1 of 4
Jeffrey D. Allred, Deseret Morning News
Salt Lake Regional Medical Center is one of the city's older hospitals. It is undergoing remodeling, and eventually the east wing will be demolished and rebuilt.

As the new Huntsman Cancer Hospital rises above the University of Utah campus, workers are busy installing the most up-to-date technology, some pieces so big and complicated they require their own room.

Still, admits Dr. Stephen Prescott, executive director of the adjacent Huntsman Cancer Institute, the loading dock and the driveway are among his favorite features.

Did you know, he asks a reporter, that the driveway took a 36-hour continuous pour of concrete?

Upstairs, he shows off a handful of VIP suites, complete with anterooms for bodyguards or support staff. Even the regular patient rooms have couches near the windows, ready to fold out into sleepers for visiting family members. And there's a patio that planners hope the community will use for gatherings or press conferences or whatever, all wrapped in an incredible view of the valley.

While some parts of the economy slog along, medical construction is booming.

When the construction is done and you're sitting on the patio at the McKay-Dee Hospital in Ogden, sipping a soda and watching the birds nearby, or hooked to an intravenous line receiving chemotherapy at Huntsman Cancer Institute, the purple and yellow wildflowers on the mountain providing a view, be sure of one thing. The atmosphere was not a happy accident.

It's health care by design, a growing specialty in the broad field of architecture. Private corridors for patients or laundry facilities for family members, how close the patient bed is to the door and whether equipment is in easy reach of staff are all the result of a thoughtful and often time-consuming design process.

Recently, the Deseret Morning News sat down with a half-dozen local architects who design medical buildings in Utah and elsewhere to talk about what makes it different and what those differences mean to patients and their families, as well as the care providers who may spend more time in a health facility than they do at home.

Big changes, better care

When Don Finlayson began designing health-care facilities 30 years ago, the latest thing in patient privacy and comfort was putting only two people into a hospital room, instead of the traditional four.

Forget that thin curtain that separates beds in older hospitals. Facilities designed today nearly always have single-patient rooms, though there's likely to be some built-in space for stay-over family members. Where intensive-care nurses used to tell architects not to encourage families to stay, even ICUs may include room for a family member in the design.

Lobbies are larger, brighter, taller, often open for two or more floors. They look more like hotel lobbies with cozy chairs and loads of greenery.

The colors are warm but muted earth tones and pastels. So-called "institutional colors" are as extinct as the dodo bird.

This is not your grandmother's hospital, nor is the medicine being practiced in new facilities that to which she was accustomed. Health care has changed, driven by an increased understanding of the human body, pure science, technology and even the economics of competition.

Architects say they start with a sense of the building's purpose: What is going to be done here? And they keep in mind that the very role of medical facilities like hospitals has changed.

"We today think of hospitals as a place to find out what's wrong and fix it. Our parents and those before went to a hospital to convalesce and die. It's really stunning to look back and realize that," said Finlayson, president of Architectural Nexus, which counts the Huntsman Cancer Hospital and the new Moran Eye Center among its many medical projects. "None of us here think of a hospital as a place where beds are. It's changed from an inpatient focus to how do we keep patients out.

"What we do responds to the way health care is delivered."

Choices

Insurance drives most of the choice when a patient decides where to be treated, made when you pick a policy, said Finlayson. "You want a convenient location and adequate parking. How easy is it to navigate the maze?"

A survey three years ago for Modern Health Care Magazine found people don't recommend a facility to a friend just because of the nurses or doctors. The facility itself was important.

"The complexity" in designing a medical facility of any size is "striking," said Garth Shaw of Mountain Health Design, which designed a new Millard County nursing home and Valley View Medical Center in Cedar City, among others. "So much more so than other building types. We have to blend ideas with use and architectural expression, codes, etc. Just the physical sites of the different departments are important."

Big medical projects and small ones are very difficult, they agree. Midsize facilities are the easiest. "The real challenge is making what's complex seem simple," Finlayson said.

How do you make sure departments that are separate but terribly important to each other come together? That the paths from place to place work? Do different imaging modalities need to reside next door to each other? How do you make sure there's a route to safely transport a dangerous inmate who needs care? And what about the physical needs, like heavy shielding for the room that houses that imaging machine? That's an issue NJRA Architects faced when designing the Center for Advanced Medical Technology at Research Park, one of the U. Hospital and Clinics sites. It has a 3T Seimens magnet for diagnostic analysis and research that had to be isolated from everything else, in a humidity- and temperature-controlled environment.

Shaw said designing answers to those types of questions is among the greatest challenges.

Function and comfort

Scott Henricksen of Mountain Health Design said the fact that patients who actually stay in hospitals tend to be much sicker than in the past moves two elements — function and patient comfort — to the top of an architect's considerations.

It's also fact that technology may be outdated as soon as you purchase it. With health care and its many innovations, it's impossible to make sure it's not, said Nathan Murray of Anshen & Allen, which designed the Dixie Regional Medical Center in St. George and the Intermountain Medical Center slated to open in spring 2007.

The answer is to design a health-care facility so that it's adaptable. For new hospitals, that may mean leaving space to add more floors and building a foundation strong enough to hold them. In technology areas, you must be able to add or change the wire (or wireless) systems for networking, for instance. Most hospitals are also expected to last up to 50 years, so part of the job is predicting what will be learned in the next century and how that will change what a hospital has to be.

"All without making it look like a warehouse," said Elizabeth Mitchell, executive director of AIA Utah, a Society of the American Institute of Architects.

"At the same time you need the ability for things to grow; with health care everything has to be within 5 feet of everything else," said Scott A. Larkin of Architectural Nexus. "We try to design buildings so they can grow, but not so big they push you away."

It's familiar ground to Henricksen, who had to design a rural medical facility that can double in size over time as the need and patient base grow — while looking and being complete at this stage, as well.

Rural health care is harder all around. Some rural hospitals are the closest help in wide geographic areas. But it's hard to keep them full enough to pay their way, to have all the latest technologies, some of which will only be used occasionally. Sometimes it's just plain hard to get there.

When you're having a heart attack, immediate care is a life-and-death issue. But with some illness, "people are willing, for the perception of a better outcome or more convenience," to travel quite a distance, Finlayson said. That's one reason regional cancer centers do well. They offer expertise that makes that travel worthwhile. "People are willing to move somewhere months at a time if they think it will save their lives."

A good neighbor?

When you have the nuts and bolts, there's community impact to ponder.

Simply consider the air-ambulance helicopters that fly over, or the impact of all those cars on local traffic. And there's the sheer size of many facilities. "They are massive," Mitchell said.

Larkin remembers when he was in the Navy Medical Corps, working in San Diego at Balboa Hospital. There was a huge park across the way, and the hospital administration realized early on that it could never expand in that direction. "There was too much community resistance. Communities are a powerful force in shaping what can and can't be."

The community determines design in other ways. You have to fold the surrounding area into the plans, said Murray. "We take cues from the environment to give a sense of place to it. I try to design so it can only be here, whether it's the materials or the perspectives."

That's one reason the upcoming Moran Eye Center, next to Primary Children's Medical Center, an FFKR design, has tons of windows and panoramic views. It's about vision and the beauty of the building itself, and what you can see from it is important, said Dr. Randall J. Olson, director of the center and chairman of ophthalmology at the U.

Hospital construction costs about $200 a square foot. And though aesthetics — that fountain in the lobby or the homelike furniture — seem so central to the building's identity, "if you strip out everything beautiful and make it as plain as possible, you might be able to get about $3 (a square foot) out," Finlayson said.

And you can't forget nature. "Nature is an important piece of our lives. If you have an extended illness, deprivation from nature can be extreme," Finlayson said.

That recognition shows up in other areas: use of animals, art therapy, music, even aromatherapy to promote healing.

Interior design is no afterthought, either. Finlayson said he has a designer on his team from day one.

That's not uncommon, Mitchell said. The process "was more sequential," starting with building design, then the construction and finally the entrance of an interior designer to the process. "Now it's more integrated. The trend is to more sustainable design."

Interior designers have to bring it all together. And consider pesky things like what color to use in certain rooms. In an examining room or patient room, wall color poorly selected could change skin color and impact treatment.

Health-care design has become highly specialized, and that has created some tension within the field of architecture, Mitchell said. "There are people who pride themselves on being generalists, but that's not happening any more" in health facility design, she said. Some architects now earn certification in health-care design, while others resist any type of specialized certification.

For architects, folding administration in is to some degree "counting up the bodies and providing a place for them to work," Finlayson said.

Still, it takes planning to make sure that the business end of health care flows smoothly, Larkin said. The registration process and accounts payable, etc., must flow into the facility and become an integral part of it.

"Like an orchestra conductor," Henricksen quipped.

New or improved?

Cost does not determine whether a facility is remodeled or constructed from scratch, said Finlayson. The cost is roughly equal. Rather, that may be determined by whether it's possible to maintain a patient base.

In the 1970s, lawmakers tried to control the cost of health care by controlling construction. Loosening that up led to the current boom.

"There are many theories," said Finlayson. One is that a campus is continuously renewing itself, with ground left for a new phase. For big hospitals, that works, he said. "For small ones, that's a disaster."

Some hospitals simply have no space; they have to remodel a section at a time to keep the rest of the facility — and its financial base — alive.

Architects also sometimes get a chance to remodel in creative ways. Larkin got his start turning an old Dee's Family Restaurant into a dialysis center.


E-mail: [email protected]