 |
| PROJECT NAME / Santa Clara Medical Center Hospital LOCATION / Santa Clara, Calif. OWNER / Kaiser Foundation Health Plan Inc., a part of the Kaiser Permanente integrated health care organization TOTAL FLOOR AREA / 710,000 gross square feet NUMBER OF FLOORS / One wing of three floors and one wing of four floors NUMBER OF BEDS / 327 PROJECT COST / $500 million CONSTRUCTION COST / $273 million GROUNDBREAKING / December 2001 OPENING / February 2006 (phase I) and August 2007 (phase II) |
Just last month, on the site of a former orchard in Santa Clara, Calif., the Santa Clara Medical Center hospital officially opened its doors—an event 15 years in the making.
While ground was broken in December 2001 for the first phase of the hospital, newest in the Oakland, Calif.-based Kaiser Permanente integrated health care organization, the project began long before that. “The property was purchased, I believe, in 1992,” says Lee Ann Knight, senior project manager for Kaiser Permanente national facilities services.
Kaiser Permanente bought the 52-acre site to house a replacement hospital for the health care organization’s existing Santa Clara hospital, located a mile and a half down the road. Architects from the San Francisco office of Anshen + Allen developed a design for the hospital, but during the regulatory review of the greenfield site, plans changed.
“Kaiser’s hospital membership was flat or declining, and the hospital strategy of the organization was that perhaps we weren’t going to be rebuilding the hospital,” says Knight. Instead, Kaiser Permanente leadership decided to build a medical office building and ancillary services facility to provide outpatient services on the site. “They asked us to create what was called at the time a bedless hospital,” says Zigmund Rubel, AIA, principal at Anshen + Allen.
But the more things change, the more they stay the same. “We were in the planning of that ambulatory services building when the strategy changed, and Kaiser decided that they were in fact going to rebuild this hospital,” Knight says.
New earthquake regulations for California hospitals were the major factor in the about-face move. “The main driver was to meet the new seismic standard in the state of California,” says Mary Ann Barnes, senior vice president and area manager for the Santa Clara Medical Center. Replacing the existing hospital, which was built in the early 1960s, also gave Kaiser Permanente the opportunity to create a modern facility that meets the latest standards for patient satisfaction, workplace safety and technological advancement, she adds.
Anshen + Allen went back to the drawing board in 2000 to create a third and final design for the facility. The ultimate design scheme, says Rubel, was a “bedded bedless hospital.”
Phased in
The final decision to replace the existing hospital was made when the permit process for the ancillary services building was already under way. “We didn’t want to lose time by stopping that whole process and starting all over again with the state,” says Knight. For this reason, the hospital was built in two phases, with what had been the ancillary services building becoming the first phase of hospital construction.
The first part of the overall project to be built was a medical office building, which is connected to the hospital by an enclosed pedestrian bridge (see Good Connections). Phase one of the hospital included the central plant, general operating rooms and imaging. Since these services were completed in the first phase, they were available for outpatient use before the hospital as a whole opened.
Phase two of the hospital included the emergency room and patient units. Although the hospital was built in two parts, it has a seamless appearance. “When you walk through it you don’t see the differences in the phases,” says Barnes.
Nature’s influence
The design of the hospital was influenced by the orchard setting. “Whenever possible, we had circulation adjacent to or destined to the outdoors,” says Rubel. The hospital’s ground floor includes a storefront system, called the garden walk, that is adjacent to outdoor landscaping.
The organizational axis of the campus is called the orchard spine. The orchard spine is an exterior landscaped area that runs in a serpentine fashion through the medical office building and hospital, ending at a large tree next to a creek that flows through the medical center campus.
Interior courtyards provide natural light and views from within the hospital. These areas are designed to appeal to all users of the facility. One courtyard includes playground equipment for children; another, deeper into the building, will likely be used primarily by staff.
By supplying natural light to interior patient rooms, the courtyards enabled the architects to maximize the footprint of the hospital. A courtyard next to the cafeteria provides natural light in this area, as well, even though it is in the basement of the hospital.
The hospital’s interior colors were also taken from nature. The building is divided into three color blocks. The west unit, which contains the medical-surgical and intensive care unit beds, features a green color scheme. “The green was chosen because it was next to the creek, to continue this idea of it being next to the outdoors. The unit to the north is a terra cotta color. And then the unit to the east is a yellow, buttery color to complement the adjacent medical office building,” Rubel says.
The amount of natural light in the building, along with the color scheme, helps create a soothing, healing environment for patients, says Barnes. “If you’ve read any literature on what kind of colors help patients get better, it’s not red and orange,” she notes.
The color blocks are designed to aid with wayfinding. Wayfinding is also enabled through an innovative signage system that identifies departments with numbers. “We tried to implement a kind of universal wayfinding system,” says Knight. “People who may not be fluent in English, generally the first thing they learn to deal with is numbers, because they have to learn about money.”
Each department that is a public destination is assigned a three-digit number, called its address. The addresses follow a logical, sequential pattern, and are stacked above one another on each floor. They are clearly posted on signs in the corridors. This system has proven to be easy for visitors to use; it has also made it easy for staff to direct visitors to the proper location, as staff are well familiar with the addresses in their work area. It has been very helpful, given the size of the interconnected medical office building and hospital, says Knight.
“At half a million square feet, it’s a very large building,” she says.
Patient unit design
The patient units are arranged around a flexible, central area of about 2,000 square feet that can be used for a variety of departmental needs. For example, in the cardiac unit this area houses a treadmill, for stress testing. In the orthopedics unit, the central space is used for physical therapy.
“It solved a problem that we had with the tightness of the site, being next to the creek, but then gave the hospital flexibility in terms of what they would like internal to the unit,” says Rubel.
Ninety-five percent of the patient rooms in the new hospital are private, a vast improvement over the double- and even triple-bed rooms of the existing hospital. The rooms are also large, at 245 square feet for a standard room (including the bathroom) and 270 square feet for handicap accessible rooms. This provides ample space for patients, families and staff, as well as room for new equipment such as patient lifts.
“We were so constrained with our old facility. Now we’ll be able to purchase the full spectrum of workplace safety devices for patient care,” says Barnes.
The neonatal intensive care unit features a corridor along its perimeter that allows parents to remain close to their children even when they cannot be with them. “If something were to occur and the medical staff needed to take control and ask the parents to wait outside, they can sit down in this waiting area but be right near where their child is,” says Rubel. “The staff is really happy about that.”
In the pediatric intensive care unit, windows between rooms enable staff to communicate with one another quickly in an emergency.
Infrastructure
The air handling system in the emergency department is separate from the rest of the hospital. The air supply to the department is negatively pressurized to help contain dangerous airborne particles.
“The emergency department chief was very concerned with bioterrorism. If one of their patients came in with some sort of exposure to an airborne particle that could be transferred, he didn’t want it to affect the rest of the hospital,” says Rubel.
Decontamination showers and a negative pressure isolation room are situated adjacent to the ambulance entry. Says Barnes, “If there’s any hazardous or infectious situation, or we’re dealing with a pandemic, we can isolate off the ED from the rest of the hospital.”
The entire hospital uses 100 percent outside air, rather than recirculating air through the air handling system. The mechanical system also includes gas-fired chillers, which can augment the main variable pitch electric chillers during times of peak usage in California, when electrical costs are high. The payback on the system is expected to come within five years.
Space savvy
Extra space was built into the hospital’s central plant for future infrastructure equipment, such as an additional boiler or emergency generator. Space was also allotted for emergency water supply storage tanks, which the hospital will be required to have available in 2030.
Areas throughout the hospital, such as operating rooms, cardiac catheterization laboratories and angioplasty suites are also sized for future growth. “Let’s say robotics at some time become the trend in ORs. Our rooms are big enough to be able to put those in,” says Barnes.
A technology dock was built next to the magnetic resonance imaging (MRI) suite and nuclear medicine department to enable staff to more easily install or upgrade large medical equipment. “As new technology comes in, we have the ability to pull it up and test it out at our facility,” Barnes says.
A four-hour fire separation wall was required between the technology dock and the MRI suites. To minimize damage to the outside wall when the hospital brings in new equipment or replaces the magnet on an MRI machine, the architects designed a permanent opening with a fire shutter. “There still would be demolition inside the [MRI] room to break up the wall for the shielding … but it solved half the problem, so to speak,” says Rubel.
Braced for anything
The seismic code that prompted the replacement hospital was met with a new technology called an unbonded brace frame, also known as a buckling restrained brace frame. “This is the first hospital in the U.S. that’s used this bracing,” says Rubel. The system is patented by Nippon Steel Corp., Tokyo.
In an unbonded brace frame, braces run in an inverted V shape from the intersection of each beam and column to the midpoint of the beam above. These braces are encased in steel tubes filled with mortar. “When this [brace] wants to bend or buckle, it’s restrained by the cement fill inside the tube because the cement pushes out on this steel tube and it has nowhere to go,” says Rubel.
The system has several benefits over other earthquake construction techniques. For one thing, says Rubel, “because the building acts like it has a shock absorber, it can be lighter, because it can wiggle a lot more.” Steel moment frames normally require a tonnage of 25 to 30 pounds of steel per square foot, he says, while the Santa Clara medical center required only 13 to 15 pounds per square foot. Also, since the steel in an unbonded brace frame is bolted, the frame can be erected very quickly. And if one of the braces is damaged during an earthquake, it can simply be replaced.
In repeated testing by state officials, the braces underwent simulated seismic forces measuring 8.5 on the Richter scale. “The brace expanded 4 inches and then contracted 8 inches,” says Rubel. “We’re talking about steel here, we’re not talking about a rubber band. These things really work.”
Template for change
Certain aspects of the Santa Clara facility, such as the unbonded brace frame, have already become part of Kaiser Permanente’s new templated hospital design, which the health care organization is applying to all new medical center development.
By employing the latest design techniques, Kaiser Permanente has ensured this hospital design—years in the making—will remain fresh for years to come. n
Amy Eagle is a Homewood, Ill.-based freelance writer and a regular contributor to Health Facilities Management.
This article first appeared in the September 2007 issue of HFM.
To respond to this article, please click here.
Related Articles
Click here for a FREE subscription to Health Facilities Management.
