| Project Name: Mark O. Hatfield Clinical Research Center Location: Bethesda, Md. Owner: National Institutes of Health Total Floor Area: 870,000 square feet Number of Floors: Seven Number of Beds: 250, plus 100 day hospital stations Project Cost: $639 million ($596 million for management, design and construction, including related utilities and infrastructure; and $43 million on new and relocated equipment, furniture and move in.) Groundbreaking: 1997 Opening: 2004 |
Susan Lowell Butler calls the new Mark O. Hatfield Clinical Research Center on the National Institutes of Health’s (NIH’s) Bethesda, Md., campus the “ultimate hospital, [the] place of last, best hope.”
And she knows more than a little about the wonders that can occur there.
In 1995, Butler was diagnosed with simultaneous advanced breast and ovarian cancer. At the time, she was told her odds of surviving another two years were less than 20 percent.
“At age 51 … frightened almost witless, I was nevertheless a long way from accepting a random death sentence without a fight,” she says. “The next step became clear. I had to seek help from NIH’s clinical center and the National Cancer Institute.”
Butler says she came to the Hatfield Center’s predecessor facility with her heart in her hand, hoping for a miracle that was not denied her. “Whatever comes, I have had my miracle,” she declares. “I have lived to see my grandchildren.”
Given the experiences of Butler, which she relayed at the Hatfield Center’s opening, it’s probably no surprise that NIH Clinical Center Director John I. Gallin, M.D., says patients have dubbed the research center hospital, “The House of Hope.”
Running down the list of achievements of past NIH researchers, he says that with the new building, “our hope is that the patients—and the country—will continue to benefit from the accomplishments of NIH.”
Miracles and breakthroughs
Many miracles have occurred at NIH since it opened its first research and hospital facility in Bethesda in 1953. The NIH pioneered translational research, the “bench-to-bedside” method of conducting research as close to patients as possible, so as to quickly translate findings into effective treatments.
Medical breakthroughs by NIH scientists include the first chemotherapy for childhood leukemia, the first use of nitroglycerin to treat heart attacks and the development of screening tests for AIDS and hepatitis in the nation’s blood supply.
In 1981, the original NIH facility was expanded and renamed the Warren Grant Magnuson Clinical Center. Gallin says the facility “was just marvelous—it accomplished everything people had dreamt it would.” But, he says, “it wore out. The infrastructure no longer could keep up with modern science and modern medicine, and we needed to replace it.”
Following an evaluation of the center by the U.S. Army Corps of Engineers, Congress in 1996 authorized the design of a new hospital and research facility on the NIH campus. Zimmer Gunsul Frasca (ZGF) Partnership of Portland, Ore., and Washington, D.C., was chosen to design the building from among 29 firms in an international competition.
The new seven-story, 870,000-square-foot Hatfield Clinical Research Center adjoins the existing 2.5-million square-foot Magnuson building to form the NIH Clinical Center. Covering 40 acres under one roof, it is the world’s largest clinical research complex.
A large part of programming the new building centered on deciding how best to consolidate the 17 NIH Institutes and Centers that utilized the Clinical Center. Each had separate patient care units that were ultimately consolidated into 13 much larger units in which similar patient types are treated together.
Margaret DeBolt, AIA, ZGF’s executive project manager for the building, worked with NIH personnel for nearly a year to develop a workable programming plan and was given the first Mark O. Hatfield Research Center Award for her efforts.
Always in flux
Because the nation’s leading research priorities are always in flux, it was important for the new building to be flexible enough to adapt to these changing needs. Gallin says he told the architects competing for the job that the new building had to be adaptable to change. “That was the one thing I could guarantee them,” says Gallin.
DeBolt says the architects did not design for specific patients or research because they knew the center’s research priorities and protocols would change dramatically from year to year.
“I fact, the building is changing as we move into it,” says Gallin. Since the building was designed, obesity has been recognized as a rising epidemic in the United States, so the NIH is adapting the facility to include a clinic for studyingn this problem. Similarly, biodefense and bioterrorism were not high priorities when the building was programmed in the late 1990s. The NIH has now added a unit to enable safe testing of new vaccines against emerging infectious diseases in the country.
“That is what happens when you are on the cutting edge of research. You’re constantly changing what you do to keep up with the demands of public health,” says Gallin.
Infrastructure priorities
One of the many unique features of the building that helps the NIH respond quickly to new demands is the generous interstitial space between floors, which allows for easier infrastructure changes.
Gallin says a major reason ZGF was chosen to build the center was the firm’s work on the Fred Hutchinson Cancer Research Center in Seattle, which they designed with every other floor as an infrastructure floor. A similar plan was used to connect the Hatfield building to the Magnuson Clinical Center. ZGF Design Partner Bob Frasca, FAIA, explains, “The old building had 12-foot floor-to-floors. What we did is make connections on every other floor, so we had a 24-foot floor.”
This space provides ample room to house all the mechanical, electrical and plumbing systems necessary for a variety of research or patient care needs, as well as room to reconfigure these systems without interfering with the laboratory or hospital work taking place on the floors below.
DeBolt says the mechanical level above the research and patient care areas helps NIH staff respond to changing infrastructure requirements. She notes the 6-foot, 4-inch pathways in this area enable workers to walk upright in the interstitial space, even while wearing hardhats. “[They] don’t have to crawl,” she says. Nor do they have to stand on stepladders on the floor below to make systems changes.
Every system has a dedicated horizontal pathway, whether or not it is in use in a particular area. “We put a lot in the risers, so there’s enough capacity for everything you would need running vertically, in shafts,” says DeBolt. Those that are not in use are stubbed out where they reach the interstitial space; their pathways are kept empty so they can easily be added if necessary. That way, says DeBolt, the hospital can run additional gases or other elements to specific laboratories or patient rooms as needed.
This design provides flexibility without the expense of running every system to every location up front. “We were always evaluating how much preinvestment was really worth it,” DeBolt says.
The designers also saved money and space by eliminating the interstitial floor in areas of the building with less intense infrastructure requirements. About a quarter of the building contains offices, which are stacked double.
‘100 percent fresh air’
The infrastructure system also enables easy changes to air handling in the building, a feature Gallin calls “very important.”
The building was designed with “single pass” air; fresh air flows through the building from one end to the other without being recycled. “If you go to any other hospital, it’s about 30 percent fresh air,” says Gallin. NIH felt is was important to have 100 percent fresh air throughout the building because of their many immune deficient patients.
Patients with very weak immune systems are cared for in rooms that have positive air pressure. In these rooms, air flows out into the hallway to protect the patients from microbes that are in the natural environment.
On the other hand, the hospital also has to be able to house patients with highly infectious diseases, which could include SARS or smallpox. The air pressure in a highly infectious patient’s room is adjusted negatively, so air flows into the room to contain airborne microbes.
The hospital opened with 25 rooms with negative airflow and 30 rooms with positive airflow. However, the flexible infrastructure system will allow NIH staff to adjust the air pressure in any patient room if necessary.
Flexible patient rooms
Indeed, the patient rooms themselves were designed to be very flexible to accommodate the facility’s changing patient population.
The rooms are wider than standard hospital rooms, so they can be used as single or double rooms. Excluding the bathroom and closet, each room is 12 feet wide and 18 to 22 feet deep. These dimensions also allow space for a vestibule to be built in the entryway of a room to transform it into an isolation room. Five-by-eight foot bathrooms are paired in the area between rooms. By replacing a pair of bathrooms with a small nurses’ station, the facility can create day hospital rooms, where one nurse can observe four to six outpatients.
The hospital has 85 day hospital rooms, where patients can spend up to 14 hours receiving treatment or participating in studies. These rooms are “a really treasured resource,” says Gallin. But, he says, “if we ever needed to turn them into patient rooms it would be very easy to do it.”
The architects provided a recess in the day room nurses’ stations, says DeBolt, so the hospital could take out the lightweight concrete fill, slope it to the drain, and create a typical patient room shower.
DeBolt says that as the architects were designing the building, “we didn’t know whether 250 rooms with 100 day stations was the magic number,” or whether the hospital would need a different mix of inpatient and outpatient beds in the future. Therefore, they designed the building so that it could be configured in many ways.
DeBolt says she believes ZGF’s room design will enable the NIH to easily modify each patient care unit to meet the center’s changing needs. “[T]hey can up the number of isolation rooms,” she says. “They could turn every single room into a double room and they could have a lot of beds … or they could turn it into a huge day hospital.”
Research vs. care
The NIH can also change the ratio of research space and hospital space in the building. The architects’ clinical module fits two patient rooms in a 32-foot structural bay; the laboratories are designed in multiples of a 10-by-8-foot module, three of which fit into the same 32-foot bay. “You can knock out walls and make patient rooms into labs and vice versa,” says Frasca. “The building is ultimately flexible.”
The clinical center has a central spine surrounded by four patient care areas on each floor. Laboratory wings extend out from the patient care areas. The laboratory and patient care areas are connected by shared office and interaction spaces that facilitate communication among caregivers and researchers. The atrium Science Court, which rises seven stories in the building’s center, is also “a great congregation area, where patients and scientists really come together throughout the day,” says Gallin.
The proximity of the laboratories and the patient care areas is key not only to the building’s flexibility, but also to the clinical research center’s success in fulfilling its mission as a research hospital.
“One of the marvelous features of the facility is that it’s literally a hospital surrounded by laboratories,” says Gallin. “It’s very easy for the clinician-scientist who needs to go back and forth throughout the day between their laboratory and the bedside to do it. Without that proximity, you couldn’t do this business.”
Some parts of the building, of course, do not lend themselves to easy adaptability. “Obviously [the linear accelerator rooms] are there to stay—they’ve got six-foot concrete walls around them,” says DeBolt. Even in the case of major medical and engineering equipment, however, the architects planned for eventual changes.
For example, they built a pathway to the cyclotron located on the lower level of the Magnuson building to create a route NIH personnel can use to upgrade that equipment. “There’s a pathway and a hatch that goes out to grade, so they could lift it up,” says DeBolt. A continuous wide corridor looping beneath the entire complex provides access to the same hatch for moving other large equipment as well, such as linear accelerators or air handlers.
Tomorrow’s cures
“Overall, people are just smiles” about the new building, says Gallin. “‘They say, ‘It’s so nice to come to work and be so excited about the facility.’”
The entire nation can share in this excitement. The term “House of Hope” should apply not only to patients, Gallin says, but “to the taxpayer and the country as the place that will develop tomorrow’s cures.
Amy Eagle is a Homewood, Ill.-based freelance writer and a regular contributor to HFM.
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