Shanghai Changzheng Pudong Hospital
Images courtesy of RTKL At the culmination of a recent international design competition, RTKL was awarded the design contract for Shanghai Changzheng Pudong Hospital. It will be the largest hospital ever built in China in one phase, housing more than 2,000 beds and comprising almost 4 million square feet. This massive hospital project was announced less than a year after China released the guidelines of an aggressive healthcare reform plan that, in addition to universal healthcare coverage, aims to provide “safe, effective, convenient, and affordable” healthcare services to all 1.3 billion residents of the country.
Expanding an urban hospital
As the name indicates, Shanghai Changzheng Pudong Hospital will be located in the Shanghai's Pudong District, a modern financial hub of China. The new medical center will provide additional capacity for its parent facility, Shanghai Changzheng Hospital, a major academic medical center in downtown Shanghai affiliated with one of the largest and most prestigious medical schools in China.
While China's healthcare reform plan emphasizes the development of community hospitals and clinics to improve the country's rural health infrastructure, urban hospitals such as Shanghai Changzheng Hospital are also expanding to serve as regional hubs. These comprehensive hospitals will support smaller local hospitals with expertise, personnel, and equipment. Too, improving large regional medical centers is expected to improve healthcare in the outer communities by pushing research, education, training, and advanced diagnostics and treatments to their catchment communities and hospitals.
The new medical center in Pudong will not replace the downtown Shanghai Changzheng Hospital; it simply will add space and capabilities. For example, new research and conferencing facilities and a major diagnostics and trauma program at the Pudong campus will help the downtown hospital strengthen its role as a regional backbone.
The current Shanghai Changzheng Hospital is already enormous by U.S. standards. It has more than 1,700 beds and handles more than a half-million emergency and outpatient visits annually. And yet, the sheer number of people in Shanghai is pushing the limits of even the largest hospitals. Since the 1990 census, the city's population has increased by at least 25%, adding 3.3 million people, and the growth continues. Plus, academic medical centers must grow in order to train additional healthcare professionals needed to achieve China's healthcare reform goals.
The new hospital will include a diagnostics and treatment center, an emergency center, an infectious disease building, and four inpatient towers (figure 1)-one being a VIP tower. Beyond accommodations for full-service tertiary hospital programs, plans also include research (figure 2) and teaching facilities, dormitories for students and staff (figure 3), an administration building (figures 4 and 5), and two hotels that will also serve as conference and reception facilities.
Customizing world-class design
As to the vision for the new hospital's design, the client has asked RTKL to draw upon the firm's worldwide experience and tailor the best ideas in the United States and global healthcare design to fit China's cultural, financial, and regulatory conditions. This directive fits perfectly with RTKL's international design philosophy. Most architects who work globally soon realize that conditions vary greatly from one country to another, and what is considered state-of-the-art hospital design in one location may not be ideal in a different setting.
In addition to customized world-class design, the client envisions that when completed, the hospital will express a sense of permanence in keeping with the institution's 100-year history, and that it will instill a sense of wonder as patients make their healing journey.
Planning the campus
In the United States, we ascribe to Thomas Jefferson the prototypical “campus” concept-a central lawn surrounded by pavilions with an important building at one end. The traditional Chinese campus concept is about procession. The focus is on the experience of a visitor moving through the campus rather than on place-making itself. This aligns well with modern hospital campus designs that strive for efficiency and ease of circulation.
Two main processions are planned through the 50-acre Pudong site (figures 6, 7, and 8). One campus axis is formal and centrally located, beginning and ending with a water feature and passing through the main buildings. It will be enhanced by museum displays, seating areas, and hospitality features. The second axis is a bucolic one that curves among the buildings. It begins in forest, moves along varied hardscape and landscape, and eventually joins the central axis at a dining terrace overlooking a river.
The buildings around the campus axes are organic in form, evoking leaves, water, and flower petals. They form a subtle spiral centered on the large diagnostics and treatment building. The spiral adds dynamism to the geometry and also plays into a yin-yang symbolism that is important to the client.
On such a large campus, clarity of zoning is crucial for visitor wayfinding and for the organization of services and support functions. The site plan makes the functional relationships of the buildings clear via a central core of diagnostic and treatment services accessible from both an outpatient side and an inpatient side. Pediatric patient traffic will be separated immediately and will enter the hospital on the park side in keeping with children's need for a smaller scale, less overwhelming experience. The teaching and research area on the southwest side of the site is designed to support medical education and translational research. Dormitories are provided for both students and staff.
The president of the new hospital believes the campus design evokes the serenity described in a famous Chinese essay about the healing a man experiences while walking through nature-a concept that is in complete accord with the tenets of evidence-based design.
Designing for large patient volumes
One big difference between U.S. and Chinese healthcare-a difference that dramatically affects hospital design-is that primary care and outpatient care in China are provided at hospitals, not in medical office buildings and outpatient clinics. While U.S. patients preselect in-network physicians in anticipation of need, Chinese patients preselect in-network hospitals. They don't necessarily know what specialists they will need in the future, so they strongly prefer large comprehensive hospitals as providers. Furthermore, because there is not an appointment system, most patients arrive at the hospital in the morning; they use a touch screen or a cashier's window to check in; then they wait in the lobby. Ten thousand patients and family members are expected to arrive at the new Pudong hospital each day. It's clear that with such huge numbers of visitors, urban hospitals must be very large and designed to handle vast ambulatory volumes. Exceptionally large public spaces such as lobbies and plazas are necessary. In fact, the ground floor of a Chinese hospital is functionally more akin to an airport than to a U.S. hospital.
That said, the new Pudong facility will not be aesthetically similar to an airport. Instead, like other world-class hospitals, it will resemble a large, upscale hotel. An Asian garden aesthetic will imbue the public spaces with the healing power of nature while indoor and outdoor water features will serve double duty as attractive amenities and as a method to control or mask noise due to the number of people. Also, a history museum focusing on Shanghai Changzheng Hospital's 100-year history wi
ll serve as a positive distraction for patients waiting to see doctors. These educational displays and themed artwork along major corridors will also aid in wayfinding, an important concern for such a large campus.
Incorporating Chinese values
One important Chinese building principle is the primacy of south-facing windows. Just as views are an important influence on window orientation in the United States, solar orientation dictates the placement of openings in China. The patient towers will have single-loaded corridors so that all patient rooms face south for the best light and exposure to the wind. This has been factored into the choice of glazing and shading elements.
Equally important, the strong southern alignment of the campus and lack of tall surrounding buildings make the project ideal for photovoltaic energy generation. That is a significant advantage since sustainable design is a program requirement for the new hospital. Sustainability is seen as a way for the facility to take the lead in promoting community wellness and to serve as a model for eco-friendly hospital design. Among its sustainable features, the hospital will have a number of green roofs, some available for therapy and respite, some providing views of nature. Auxiliary buildings will have operable windows, and the spine of the large diagnostics and treatment building will have a partly retractable roof.
RTKL's design for the new Shanghai Changzheng Pudong Hospital is a response to the client's desire for a world-class hospital to serve a growing urban population. The design incorporates innovative ideas, honors Chinese culture, and draws from the latest advances in healthcare design worldwide.
Brad Barker, AIA, is an executive vice president with RTKL and the managing director of the firm's Health + Science Practice Group. He can be reached at firstname.lastname@example.org. Helen B. Jeffery, AIA, LEED AP, is a principal with RTKL and the firm's healthcare operations leader in Asia. She can be reached at email@example.com. To learn more about RTKL, please visit www.rtkl.com. Healthcare Design 2010 October;10(10):50-57