Project Name Modesto Medical Center
Location Modesto, Calif.
Total Floor Area 254,375 square feet for MOB and 386,460 square feet for hospital
Number of Floors Four (plus fifth-floor lobby tie-in to hospital) for the MOB; five (with no basement) for the nursing tower; and three (plus a basement) for the diagnostic and treatment block
Number of Beds 224 with full build out (72 are currently shelled)
Project Cost $436 million
Construction Cost $240 million
Groundbreaking October 2004
Opening October 2006 for MOB and October 2008 for hospital
Owner Kaiser Permanente
Architect SmithGroup/Stantec joint venture (hospital and central utility plant) and Lionakis (MOB)
General Contractor Harbison-Mahony-Higgins Builders Inc.
Interior Designer Taylor (hospital) and Lionakis (MOB and hospital)
MEP and Structural Engineering (hospital) Arup MEP Engineering (MOB) Capital Engineering Consultants Inc.
Electrical Engineering (MOB) Harry Yee and Associates
Structural Engineering (MOB) Lionakis
Landscaping MPA Design (hospital) and Pollack + Partners (MOB)
Kaiser Permanente’s Modesto Medical Center, Modesto, Calif., is designed to be one of the greenest health facilities in the nation, with an efficient floor plan, infrastructure and environmentally sensitive materials based on the organization’s new template hospital design.
“Sustainability is part of Kaiser Permanente’s DNA,” says Tom Cooper, the Oakland, Calif.-based nonprofit health system’s national manager for sustainable building design and research. The health plan’s leadership has always had a “deep understanding … of the connection between public health outcomes and environmental issues.”
The Modesto hospital was a joint venture between architects from the San Francisco office of SmithGroup and Chong Partners Architecture (which is now part of Stantec, Edmonton, Alberta), with interior design by Taylor, Newport Beach, Calif. Lionakis, Sacramento, Calif., designed the adjoining medical office building (MOB) and overall site.
Healing garden elements are visible on the south side of the medical office building.
Total health, wellness
The goal for the project, according to Brad Smith, IIDA, CID, creative director, Taylor, was to create an environment of total health and wellness. Natural light, living plants and artwork were all seen as elements that promote a healthy body, mind and spirit.
The cafeteria and other public functions are located near the entry on the first floor, providing a ground level linkage of interior and exterior spaces
The building’s circular, glass-walled main lobby “has a lovely feel to it. It’s light, it’s sunny, very open and airy,” says Smith. The space was designed not to be overly grand, as hospital lobbies tend to function primarily as informational and pass-through areas, he adds.
The hospital’s courtyard, cafeteria and outdoor dining terrace are located just beyond the lobby; these are the first areas patients and visitors encounter as they move along the facility’s light-filled central circulation spine.
“It’s a unique feature in many ways,” says Carl Christiansen, AIA, LEED AP, vice president, SmithGroup. “Not many hospitals put the cafeteria by the front door.”
This social heart of the building, near the entry, café, and dining and garden spaces, also connects the hospital and MOB on the first floor. Here, visitors can choose to watch activity in the kitchen or retreat to a more peaceful spot in or near the courtyard’s healing garden.
The main drop-off area for the new Modesto Medical Center serves the hospital and its medical office building.
Natural light and views are also prominent on the hospital’s patient floors, where private patient rooms are arranged in triangular units with exterior windows overlooking the courtyard or hospital grounds. A common module for intensive care and medical-surgical rooms allows the rooms to stack more easily, making them more efficient to build.
Triangular-shaped wards cut down on steps nurses have to take.
Special attention was paid to lighting and color tone in the patient rooms to make those spaces soothing, with a comfortable transition from the outside corridor. The designers used a full-spectrum palette to bring a variety of warm and cool shades into the facility because, as Smith notes, “we live in a full-spectrum world.”
On the medical-surgical floors, distributed charting areas are located along the interior side of the corridors, giving nurses direct access to computer workstations outside the patient rooms.
Labor and delivery suites have a high-tech and high-touch design.
The corridors were built extra wide to accommodate these work spaces; to maintain the regulation eight feet of open corridor, low walls enclose each charting area.
Michael Wilson, AIA, LEED AP, senior principal, Stantec, says the absence of full-height walls or columns in the charting areas give the corridors an incredible feeling of openness.
Printers are kept behind doors in the central core, where supplies are stored and the nourishment and medication rooms, clean and soiled utility rooms and staff toilets are located.
Sliding glass doors on emergency department treatment rooms retain patient privacy while allowing constant visual access for caregivers.
Air quality focus
Low-volatile organic compound (VOC) paints and upholstery and formaldehyde-free fiberboard were used throughout the facility to promote indoor air quality.
“If your child has an asthma attack and you bring him to the ED at Modesto, there’s nothing there that’s going to continue to trigger that asthma attack,” says Cooper.
The facility’s rubber flooring does not leach toxins or need to be waxed or stripped with harsh chemicals; it also provides good traction, noise reduction and cushioning.
Some materials used in the facility were developed for the health care market in response to Kaiser Permanente’s environmental standards for this project. These include wall protection that’s free of polyvinyl chloride (PVC) and carpeting backed with chlorine-free polyvinyl butyral (PVB) recovered from recycled safety glass laminate.
Among its other innovations, the medical center’s parking lot is the largest installation of permeable paving west of the Mississippi, according to Kaiser Permanente.
The health system also has a grant to test displacement ventilation in the new facility. This heating and cooling technique uses the natural convective properties of warm and cool air to condition the first six feet of air space in a room, instead of using excess energy to blow air throughout the entire room.
Jeff Dean, Kaiser Permanente project director, reports that with displacement ventilation the medical center has been able to maintain 70 degrees with one-third less air flow, which could represent
a significant savings in terms of air handling equipment, ductwork and related infrastructure. It is believed that the system may also have air quality benefits, by reducing the amount of bacteria blown throughout a building.
Kaiser Permanente will share information about this and other design strategies used in the facility through a number of organizations, including the Centers for Disease Control and Prevention, the Center for Health Design, the Green Guide for Health Care and the Global Health and Safety Initiative.
“If we can do it, others can do it. We are committed to moving the industry as a whole toward greater sustainability,” Cooper says.
|Sidebar - Integrated MOB fits in with hospital|
The medical office building (MOB) at Modesto Medical Center in Modesto, Calif., fits seamlessly into the hospital building. “They’re designed to be very complementary,” says Larry Yee, AIA, LEED AP, principal at Lionakis.
The two buildings appear as one, with the same exterior materials and interior finish palette. Much of the same architectural vocabulary was used for both structures. Lighting coves, soffits and similar features carry through from one building to the other, easing the transition between inpatient and outpatient care.
The integration is more than skin deep. Related inpatient and outpatient services were built near one another for the convenience of patients and caregivers. The women’s health center in the MOB is on the same floor as labor and delivery in the hospital. Inpatient and outpatient radiology services are located near each other and the emergency department.
“It’s very easy for the specialists to go back and forth between buildings,” Yee says. Adjacent inpatient and outpatient services and shared waiting areas create efficiencies in regard to both staffing and square footage.
Structurally, the buildings are different. The MOB has a braced frame, while the hospital has a moment frame. “Because the hospital is regulated by the state, it’s a much stricter application of the building code,” Yee says. By adjoining the two, Kaiser Permanente gains the economy of a separate building and the efficiency of integrated care.
The differing codes allowed the project team to install solar panels around the air handling equipment on the roof of the MOB in place of typical mechanical screens—something that would have been more difficult on the hospital, according to Yee.
The array generates approximately 50 kilowatts of energy—enough to power 15 to 20 homes in the community, says Tom Cooper, national manager, sustainable building design and research, Kaiser Permanente. With a rebate from the local power utility, this feature saved the project $40,000.
|Sidebar - Efficient layout boosts brand|
The design is characterized by an adjoined hospital and medical office building with a shared entrance. A central circulation spine runs along an interior courtyard that provides natural light and views and serves as a wayfinding device that enables users to orient themselves within the building. The central corridor separates the diagnostic and treatment block and patient tower; these are built next to one another, rather than stacked, to allow for more flexible facility growth. The design is adaptable to different sites and scalable from 100 to 270 beds, to meet the needs of specific communities. Artwork provides an opportunity to localize each template hospital.
“There are tremendous benefits to the template hospital,” says Christine Malcolm, senior vice president of hospital strategies and national facilities, Kaiser Permanente. Hospitals based on the template have moved through the demanding California review process—which can take as long as two years—in as little as six months, according to Malcolm. And they cost roughly $65 less a square foot than the health system’s previous hospitals, due to efficiencies in the design and the benefits of bulk purchasing, which is made possible by standardization.
Design features like the distinctive, drum-shaped entrance advance the Kaiser Permanente brand. Brad Smith, IIDA, CID, creative director for Taylor, the interior design firm for the Modesto hospital, says the health system “wanted people to know you’re in a Kaiser Permanente facility, a facility that cares about your well-being and your health.”
|Sidebar - Spec sheet|
Principal Design Materials Carpet: Tandus Carpet tile: InterfaceFLOR Ceiling: Armstrong World Industries Curtain wall framing: Royal Glass Co. (custom design) and Vistawall Door hardware: Dorma, Hager Companies, Horton Automatics, Stanley Security Solutions Inc.’s Precision Hardware division, Rixson, Rockwood Manufacturing Co. and Trimco Doors: Algoma Hardwoods Inc., Besam, Cookson Company Inc., Cornell Iron Works Inc. and Kawneer North America Flooring: Armstrong World Industries, Lonseal and nora systems Inc. Glass: PPG Industries Paint: Akzo Nobel (formerly ICI Paints), Benjamin Moore & Co., Dunn-Edwards Paints and Sherwin-Williams Co. Plumbing accessories: American Standard and Kohler Co. Plumbing fixtures: American Standard, Haws Corp. and Kohler Co. Roofing: Johns Manville Signage: AGS–Environmental Graphic Design and Ace Design Tile: Casa dolce casa, Crossville Inc. and Dal-Tile Corp. Wall coverings: Marlite Window treatments: Levolor Window Fashions Principal Furnishings Cafeteria seating: Leland International (chairs) and West Coast Industries Inc. (booths) Cafeteria tables: Versteel Casework: Mission Bell Manufacturing Conference tables: Mission Bell Manufacturing and Versteel Files, shelving and office desks: Steelcase Inc. Lounge seating: Brandrud Office seating: Gunlocke and Steelcase Inc. Patient beds and over-bed tables: Hill-Rom Patient room seating: Brandrud and Loewenstein Major medical equipment Computed tomography, labor and delivery charting and fetal monitoring, and magnetic resonance imaging: General Electric Co. Computers: Hewlett-Packard Co. General radiology and cath lab: Siemens Headwalls: Modular Services Co. Nurse call: Rauland-Borg Corp. OR documentation center: Smith & Nephew OR equipment and medical gas booms and lights: Berchtold Corp. OR stretchers and beds: Stryker Physiological and fetal monitors: Philips Healthcare Printers: Lexmark International Inc. Sterile processing: Belimed Inc. Infrastructure Elevators: Otis Elevator Co. Fire safety: Convergint Technologies Kitchen equipment: Hobart Food Equipment Security: Online Security
|Amy Eagle is a Homewood, Ill.-based freelance writer and a regular contributor to Health Facilities Management.|
This article first appeared in the April 2009 issue of HFM magazine.
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