Imagine you are 80 years old and driving your wife to a university medical center for her cancer treatment. You arrive at a building complex that is intimidating, confusing and hard to navigate. You can’t find the parking garage, let alone the front door. By the time your wife has checked in, you have walked through a maze of corridors and can’t even remember where you left the car.
This scenario is frequently played out in medical centers all over the country. It stems from an acute problem — the lack of physical planning as the institution incrementally expands over time. What may have started out as a clearly defined hospital often grows haphazardly like a shell sprouting barnacles. As a result, the poorly related parts of a medical center leave patients and visitors feeling unwelcome and stressed out when they are already coping with illness.
For architects and planners, improving these dysfunctional environments requires reconfiguring streets, walkways, buildings and landscapes into cohesive, pedestrian-friendly settings. The aim is to clarify circulation routes and connective spaces so that getting around the medical center is based on an intuitive plan rather than layers of signage.
From its work at more than a dozen academic medical centers, Ayers Saint Gross has developed a consistent approach to improving both on-campus and off-campus hospital and out-patient facilities based on the following recommendations:
Create the ideal patient experience.
Demand for public accessibility has led medical center buildings to be designed like airport terminals and retail malls. These environments are less intimidating to patients and visitors, while easier to navigate because of their clearly marked roads, gateways, and entrances. Once inside the hospital or clinic, mall-like atriums allow clear views of destinations on multiple floors. “From a business point of view, this also speaks to the importance of attracting patients who have a choice of where they go for care,” says Luanne Greene, director of the planning studio at Ayers Saint Gross.
At Emory University’s Woodruff Health Sciences Center, the patient experience is improving as connections are forged between the hospital on one side of a busy avenue and outpatient facilities on the opposite side. Existing roads will be rerouted so that traffic will flow around the medical center to parking garages at the periphery. This redirection will allow the avenue at the heart of the site to become a pedestrian-friendly street, and the hospital and clincs to be linked by sky bridges and tree-lined walkways.
A new patient drop-off area will be created for the hospital and clearly marked with a glass-enclosed pavilion. A separate drop-off area for the clinics will be moved to a new 420,000-square-foot outpatient building built next to a parking garage. The plan allows for phased growth of the medical campus while ensuring patient accessibility even before new buildings are constructed to augment existing facilities.
Connect research facilities to patient care.
“Bench to bed” is the latest catch phrase used by academic institutions to describe the links between science labs and patient rooms. “Doctors are using information they are gaining in the lab and applying it to patients – it’s a cutting-edge approach,” explains Associate Principal Kevin King of Ayers Saint Gross.
Connecting bench to bed is often harder on an existing medical campus where researchers are separated from patients by distance and indirect circulation routes. That was the situation confronting Ayers Saint Gross in proposing a master plan for the University of Southern California Medical Center, located several miles to the northeast of its main campus in Los Angeles.
Currently, research facilities and clinical patient rooms are divided by busy streets, unrelated buildings and hilly terrain. Analyzing existing circulation routes led the architects to propose a system of elevated walkways, landscaped pathways, and open spaces that connects researchers to patients while improving the overall campus setting. Service alleys now used by faculty to reach clinical facilities will become tree-lined passageways, while vehicular traffic and loading docks will be moved out of the campus core. New gateways to the medical center will lead to separate drop-off areas and entrances for in-patients and out-patients.
Integrate medical and academic programs.
When the medical center is located adjacent to the main university campus, health sciences and academic programs can share beneficial relationships in close proximity.
At the University of Rochester, for example, the business curriculum is beginning to cross-fertilize with medicine, and allied health has ties to the core campus. “That leads to a very interesting discussion about the diversity of medical degree programs,” says King. “You may be a doctor who deals with insurance issues or research issues. All this begins to create a new niche market that other schools don’t have.” This commingling of academic and medical programs means architects and planners have to create physical connections that work.
Incorporate amenities for town and gown.
Ground-floor spaces of new academic medical facilities offer the opportunity for amenities serving the campus community and the public “so the separation between the town and gown starts to disappear,” King points out.
At the University of Rochester, Ayers Saint Gross proposed a grouping of seven-story buildings on a parcel located between the medical campus and a residential neighborhood. These courtyard buildings are arranged as a village with landscaped open spaces and streets connecting them to busy boulevards bounding the site. They could include ground-floor services such as restaurants, meeting spaces, movie theaters, fitness centers, or dry cleaners – amenities recalling the character of a college town. The upper levels could support student housing or faculty research space, says King. “It’s a very healthy approach. The visitor experiences a much friendlier environment that makes the campus seem much more accessible.”