Rethinking the future of medicine
| Project Summary Project Completion Date: June 2008
Owner/Client: University of California, Los Angeles Executive Architect: Perkins+Will (Eric Van Aukee, AIA, LEED AP, Managing Principal; Gabrielle A. Bullock, AIA, NOMA, LEED AP, Principal, Project Manager; Jean Mah, FAIA, FACHA, LEED AP, Planning Principal; William J. Schmalz, AIA, CCCA, CSI, LEED AP, Technical Principal; Mervin Burtnett, AIA, LEED AP, Sr. Project Architect) Design Consultant: I.M. Pei Design Architect: Pei Partnership Architects LLP (Chien Chung Pei, AIA, Partner-in-Charge; Ralph Heisel, AIA, Principal, Lead Designer; Stephen Achilles, AIA, Principal, Project Manager; Michael Zakian, AIA, Construction Coordination; Christine Hardin, CID, LEED AP, Project Interior Designer) Consulting Architect: RBB Architects, Inc. (Art Border, AIA, Principal; Olive Schroder, AIA, Project Manager; Carlos Amato, AIA, Medical Planner) M/E/P Engineering: Arup Structural Engineering: John A. Martin & Associates Civil Engineering: RBA Partners, Inc. Construction Managerment: UCMT Contractors: McCarthy (site prep and demolition); Tutor-Saliba Perini (construction) Photography: © Benny Chan/fotoworks Total building area (sq. ft.): 1,200,000 Total Construction Cost: $600 Million Cost per square foot: $500.00
After the 1994 Northridge earthquake damaged the existing hospital on the UCLA campus, the decision was made to construct a replacement hospital—the Ronald Reagan UCLA Medical Center. Needless to say, this was no small undertaking, especially for a client with a reputation for leading the world in medical science. Conceived by a world-class design team, the 1.2-million-square-foot hospital includes 525 private patient rooms and the largest complex of interventional operating rooms ever built, all in a timeless three-tower design that can withstand an 8.0-magnitude earthquake. HEALTHCARE DESIGN Managing Editor Todd Hutlock discussed the details of the project with Eric Van Aukee, AIA, LEED AP, of executive architect Perkins+Will, and Chien Chung Pei, AIA, of design architect Pei Partnership Architects, LLP.
Assembling the team
Chien Chung Pei, AIA: In 1994, after the Northridge earthquake, UCLA's existing hospital was significantly damaged. The conclusion was that the building could be saved at a great cost, but the changes in medical care had been so dramatic that it would severely compromise their ability to move forward. For the same amount of money, they could build a new hospital if they could find a place to do it.
UCLA was very pleased with our conceptual design and stacking diagram for the building. Then we proceeded with a schematic design process together with Perkins+Will, the executive architect. In this process, a number of design elements were incorporated to refine the concept. We assumed the responsibility of all the public spaces, the exterior, and the site work. In this process, a number of design elements were incorporated to refine the concept.
Eric Van Aukee, AIA, LEED AP: Perkins+Will began our engagement as executive architect in early 1998. I.M. Pei had already been engaged by UCLA as the designer of the project and Pei Partnership Architects as the design architect. Along with being the executive architect, Perkins+Will was responsible for the interior design, medical planning, and coordination of all the systems.
We took it as our charge from UCLA to create a team in West Los Angeles as rapidly as we could. To bring the entire team together, we quickly identified a local firm, RBB Architects, Inc., to be our consulting architect. Our technical and architectural and consulting teams met on a weekly basis as we advanced and made the critical design decisions about structural systems, mechanical systems, civil engineering systems, and the building's skin.
Pei: It actually worked out quite smoothly. Whereas it's true that we divided the project up among the three architects, everybody sat together in all those meetings so it became very collaborative in every stage of the way.
Site and exterior design
Pei: The building sits at the gateway to the entire UCLA campus. Over time, this entrance from the south has become the main entrance to the campus; the way you come into the UCLA campus today is like when you're going to someone's house and everyone comes in through the kitchen instead of coming in through the front door. The old front door is still there but nobody ever uses it, so we created a new gateway to the entire campus, one that provides clarity to the surrounding context.
This is the largest building that has ever been built on any campus in the entire University of California system. The real challenge for us in terms of the design was to fit this enormous building into a very congested campus. Our goal was to design a hospital that would preserve the scale of the campus without appearing overwhelming in size. The massing of the architecture was articulated to respond to the scale of the adjacent buildings. It was a true urban design challenge.
Aukee: The outside of the building is designed in travertine from Tivoli. The design was to create a unifying grid of stone over the entire exterior using roughly 41.5” stone panels. This is done as a rain screen; the building has a fully insulated and weather-tight system behind this stone. The stone is gasketed to a metal frame and that becomes the exterior skin to which the window system connects.
Creating this rain screen and then the secondary “belt and suspenders” design allows for differential movement on the exterior without a loss of performance of the wall. The unitized structural system that has its own structural connections back to the primary structure allows for that differential movement without failure. So in the event of a seismic event, the skin of the building does not fail. The building is designed to withstand an 8.0 magnitude earthquake—the currently defined maximum credible seismic event—and is designed to function under its own power and services for 72 hours.
Pei: I believe that the architecture should tell you where to go and how to get from here to there; you should not have to rely on signs. Not that you shouldn't have signs, but if you rely on signs to get where you need to go, you're already in trouble. I think that we achieved our objectives here and everyone is pleased with the result.
The visitor elevators on every floor open out onto an elevator lobby, one side of which is made entirely of glass. So when you go up in the elevator and the doors open, you know exactly where you are. In the old days, the minute you got onto the elevator, you were in the middle of this maze of corridors. To me, that's the first way visitors start becoming anxious—Where am I? Where do I go? By the time they reach the patient rooms, they're already uneasy and not feeling very well.
Aukee: We worked to create strong views throughout the building to help visitors and staff immediately feel oriented from the inside out. We worked very carefully in planning spaces to give the visitor and the patient an orientation to the outside.
Aukee: A fundamental concept for UCLA was to plan an interventional floor that allows flexibility in how these rooms can be used, in the type of procedures that can be performed in them, and for care. We know the evolution of care—whether it be cardiovascular, neuro, transplant—can all be done in, essentially, the same series of operating rooms. There are three different types of rooms, the idea being that these rooms could be used interchangeably between departments and between disciplines in the hospital and physicians practice.
The interventional floor has a sterile core that serves all of the operating rooms. Imagine a rectangular space in the center with all of the core functions that need to happen on every floor. The public elevators are outside of that rectangle on the east and the west sides. The rectangle has a public corridor that runs around it, but within that central core, there are support functions for each floor; the patient transport and staff elevators are located within that back-of-the-house core. It's the same on every floor of the hospital.
The other important vertical element is the transport elevators. There are dedicated transport elevators that go straight from the roof helipads down to the emergency department. These elevators are oriented so that on the nursing floors, they open out and go directly into ICUs. These trauma elevators are designed so that they are almost procedure rooms in and of themselves. The medical gases, oxygen, vacuum, and other services that you would normally find in an emergency vehicle or and ICU are available in these trauma elevators.
Given the modular design of the building, there is a fundamental concept of ultimate flexibility. The quaternary and tertiary care that can happen in a patient's room is based upon the module of that room. Generally, every room is designed with the same dimensions and the same requirements so that three-sided care can be provided in the standard med/surg room; in the ICUs, the services are provided by a boom which allows four-sided access to the patient. Every patient room allows for this flexibility as the evolution of medical care changes. The module is designed so that these facilities could be converted to a higher level of acuity if and as necessary.
On the whole, the building breaks down in its form to respond to medical functional requirements. The five upper floors are separated into three quarter-round towers that contain the nursing functions. An M-shaped tower contains the ICU functions. Below that, the first three floors form a continuous building base or “podium.” On the first floor are the walk-in and drive-up emergency areas. The imaging department is on the ground floor, as well as the public spaces, the administrative offices of the school of medicine, interventional waiting, and the dining hall.
Public spaces and interiors
Pei: We tried to make the public spaces very generous and airy, and make it not feel like a hospital. We designed exterior public spaces such as plazas and courtyards to encourage interaction. We introduced a great deal of natural light to the interiors to create a welcoming and compassionate environment.
Aukee: In keeping with those original design concepts of light, airy openness, and creating a calming environment for folks, it's a very simple design; clean and quiet.
To reinforce the calming influence, the idea of the orientation to the outside is very important and the selection of materials and articulation of the design is very classical and simple. It's modern but in a classical sense of having the desire to not be trendy but to be timeless.
Again, that module that was the basis of the structural medical planning, the exterior design, is brought through and carried consistently through as an organizing principle in the interiors, so that it brings a consistency into the building and throughout. There's a use of wood and natural materials where they're important to the touch of visitors and the patients.
The use of color is very subdued. The concept of the interior design is an intentionally neutral backdrop for art and for creating a sense of calm and order throughout the building. Each of the nursing towers has a unique color that helps you orient yourself in the building. We also came up with a unique lighting design. Because the nursing towers have a large percentage of their rooms along a curving corridor, we created a custom fixture located at the intersection of the wall and the ceiling with the specific intent of not having the typical 2 × 4 fixture right over the corridor, since they produce a level of brightness very disturbing to patients. The light fixture used instead is off-center, helping to reinforce a calming influence in all the spaces, including public areas.
The Stewart and Lynda Resnick Neuropsychiatric Hospital
Aukee: The psychiatric hospital is located on the fourth floor because sitting directly over the third floor, which is the mechanical interstitial floor in the hospital, allows the requirements for outdoor space to be directly adjacent to the nursing towers. It is important to allow for outdoor spaces for the psychiatric patients.
The Mattel Children's Hospital
Aukee: The Mattel Children's Hospital is on the fifth floor. It has ICUs and specific areas for OB-GYN; labor and delivery suites are also on the fifth floor.
Because the Mattel Children's Hospital attracts children and families from around the globe who need world-class care, the theme is educationally oriented—ideas of understanding the world, understanding the universe, understanding the environment, and seeing where your home is—so there's a lot of imagery for the stimulation of children that is focused on those sorts of things. There's a room, for example, with stars in the ceiling, maps of the world on the walls, an orientation of the building and a compass on the floor.
Immediately as you arrive at the children's hospital entrance, there is the 60-foot-long, 12-foot-high “Welcome Wall,” which is an interactive multimedia design with the intent of immediately recognizing that patients entering are families with children. Patients and visitors who enter there are greeted and then taken up to the fifth floor.
Pei: The Ronald Reagan UCLA Medical Center will offer an efficient, warm, and welcoming environment for patients, visitors, and staff, which is conveyed in every aspect of the design, from the thoughtful application of building materials and the clear disposition of parts, to the meticulous detailing of public spaces and the widespread integration of natural light, landscaping, and outdoor views. The medical center has been designed as an active component of the healing process.
Aukee: This was a design that was developed in concert with an overall master plan that Perkins+Will developed earlier for the UCLA Health Sciences Campus. There will be a future renovation to the existing hospital buildings after the move happens. Along with creating the healing environment and a caring environment for patients and family, this is also a teaching hospital. There were important parts of the medical plan design, interior design, and the architectural design that served those needs. Throughout the interventional floors and nursing floors, there are staff areas. The nursing towers are designed with rounding rooms in which staff who are a part of a regular process of medical education will meet in a nursing tower to discuss the patients and to discuss the care that's being given in that particular part of the hospital. Special care was taken to provide those spaces within each nursing tower, within each nursing suite, within the ICUs.
This priority was an important part of the design process that we went through because in the end, we're teaching the future doctors, nurses, and all affiliated and allied healthcare professionals within this new facility. The design for the new hospital preserves the interactive environment that makes UCLA a pioneer in academic medicine and a world-class facility for patient care. HD
For more information on Ronald Reagan UCLA Medical Center, visit http://www.uclahealth.org/homepage_med.cfm?id=264.