By Kings County Hospital Center, Brooklyn, New York
Client: the Dormitory Authority of the State of New York (on behalf of New York City Health and Hospitals Corporation, Kings County Hospital Center)
Architecture: Skidmore, Owings & Merrill (SOM), LLP (Phases I, II, III); RBSD Architects/Lomonaco & Pitts Architects, PC (Phase IV)
Photography: Eduard Hueber/Architectural Photography
Total Project Area/Cost: Phase I (new Bed Tower) 250,000 GSF/$90 million; Phase II (Emergency, Diagnostic and Treatment Pavilion) 265,000 GSF/$150 million; Phase III (Ambulatory Care Center) 125,000 GSF/$50 million; Phase IV (Behavioral Health Center, not shown) 300,000 GSF. To be completed December 2008; projected cost, $140 million; Phase V (Renovations, Demolitions, Landscaping) 90,000 GSF. In planning, to be completed December 2010; projected cost, $60 million
Take a massive urban hospital campus for which most of the buildings were designed in the early 20th century and transform it to the 21st century in appearance and function. Construct or renovate about one million square feet and spend a half-billion dollars over some 12 years. That, in a nutshell, is the story of the Kings County Hospital Center Major Redevelopment Project, just completing its third of five phases this past August. The story is a long-running one of plans and false starts spanning nearly 40 years, culminating in a mega-collaboration of the New York City Health and Hospitals Corporation (HHC)—the largest municipal healthcare system in the United States—and New York State's oddly named, big-project–oriented Dormitory Authority of the State of New York (DASNY). Recently, Mustafa Abadan, partner-in-charge for Skidmore Owings & Merrill (SOM), the architects for the first three phases of the project, and Warren Hansen, deputy executive director, facilities development at Kings County Hospital Center and the HHC project executive for the project, laid out the story for HEALTHCARE DESIGN Editor-in-Chief Richard L. Peck.
Hansen: We started the project in 1998 with a campus of 25 buildings on 44 acres, encompassing about 2.5 million square feet. The average building age was about 70 years, with some buildings dating back to 1912. No new patient care buildings had been built since the 1940s. We had buildings with limited vertical access, no central air-conditioning, deteriorated utilities, 20-bed open wards, and 40 inpatients sharing one bathroom
Abadan: It truly looked like buildings from a bygone age. When I first saw them, it was obvious that they were very obsolete and that replacement and major renovations were essential.
Hansen: Campus rebuilding efforts started in the mid-1960s but failed for a variety of reasons, principally the sheer magnitude involved. Plans were made in the mid-1980s for a 1,200-bed hospital, with a total project cost of $920 million. A total of $150 million was spent on clearing a 2.5-acre site, building a new 304-bed nursing facility, constructing new office and support facilities, making extensive renovations, and rerouting utilities. However, just before the start of excavation for the new hospital in early 1994, the New York City administration suspended the project for further study. After 3 years of study, a smaller project was recommended of some 650 beds, reflecting current trends in outpatient care, ambulatory surgery, increased competition, and managed care.
In 1997, HHC agreed to proceed with a downscaled, multiphase, multiyear project in a partnership with DASNY as project manager. DASNY selected SOM for the design of Phases I, II, and III. Phase I was a new Inpatient Bed Tower of 340 beds, with all private and semiprivate rooms, central air-conditioning, private bathrooms, and various intensive care suites. The building was completed and opened to patients in December 2001. Phase II, completed and opened in May 2006, was a second new building, the Emergency, Diagnostic and Treatment Pavilion, which provided new facilities for all the diagnostic and treatment services previously scattered among five different buildings, including a 40,000-square-foot Emergency Center, an Operating Suite, Labor and Delivery, and extensive Diagnostic Suites. Phase III, completed and opened in August 2006, renovated a 1948 building to accommodate all outpatient services, with private examination rooms, procedure rooms, counseling rooms, and support services for an annual volume of 400,000 patient visits.
Abadan: It was important to have the new buildings fit in with the old, especially with the 1931 ABC Building that the American Institute of Architects had cited as one of the most architecturally distinguished hospital buildings in New York City. Although the old buildings are brick masonry, we found that precast concrete not only was less expensive, but also had several other advantages. It provided an enormous amount of flexibility in terms of texture, detail, precision and color—all of which were important in working with these architecturally and historically significant buildings. With an abundant use of glass in opening up the southern exposures of the buildings to natural light, the new renovated buildings glow at night and tie together the adjacent buildings, linked by pedestrian bridges
Hansen: The 1931 ABC Building is architecturally flamboyant, with what I can only describe as Spanish Gothic style—massive, slab-sided, red brick towers with ornate lead panels, ornamental Spanish-tile roofs, loggias, ornate crowns, and weathervanes. The tower on the central B Building is a Brooklyn landmark, an icon representing 175 years of healthcare services to the Central Brooklyn community, and we didn't want to compete on the skyline with that icon. We also wanted to make sure the new buildings looked as though they belonged on the campus. With the use of precast concrete, which was the most affordable material at the time, we were able to accomplish harmony in terms of color, styling, and window treatments.
Hansen: Another important design criterion was to take advantage of the open southern exposure of the hospital's principal buildings. In the renovated Ambulatory Care Building, we shifted the east-west corridor to the southern perimeter of the building. That really revolutionized the design of this building, opening it up to the outside world. We even have windows in the examination rooms, a novelty in this area. About the only complaint I get these days is that there's “too much sun”—this from staff who worked for years in spaces with no windows at all. We believe that promoting the use of natural light in a facility helps with its healing mission.
Abadan: One of the principal concepts here was that daylighting can be an incredible orientation device. With gallerias facing south, we could turn the hospital “inside out” with a design welcoming natural light, controlling it with solar shading, setbacks, and so forth. The view to the outdoors greatly helps people to orient themselves as to where they are in the facility. This was not done throughout, by the way. The north, west, and east sides of the new Emergency, Diagnostic and Treatment Pavilion use far less glass than the south side, and that helps from the standpoint of budget and temperature control. But the opening up of the south really turned inward-looking buildings outward and gave them a bright, sunny interior they'd never had before.
Abadan: In the old building, there were limitations in the size of the LDR rooms, and the Labor and Delivery Suite needed upgrading. Designing the new LDR rooms was a bit of a budgetary struggle, given that this is a public hospital but I think we achieved the goal of giving women a more modern and hospitable environment for birthing, with plenty of room for family participation.
Hansen: This was one of many examples where value engineering really did contribute value. We had originally designed the LDR rooms to be about 350 square feet, but value engineering by city-retained consultants determined it would be less costly to provide 500-square-foot rooms and avoid the complex roof details needed to accommodate the smaller rooms, since these rooms are located on the top floor. The LDR rooms have proven to be exceedingly popular, with continuing high demand. Also, the Birthing Center contains cesarean section rooms, triage rooms, and antepartum ultrasound. This comprehensive program makes for much-improved staff efficiency and patient satisfaction.
Abadan: The new Radiology Suite features all the latest in technology. The challenge here was to organize patient traffic from both the inpatient and outpatient sides, with outpatient waiting and recovery areas oriented by daylighting, the New Bed Tower on one side, the Ambulatory Care Center on the other side and the Emergency, Diagnostic and Treatment Pavilion in between.
Hansen: Phase II was quite a complicated project, especially since we changed radiology equipment vendors during construction. As with any healthcare project, you know that technology is going to change during construction; fortunately, the design was flexible enough to accommodate the necessary changes in electrical supply, lead shielding, and weight bearing without a major redesign. The Diagnostic Suites bring together services that had been located in five different buildings, and this consolidation makes a tremendous difference in staffing efficiency, overhead, and patient access. Also interesting is the fact that we have interventional radiology on the surgical floor, actually incorporating radiology into the Surgical Suite. This was done at the urging of both radiology and surgery on grounds that this was the future of interventional care, and it's worked out well.
Hansen: HHC is the largest municipal healthcare system in the U.S., and the state Dormitory Authority is highly experienced in managing public projects of great size. Many of HHC's hospitals have been modernized and updated during the past 10 years, with the Kings County project the largest project yet. My job—under the leadership and direction of Hospital Executive Director and Network Senior Vice-President Jean Leon, and in collaboration with the HHC Office of Facilities Development under the direction of Senior Vice-President Phillip Robinson—is to serve as the HHC Project Executive. This ensures that the project meets the needs of the community and the hospital in terms of function and programs, that all work is performed to HHC standards within the approved budget and schedule, and that the new and renovated buildings are both coherent and functional within the context of the 44-acre campus.
Abadan: Working with the HHC and the Dormitory Authority was very helpful in facilitating the process for us, and I think the hospital found this was helpful, too. Obviously there can be conflict between the budgeting agency and the service agency, and this has to be worked out, but there was good budget and management control throughout all components of this complex project.
Abadan: We think this project has to date been a huge success in positively affecting patient care with increased capabilities, a beautiful and modern environment, and more efficient access, and that staff have gained incredible efficiency with well-planned and consolidated spaces. The community really is being provided with a 21st-century hospital.
Hansen: Every floor of each building was designed from the ground up, with full staff participation—more than 400 staff over the course of this project. There were a lot of meetings, a lot of negotiations, and lots of trade-offs involving every department in the hospital. The original architectural concept often was changed in light of current practices, better staff efficiency, or improved ergonomics. All in all, Kings County is going from the 1940s to the 21st century in one leap.
Phase IV, a new 230-bed Behavioral Health Center to consolidate Psychiatric and Addictive Disease inpatient, outpatient, and day treatment services—now located in six obsolete buildings—into a new state-of-the-art facility, broke ground in June 2005 and is now 40% complete. Phase V, now in initial planning, will entail the remaining renovations, demolitions of vacated buildings, and campus improvements.
Our ultimate goal is to organize the campus so that patients can easily access all services in five buildings. At the conclusion of the Project in 2010, all patient services will be in new or renovated structures. We will eventually provide 650 inpatient beds and accomodate 700,000 outpatient visits and 150,000 emergency visits annually. This tremendous effort will support the organization and meet the needs of the Central Brooklyn community for many years into the future. HD