The new hospital building, the Tower, at Rush University Medical Center may only have opened in January 2012, but its status as a signature building on the Chicago skyline has already been cemented. With the distinctive “butterfly” shape of the patient tower, white-paneled façade, and multiple rooftop gardens, the new Rush is the latest—and largest—piece of a campus transformation that has been in the works for several years.

Home to a new state-of-the-art emergency center, a three-story interventional platform that places surgical, diagnostic, and therapeutic procedures in one location (one of only three in the country to do so), and of course those signature patient care floors, the 14-floor, LEED Gold-certified Tower successfully reinvents the Rush campus for the future of healthcare and beyond. The new building cost $683 million, including capitalized interest and operating costs.

HEALTHCARE DESIGN Senior Editor Todd Hutlock spoke with Rush’s VP of Campus Transformation Mick Zdeblick, as well as Design Principal Ralph Johnson, FAIA, LEED AP, and Senior Project Designer John Moorhead, LEED AP BD+C, of Perkins+Will’s Chicago office about this iconic project.

Mick Zdeblick: In 2004, Rush came up with a 10-year master plan to transform the campus with Tsoi/Kobus & Associates. The plan outlined the overall zones of the campus and how we wanted to use the entire campus to achieve our mission of academics, research, and clinical activity. That quickly turned into a facility transformation plan that originated shortly thereafter, as we established the phasing and the capital strategy around the changes.

We went through a programming activity with Kurt Salmon Associates to help us understand overall what we were trying to build—how many ORs, how many patient rooms, and the like. As we finished the program, we had brought the Perkins+Will team on, around mid-2006. Within a few months, they produced a sizing and massing model that wound up staying fairly true all these years later; the “butterfly” design was certainly in place at that point.

Ralph Johnson, FAIA, LEED AP: This project came to the Perkins+Will office in mid-2006, and I started working on it in January 2007, right up through opening day. The client’s goals were to build a home for 21st-century medicine, provide flexibility to remain on the cutting-edge of technology for the present and for the future, and to be the medical center of choice in the Chicago area; the image of the building needed to fit all of those goals through the quality of the architecture and the environment. There is a very ambitious master plan in place for the Rush campus, as well, including many elements beyond just this building.

Zdeblick: The project has four phases. Phase one was a new Central Energy Plant, parking, a Supply Chain/Loading Dock, and the Orthopedic Ambulatory Building. The Tower is phase two, which just opened to patients in January 2012. Phases three and four are renovations to the Atrium and Kellogg buildings and the demolition of the Super Block, respectively. 

Johnson: One of the challenges we met via the design was to connect the existing campus elements to the new ones, as well as accommodating future buildings. For example, there is an existing parking structure with an existing bridge, so we connected that to the new building as one of the entrances into the fourth floor; there are also ground-level entrances, of course.

There are also connecting bridges to the existing atrium building, including public and staff connections. The reason for the separation between the new building and the old building is because we couldn’t build over a certain portion of the site. It wound up being much more cost effective to separate the two buildings with a gap. That gap separates the existing and the new diagnostic areas of the hospital, so we turned it into a positive by making it into the new lobby and courtyard space.

We even utilized the roof of that space, making it into one of the building’s many rooftop green spaces. The lobby doubles as the new Emergency Preparedness Center for the facility, as it is located right next to the new Emergency Department on the first floor.

There are really two front doors to this new building: one on the fourth floor where the garage connects to the new building and heads into the main reception area, and the ground floor entrance via the new lobby and courtyard space. We also wanted to introduce green space into the building, but the infection control issues with putting live plants in the lobby space ruled that out.

We ended up installing a terrarium piece, which is an open-topped tube that descends into the space from the rooftop, but is sealed inside the building. So the tube contains live plants and exterior air, and introduces green into the lobby visually, but there are no infection control problems to deal with. There are also a number of public and staff roof gardens throughout the new building, allowing this very urban setting to take on some green elements.

We went through a number of alternative designs for the bed tower before we decided on the distinctive butterfly design, from the traditional to the very radical. The client wanted a certain number of beds per floor, each broken down into four communities of beds, as well as decentralized nursing.

The modified X-shape that we came up with allowed those designs to work, as well as providing a large core space in the middle which is essential in a teaching hospital. This core space also accommodates the many different elevator banks and support spaces, including an enclosed work room in the center. 

The beds themselves are arranged in a triangular shape, getting very tight at the four corners of the X, which have either opening lounges or conference spaces. The nurses appreciate the fact that the corridors come together in the middle, leading to reduced walking distances.

John Moorhead, LEED AP BD+C: The arrangement removes the barrier between the nurse and the patients and their family members. Rush felt strongly about eliminating those barriers, both visual and otherwise, that come from a typical 42-inch-high counter coming between caregivers and patients. The decentralized stations also allow the nurses to enter charting information immediately after collecting it, as opposed to having to walk back to a station and potentially being distracted and interrupted many times along the way.

Zdeblick: Rush began this design process by trying to build a very efficient, well-run hospital from the inside, and I think the Perkins+Will team did a great job of listening to us and creating a stunning building from the outside. What drove the butterfly and the podium on the bottom was really the idea of efficiency and how a hospital should work; they were creative and visionary enough to turn it into something that physically worked. But the conversation really began, from the early stages, with the idea of how a patient care unit works the best. 

Moorhead: Before the design was finalized, the construction team painted the triangular shape of the unit on one of the tennis courts so the nurses could walk around in it at full scale. Once they started getting a feel for the space, all talk of squaring off the building was gone. Rush decided that this shape worked, so we went with it.

Rush also committed to building full-scale mock-ups of two types of patient rooms, various surgery suites, LDR—all of these spaces were mocked-up for the nurses and doctors to walk through. For example, there was lots of internal debate over the decision to use carpet in the hallways of the bed floors.< /p>

The idea was to reduce noise and to improve the quality of the work experience for nurses, who have to walk great distances during shifts. The decision was ultimately made concrete through the use of these mock-up spaces. 

Zdeblick: We assembled an internal team of physicians, nurses, operations people, and we collectively titled it the Office of Transformation. This team really saw the project through the entire way, serving as the “owner” all the way through this process.

We really adhered to the idea of standardization to promote efficiency; the idea that everything from supplies to the actual patient will be in the same spot throughout the entire building was key. That leads to the caregivers being able to focus on the patient as opposed to where to find things. We also really changed the care model because of the way the building is laid out and how it flows.

Another key component was the green and sustainable elements of the project, which resulted in the building achieving LEED Gold certification. This was the product of working closely with all of the engineers, as well as the architects, to make the building as efficient as it could be.

Johnson: The relationship between our team and the client was unique in that the client was very involved, probably at the extreme end of the scale. There were many voices in the user group, and with a building of this size, it was much larger than average.

Zdeblick: Today, Rush enjoys a new presence in the Chicago market, with the new Orthopedic Ambulatory Building and now the Tower coming online. We are getting many more patient referrals and excited clinicians as a result. The project really allowed Rush to re-focus on its clinical mission and to bring new technology to equal the great clinical care we have always had at Rush. In fact, the only complaint I’ve heard about the new building is that it is too quiet. HCD 

For further information, visit www.rush.edu.