In designing the 359,940-square-foot teaching hospital for La Universidad de Los Andes in Santiago, Chile, the international design team addressed the conventional demands of such a project, its site, and a wider set of cultural issues. This included understanding the client's unique religious and social requirements for hospital care and meeting the challenges of distance, language, and the expectations of a highly motivated client with peer campuses in different countries and continents.

Shepley Bulfinch sought out resources from within its ranks, engaged its network of contacts with knowledge of Chile and Latin America, and developed a relationship with the client and the local architect that was respectful, honest, and valuable.

The La Clinica (CUA) project, scheduled for completion in 2009, is part of a larger plan for the university campus, for which Shepley Bulfinch has prepared a two-phase master plan, including the new library and business school. La Universidad de Los Andes (UA) was founded in 1989 as a corporate work of the apostolate of Opus Dei. This project came to the firm through the Opus Dei, which had been a client in the United States. Shepley Bulfinch was approached by UA because of the firm's reputation for designing libraries.

UA was the first international client for Shepley Bulfinch in decades, so the firm was cautious. The team arranged a meeting in the United States to discuss the institution's vision for the campus, which included a master plan, library and business school, as well as the hospital. A bilingual (Spanish-English) architect at Shepley Bulfinch took the initiative in pursuing the project on behalf of the firm, and reached out through personal contacts in Chile to learn more about UA and the scope of the project.

Project challenges

Some challenges the design team faced on this project were common to many healthcare projects, regardless of international boundaries. In siting La Clinica on the highest developable spot in the Andes foothills overlooking Santiago, for example, UA faced the challenges of locating the hospital on its suburban campus rather than in the city, and of ensuring that the facility was designed to attract patients and physicians from such a distance. It was also essential to design for flexibility and growth as in a core-shell approach: patients arriving at the new hospital had to be presented both with facilities and a façade that were complete, yet flexible in their capacity for both clinical bed expansion to meet projected increased demands over a 15-year period.

Other challenges, including a cultural approach to deal with problems only once they emerged rather than proactively, were addressed through an integrated approach that vested all participants, including the client, the U.S. and Chilean design firms, and multinational engineers in the process from its earliest point.

Collaboration as key to success

The collaborative style of Shepley Bulfinch was essential to the project. Its responsibility was to take the project through the hospital's schematic design phase, at which point the project was to be taken forward by Alemparte y Barreda. The integrated approach that Shepley Bulfinch promoted was essential to establishing credibility and ensuring a good working relationship with the project team, which included a representative of Opus Dei Central, the Hospital Gerente General (COO), UA's project manager and physician project programmer, and American and Chilean architects. This included not only an integrated approach to planning and design, but also to the engineering work that would be required once the project passed from Shepley Bulfinch's hands the local architect. Collectively, the project team developed narratives and design concepts for key project drivers, including code compliance, structure, elevators, mechanicals, and landscape architecture.

Since the project involved two cultures and two languages, it was essential that all parties were clear about any assumptions regarding the project, and that the planning and design process established and applied a mutual and rational basis for decision making. The principles guiding the project's design were discussed, reviewed, and confirmed with the steering committee. The project outcome was a fusion of state-of-the-art U.S. and European healthcare and ambitious Chilean spirit.

Finding a medium for communication

While communication between Santiago and Boston for Shepley Bulfinch's first projects with UA was achieved largely via e-mail, the complex requirements of this hospital project required a more dynamic exchange, achieved through twice-weekly videoconferencing sessions. Although Shepley Bulfinch architects made periodic visits to Chile, the instant communication of videoconferencing, supplemented by the use of e-mail and the exchange of larger documents through the US firm's FTP site, worked smoothly.

Speaking a common hospital design language

To establish agreed-upon benchmarks and to assimilate individual cultural characteristics, the core project team comprising representatives of Shepley Bulfinch, Alemparte y Barreda, and UA toured healthcare facilities in the United States chosen by the architects, and hospitals in Spain and Chile selected by the client. This served to develop a common set of references for all aspects of the design, from conceptual organization of the hospital to detailed layout of clinical spaces. The tour not only familiarized all parties with current trends in global healthcare, but also crystallized the philosophy driving the client's design vision. Further, it established a healthy dialogue that formed the basis for collaboration between architects and client that would carry forward throughout the project.

From the United States, we learned the importance of clarity in the organization of building components and their adjacencies. The experience of daylight in the ICUs at Children's Hospital Boston was recognized as an important design element for Chileans, as was light in examination rooms. It was equally important to learn what the client did not want. While they were impressed with certain aspects of U.S. healthcare technology, the client did not want to emulate a “medical mall” model, preferring an orderly and more formal work and private patient space to the relaxed informal environment of many U.S. hospitals.

In Spain we saw healthcare through the clients' eyes, visiting the Hospital Universitaria de Navarra, a top European hospital also run by the Opus Dei that served as a model institution for the Clinica De Los Andes. Navarra also offered object lessons on the importance of horizontal connections of exam clinics, high-tech diagnostic and treatment core building and patient bed wings, including a focus on patient dignity and privacy. Here the clients demonstrated the importance of the spiritual community through the significance of the chapel and through the concept of work (in kitchen and laundry facilities) as a sacrament. The tour offered valuable understanding of the spirit of an Opus Dei hospital, as demonstrated through staff attitude, patient treatment, and architecture.

Understanding the clients' vision

The clients had a clear vision of the new hospital as a community committed to excellent medical practice, teaching, and building the “Kingdom of God.” This dedication is seen in many ways, such as in the preparation of meals and the laundry's provision of embroidered linen. Understanding the importance of spiritual awareness and commitment to the patient experience in sickness and health, as well as in dying was essential to the architects in creating a design team that embodied that philosophy.

In the design context, this was interpreted as a need to provide:

  • cleanliness, orderliness, and organization, with a degree of formality and reinforcing the presentation of the hospital and staff in serving patients;

  • an emphasis on privacy through the separation of inpatient and clinical entrances, as well as the complete separation of patient, service, and visitor circulation;

  • the careful separation of kitchen and laundry facilities from the hospital's clinical operations;

  • a chapel that was prominent, central, and accessible; and

  • a focus on accommodating the needs of the family in the patient's room, paying particular attention to space, privacy, and the capacity to accommodate a dying patient and his or her family.

Understanding the regulatory environment

Shepley Bulfinch used the AIA Guidelines for Design and Construction of Health Care Facilities and the Joint Commission on Accreditation of Healthcare Organizations standards to inform most aspects of the design of La Clinica. When an exception to our norm for design was requested by UA, we researched the request and the relevant U.S. guidelines and, while meeting the client's expressed wish, ensured that they understood the deviation from standard requirements.

Conclusions

On its anticipated completion in 2009, La Clinica will provide Chileans with medical treatment and facilities forged by international expertise and research and shaped by a cultural and spiritual imperative of respect and care. Less apparent to patients and visitors than the medical staff and the hospital building itself, the collaborative process and integrated team approach will have played a role of equal importance in ensuring the delivery of the highest standards of patient care. HD

Charles H. Osborne, AIA, is a Senior Associate at Shepley Bulfinch and a senior member of the firm's healthcare practice. He specializes in the programming and design of healthcare facilities. Ray K. Warburton, AIA, LEED AP, has worked extensively in higher education and healthcare design and planning for Shepley Bulfinch

For further information, contact Terri Evans at 617.423.1700, e-mail tevans@sbra.com or visit http://www.sbra.com. To comment on this article, visit http://healthcaredesi.wpengine.com.