Designers Give Hospitals More Appealing Face Lift

Each room is decorated with colorful Amish quilts and cheerful ferns. The rooms are spacious enough to allow a relative or friend to sleep overnight, while the large bay windows offer long views over Santa Monica and the Pacific and let in floods of light. “Natural light lifts people’s spirits,” said Michael Bobrow, the architect who redesigned the Santa Monica building.

Only he’s not describing a new luxury hotel, but the $30-million remodeling that he designed for the 61-year-old Santa Monica Hospital.

Bobrow, along with his wife, Julia Thomas, run BTA, perhaps the leading architecture firm in the area to specialize in hospital design. “There has been a revolution in the character of the hospital, especially in the past five years,” he said. “The old institutional atmosphere based on long periods spent in a sickbed is on its way out.”

Their redesign of the hospital, since renamed the Santa Monica Hospital Medical Center, is a prime example of the new kind of hospital architecture that is necessarily more residential in character. Or what Bobrow called a “health care campus.”

The change in hospital design stems not so much from architects, however, but from cutbacks in federal and state spending on Medicare and Medicaid. Now the federal government imposes a price ceiling based on average regional treatment costs for groups of illnesses and therefore limits the amounts hospitals are reimbursed for specific treatments.

The federal price ceilings also have sparked a trend toward separating traditional services, such as minor operations and standard tests, from the hospital to specialized medical boutiques run directly by doctors or outside laboratories.

Efficiency Stressed

As a result, there has been a shift from long-stay inpatient care to shorter stays and more outpatient treatments. Hospitals are now under great pressure not only to be more efficient, but to compete for more sophisticated clientele who are careful about costs and care about the quality of the hospital environment.

To define and refine the right hospital image, Bobrow and Thomas held a number of community workshops in Santa Monica, plus consultations with the staff. A clear picture of the changing hospital scene emerged.

Besides the increased competition for patients, they learned that there is a growing independence by doctors who now often provide treatment in their own surgeries rather than sending patients to hospitals. And hospitals must deal with a shortage of nurses, which dictates a more compact hospital layout so that fewer staff members can supervise more beds from one nursing station.

During their design work, Bobrow and Thomas kept in mind a residential image for the modernized hospital. The new center’s exterior features pink stucco walls and generous bay windows that give it the air of a series of brownstone row houses. The lobby courts between the wings are small Japanese gardens meant for “contemplation and visual relief,” Thomas explained.

Rooms With a View

A new west wing was added to accommodate the redesigned patients’ rooms. Although the number of rooms dropped from 365 to 320, each patient’s room is half again as large. In the old hospital, the cramped patients’ rooms had small windows so the rooms were dark, and the rooms sometimes faced another hospital wing, so there was no view worth enjoying.

Today, the spacious bay windows not only cheer up patients, but as the natural light spills into the hallways, they also help visitors find their way around an often confusing hospital layout.

By now it has become accepted in the architectural community that the need to economize has profoundly affected hospital design.

“The bottom line has impelled the health-care community into a long-overdue concern for the comfort and convenience of both patients and staff,” said Margaret Gaskie, senior editor of Architectural Record magazine. “Sheer economics has spurred the introduction of new programs, new settings and new images.”

The designs of new hospitals now being planned also reflect the streamlined, cost-conscious relationship between doctors, nurses and patients. Bobrow and Thomas also have designed the proposed 150-bed Palmdale Hospital Medical Center in Antelope Valley, which is scheduled to break ground this summer. The hospital will separate the inpatient and surgical areas of the hospital from the wing of independent doctors’ offices. Every procedure that does not require an extended period in bed, from light emergency care to minor surgery, will be performed in the doctors’ and outpatients’ section of the center.

This separation of the mildly troubled from the truly sick ensures that people who come in to see their physician or have an X-ray, need never confront patients being wheeled about on gurneys, or catch glimpses of post-operative inmates plugged into an array of intravenous tubes.

Airy patient rooms will be laid out around a central nursing station that resembles a hotel lobby with a fireplace and easy chairs. Paintings and plants, which often seem an afterthought in traditional hospitals, will be carefully integrated into the design.

Sophisticated Equipment

In contrast to these home-like touches, the technical areas of the hospital are designed to seem highly efficient. The rooms that contain sophisticated X-ray-type machines such as lithotripters, a computerized tomography scanner, linear accelerators, along with cancer radiation equipment, will have a sleek, high-tech look. “People like hospitals to look friendly in the private rooms and public spaces,” Bobrow explained, “but when it comes to the technology, patients need to feel reassured that the machines and procedures being used upon their bodies are extreme state-of-the-art.”

Standardization is fast disappearing in every aspect of hospital design. The old days of institutional beige are over. Color schemes today are a fine-tuned response to an age of increasing specialization of services.

At the California Pediatric Center on South Olive Street, designer Pat Ford talked of “creating something joyous” to reassure children taking a trip to the doctor. Ford planned family seating groups of metal outdoor furniture painted in bright reds and yellows to give young patients something appealing to sit on as they anxiously await consultation. The metal benches, Ford noted, also were “too heavy for the kids to throw at one another.”

Splash of Color

The color scheme Ford devised relies on mauve, cream and blue, “which are just interesting variations on the traditional red-yellow-blue children’s colors,” she said.

In older hospitals, one major problem that often disorients patients and visitors is the simple matter of finding one’s way through the maze of corridors to a specific room. To remedy this, a new design specialty called “way-finding” has been developed.

A leading specialist in this field is designer Diana Polkinghorne of La Jolla-based Jain Malkin Inc. Her company has been hired to help people find their way around the 35-year-old Kaiser Permanente Medical Center in Fontana. “Right now the Fontana facility is confusing and huge,” Polkinghorne said. “People often get lost.”

To remedy that, Polkinghorne relies on “a directional concept of visual clues.” She said that “we have developed a system of color zones that help you locate yourself in the maze. We have set up a landmark system that points up the main corridors used by patients and the public from the secondary corridors restricted to staff use. The landmark system also clearly distinguishes the various hospital departments, so you know where you are at all times.”

Easy to Follow

In many hospitals, the abundance of printed signs and numbers often confuses more than it clarifies. Way-finding weeds out unnecessary signs, and makes the notices that are left more prominent and simple to understand.

“The overall effect of all these changes in hospital design signals a basic shift in attitudes as well as services,” Thomas said. “In the past, patients often had the feeling that medical facilities were huge and complex mechanisms that functioned autonomously, without much concern for the individual sufferer.”

In the new hospital, Thomas declared: “The patient is a precious human being who happens to need care, and the staff are also people sharing a humane and sensitive architecture.”