A common problem we face as Architects/Designers is creating an iconic element of entry for existing structures that have evolved through many reiterations void of such foresight. Existing hospitals, one of our biggest challenges, are what I would consider as Nonlinear Technologically-driven Organisms. They are extraordinary structures that grow along the landscape with no regard to exterior identity. At best, we salvage some sort of navigational infrastructure with respect to their massive footprints with way-finding signage using colored walls and directional arrows.

When I visit a friend in the hospital, I’m faced with small anxiety attacks just finding the “main entry” due to my terrible sense of direction. Not to mention navigating through 500,000 s.f. of corridors.

Existing structure is a composite of 1,2 and 3 story structures that are intertwined together, a function of technologies and budgets perhaps. During the history of additions existing entry has shifted from main circulation axis providing less than adequate drop-off area for patients. Site is fairly flat with respect to building frontage and main drive. This makes it more difficult to see main entry when approaching.

Program encompasses a main entry and axial realignment with respect to “Main Street” with welcome/information area. Adjacent to “Main Lobby”, a cafeteria, lounging and elevator core would be added as well. Extents of how proposed structure would connect to existing facility is limited due to required access to vertical core critical ventilation shafts and MRI auxiliary repair bay along the left face of existing structure (when viewing form front). The new addition would be in three parts: 1.)Main two story lobby and drop-off. 2.)Cafeteria and 3.)Lounging area.

The solution was to address program needs within a budget, phase additions as noted with minimal sacrificial construction (during parts 2 and 3), create a iconic element for drive approach at main entry and establish a baseline for campus design to evolve from.

Image 01
Following image shows existing facility to mid 1990’s (prior to latest addition). Blue indicates where proposed addition will be located. Red indicates mid 1990’s addition with axis shift.

Note addition offsets “main street’ axis with respect to circulation core. Note small overhang for patient drop-off.

Proposed Scheme "A" showing new entry and program. My approach was to bring as much light into building and establish a tall element that could be viewed from great distances and even described over the phone as a way-finding element. Use of horizontal elements with broken faces assisted in the massive scale of existing structure.

Close-up of proposed addition massing study.

Close-up of entry/drop-off massing study.

Scheme "B" – showing a second approach with barrel vaulted roof structure. Main entry has been realigned with existing building core axis. This particular scheme sports a exterior landscape feature that supports the new addition creating a pedestrian plaza. I favor this because it’s inclusive of site alignment. Again, the intent is to create a strong identity at main entry. The client wanted a fairly sizable drop-off. Large vertical element could be accented with light and client’s logo. Attempting to create a “way-finding” element that can be seen from major streets fronting the hospital.

Scheme "B" – rendered for client proof.

Scheme "B" – Another rendered for client proof.

Scheme "C" - A derivative from Scheme "B", this was done be another colleague in attempt to respond to preliminary pricing exercise by General Contractor. Once again, budget drives the pencil that draws.

To be honest...I like more scheme A.... blendes better with existing building...and doesn´t show off as scheme B, (It seems a mall add on)...

PB,

Funny, I drove by one of Altanta's mega-malls and saw a few elements that bridge your comment with Scheme "B". I'm working out the axis issue with first scheme and expanding level of detail. Good insight. It's good to have a second pair of eyes.

I actually prefer scheme b. Scheme a to me seems to be too small...but pedro's comment is something to be careful of I suppose.

I think your presentation is great - well done. :cheers:

Healthcare facilities are now being labeled under the "hospitality" group, being made to look more like hotels. Entrance lobbies have become more and more almost a small commercial mall in many newer facilities, with several stores like flower shops, banks, clothing and others. It would make sense if it looks like something between a shopping mall and a hotel. Anyway it's better that looking like a cemetery, marble is out.

Hospitals are complex ever changing systems. New diagnostic equipment comes out every few months, labs, pharmacies are changing to be more industrial type automated etc...

Have you considered at least in general terms a plan for future expansion? As you say, it has happened before that they have made short term decisions that have been affected by the need of expansion. Maybe you are only being tasked this specific work, but the question should be asked.

I prefer option A but with the scale of B, that is, the addition matches the height of the existing building.

I prefer A because of the angle of approach and simplicity of the solution. Not saying it wasn't complex, but it seems to me to be a less obtrusive transition to the existing facility facade wise. The other schemes are also well done, but A seems to be my overall visual favorite.

I actually think A looks good, but it is obtrusive, just as Primo pointed out...it doesn't interact with the existing building as you have shown it. B seems the most "iconic", as you allude to this topic. I would ask how it can be more iconic than just being symbolic of a grand entry. How can you embellish it more to make it substantially iconic or find uniqueness in a proposal that has been viewed as being similar to a mall entry? I find the conversation about Rem Koolhaas's favorite topic (shopping) interesting...

Forgot to say, also Scheme A, but with a new canopy design.

Healthcare facilities are now being labeled under the "hospitality" group, being made to look more like hotels



Franjayo,

Very insightful. You go to a bookstore and they’ve partnered up with a coffee shop. Venture into a Grocery store these days and you see a full-blown bank with tellers. I truly believe the word “hospital” has shifted in meaning over the past decade. Just the word “hospital” brings back memories of booster shots with needles 15 cm long. The world doesn’t won’t to face becoming older so we’ve rebranded “hospitals” to “Wellness Centers”. Seems to take the sting out of visiting your doctor. Some of our smaller satellite care units resemble health clubs. Present fundamental programming for these facilities requires amenities for both patient and family.

When we’re faced with both existing and new, we do master plans. This is quite difficult to adhere to because Hospitals evaluate what portions of care-program generates the most revenue and adapts/expands accordingly. If a particular facility has a noteworthy trauma unit and a good portion of ambulances pull up to their front door, chances are they’ll allocate a good portion of the fiscal building development budget for expanding trauma suites. Shifting priorities would most likely affect master plan. It’s a continuous moving target.

Then you’re dealing with progressive technology. Very seldom do we ever have a chance to create a fully functioning hospital. Hard-cost for medical equipment alone ranging from simple outpatient care, surgical suites, emergency rooms and intensive care units would reach double digit millions. Hospitals are constantly evaluating isolated programming. Facility directors have to be very frugal with financial resources. This all translates back into limited scope. We do the best we can and hope that any addition preformed has added value to both patient and program. After all, I much rather pull up to a nice covered entry and feel like there’s hope.

I do appreciate the comments.

reurbanize

After seeing the images, I come back with the feeling that you strongly prefer Alternate "B", as it's been given care and considerably more time, yet spatially Alternate "A" feels broader, lighter and somewhat ethereal. The fenestration seems sketchy, yet there is little structure in this almost completely glazed space.

As Jayo ( whom by the way has an enormous amount of hands on experience in the management and design of healthcare facilities )mentioned, I feel that the canopy does not do justice to the possibilities of scheme 'A', personally I would prefer to see it much more directional, reinforcing the axis the entrance itself creates.

I agree with the idea of enhancing a sense of competence, of knowledgeable skills and curative capabilities, these are perceptions, and perception is everything in a therapeutic environment. It should 'feel' busy, active, ongoing. Compare this with small, cold, dank, stifling dark spaces, with green or grey surfaces, and an antiseptic smell.

As you, I would place my vote wholeheartedly with hope.

Saludos

Juan

Thank you Reurbanize and Juan for enhancing the positive in us. Juan has the sensitivity to see beyond most of us and help us understand ourselves better.

I can tell Reurbanize has a lot of real experience in the fields of healthcare and planning. I understand the reality you are talking about, sorry if my frustration is noticeable.

The only sure thing in a Master Plan is that it will change. The more specific plans have a very short lifespan. A general block plan that helps set goals and establish concepts for areas that could be used for future development has a better chance for extended value.

The scope of your project however, calls my attention in terms of scope. This is not only an entrance and a canopy. You are shifting the major horizontal circulation of the building, we do not even know about the vertical circulation. One of the most complex systems in a hospital is material handling. This includes movement of different types of clean supplies, general supplies, specialized medical supplies, dietetic carts, pharmacy carts etc... Soiled is also classified in a series of systems. Your project includes a cafeteria for example, which also has special service area. I guess the small roads entrance is for such service.

Anyway, my point is that the changes in your project have a substantial impact in the overall building operations. The impact of planning is not very well understood by the decision makers. These administrators believe they are being frugal and saving time and money by making quick decisions that cost a lot. Truth is that they do not want to hear it, and as an architect you are probably much better if you just do as told, you may have the chance to rebuild the entrance a little further out with another project in a few more years.

The best we can hope is that everyone is happy.

I like very much your 'A' but deserves, in my opinion, a simplier horizontal roof.

This project from the TVS architects site reminds me of your project.