UCLA Looks to Future in Reshaping Medical Complex
The 1994 Northridge earthquake that left much of UCLA’s medical complex unstable has given the university the rare opportunity--and nearly half a billion dollars in government funds--to define in concrete terms what academic medicine will look like in the 21st century.
Though it can hardly be called a stroke of luck, the ruinous temblor is allowing UCLA to reinvent its medical campus, to scrap the dull blocks of buildings with their miles of serpentine hallways, and begin anew.
To ride the economic and technological waves that are expected to shift ever more rapidly in the next century, the new, $600-million hospital is being designed with maximum flexibility in mind.
The key, said Dr. Gerald S. Levey, UCLA’s provost for medical sciences, is to be ready for just about anything.
If the patient population becomes sicker, average rooms can be converted, without much ado, to intensive care units. If surgeries fall off, the number of operating rooms can be reduced to make room for gene therapy or other developing technologies--without knocking down walls. The corridors will wrap around the building, rather than cutting through it, so that there is plenty of undissected room for change.
“What we are going to see even in the next 10-20 years [of medicine] is staggering to the imagination, so it’s even more important that we be [both] comforting and flexible,” Levey said.
If designs for the hospital, to be unveiled today by renowned architect I.M. Pei, are any clue, 21st century academic medical centers will be a lot snazzier, with buff-colored buildings, garden getaways, spacious single rooms and rounded travertine towers to capture maximum light.
The new UCLA hospital is intended as a friendly place, as simple as possible to navigate, however high-tech the goings-on inside.
“I think this hospital is unlike many others that I have seen in that it is broken down into smaller units, so there is a more human scale,” said Pei, who worked with his sons at Pei Partnership in New York and local architects Perkins and Will on the project. “Light is curative. It’s very helpful to patients . . . cheers them up.”
Designed to ride out an earthquake of up to magnitude 8.4, the hospital is the centerpiece of a $1.3-billion face lift of the medical campus, the largest and most costly single building project in UC history. Some employees are making proud comparisons to the new incarnation of the Getty Museum.
But some independent health care experts are nervous about the tab, given the struggles faced by teaching hospitals nationwide to meld cutting-edge research and treatment with essential cost-consciousness. “There needs to be a major public debate about [spending] this amount of money,” said Marc Roberts, a health policy expert at the Harvard University School of Public Health.
The project, however, was unanimously approved by UC regents in November, with nothing close to the controversy that has marked the rebuilding of Los Angeles County-USC Medical Center. Of course, UCLA is not a county facility; it functions more like a private hospital. Now, it will look like one.
Mindful of Medical History
The money for the UCLA project is buying more than a comforting environment, pleasing to the eye, UCLA officials say. It is buying--or so officials hope--the ability to accommodate just about any fathomable change in medicine in the next 100 years. In that sense, it is less a prediction about the future of medical care than a bet on its unpredictability.
The designers are mindful of history. Who in 1900 would have guessed that space would be needed for machines that watch brains thinking? Or accommodations required for open-heart surgeries and organ transplants?
“There isn’t a person who can tell you with any certainty what the health care system is going to be like” beyond the next few decades, Levey said.
UCLA officials believe that not only have they planned for every possible contingency, they have done so in a way that will save dollars. The current Center for Health Sciences, including the hospital, is a sprawling complex with 86 entrances and exits, 27 miles of hallways and plodding, multipurpose elevators, where time and effort is wasted simply getting anywhere (and, in the case of visitors, getting lost).
In the new hospital, by contrast, related services will be clustered together--with entire floors devoted to maternal and children’s services or neuropsychiatry--and high-speed elevator service to each location.
For all the emphasis on flexibility, UCLA’s plans are based on the assumption that certain basic trends in health care will continue. Hospital patients are expected to arrive more acutely ill than ever before and to stay for shorter periods. Most routine care will occur in outpatient settings or in UCLA’s newly acquired community hospital, 250-bed Santa Monica-UCLA Medical Center. The main hospital--322 beds smaller than the current 857-bed facility--will be reserved for more intensive and specialized care.
As in academic medical centers nationwide, the main hospital will be part of a health care system, not the sole bastion of research and treatment.
“Academic medicine has really changed”--becoming much more integrated into surrounding communities, said Dr. David B. Skinner, chief executive officer of New York Presbyterian Hospital, which was recently rebuilt to the tune of $760 million and provided inspiration to UCLA planners.
This transformation of academic medicine has enormous upfront costs.
Fortunately for the university, the Federal Emergency Management Agency is providing $432 million toward the hospital reconstruction, with $44 million from the state. The infusion of government dollars gives UCLA a boost that many seismically shaky hospitals--about 28% of the state’s total--won’t have as they rush to abide by a state deadline to rebuild or retrofit by 2008.
Strategic Planning for the Long Term
Beyond the new hospital, UCLA’s project includes erecting three replacement buildings for research and education, demolishing the existing hospital, retrofitting other structures on the UCLA campus and making improvements at the Santa Monica hospital.
About $700 million--of which more than $120 million has already been raised--will come from private sources. This includes about $300 million in bonds approved by the UC regents.
In today’s volatile health care market, the university is banking not only on its ability to raise enough private funds for construction but to support the facilities’ operations over the long term.
Roberts, of Harvard, is skeptical. “In the past, the strategic planning has been done on the ‘field of dreams’ principle: If you build it, they will come. In a highly competitive health care environment, it increasingly has been hard for very high-cost providers to convince people to come.”
Dr. Michael Karpf, UCLA Medical Center director, said he is confident that patients will keep coming because of UCLA’s “essential services,” from basic primary care to specialized therapies such as liver and heart transplants. Karpf said the medical center is often at capacity now and has vastly improved its financial picture in the past five years.
Given demographic trends, “I can’t imagine the demand not being there” for UCLA, said Jim Lott, executive vice president of the Health Care Assn. of Southern California. He cited state estimates that the population in the Los Angeles area will grow to 14 million by 2040, with an increasing number of poor residents--which portends higher rates of disease.
Though it may be too much to expect a hospital to be an alluring place, many doctors, nurses and staff members involved in the planning of the new facility said they hope that it will make an often sad or scary experience more agreeable.
“We wanted to break away from the notion of a hospital as a square building with a few windows which people enter and then leave again with great relief,” said Dr. Peter Whybrow, chairman of the Department of Neuropsychiatry and Biobehavioral Sciences.
“Nobody likes going to the hospital anyway, but [we thought] if you had a sense of light and space . . . and could remove some of the onerous sense of doom and dismay that very often surrounds hospitals, [patients] would be much better served.”
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A New Medical Plan
A new hospital will form the centerpiece of a $1.3-billion project to repair and replace earthquake-damaged portions of UCLA’s health sciences complex. The eight-story, 525-bed facility is scheduled to open in 2004.
UCLA Medical Plaza: Existing outpatient center.
UCLA Medical Center: New hospital to be built.
Neuropsychiatry: Building to be razed.
Westwood Plaza circle
Rendering courtesy of UCLA
