presented challenges of extreme heat and a regular pattern of winds that often carries with it the fine sand that surrounds the area. The site also had a limited number of access points and no significant topography. Local architectural context was limited to nothing over two stories in height. As a result, we developed a variety of schemes that focused on a two- or three-story building and sited it to maintain options for future growth.

The low building would create courtyards with controlled areas of landscaping and protection from the weather. Proposed gardens would provide exterior spaces that could be accessible visually or physically from patient rooms and public spaces. The landscaping plan would buffer the cardiac center from the harsh desert of the surrounding site and the intense heat and sandy winds—so we thought.

The initial design was well received by the hospital and government agency—but our presentation to the sponsor stopped almost immediately when we were asked to clarify how tall the building would be. It became clear that the sponsor wanted a taller building, and he directed us to make the building a bed tower with a diagnostic and treatment base. To reinforce his idea, he drew a “napkin sketch” showing a rudimentary elevation—rudimentary but clear enough. This building was going to be made as high as we could.

With the new design direction set, we have focused on a scheme that reflects the sponsor's vision of a patient bed tower. With a limited program and a desire to create 30-bed patient floors, the building is being planned at approximately 130 feet tall (about 40 meters). This includes an interstitial mechanical floor, a shelled bed floor, and a mechanical penthouse.

The hospital is now being planned to focus around a larger lush courtyard. A drop-off drive will extend into the space and further animate the heart of the hospital. Plantings and water features will create a garden landscape that will provide views and spaces for healing and relaxation from many areas of the building. The lobby concourse will offer views through the screened wall (called a mushrabia) and engage the outdoor space with the public prayer rooms.

The hospital will offer a total of 60 single occupancy patient rooms, 20 critical care beds, 10 pediatric beds, and 22 patient spaces for perioperative functions. Each patient floor will include two private rooms with a small private lounge space. Two-bed suites will be included on the upper floor with private nursing space and support amenities. Each room will include a larger lounge space for family and guests. Access to this floor will be through a dedicated entry and elevator. The entry pavilion will include traditional majlis space (meeting space) for guest reception and visiting.

Two cardiac operating rooms and four cardiac catheterization laboratories will form the basis of the interventional unit. MRI, CT, nuclear imaging, and a variety of diagnostic testing modalities will provide the core of the diagnostic and treatment services. The hospital will also run a dedicated cardiac emergency department and chest pain clinic. The building is currently programmed to be approximately 280,000 square feet (about 27,000 square meters).

The lessons we've drawn or seen reinforced by this: Engaged, passionate, and forward-thinking clients are the key to a great project. Whether a committee or a single person makes the decisions, great outcomes can evolve. Our sponsor in this project has a clear personal image of the building he would like to see, and he is in the fortunate position of being able to ask for it. It is our challenge to interpret his direction in a building that expresses the collective aspirations of the entire design team. HD

Simon Thomas is Director of Medical Planning at Ellerbe Becket, based in San Francisco

For further information, phone 415.908.6150, e-mail simon_thomas@ellerbebecket.com, or visit http://www.ellerbebecket.com. To comment on this article, please visit http://www.healthcaredesignmagazine.com.