Back from holidays spent back East where I was reminded why I live down here like a blustery smack in the face by 20 degree temperatures. To kick off the new year, here is my column in the latest Columns Magazine, distributed by the local Dallas AIA. The issue is all about "mega-projects" which as you'll see I used in the opening of my column on the new Parkland Hospital. The issue, which also includes features on the Dallas Convention Center Hotel (aka the Vegas Casino Hotel without the fun) and Cowboys Stadium (aka the world's largest sports bar) is at local Borders, Barnes & Nobles, and will be in the luxury suites at the Super Bowl if you happen to be lucky enough to secure one of those spots.
As a bit of background, I have a good deal of experience working with hospitals around the country to break down the "castle and moat" form most have accidentally adopted, including winning the Daniel Burnham Award from the Illinois AIA for the Illinois Medical District Plan. Hospitals, typically and defensibly, are so focused on their core "business," the treatment of patients, often forgetting that the experience, safety, and quality of the neighborhood around them is central to that "business." It can improve patient well-being, while helping to attract and retain the best docs and staff from around the country.
The central, if perhaps underlying thesis to this article, is that while "mega" buildings/projects/hospitals are antithetical to neighborhood and community well-being (particularly in the long-term), the current business model of healthcare supports little but. At the end, the only place where I editorialize, is where I suggest that the health of the neighborhoods around Parkland (and the success of the new design) will ultimately be entirely determined by how well the adjacent auxiliary development bridges the intensity gap from medical to functioning, walkable neighborhood. To me this is a fitting judgment, as the success of any one building is never determined by its lonesome, but by the network it resides within and amongst.
Parkland: The Mega-Project by the People, For the People
By Patrick Kennedy
By Patrick Kennedy
Institutions such as hospitals are often thought to be recession-proof as they provide essential services for their constituents. So perhaps it is fitting for a non-profit community-based hospital, such as Parkland, to be a life raft of sorts for the local architecture and design industry.
It is commonly accepted that Dallas has escaped the worst of the on-going recession. That has not been the case for the architecture, construction, and real estate industries where many firms have cut more than 50% of their staff and some have closed their doors entirely over the past two years.
There have been several other recent megaprojects designed or constructed since the market crash in 2008, Their effect on the local economy has been a scattershot of unintentional Keynesianism focused acutely on a few very large, complex projects. They have kept many people at work, building totems to the times, and providing value to the community.
The key difference is that Parkland Hospital is the only one where the primary user will be solely the local user, a cross-section of the Dallas County citizenry--the same people that overwhelmingly voted to support the funding of the new construction in the 2008 bond election. It truly is a hospital by, of, and for the people.
The Protean Years
The seed from which the new Parkland hospital will sprout was planted in 1999. Dr. Ronald Anderson, president and chief executive officer of Parkland, and his team, travelled to Atlanta, Georgia to visit Northside Hospital, another large birth hospital. There he met Walter Jones who was the project manager of the newly constructed Women’s Center expansion for the non-profit community-based hospital.
Shortly thereafter, Dr. Anderson asked Walter to join Parkland as senior vice president for facilities and development as they were going through their own study to determine the future of their 55-year old facility. Rather than continuing to attempt to practice “good medicine in a bad facility,” in 2002, the Parkland Board of Managers unanimously approved a full replacement hospital as part of a new campus across the street from its current location on Harry Hines Boulevard.
Inherent to their mission of healing, the team was determined to heal the hospital planning process as well. Contemporary hospital growth is often plagued by shortsightedness, often growing in aggregated steps but with little overarching guiding vision. At this point, the team decided that their new campus needed a masterplan to provide guiding principles for their growth as a community-based hospital, not just in terms of function, but in form as well. Parkland wanted a hospital that gave back and participated in the physical form of the city rather than the typical castle-and-moat arrangement of many modern hospitals.
In 2002, Parkland chose Skidmore, Owings, and Merrill (SOM) architects out of Chicago to assist HKS Architects in Dallas, the facilities planners who had been working with Parkland to determine their needs for growth. The goal was to master plan the entire campus with the hospital as the centerpiece of a new, mixed-use medical district.
After two years of work, Parkland approved the SOM masterplan for all of their land between Harry Hines Boulevard and Maple Street. The plan defined the basic blocks and organization for the new medical district. It is reminiscent of English quadrangle campus planning, defined by two large central public squares along Medical District Drive (formerly Motor Street). In concert, they provided the primary organizational device for the campus to define its eventual growth.
The plan also proposed that each of the facilities, the Ambulatory Surgery Center, the WISH clinic (for Women’s and Infants’ Services), and the Acute Care and Trauma Center, would be built as part of a phased construction process, each on their own block and organized around one of the central squares. Eventually economic factors won out and it was determined that a single facility holding all of the needed services was best, as determined by an objective panel of local civic and healthcare industry leaders.
Financing for the design and construction of the new facility became the next logical step in the process. It was determined that a $747 million bond issue would help build the $1.27 billion, 862-bed facility. This culminated in the 2008 election where Dallas County voted 83% in favor of building the new hospital.
Designing the Team to Design a Hospital
In early 2009, Walter Jones wanted information. He asked for input from representatives from virtually every staff level and position within the hospital. His question: “How do you do what you do and “how could you do it better without the encumbrances of the existing facility?”
In order to move the staff out of their comfort zone, this engagement process included an educational component to show what else was being done around the country. The staff was then surveyed whether specific techniques or technologies would help them do their job better. This feedback system allowed the Parkland management team to determine the direction they wanted to go in with the facility in preparation for selecting their future design team.
Expecting to be an underdog for a billion-dollar-plus facility, HDR Architects, out of Omaha, NE and Corgan Associates from Dallas decided to go all out in their pursuit of the project. They underwent internal design charrettes and built 3-D models of their initial ideas several weeks in advance of their interview. The extra effort paid off as they were awarded the commission for design and construction documentation along with a project management and construction consortium called BARA, made up of Balfour Commercial, Austin Commercial, H.J. Russell & Company, and Azteca Enterprises.
As mentioned previously, the modern hospital typically expands incrementally and aggregately, focusing purely on immediate needs and little on how that expansion would affect further long-term growth or functionality. Eventually, the series of individual “best interest” choices ultimately creates an inefficient facility that, in its complexity, becomes a nightmare for intuitive wayfinding for the visitor. It creates confusion and discomfort for those who already under personal stress.
This could perfectly describe what has become of “Parkland 2.0,” the existing facility if the original Parkland recently rehabilitated by Crow Holdings, is considered “1.0”.
For “Parkland 3.0,” Jones concocted another challenge, this time for the architects newly on the job. He had travelled to hospitals around the country during his due diligence for the project where they advertised that they had dedicated corridors where staff and materials could move virtually invisibly from patient flow. However, he was unsatisfied with what he saw. Many were able to execute the concept at the lower levels of the hospital but none were able to deliver the idea in the nursing towers.
The HDR/Corgan team was inspired by an unlikely source, Disney World, where staff and performers have “on-stage” areas and “off-stage” corridors where they move throughout the park without detection, allowing the magic kingdom to seem…magical.
For background, any hospital has five streams of flow: patients, staff, visitors, material, and information. To maximize efficiency of movement, each of these must be effectively channelized. However, where this gets complicated is that they must necessarily overlap in order to function properly, adding complexity and potentially inefficiencies of movement.
The design team created a series of interconnected towers with “on-stage” and “off-stage” corridors. An IT consultant was added along with a core group of Six Sigma trained individuals to facilitate planning of logistical flows, particularly where new technology could improve staff connectivity between patient treatment areas and the servers where patient data is housed through digital mobility.
Even with all of these dedicated corridors, layout efficiencies of the new building will rival those of highly efficient, conventional non-profit community-based hospitals. This is quite an accomplishment for an academic teaching hospital. They were able to achieve a highly efficient building by adhering to one of the key principles of the design: flexibility.
One of the key innovations within the design of the new Parkland hospital was the design team’s decision to see how far they could push utilizing pre-fabrication. Within a traditional model of segregated departments in distinct towers on a four-story podium for diagnostic and treatment, all of the individual patient rooms are to be designed as one. In other words, one room is all 862 of them. This will allow for an expedited construction process, improved quality of construction as corrections can be made to the mockup before mass production begins, and vastly reduced costs allowing a massive building with numerous moving parts to stay under budget.
The designers set up shop at a field office in the nearby ground floor of the mixed-use development CityVille on Medical District Drive. Utilizing building information modeling (BIM ) and Design Assist, they were able to build 3-D mockups of the entire hospital as well as an actual to-scale patient room. By building all of the patient rooms to the same specifications, rooms and floors of rooms can flexibly adjust to whatever patient demand dictates. This makes the entire hospital malleable; as equipment is exchanged, the function of the room can alter entirely.
To translate to other real estate markets or architectural divisions, the conventional hospital is similar to housing developments where the developer essentially must take an educated guess at what the market will bear in terms of layout, and hope for the best rather than perpetually adapting to the needs of the market. Parkland sought to maintain flexibility to meet its needs over time.
Beyond the Walls of the Castle
Hospitals and universities are beginning to rethink their role in the quality of their neighborhood. This concept can be traced back to Johns Hopkins University. In their desire to become the best medical school on the planet, surveyed prospective faculty and students asking what they were looking for in a potential employer or place of study. With their hypothesis that the responses would revolve around improved facilities, what was inside the walls, they were surprised to learn that the majority of responses focused on safe, walkable, urban neighborhoods with a variety of amenities and living options nearby.
In the Dallas/Fort Worth metroplex, the private market was the first to realize this opportunity, at large developments such as Midtown Park near Presbyterian Hospital and CityVille on the south side of Medical District Drive near Parkland. The developer at the time, John Allums, said his company noticed that “there were also 25,000+ jobs that were recession-resistant in the medical district and a severe lack of housing and retail services nearby.”
The challenge of many of these projects was getting close enough to those hospitals to effectively capture the market. Many hospitals lock up as much land as possible around their campuses to accommodate potential expansion. They fill this land with surface parking as a temporary, transitional use. For the institutions, it makes good business sense to invest or partner in the development around their immediate core campus, bringing increased safety and amenity and impacting retention of employees, doctors, and staff which can be very competitive in the health care industry.
The work at Johns Hopkins and shifting preferences of demographics have led to a new understanding of the word “campus,” from a suburban to a more urban or contextual form of design and development that is appropriate of its place.
Building an extension to the community around one patient
One of the core concepts behind the design of the new Parkland was that the individual patient’s experience should drive the entire design, from the individual patient room to the arrival experience. Because the four hospitals had become one, this meant necessary adjustments to the masterplan and site layout for the hospital.
The scheme that moved forward to become the approved design was initially entitled “connections.” It canted the massing of the hospital at an angle to the contextual street grid to account for sun angles and ,perhaps more importantly, for the facilities to better relate to their sister institutions across Harry Hines at the University of Texas Southwestern Medical Center. Furthermore, the turning of the building forms allowed designers to segregate traffic by walk-ins, ambulance, and emergency entrances. The increased prominence of the emergency entrance was necessary. In the existing facility, 85% of foot traffic first comes through the E.R., so it is imperative that the entry point be highly intuitive and easily accessible.
The new plan maintained a central open space feature, which was no longer publicly accessible because of security concerns and a new diagonal entry boulevard. In comparison to the existing Parkland, it was no longer about greening up leftover, vestigial spaces around the edge (where there is actually quite a bit of acreage that it is undefined and purposeless) except to make rather harsh buildings tolerable. As designer Tom Trenolone of HDR said, “They wanted to put the ‘park’ back in Parkland,” recalling the original Parkland or Parkland 1.0. The new plan expressed a desire to change that and to have programmed public space that is well defined and comfortable to use.
The idea of restoring the “park” to Parkland did not end outside the walls but also found its way onto the walls. Early in the design process, team members recognized that the presence and experience of natural processes, such as seasons, helps in the restorative healing process. As a result, the landscape began to inform the design of the building.
Shading of both the public spaces and the internal spaces was important to the designers. The concepts married in the skinning of the four-story base with a fritted glass print where trees in seasonal states of foliage wrap around the building. The summer trees, those providing the most shade for the internal spaces, are situated on the side receiving the most direct sunlight. This then wraps around to the side with the least, which represents winter. This became the pattern language throughout.
Exhausting every imaginable façade material through the design process, the design team decided upon a contextual solution: that the design had to be of its place and in Dallas, which meant a glass tower. This allowed the design of the huge mass to appear lighter, mitigating the scale to reflect Texas’ big, blue sky. The curtain wall was created with a four-way silicone system allowing it to be installed from the inside.
Open Space Features
The large scale of the building presents challenges, particularly when creating healing gardens with contemplative space. But as landscape architect Christie Ten Eyck of Ten Eyck landscape architects described, “The master plan for Parkland allowed green space to be interwoven throughout every building. We have the room to create level changes and different spaces with places for social interaction or contemplation surrounded by restorative native gardens. When you take an average-sized person and allow him/her to explore accessible paths that pass under groves of trees and into different spaces with a bit of mystery, the buildings don't make nearly the impact on the individual as the detailed human scale of the gardens and spaces within.”
From an urban design perspective, the central open space feature will be activated through direct access from the main cafeteria, spilling out to ground floor retail space.
The high-performance landscape is expect edto eliminate 50% of the water usage. This will be achieved by using drip, in-line irrigation systems with injected fertilization, and only adapted, drought-tolerant vegetation.
Teamwork has been the most impressive feature of the Parkland Hospital design project. It might seem superfluous to hire a consultant strictly focused on teamwork and collaboration, but in this case it has paid off by eliminating the finger pointing that often accompanies projects of this scale and with this many moving parts. Each team member was asked to buy-in to a covenant when starting the project that Parkland, and the Dallas County public that supported it, come first. That commitment shows, not just in the care and passion inherent in the design but also when listening to each of the team members talk about their roles.
There is little doubt that internal innovations, derived through the creative design process, will make for a world-class hospital. However, whether or not the Medical District succeeds as a place beyond its specific function remains to be seen. The new masterplan is still internalized to some extent and that may be a necessity. The organizational open spaces lack the strength of an individual hierarchy of space that is evident in the hospital’s internal layout and organization. Instead, they compete as the central feature. With the hospital as the demand driver that it is, the vitality created through high quality, walkable urbanism will ultimately be determined by future expansion and by partnerships with auxiliary facilities and potential mixed-use development.
Patrick Kennedy is an urban designer and partner in the design firm Space Between Design Studio, LLC.