Hospital Designer: Prepare for Changes
Hitting a moving target isn’t easy; it takes skill, training and concentration and even then you probably miss about as often as you hit.
But suppose the target is moving, not through space, but through time? And suppose you aren’t allowed to miss at all ?
Then you’re in pretty much the situation of the hospital architect.
That seems to be what Julia Thomas, chairman, and Michael Bobrow, president, of Bobrow/Thomas & Associates, Westwood-based architecture, planning and consulting firm, were driving at in a recent interview.
“Designing and building a hospital takes a long time span--seven to 10 years,” Thomas said.
Design for Changes
With the practice of medicine changing rapidly, with new discoveries, new techniques and new equipment, it is not enough to design a hospital that will be sufficient for today’s medical practices, she explained; it is necessary to design a hospital suitable for whatever the practice of medicine will be a decade down the line.
“The challenge,” Bobrow said, “is how to design a facility general enough to accommodate change but specific enough to do what is wanted.”
An example of the sort of change that must be allowed for could be the fairly recent introduction of MRI (magnetic resonance imaging), which is superior in some ways and for some uses to X-rays, ultrasound or CAT-scans. It must be used in a room perfectly shielded from the slightest trace of outside magnetism. Who made that kind of a room until this came along?
MRI wasn’t foreseen, it just appeared and had to be accommodated, sometimes through a great deal of interior remodeling and reconstruction. Now, new hospitals are set up for it--but what will be the equivalent “surprise” a few years from now?
Non-Architect Principals
Thomas and Bobrow head a staff of about 100 in their full-floor office at 1001 Westwood Blvd., backed up by the other principals, Erich Burkhart, Carl Hunter, Kenneth Lee, Kenneth Liu, Richard Quintana and Robert Weilage, several of whom are public health and public administration professionals, not architects.
Bobrow is a registered architect and a member of the American Institute of Architects. Thomas by profession is a planner; on June 19 she received an Outstanding Leadership Award from the Los Angeles section of the American Planning Assn. for her contributions to women in planning.
The award cited her accomplishments in planning for an aging population and her leadership as president of the Committee of 200, a national association of women corporate presidents and entrepreneurs.
Major Projects
Six of their Southern California projects, totaling about $100 million in construction costs, either have opened very recently or will open in the next few months. (Bobrow/Thomas has a number of other major projects both in and outside of the Southland, one as far away as Shreveport, La.) The local projects include:
--The $28-million, 195,000-square-foot addition to Hollywood Presbyterian Medical Center, 1300 N. Vermont Ave., which added 204 patient beds--30 of them for intensive care--and a neonatal unit as well as a rooftop emergency heliport. It opened in April.
--The Beckman Laser Institute and Medical Clinic at UC Irvine, a 25,000-square-foot, $7-million building that the architect says is the first free-standing building to combine a research facility for laser development with a clinic for medical treatment. It opened earlier last month.
--The Phase 4 expansion of Valley Presbyterian Hospital, 15107 Vanowen St., Van Nuys, a $27-million, 200,000-square-foot project that added space for support and administrative functions, and in-patient and ancillary services, as well as the remodeling of the existing facility. Completion is planned for late summer.
--The U. S. Navy Branch Medical Clinic at the Military Battalion Center in Port Hueneme, Ventura County, to provide outpatient primary health care services for military personnel and dependents. The $9-million, 48,000-square-foot clinic, being built by H. J. Younger Associates, Sacramento, is to be completed this month.
On June 16, it was announced that the clinic has received one of 10 national Department of Defense Excellence in Design Awards--the only medical facility to receive such a recognition this year. They will be presented Wednesday at the Pentagon.
--A $28-million, 190,000-square-foot expansion and modernization project at Santa Monica Hospital Medical Center, 1225 15th St., Santa Monica, called by the architect the largest such project ever approved in California under the state Certificate of Exemption requirement and the first in the Los Angeles area to involve the community in its design. Completion is scheduled in 1987.
--A $500,000, 6,000-square-foot labor/delivery addition to the Medical Center of La Mirada, 14900 E. Imperial Highway, La Mirada.
‘Terrible Neighbors’
Hospitals face some problems.
One is the size of hospital sites, larger than in earlier times. “Hospitals are terrible neighbors,” Thomas said, only half-jokingly. She explained that they grow, they become major employers and there is a great deal of traffic at shift changes, so “now we’re recommending a minimum of 50 acres.”
Bobrow added, “Hospitals are going through some unusual trends. Small hospitals are failing.” Their occupancy is low, he said; they have cash problems under new reimbursement (insurance and governmental) programs and, “aren’t competitive with larger hospitals; for example, they might not have sophisticated cancer treatment or a CAT-scan.
“Also, more patients are now being cared for as outpatients so the hospitals are fuller of the critically ill.”
More Efficient Use
Thomas added, “They’re being asked to care for sicker patients with a smaller staff.”
He noted that a different type of hospital administrator is coming to the fore nowadays. Previously, the administrator had to work with the doctors to get patients in, to fill the hospital and keep it full. Now, with circumstances favoring minimum stays, the job is to use facilities more efficiently.
In the seven to 10 years it takes to design and build a hospital, the staff will probably undergo major changes and when it is completed, may not be the people the architect worked with in designing the facility.
In addition to “wearing out the architectural staff,” this impels the use of “project books,” which contain a meticulous record of design and use assumptions, changes and such matters so the architects can teach the staff how to use the hospital when its built.
Forty per cent of all surgery can be done on an outpatient basis, so big, monolithic structures are not efficient. The better way is a number of smaller structures in a “medical campus.”
‘Humane and Beautiful’
Construction of many of the smaller structures must meet, not the hospital code, but the ambulatory-care facility code, so that they can be built at 60% to 70% of the cost of acute-care hospital construction.
Finally, Thomas said, “Hospitals don’t have to be just functional, they can be humane and beautiful.”
“And,” Bobrow added, “they don’t have to be more expensive--we don’t have to gold-plate them.
“Two things are very, very important: We must design facilities that can capture the market and we need facilities that are the most economical to construct and operate.”
