Every project has its obstacles and challenges. As evident by the examples that follow, creative solutions to problems require strategic planning and testing of many ideas. Judges were impressed by efficient layouts and site plans that accommodate existing structures-whether they be trees or utility runs. They also liked design solutions that not only solve a program need, but also create visual wayfinding.

Obstacles that our judges picked as standouts didn't always surface around design issues either. One design team was engaged to come up with solutions for dealing with the anxiety of the neighbors and the short-sightedness of the city planning commission. These examples are the practical side of the design process, out of which innovation sometimes happens. As one judge noted, “Innovation is evolving. We're seeing new things, but they are not necessarily new ideas.”

Jefferson County Health Center

HGA Architects and Engineers

Photo credit: Steve Henke Studio

Obstacle: Create visibility and a sense of presence with a one-story facility. With the construction of a new highway overpass, there was a concern that drivers would actually be looking down onto the roof of the building.

Solution: A tower element featuring the hospital's logo was incorporated at the building's main entry. The tower rises above the height of the overpass and is especially striking when illuminated at night. The design also features a one and a half-story public concourse running along the south side of the building facing the highway, while a mechanical penthouse contributes additional height and screens unsightly equipment from passers-by.

St. Mary's Hospital

Kahler Slater

Photo credit: Wheelock Photography

Obstacle: Prior to hiring the design firm, the hospital has been denied city approval for expansion due to neighborhood opposition of its plans.

Solution: The design team led a process that collaboratively included all city representatives, neighborhood groups, and the adjacent business district to create a design that satisfied all constituencies. Neighbors were asked what the hospital could do to enhance their neighborhood. Monthly meetings were conducted for 18 months during the design process and neighbors’ suggestions were incorporated into the project solution. At the final city commission meeting, all neighbors were in support and many testified that the new addition was essential to the revitalization and health of their community.

Pediatric ER Suite and Observation Room at Riverview Medical Center

Saphire + Albarran Architecture LLC

Photo credit: Sam Oberter Photography

Obstacle: Create a fully functioning pediatric ER in a small space-1,697 square feet.

Solution: Look for opportunities to reduce the amount of circulation space in favor of gaining more program space. In the schematic phase, many different spatial configurations were developed that met the client's needs and the codes before settling on the final layout. Windows were a driving force, as the desire was to have them strategically occur in patient rooms. The project tested the team's design intelligence and the result was a very efficient and lean plan.

Banner Health, Cardon Children's Medical Center

HDR Architecture

Photo credit: ©2009 Mark Boisclair Photography Inc.

Obstacle: To accommodate the new pediatric hospital, the existing loading dock had to be relocated along a new artery that serves as the major entrance to the site.

Solution: In order to hide the loading dock's unsightly and noisy activities, its functions were turned away from the public roadway and view. This transformed the rear of the building into the “public side” to serve as both a visual introduction to the hospital and as a wayfinding device. Stucco panels match the hospital's indigenous red sandstone exterior and lead the eye to the facility's main front door. Panels are pulled away from the building skin to reduce its box-like appearance. A play area and garden are located at a connecting link between the receiving building and the hospital.

North Carolina Cancer Hospital

ZGF Architects LLP

Photo credit: Chuck Choi

Obstacle: Achieve an effective planning module and grid to organize and stack diverse programming pieces.

Solution: Because one of the primary goals of the new cancer center was to consolidate all oncology programs into one facility to provide a “continuum of care” for patients, the placement and organization of programs significantly impacted the overall building design. The facility's adjacency to the main hospital's emergency department and support spaces; and requirements for the various disciplines and cancer programs resulted in a stacked building with a different function for each floor-unusual for a hospital of this size. To integrate the separate program pieces, the cancer hospital provides efficient links with clear horizontal and vertical circulation pathways. Arrival and drop-off locations offer direct connections throughout the facility and to existing medical facilities.

Stamford Hospital-CyberKnife Addition

WHR Architects

Photo credit: Woodruff/Brown Architectural Photography

Obstacle: The hospital had an existing utility run on the site of the addition that prevented anything from being built on top of it.

Solution: It was determined that a stair-stepping design would accommodate the CyberKnife Suite addition without adding significant extra costs and time that would be associated with moving the utility run. The design progressively moves the spaces up and away from the utility run so that addition was not directly on top of it.

Christus St. Frances Cabrini Hospital-Women & Children's Services and Emergency Department Addition

WHR Architects

Photo credit: Aker/Zvonkovic Photography

Obstacle: Century-old oak trees-a significant characteristic of the site-were located in proximity to the expansion, construction of which threatened their existence.

Solution: A concerted effort was put in place to save the trees during the construction. This included a thorough assessment and protection plan that was executed by an arborist. The tree canopy line was cordoned off throughout the construction phase and was treated as sacred land. As a result, trees onsite are preserved, providing shaded havens.

Veterans Affairs Medical Center Orlando

RLF and Ellerbe Becket

Photo/Rendering credit: Gottfried Schmidtke

Obstacle: This program required a first phase construction of 1.16 million gross square feet (gsf) distributed among five buildings with future expansion capability of 50% and another half million gsf of research space. The 65-acre site has a 100-foot height restriction due to its proximity to the local airport and a 12-acre storm water detention area.

Solution: The solution was to provide 85% structured parking and to contain the storm water offsite within surrounding manmade lakes. The interstitial floor height allowed only four occupied levels with a mechanical floor on the fifth level, providing more natural daylight to both patients and staff. A 40-foot variance was allowed for the curved super roof on both sides that serves as a collector of rainwater, absorption of solar energy through photovoltaic panels, and a visual wayfinding feature for patients and visitors.

Regions Hospital Expansion 2009

Ellerbe Becket, Inc., an AECOM Company

Photo credit: ©2009 Don F. Wong

Obstacle: The expansion project nestles next to the hospital's existing radial nursing units, and to extend the facility's flexibility the design team needed to incorporate the units in some way to find a solution. A move to all private patient rooms made the radials difficult to staff economically for a typical medical/surgical unit because of the low bed per radial ratio, but their layout works for specialty support units for the new tower.

Solution: To use the radials in this capacity, a connecting link from the tower to the south radial was developed. The radials can house support spaces such as dialysis, rehab, hospitalists’ offices, etc. Through this connection, the new elevator core serves all floors of the existing building, as well as the expansion.

Lakeside Medical Center

Gresham, Smith and Partners

Photo credit: John Rickson Photography

Obstacle: Design a hospital to withstand hurricanes and flooding.

Solution: The new hospital site-a former sugar cane field-was reworked to allow the building's first floor to sit well above flood levels, which is more than three feet above the 100-year flood elevation. Its helipad was also built above flood levels to enable the hospital to transport patients in times of disaster. The hospital is constructed out of 50-foot high sitecast solid concrete panels. These solid panels provide bunker-like strength in hurricane situations. To ensure that there are no weak points in the structure, windows and doors that are rated for hurricane-level impact resistance were also utilized. HD

Healthcare Design 2010 September;10(9):70-73