Queen of the Valley Medical Center (QVMC), the largest healthcare facility in California's famed Napa Valley, is an exemplary synthesis of the most advanced healthcare design initiatives in place today: evidence-based design (EBD), Leadership in Energy and Environmental Design (LEED), Integrated Project Delivery (IPD), and Building Information Modeling (BIM).

The new three-story, 72,370-square-foot expansion to QVMC is under construction, as designed by Los Angeles-based CO Architects. Notably, QVMC-a Center for Health Design Pebble Project-provides comprehensive medical services as part of nonprofit St. Joseph Health System, a ministry of the Sisters of St. Joseph of Orange, California. The new facility's target of LEED Gold certification from the U.S. Green Building Council is reflective of the Sisters of St. Joseph's dedication to holistic stewardship.

Functionally speaking, the $74-million Advanced Surgical and Diagnostic Pavilion adds two 10-bed critical care units to QVMC and houses a relocated surgery department. It also provides space for central sterile processing, a clinical lab, a pathology service, and hospital-wide system upgrades for those services.

Pebble Project goals

The hallmark of a Pebble Project is, of course, EBD and sustainability, as generally outlined in this brief synopsis of working principles, based upon recommendations of The Center for Health Design. On a fundamental level, hospital design should:

  • Target improved patient outcomes safety and well-being;

  • Address high-level priorities, such as infection control and emergency preparedness;

  • Include staff, patients, and families in the design and planning process to improve workflow and patient safety, and to create patient-centered environments;

  • Create flexible buildings to better adapt to continual innovations in medicine and technology; and

  • Incorporate sustainable initiatives.

The Advanced Surgical and Diagnostic Pavilion

In the QVMC Advanced Surgical and Diagnostic Pavilion design process, EBD and sustainability practices were incorporated into the earliest conceptual design discussions. The QVMC leadership was committed to the Pebble Project objective of implementing design principles proven by research to improve patient safety and well being, and the participation in a community of healthcare providers dedicated to the continual improvement of healthcare. This commitment was crucial, as issues of cost and organizational culture were constantly in play. To meet the fundamental goals of the Pebble Project, CO Architects developed the following specific design initiatives that were adopted for QVMC:

All patient rooms private. Private rooms are more expensive to construct, especially in terms of the more robust patient-room infrastructure now considered requisite. But both patients and staff are more comfortable with private rooms, and studies show recovery times are improved.

Family spaces in all private rooms. In addition to being part of the holistic healing process, family members can actually reduce nurse loads by observing patients and providing some assistance, such as helping patients to restrooms.

Ceiling patient lifts in all patient rooms. Such lifts reduce nurse and patient injuries, and allow patients to be moved onto gurneys or turned over more easily by nurses.

Distributed nursing and supply stations. In previous eras, the centralized nurses' station and supply closet were standard, resulting in “back-and-forth” walking by nurses. A new distributed model for nurses and supplies has evolved, but nurses have voiced concerns about reduced interaction with other nurses and staff. At the new Pavilion, we created a “hybrid” model in which nurses are stationed closer to patients, but also have an interdisciplinary workroom in which to interact with other staff members.

Access to nature and sunlight. This is instituted in all patient rooms, and as widely as possible throughout the hospital. Patient rooms have views, some to distant hills and others of the central healing garden. Patients have control over artificial lighting within their rooms.

Respite areas. The healing garden is open to all, including families and visitors, and there are also private “quiet rooms” for the staff.

Sound abatement. In general, sound-absorbing material and finishes were used where possible. In addition, the ubiquitous intercom of the past-“Dr. Jones, please go to surgery”-has been replaced by pagers and intercoms limited to specific zones. There is no general intercom in the new patient wing.

Safety. Floors are designed to be smooth for cleanliness but also resilient, helping to prevent slips and falls and providing comfort for nurses who are always on their feet.

Interior air quality. Enhanced filtration and room air changes are provided for patient safety and comfort.

The green and garden hospital

At CO Architects, the expression “green hospital” often has a double meaning, referring not only to sustainability but also to the concept of a “garden hospital.” Creating naturally lit garden hospitals is a prerequisite to providing superlative care for patients, as well as a positive environment for medical staff. Studies have shown improved patient outcomes in natural settings-shifting the focus of healthcare advancement from pure reliance on medical technology.

There is no doubt that medical outcomes are improved by advancing technology-the good news is that the construction of garden hospitals is achievable in a manner that is consistent with the latest hospital formats. Healing gardens, planted atriums, views to nature, and daylight can readily be planned into new structures with little or no conflict with functional or programmatic needs.

Garden hospitals also are consistent with newer efforts to build “green” hospitals-indeed, some aspects of garden hospitals, such as the abundant use of natural light, resonate with the sustainable movement and the goal of reduced energy consumption. Likewise, rooftop gardens can decrease air-conditioning bills, while most gardens can use or filter rainwater.

Sustainability initiatives

The Advanced Surgical and Diagnostic Pavilion will consume 15% less energy than that required by California's strict Title 24 standards, due to high-efficiency HVAC systems, high-performance lighting, the use of daylighting, and overall building insulation, shading, orientation, and design. Other sustainable initiatives include low-flow water fixtures; recycled, local, or rapidly renewable building materials; mercury-free and low off-gassing materials; and alternate transportation (bicycles, public transport, fuel-efficient vehicles) incentives. These initiatives were woven so successfully into the Pavilion design that LEED-NC Gold certification is expected.

The superior performance of the Pavilion in part reflects close coordination with the mechanical and electrical trade contractors (FW Spencer and Son and Rosendin Electric) and the design engineer, San Diego-based X-nth, Inc., from the earliest design stages. Additionally, we employed a strategy called “enhanced commissioning,” which tasked the team to meet certain green goals in the design and implementation of MEP equipment and systems.

The Queen of the Valley plans to enact a green building education program, in which tenants and visitors are instructed on the proper use and functions of the building.

The team utilized BIM as a tool for all design and construction parties to participate in building the project virtually.

Integrated project delivery and BIM

Implementation of the many initiatives adopted on the new Pavilion required close coordination and communication within the design and build
er teams. The project employed an IPD approach, with a general contractor involved from the schematic design phase and trade contractors entering at the beginning of design development. Whether the trade contractors filled a design-assist (exterior wall systems, elevators, framing) or design-build (MEP, fire protection, pneumatic tube) role, they were instrumental in providing constructability feedback to the design team to bring the project to a refined level of coordination. The team utilized BIM as a tool for all design and construction parties to participate in building the project virtually. BIM is an excellent collaborative design tool, dramatically reducing errors and solving many issues before they reach the field.

The outlook for EBD, sustainability, and healthcare design

The design process for a healthcare building has become much more intense, as new demand and needs of EBD and sustainability are placed alongside usual requisites of function, safety, and cost-effectiveness.

If there is one lesson from the Queen of the Valley Medical Center Advanced Surgical and Diagnostic Pavilion, it is that early coordination and planning among all players-architects, clients, contractors, and others-is necessary for best results. The tool of BIM helps substantially, aiding IPD by facilitating the close coordination of architect with builder and client.

Finally, EBD and sustainable initiatives, embedded early enough into a coordinated design process, do not materially increase the cost of construction. The deployment of new tools and project delivery methods in hospital design and construction help to mitigate the increasing design and planning complexities involved in achieving sustainable, healing, and safe architecture.

Gina Chang, associate, CO Architects, has 10 years of experience in healthcare architecture in California. For more information, visit For more on the Queen of the Valley Medical Center Advanced Surgical and Diagnostic Pavilion, visit

The Pebble Project creates a ripple effect in the healthcare community by providing researched and documented examples of healthcare facilities where design has made a difference in the quality of care and financial performance of the institution. Launched in 2000, the Pebble Project is a joint research effort between The Center for Health Design and selected healthcare providers that has grown from one provider to more than 45. For a complete prospectus and application, contact Mark Goodman at

Healthcare Design 2010 December;10(12):20-24