Preserving Tradition, Ensuring the Future
Educational buildings, civic buildings, and healthcare buildings all have roles to play in supporting their culture. Around the world, people share many of the same daily needs, which will eventually lead them to one of these institutions. The architect Louis Kahn once described the ideas that reside within these buildings as “institutions of mankind.” These ideas-learning, thinking, and healing-form the foundations of society. Architects who are concerned with making these institutions should not follow a prescriptive design process.
In the case of a healthcare facility, design should not begin with medical planning alone, but also include an understanding of place and cultural events, and how these events are experienced in the landscape. This cultural landscape is formed, in both urban and rural environments, from the perspectives of both history and current conditions.
Yonsei University Medical Center (YUMC), Korea's first-ever Western medical center was established 121 years ago, and it has been the largest and most influential institution of its kind. Facing southwest toward the Han River, the campus gently rises up the side of Moo-Ahk Mountain. Although the campus had served YUMC well, by the mid-1990s, changes in healthcare delivery and technology and an increased population had caused the campus to become physically constricted, less flexible, and inwardly focused. The buildings did not afford views to the mountain and the city beyond, nor did they create a comforting and inviting image of the future of healthcare delivery.
YUMC's Severance Hospital, completed in May 2005, is a world-class facility with an atmosphere that resembles a hotel more than a traditional hospital. The 1,600,000-square-foot, 1,000-bed project was designed to serve the dynamic conditions of a healthcare facility in the 21st century. When Ellerbe Becket began designing this project, the client asked that the new Severance Hospital reflect an environment of well-being, incorporate cutting-edge technology, and be worthy of drawing visitors from all over the world. The client hoped that when people visited, they would be moved to tell others.
Because of the importance of these project goals, the scale of the building, and its program, the site and campus planning adjacencies were complicated and the historic and cultural organization of the campus and landscape was in danger of being lost. It was important that we continuously evaluate the project through constant communication with the client to articulate the design direction for the new hospital. We immersed ourselves in the Korean culture and learned how medicine is practiced there. The time our design team spent in Korea in various stages of site planning, medical planning, and architectural and interior design was crucial to the building's success.
Bringing Culture and Tradition to Design
Several important aspects of Korean culture were instructive in helping the design team incorporate traditions into the project. These included the organization of architectural elements on the landscape, the procession through those elements, the geometric relationship between architectural elements, and the order of construction relative to materials and systems.
Examples of traditional architectural elements were found in city gates, temple and palace grounds, and monuments and temples in the countryside. At YUMC, the way the gate frames the view inside, the steps up to the gate, the step down to the courtyard, and the orientation of the principal monument and the mountain beyond were influenced by nature and Korean history. The way natural light, wind, and water effects the use of space is highly respected and important in traditional Korean culture. These elements were used to analyze the existing campus site and measure the changes required to accommodate the new project.
The building is organized into five primary components that house the main operational elements of the program and the major circulation elements through which they connect. Each element relates in a particular way to the immediate environment and local culture and traditions through the use of scale and materials:
The Bed Tower's primary role is to project the image of YUMC as a state-of-the-art medical facility for the next century within the larger context of the city of Seoul. The shape of the Bed Tower (which bridges over the Grand Stair) was developed to provide a functional and efficient inpatient-unit floor plan.
The Diagnostic and Treatment Base is the largest horizontal component of the hospital. It provides the image at the south gate, the inpatient front door, and the south wall of the Atrium.
The outpatient building is a linear element, with one long wall facing the Atrium on the south and the other long wall facing the existing Bed Tower and Rehab Center to the north. The west end of the building has a stone veneer panel treatment similar to the Diagnostic and Treatment Base, also relating to the scale of neighboring buildings.
The Atrium is a volume of space defined by the outpatient building, the Diagnostic and Treatment Base, and the Bed Tower components. The use of glass on the east and west walls and the roof allows light into this important public space while revealing the relationship between the main hospital components to provide orientation for patients and visitors. The Grand Stair is the formal connection between the upper and west sides of the campus. The slope, height, and stone construction of the stair give the new hospital a sense of timelessness by integrating the building into the larger campus context. At level four, the stair provides access to a Roof Garden, completing the connection of the east and west campuses, and providing a formal outdoor prefunction space for the Auditorium.
In Korean culture, it's important not to block views and connections; we needed to respect that in the design. By preserving the connection to upper campus via the grand stair, a journey was created from the campus through the hospital to the mountain
The design team was directed to holistically address the senses of all who experienced the hospital. It was critical that wayfinding be innate to the architecture, not dependent on signage. Within the building, local materials such as Korean granite were used as much as possible to reinforce cultural traditions and address sustainability and maintainability. A variety of stone walls are found all over Korea. They hold back earth and define inside and outside space. We used a stone wall as primary exterior and interior organizing features. Made out of red stone, like the earth, the wall runs the entire length of the atrium both inside and outside, linking outpatient and inpatient waiting and reception areas.
The important elements of the mountain, natural light, water, and wind create softness in the design of interior spaces. Elevators in the atrium are translucent and ephemeral, like the screens used to divide rooms and soften lantern light. A bamboo garden and large-scale public art in the atrium supports the healing environment. Clinical waiting areas are framed by windows at one end and the atrium at the other, allowing patient and family waiting areas and nurses’ stations to receive daylight, as well. Because of the abundant natural light within the hospital and clinic, there is a sense of calm that extends throughout the healing environment.
Incorporating Local Technology
While maintaining traditions and ties to local culture, the project also supports leading-edge healthcare delivery, including technology that allows an entirely wireless patient experience guided by a single electronic card. This Smart Card technology allows patients to access details of appointments, pay bills, track prescriptions, or find out where in the 1,000-space garage their car is parked. The technology also provides physicians access to electronic medical records.
Ellerbe Becket was engaged to introduce advanced medical facility design to Korea. The dilemma was that we also had to take into consideration the reality of Korean medical services. For example, people are given preference by caste in Korean society. A patient's clinical appointment may specify “morning” or “afternoon,” but even then, patients can't be sure exactly when they'll be seen. This affects tremendously how the clinic functions, as well as its size and scale. More family members accompany the patient during a visit than in Western hospitals, frequently filling bench seating in the corridors outside of exam and procedure rooms and compromising access and patient privacy.
Inpatient areas were designed to accommodate both patients and caretakers-a concept that is inherent in the Korean culture, but only recently readopted in Western healthcare. Each room provides sleeping space for the caretaker, who stays with the patient and delivers basic care to free up the nursing staff for more critical functions. Dayrooms infused with sunlight are located at the end of each patient wing for enjoyment by visitors and patients alike. VIP rooms feature hotel-like amenities, such as a living room, an extra bed for a family member, and a whirlpool bath.
The integration of daily life activities into the hospital and clinic areas was an important cultural imperative for patients, visitors, and staff. For YUMC, giving back to those in need and to the larger community defined the organization's mission, stimulating both wellness and a sense of community within its specific cultural framework. For instance, large public gathering spaces were planned internally and externally to engage and delight the patients, visitors, and staff in traditional Korean art and music programs. Built-in seating alcoves surrounded by plants and gently cascading waterfalls were strategically located adjacent to those areas to allow comfortable viewing. Several dining venues are located adjacent to retail shops to further enhance the experience and provide distraction and nourishment. In addition, a 487-seat Auditorium on the fourth floor garden level accommodates medical education, as well as spoken and musical performances.
Throughout the design process, especially when working in a place with a cultural history different from our own, the spaces that serve the healthcare operations should be constantly measured against both present and historical cultural conditions. Whether inside or outside, campus or urban, if the resulting building is going to fit into a particular place, it must touch all aspects of the soul of the culture.
Design firms in the same city often have different cultures. It is the same for design firms in different countries. For a U.S. design team looking for the right local partner, it is important that the firm's values of client service and design quality are in alignment with the associate's. As a team, the firm must also be willing to absorb each other's culture. Ellerbe Becket and our local partner, Junglim Architects, had achieved success independently through efforts to understand and satisfy clients’ requirements and needs, and by producing excellent design. We further supplemented our team with Korean firm Kesson International, who helped with cultural issues and translation, as well as local building methods and materials for the interiors portion of the project. The mutual understanding and sensible consideration of each team member made it possible for this multicultural team to carry out the project so successfully and support the rebirth of Yonsei University Medical Center, Korea's oldest hospital, as one of the country's best.