In 1972, the U.S. Department of Veterans Affairs (VA) published its Hospital Building System Research Study Report, better known industry-wide as the Red Book.
“Faced with rising costs, lengthy periods between programming and occupancy, accelerating obsolescence, and inadequate building performance, VA decided to study the application of systems integration to a prototype design for new hospitals,” states a description of the report’s history from the 2006 Supplement to VA Hospital Building System Research Study Report.
More than 30 years later, the building team behind the new VA Las Vegas Medical Center was challenged with incorporating modern design, engineering, and construction principles into the project while maintaining VA standards.
Using a building breakdown similar to those of the past, the team added in state-of-the-art technology to implement its plan and brought concepts of 1972 into 2012.
“It’s a model of the throwback, but updated for the 21st century,” says Scott Rawlings, vice president, healthcare practice, RTKL, which served as architect on the project in a joint venture with Las Vegas-based JMA Architecture Studios.
Setting the goal
Beginning in the early 2000s, the VA set out on an initiative to build mega-hospitals around the country. “It actually hadn’t built large freestanding medical campuses in more than 20 years, and the first one that came out as an offering was the VA Las Vegas,” Rawlings says.
After winning the project in 2005, the design team began creating a facility that would best meet the needs of the Las Vegas veterans community, which at the time didn’t have an existing VA hospital.
However, the VA didn’t come to the table with specific design goals in mind. “They really sat down with us and asked us, ‘Where do we need to be?’” Rawlings says.
But before digging into what a modern healthcare facility might look like, Rawlings says the team had some of its own listening to do.
“They came in with a lot of data and advice for us on what the veterans needed, where they were getting their care, what types of care they were getting, and they filled in the map for us. Then we turned around and started talking about what we were seeing internationally and nationally on how you take care of those types of patients,” Rawlings says.
The resulting plan was three-fold, with the first goal being expandability. The Las Vegas site covers about 150 acres where the VA intends to grow its service line over the next 50 to 100 years. But in the interim, the VA also requested that all medical services that had been provided in and around the Las Vegas area instead be housed in one location.
“We sat down and really defined what the veterans needed—what do they run off to? We found they go to four or five different places in Las Vegas, and some of them have to travel as far as San Diego for certain treatments,” Rawlings says.
And to create its vision for the future of VA care, the third project goal was to incorporate the past. “So we reached all the way back to the ’70s and started looking at the basic VA hospitals, how they were set up and why, and then really used this as an opportunity to work with them and update that model,” Rawlings says.
To start, the design team relied upon a master plan it created for the VA Las Vegas, focusing on the need for flexibility and future expansion. The result was a dual-axis approach to the design that created a pedestrian mall for the public and patients along one side and a parallel path for materials and staff.
“If you run them edge to edge, those form your track,” Rawlings says. “Then all of your component buildings simply fit within the two tracks. It’s a very simple way to put a building together—it says every time you drop a function in, you’ve got a front side and a back side.”