St. Louis Post-Dispatch December 15, 2002 A hospital that's hospitable By Robert W. Duffy Post-Dispatch Architecture Critic (Reprinted with permission from the St. Louis Post-Dispatch) The great medical center that has grown up around the Barnes and Jewish hospitals and the Washington University School of Medicine is one of the most prestigious teaching, research and medical treatment organizations in the world. Nevertheless, the medical campus itself was daunting for the people who needed it most - the patients who came to it for care, and their families and supporters. Although the medicine and science were top-drawer, the medical center became a maze of buildings, corridors, elevators, streets and tunnels that could bewilder even the most clear-headed visitor. "We were not patient-centered," said Dr. James P. Crane, associate vice chancellor for clinical affairs at the medical school - not patient-centered in terms of ease of use and convenience to consumers who have problems of one sort or another, many of them critical. Today, as you pass the intersection of Forest Park and Euclid avenues, you'll see a multimillion-dollar testament to a change in attitude and changes in procedures related to patient care. "We wanted to make not only a new place for our doctors but we also worked hard to make it a very good place for our patients," said Dr. Ronald G. Evens, president of Barnes-Jewish Hospital. That testament, that place, take form in a new building: the Center for Advanced Medicine, a cooperative venture of Barnes-Jewish Hospital and the School of Medicine. Recently, the design team that created the building won the Modern Healthcare/American Institute of Architects Design Award. The award acknowledges the center's efforts, through architecture and planning, to become more patient-centered. The team that created it included architects from the firms of Hellmuth, Obata & Kassabaum, Cannon Design and Tchoukaleff Kelly Harke. The Center for Advanced Medicine is a significant part of a developing plan meant to bring coherence to the medical center and to connect parts of it more directly and efficiently. This building, and the new Emergency Department and Trauma Center on Kingshighway south of Children's Place, represent an initial phase of the plan. The total cost of these buildings is about $364 million, which bought 1 million square feet of space, including new parking facilities. The Center for Advanced Medicine is glass, precast concrete and metal, with polished granite at its base. The visual emphasis is on geometry, a bringing together of shapes that can be read as a metaphor for the building's complex purposes. Although lacking in the sort of visual poetry that brings genuine greatness to architecture, and diminished by the unnecessary bonnet it wears, it is a good building, and from all the accounts I have heard from occupants and visitors, a serviceable building. As you approach from the north, on Euclid, or from the east, on Forest Park, it looks as if an eight-story architectural arc is rolling out from the 14-story tower behind it. The building is open to the street, transparent on the lofty lower story of this curved portion of the building. Interestingly, it is a much more affecting building at night, when fixtures in the north-facing corridors of the tower form horizontal bands of light. Behind all that lower-story glass is the lobby, which looks like something you'd find in a nice, new hotel - hospitable, rather than hospital-like. "One-stop shopping" Back in 1995, Crane said, Barnes Hospital and Jewish Hospital recognized they needed to merge in order to rationalize clinical services. "There was much duplication," he noted. "Plus, the hospital campus historically was perceived as intimidating. "Within the hospital complex - buildings between Kingshighway and Euclid and Forest Park and Barnes Hospital Plaza - there is 5.7 million square feet of space. There are about 970 practicing faculty physicians, taking care of patients in some 32 separate geographic locations." Fragmentation spelled confusion and sometimes genuine physical and emotional distress. "A major tenet was to achieve what I call one-stop shopping," Crane said. "We wanted to organize clinical services in a highly visible place." Inpatient services would be taken care of in the south part of the complex. Outpatient care would be in the north part, the Center for Advanced Medicine. Evens said both the administration and the doctors wanted to "bring this great hospital into the modern world of ambulatory medicine. "Over the years we'd built two very good hospitals focused on the inpatient scene," he explained. At the same time, "our ambulatory (outpatient) business had grown, but we'd not paid too much attention to it. If you came here to see three doctors and take a test, you might go all over the place." To address that, Crane said, "we took 43 different adult specialties and integrated them into 16 multidisciplinary clinical centers of excellence" in the new building. For example, all out-patient cancer care has been brought together in the new building, in the Alvin J. Siteman Cancer Center, a major tenant. Radiation oncology is below grade; the seventh floor of the building is specifically for other outpatient cancer care, including chemotherapy infusion treatment. In the cancer center, in addition to the radiation and medical oncologists, the services of psychiatrists and "spiritual care counselors" are also available. The beneficial effects of natural light and openness were considered throughout the building. But light shines in even in what you might expect to be dark corners. For example, the below-grade waiting room for radiation-treatment patients is filled with natural light, borrowed for the basement by leaving a section of the main floor open. The old with the new Parts of some older structures, eastern sections of the old Jewish Hospital buildings, were integrated into or connected to the new building. A eight-story skylit atrium brings even more light into the building's interior. Some walls and ceilings in public areas are covered with light wood, providing more luminosity. A "team of firms" A professional collaboration was formed to do the architectural work for the Center for Advanced Medicine and the Emergency Department and Trauma Center. Hellmuth, Obata & Kassabaum designed the exteriors and cores of the buildings. Cannon Design was responsible for the interior planning of the Center for Advanced Medicine; Christner Architects and Planners was responsible for the interior program for the emergency facility. Tchoukaleff Kelly Harke did preplanning for the Center for Advanced Medicine. "I decided we needed a team of firms," Crane said. "I didn't think any one firm could do it." So what amounted to a brand-new, if temporary and ad hoc, architectural firm was established in the old Ettrick Building across Forest Park Avenue. Hank Winkelman, group vice president at HOK, said that when the office was going full speed, there were 40 architects working together in the office. Cannon vice president Michael Felton described the collaboration as challenging and productive, an example of genuine teamwork. In response to praise for the interior lighting, Felton said the work was a collaboration of Tom Kaczkowski, lighting group director of HOK, and David Polzin, a senior associate at Cannon. Because of the size and intricacy of the place, and the multiplicity of needs and desires, there was lots of discussion before the first shovelful of dirt was moved. Steering groups were formed, then divided into subgroups with front-line physicians and staff to look at particular specialties. They listened to all sorts of people: doctors, clinical support personnel and patients, of course, but also specific groups of patients, such as the disabled. For the emergency department, Crane said, they sought advice from the police, from ambulance drivers and helicopter pilots. (A new heliport is on the roof of the emergency department building.) Crane, besides working in the administration of the medical school, is an obstetrician who maintains his practice and his paramount concern for patient care. In that regard, he is especially pleased with this new building. "I wanted it to be intuitive, easy to navigate, easy to figure out how you get from point A to point B," he said. He thinks the views are tremendous; he appreciates the light for its "sense of openness and calm." Evens acknowledged that, as a large academic hospital, Barnes-Jewish "will never be as patient-friendly as a small doctor's office in the county. "But our goal," he added, "was to make (the Center for Advanced Medicine) as patient-friendly as it could be. And based on what we have heard, we think we've done it." So did Modern Healthcare, a healthcare business newsweekly, and the AIA. In their commendation, the project's design team was praised for being able to "create a human scale in a large urban building and and convey a calming atmosphere," to "locate clinical ancillary services close to their primary referral sources," to "design easy-to-understand pathways and signage leading patients from parking curb to exam room," and to "group services in multi-disciplinary suites on a single floor for greater patient convenience and to optimize the delivery of medical services." Architecture Critic Robert W. Duffy; E-mail: rduffy@post-dispatch.com; Phone: 314-340-8128 Copyright 2002, St. Louis Post-Dispatch, Inc. (To see the St. Louis Post-Dispatch online, go to http://www.stltoday.com) Photos by Bob Boston, Photographer, Medical Public Affairs, Washington University School of Medicine