One firm at the forefront of healthcare's brave new world of design is HMC Architects of Ontario, CA. Its staff saw the face of the future at a new diagnostic and treatment pavilion they completed over a year ago in Reno, NV: the Washoe Medical Center South Meadows. There are no X-rays on file at Washoe—all radio graphic equipment is digital. High speed fiber optics connect the center to a main location in Reno so that everything— from patient insurance records to X-rays, test results, building and security systems—is accessible instantly from either location.
When a patient of this center is traveling anywhere in the world and the need arises, his computerized records can instantaneously be made available to local physicians—an unprecedented boon to diagnosis and treatment. What's more, data ports are located in every patient room at Washoe: doctors and nurses use laptops to access patient data (tests, allergies, you name it) on the spot.
But perhaps even more exciting to HMC Architects is the new ground they'll be breaking (both literally and figuratively) at the La Maestra Community Health Center in San Diego, CA. Although the firm has embraced green design and applied its principles to a host of education and corporate projects, this is the first time they are seeking LEED Silver certification in healthcare.
"The process is so new in the [health] field that the Green Building Council is just working on its Green Guide for Healthcare, a set of sustainable design application guidelines that will ramp up efforts for LEED certification in public, private and not-for-profit healthcare sectors," says Eric Shamp, HMC Architects' sustainable design coordinator.
A LEED-certified AIA architect, Shamp says until the past year, any sustainable design for the firm's healthcare clients was based on what could be done within the owner's requirements. And as with any firm championing green design in various market sectors, application of sustainability principles is recommended on an opportunistic basis— and with cost limitations in mind.
This was not the case with La Maestra, however. Before they even began interviewing architectural firms, leaders at the Community Health Center were aware of LEED and wanted to go for it. In fact, their goal led them to HMC architects, which happened to have both a corporate sustainability guru (Shamp) and a San Diego branch office, complete with resident healthcare studio leader Michael Rousch.
Fast-forward past the screening, bidding and presentation stages, and project architect Roush is now commandeering the design of the threestory 32,000 square foot mixed-use facility, while Shamp sorts through myriad sustainability-centric functions like grant rebate and incentive research, building and lifecycle cost analysis, and energy modeling. Indeed, the process can be exhausting: in addition to following (anticipating may be the operative word) LEED criteria, the HMC team had the city of San Diego to contend with. "The process of getting city approvals took almost a year," Shamp explains. He says that process was critical, however, because La Maestra—located in the heart of the City Heights district of San Diego—was the first project to hit the drawing boards in the community, which the city has targeted in its entirety for redevelopment.
"This is an underprivileged, extremely mixed population," he says about La Maestra, a Public Housing Primary Care Provider to 48,000 low-income patients. "From the beginning La Maestra recognized that green design was not just an opportunity to create a more patientfriendly clinic or a healthier place to work," Roush adds. "They saw it as educational tool—a way to set an example and encourage more green design throughout the neighborhoods in City Heights as the redevelopment program rolls out."
The La Maestra Center proposed by HMC will encompass an open structure circular design allowing room for future expansion. Some of the ground floor will initially be leased to partner tenants to provide rental income until La Maestra grows into the space. Functional units will be re-engineered within the new facility to improve patient flow. And the design intentionally reinforces the center's Circle of Care mission (it houses a full range of community and health services, educational programs as well as housing assistance and on-site job training and referral services).
Designed around a covered interior atrium space, the circular floor plan allows easy physical and visual access to each of these programs and services. Windows around the building perimeter will allow natural light to filter through to interior spaces. "The lower level of this atrium space accommodates play and waiting areas," Roush explains. "A centralized check-in and greeting function provides immediate assistance and orientation for patients, first time visitors and extended families. And the second and third floors each house primary healthcare clinics, with their own distinct waiting and sub-waiting areas to segregate well and sick children."
The architects say the green initiative at La Maestra is productdriven and focused on interior finishes and materials that don't require toxic cleaning. And while La Maestra will use its stature in the community to push the concept of green design through public awareness, another green pioneer has been pulling sustainable products into the healthcare system via its buying power.Kaiser Permanente is a 300 pound gorilla," says Shamp of the nation's largest HMO with 8.2 million voluntarily enrolled members in nine states (over 6 million in California alone) and Washington, DC. Indeed, he has watched this client standardize to Nora rubber and Stratica flooring within the last year due to environmental issues. "They want to eliminate PVCs from buildings," he says, and they're challenging the U.S. Green Building Council to reassess standards for fabric finishes, flooring and wall coverings, as well. "Because of Kaiser's initiatives, manufacturers are scrambling to find products that perform as well," Shamp reports.
Pam Maynard, director of interior design for HMC Architects, concurs. "Kaiser has initiated a big change in flooring," she says. "For healthcare we used to line all of our corridors and patient rooms with VCT (vinyl composite tile). Now we're taking a step back and using rubber PVC-free products like Stratica—where even the rubber is latex free. There's no off-gassing, the products are recyclable, and less maintenance is required. So, you're using green products, with the advantage of less maintenance. The up front cost is a little bit higher," she says, "but when facilities look at life cycle costing over a period of years there is actually an advantage to it."
HMC Architects has worked on Kaiser's medical centers in both Ontario and Baldwin Park, CA, and has projects on the boards for others in Downey and West Los Angeles. Eco-friendly design has proved to reduce life cycle operational cost of its facilities, but equally important to Kaiser Permanente is the social responsibility aspect of green design, says Maynard.
Currently, HMC is also working on an 80-bed tower addition for Providence Holy Cross Hospital in Mission Hills, CA—the first phase in a total replacement plan. Necessitated by increased patient load that resulted from area hospital closures, the three-story tower has become a showplace for some of the newly emerging design strategies in healthcare—including the hotly-debated centralization or decentralization of nursing stations.
Indeed, Providence Holy Cross proved the validity of HMC's theory that the best design is collaborative. "We take pride in the fact that we listen to our clients," says Joe Kragelund, AIA and studio leader of the firm's Pasadena office. "On preliminary concepts we like to see how the users react. We try to be as graphic as possible, explore with them three or four different solutions, and through this client interaction find the one that will serve them best."
Although hospital administrators were keen on moving to a centralized nursing station design, interviews with the nurses revealed a desire to maintain a decentralized format. HMC satisfied both factions with a compromise that kept the nurses close to their patients, yet offered central spaces for meetings with doctors, technicians and other staff members as well as private consultations.
"In patient rooms at Providence Holy Cross, we're incorporating what we call a light shelf," adds Maynard. "Lighting from the exterior window actually bounces off the shelf, thereby requiring a lower use of artificial lighting during the day," she explains. Maynard says she's pushing natural light, windows and the use of indirect lighting in all of the firm's healthcare projects for a multitude of reasons.
"Studies show patients improve at a quicker rate when we incorporate more natural lighting in their rooms," she says. That's why HMC is looking to improve patients' encounters with corridor lighting as well. "Imagine a patient on a gurney looking right up into a fluorescent light," she says. "We're trying to move that light source to the perimeter of the corridor and to incorporate indirect lighting instead."
What's good for the patient is also good for the administrator who wants to cut costs, Maynard points out. Lighting, she says, can account for up to 30 percent of a hospital's energy costs, and eight percent of the facility's total operating budget.
"I find it quite interesting that when we incorporate the green principles of architecture, which is actually intelligent design, we're not only benefiting the planet as far as the materials, or providing cost savings for facilities managers; we're also giving an advantage to each individual patient, both psychologically and physiologically," Maynard explains.
"Isn't that exciting? We're doing something that is good for the environment, but there are all these other benefits, as well. When it comes full circle, it tells you this is the right thing to do."After 65 years in the business, and with a multitude of green installations, especially schools in California and Nevada under its belt, HMC has chosen to lead by example. Its recently remodeled 8,000 square foot Pasadena headquarters in the historic Florence Theatre recently won a sustainability award from the Pasadena-Foothill chapter of the AIA. "We demonstrated that it is possible not just to preserve existing buildings, but to design them in a way that blends the old with the new," says Michael Tome, AIA, senior designer and lead proponent on the project. A showpiece for green design, blending environmental sensitivity with resource efficiency and comfort, the headquarters emphasize the construction process by exposing building systems. The space hinges on exposed steel, wood framing and concrete walls to define office areas. A wall of metal studs lines the path from the reception area through the workspace into the employee kitchen, dining and library area. "The building's framing and structural systems were influential in our decision to renovate," says Tome, who notes
that the project cost just $20 per foot. With all the green products, natural lighting and clever reuse of furniture, the project had all the bells and whistles to earn an award for green design. But that's just an aside for Maynard. "What I try to impress on my group is that we're not designing projects to win design awards. That kind of falls flat. "When we're designing a medical center, and provide more of a healing environment or a better place for staff to work—boy that makes all the difference in the world. Then design is not just about making something pretty. It's effecting change within education and healthcare. When we thing of our jobs as effecting change rather than just color or just makeup, that's exciting.
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