The 10-story Sky Tower includes 84 emergency center treatment positions, of which 10 are trauma rooms, 35 operating rooms and 420 new private rooms. Perkins + Will, with offices in Dallas, designed the building to fit the needs of the growing community with an art-filled, patient-centered design.

Emphasis on Art

The design of the Sky Tower emphasized the integration of local and international art. In a community with a longstanding appreciation for the arts, the incorporation of art was a dual effort between the surrounding community and health system officials. The art installations in the Sky Tower is an important and visible part of the patient, visitor and staff experience, according to Steve Milner, LEED AP, senior medical planner with Perkins + Will.

“The spirit of the art program with this project and this client was to create a familiar and reassuring cultural response, creating a sense of place uniquely San Antonio by employing color, pattern, form and known cues, integrated with the architecture and the site,” Milner said.

Eight countries and 21 states are represented in the art program. However, the art program placed a large emphasis on local artists with the majority of artists being from the San Antonio area. All framers and installers were also local. Coupled with the inclusion of design enhancement, which Milner defines as development of narrative or lyrical ideas into the building and site, the art in the building is integrated into the construction process as a collaborative engagement between the architect, interior designer, artist and contractor, not simply an after fact measure, Milner said.

“When art and architecture meet, there are opportunities to go beyond the common expectations,” Milner said.

A Healing Atmosphere for Patients and Staff

The interior of the Sky Tower promotes a healing atmosphere with abundant daylight, gardens, lounges and extensive views.

“Several studies have linked healthy, sustainable environments as having positive effects on people in those spaces,” Milner said. “Patients have had very positive results in hospital rooms with access to views and daylight, and now research is being used to support improvements to staff environments for positive effects on staff.”

The design focuses on reducing as many stressors as possible not only for patients, but for staff as well, which is equally important to consider, as patient safety is dependent upon health care staff, Milner said. With the amount of intensity and concentration required of health care staff, the built environment must reflect a calming atmosphere.

“The project team is focused on creating a healing environment where anxiety and stress are reduced. Positive distraction will provide psychological relief for patients, visitors, and staff,” Milner said. “Employing active and passive design strategies —such as a quality sense of arrival, dedicated staff spaces, both indoor and outdoor, and additional support programs — help encourage staff well-being.”

Sustainable Focus

The building is currently pursuing LEED Gold certification, and with Perkins + Will’s sustainable health care design, the energy-efficient goals aligned with the sustainable integrity of Perkins + Will.

“We saw early on that the health system’s deep level of stewardship to create an environmentally responsible project was very much in alignment with long time missions of Perkins + Will,” Milner said. “UHS was extremely supportive of the sustainable design strategies, systems and technologies that addressed our common goals for the project.”

The building uses one-third less energy than required by code. Sustainable practices include recycled water for landscaping irrigation and rooftop gardens. The gardens contain vegetation and art program sculptures that, in addition to adding to aesthetics, help reduce the radiant heat of the site and reduce demand on the building’s cooling systems, Milner said. The project also maximized the use of local and regional materials.

“The 1 million-square-foot-plus project is a study in how innovative design can maximize resources to minimize environmental impact,” Milner said.

The construction management team for the project was a joint venture between locally based Zachry Construction Corporation, J.T. Vaughn Construction, with offices in San Antonio, and Salt Lake City-headquartered Layton Construction Co.

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"University of Missouri Health Care is proud that our patient care tower has achieved LEED Gold certification," said Mitch Wasden, chief executive officer and chief operating officer of MU Health Care, in a statement. "This recognition demonstrates our commitment to providing patient and family-centered care in a healing environment, as well as our dedication to our community by being good stewards of the environment."

The tower includes six operating rooms, 25 pre-procedure rooms, 18 post-procedure rooms, 90 private patient rooms with smart room technology, a 7,000-square-foot inpatient pharmacy with robotics to automatically dispense medications, an 1,800-square-foot lounge for families of surgery patients and a new facility for Ellis Fischel Cancer Center outpatient services.

The north-south orientation of the patient tower maximizes scenic views and connections to nature, providing views to Missouri farmland. Additionally, more than 100,000 square feet of roof gardens are located on the north and south sides of the building. The 3,150-square-foot Brown Family Healing Garden, specifically designed to reduce stress in patients and staff, is visible from all floors and serves as a crossroads between the new tower and the main hospital.

"Medical research has shown that patients benefit from a healing environment that provides a comfortable environment with natural light and a connection to nature," said Paul Dale, chief of surgical oncology at Ellis Fischel Cancer Center and medical director of Ellis Fischel, in a statement. "Our achieving LEED Gold certification is a testament to our efforts to provide our patients with a state-of-the-art facility that puts our patients at the center of everything we do."

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Los Angeles-based CO Architects is serving as architect and Hensel Phelps, headquartered in Greeley, Colo., is heading construction on the $900 million project. Built on a 19-acre site, the 565,000-square-foot facility will be a partial replacement for the San Diego Medical Center and provide the growing community with the health care space it needs. The project includes a 321-bed hospital, which will have the ability to expand by an additional 129 beds, a central plant, hospital support building and an expandable parking structure. All rooms at the hospital will be private.

The health care facility will include an emergency department, operating rooms, recovery spaces, pharmacies, a gourmet cafeteria, a laboratory and a blood bank, as well as support spaces such as administrative offices and conference rooms. To create a tranquil healing space for patients and visitors, a half-mile walking trail and a wrap-around healing garden will also be made available.

“Kaiser Permanente’s new central hospital will be a high-tech hospital of the future,” said Mary Ann Barnes, senior vice president and executive director for Kaiser Permanente San Diego, in a statement. “From green design to the latest technology, it will have all the tools to provide our members with the highest quality care in a beautiful, healing and nurturing environment.”

The new hospital will have several sustainable features and aim for LEED Gold certification. The facility will use solar panels on the campus’ parking garage, thermal insulation, chilled beams and LED light fixtures throughout to reduce energy demands. The facility will also employ rainwater utilization and waste recycling systems, and place focus on using locally produced materials for both construction and landscaping.

Technology that will be utilized at the hospital includes video conferencing, touch screens in patient rooms and surgical robots.

The project is aiming for a 2017 completion date.

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Located on the Tradition Center for Innovation Campus in Port St. Lucie, the new $110 million building includes emergency services, an intensive care unit, labor and delivery, neonatal intensive care unit, general and specialized surgery, inpatient oncology, diagnostic imaging, clinical research and gastrointestinal endoscopy. The facility was designed and built at a time when many health care systems were waiting out the recession and the uncertainty over the impact of national health care reform on medical reimbursement.

HKS Architects designed the approximately 200,000-sqaure-foot health care facility and Balfour Beatty Construction served as construction manager. Both firms hold regional offices in Orlando, Fla.

The center, which is expected to see 30,000 emergency department visits, 6,000 patient admissions and 1,500 births in its first year of operation, was designed with flexibility in mind. Traditional Medical Center has the ability to expand to 300 beds in order to meet future growth.

Strong Collaboration

The project team worked closely, using the Integrated Project Delivery (IPD) method to maximize efficiency. According to Roy Gunsolus, AIA, LEED AP BD+C, director of sustainable health care with HKS, the IPD method allowed for strong collaboration from the outset of the project.

Six “component teams” were established with a diverse set of players, Gunsolus said. The teams included site; exterior envelope/structural; interiors; MEP/sustainability; technology; and schedule/general conditions. Each team had members representing the owner, design team and construction team on the project, which brought about more informed decisions as well as unique perspectives.

“It intentionally varied in who was involved,” Gunsolus said. “Regardless of whether somebody was the stereotypical leader of that group or just loosely allied, everyone had an equal voice.”

The IPD method also allowed the team to design the project to budget rather than design and price later only to be over budget and require redesign, Gunsolus said.

BIM Technology

The project used BIM modeling and Constructware software to further foster collaboration across the project team. By using BIM technology, Gunsolus said, the contractor was able to view models and make comments or identify potential construction issues before decisions were made.

The team also took on a sort of lean methodology to the BIM process. Architects and engineers can end up drawing the same thing twice, Gunsolus explained.

“We tried to have people take ownership and do everything once,” he said. “We discussed as a group who would be the logical person to implement whatever feature it was into the model.”

For example, lighting fixtures would be a responsibility dedicated to the electrical engineer with guidelines given by the project team.

Sustainable Goals

The project team, which is seeking LEED Gold certification for Tradition Medical Center, made sustainability goals clear from the outset. The team began with a sustainability workshop.

“We talked about the advantages of being sustainable and why it made sense to do this not only from a cost savings standpoint, but also from more of an intangibles perspective, such as patients healing quicker when they have connections to nature,” Gunsolus said.

The acute care hospital, which overlooks a large retention pond, used connections to nature and natural light as an overarching design driver. In addition to typical public spaces such as the main lobby, dining and waiting areas, daylighting was also used via high windows in uncommon areas such as the receiving area, pharmacy, lab and the kitchen.

Approximately 83 percent of construction waste was diverted from the landfill. Additional green features included a heat recovery chiller, LED lighting and a reflective roof. The siting of the building, which also provides connectivity to a medical office building developed in collaboration with Mann Research, also created energy-efficiency opportunities.

“The natural inclination might have been to site the building in the middle of the site to maximize proximate parking,” Gunsolus said. “The project team considered a variety of factors and ultimately located the building more proximate to the retention pond to maximize patient views while minimizing eastern and western exposures to maximize energy efficiency. This location reinforced the overall master plan, which was developed to allow for future ambulatory services and structured parking while separating public and service traffic.”

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The seven-story research building, which broke ground in July 2011 and opened in June 2013, was designed by Perkins+Will’s Seattle office and constructed by locally based Sellen Construction. The $164 million building will accommodate approximately 400 researchers focused on finding cures for diseases in five major areas: immunology, rheumotology, kidney research, infectious diseases and vision science.

An undulating exterior glass curtain wall faces a beautiful shared courtyard, which will be at the center of several UW medicine buildings. The courtyard features several plants and water features to reduce urban heat island effect and a cistern to capture and store rainwater to irrigate the courtyard’s landscape. Designers hope the attractive outdoor space will encourage interdisciplinary collaboration among researchers.

“Interaction and collaboration is key for the university and the researchers, so we wanted this to be a place that people would want to go, especially in the warmer months in Seattle,” said Andy Clinch, project designer with Perkins+Will. “It’s the center and the heart because all these buildings will face inward toward this courtyard.”

The courtyard, along with the transparent building, also intends to create a deeper connection between the building and the surrounding neighborhood. Passersby in the tech neighborhood will be able to see what is happening inside the building and enjoy the striking architectural elements of the project.

“We wanted to do something very special, dynamic and unique for that courtyard for not only the UW students and people who use the courtyard, but also for pedestrians who walk by,” Clinch said.

The transparent nature of the building also creates more visibility for researchers.

“From a transparency standpoint, research buildings tend to not have a lot of glazing or transparency,” said Tony Gainopoulos, managing principal with Perkins+Will. “From the ribbon wall to the other side of the building, this is a very transparent building, which allows users who work in their cubicles or lab spaces to have outside awareness and have light brought in.”

In research facilities, Clinch said, it’s all about energy conservation. Lab technologies are heavy energy consumers and lab space requires a lot of conditioned air, which creates a huge impact on the mechanical system.

To counter the large need for air conditioning, designers pulled the private offices out from the labs so offices would not require a heavy level of air conditioning. This was also a benefit because offices on the perimeter can now enjoy operable windows and natural light.

Other energy-efficient features in the building include chilled beams, heat recovery chiller, high-efficiency boilers, exhaust air energy recovery and improved lighting controls.

With two more phases to be completed in the UW research complex, Phase 3.1 has opened new doors for green design, Cinch said.

“We also help the university and push them outside their comfort level or what they’re used to doing,” Clinch said. “We bring them along to newer or better ways [of design].”

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With plans to spend about $30 billion in construction over the next 10 years, Kaiser Permanente estimates that the LEED Gold commitment will affect 15 million square feet of real estate or more than 100 buildings. HealthCare Construction + Operations News speaks with Kaiser Permanente’s Chief Energy Officer Rame Hemstreet about the LEED Gold commitment and what it means for the organization, as well as the health care industry as a whole.

Q: What are the key benefits for Kaiser Permanente when it comes to deciding to build LEED Gold?

Hemstreet: It was a natural progression for us. We’ve been a leader in sustainable design and construction for a while and even helped write the Green Guide for Health Care [prior to the new LEED for Health Care or LEED-HC rating system]. We thought we’d demonstrate that if you took sustainability into account from the initial phases of the project that you can build a sustainable facility with little or no additional costs and reap long-term benefits. There is a health component to sustainable design that will assist us in our mission of health care and also make the building more productive for the people that work there.

Q: What do you think about the LEED-HC standard and are you looking to reach those requirements as well?

Hemstreet: For our hospitals and large ambulatory service centers, yes. Of course, we also build a lot of medical office buildings, and we think for that LEED for New Construction would be more appropriate. LEED Gold will apply to all new footprint over $10 million, but whether it’s it LEED-HC or LEED for New Construction will depend on its purpose.

Q: Are you actually seeking LEED certification for each project or just building them to those standards?

Hemstreet: Certification. I feel that “certifiable” is like saying I can run the 100-yard dash in 10 seconds, but I’ve never actually timed myself.

Q: How has the building of the Westside Medical Center influenced your decision to build LEED Gold?

Hemstreet: Westside was proof of the concept that we could do it. We tried to define the costs attributed to LEED certification and it was less than 1 percent of the total costs; those attributes would actually have a hard economic payback five times that over the life of the building. Then, there are the noneconomic benefits or difficult-to-quantify economic benefits, such as increased productivity and an enhanced healing environment. There’s also a brand aspect; obviously, having a LEED Gold plaque enhances the brand and long-term value of that building.

Q: How do you think Kaiser Permanente’s commitment to building green will affect the overall health care construction industry?

Hemstreet: Already, we’re not alone. The last count we had was that there are 28 hospitals across the country that have met LEED Gold/Platinum. As one of the largest real estate owners in the health care industry, this will enhance that trend and perhaps accelerate that trend, but it’s occurring regardless. Across the industry, we’re recognizing the hard and soft benefits of sustainable construction.

Q: What has the community’s reaction to the commitment been, and how do you think it will affect the health care industry as a whole?

Hemstreet: The reaction of the community is very positive. That was one of the drivers for Westside being the LEED Gold pilot because the local community is very supportive. Increasingly communities are demanding it. As far as the health care industry, I hope we can demonstrate to our members that are cared for at our hospitals that a high-performing building can reduce the hospital stay time of members. There’s anecdotal evidence along those lines, but I think as we develop an inventory of these high-performing buildings, we can demonstrate the health care and productivity improvements that they provide us.

Q: What Kaiser Permanente projects are currently in the works?

Hemstreet: We have a number [of projects] in design (and some that are actually starting construction) that are targeted for LEED Gold — about half a dozen actually. There were some other buildings underway prior to our policy that will not necessarily reach that goal but will be LEED Silver opening over the next year to 18 months. Following that, over the next decade, there will be up to 100 LEED Gold buildings.

Q: What do you think this commitment means for the future of Kaiser?

Hemstreet: I think it means the built environment will contribute to high quality affordable health care for members. I’m convinced that the built environment is one aspect of health care that occurs within those four walls and a ceiling and that sustainable design can also help make us more affordable by reducing long-term operating costs. We made a commitment to a 35 percent greenhouse reduction goal by 2020 compared to our 2008 baseline. That’s not relative to our size considering we’ll be growing our footprint in the course of those 12 years, so the reduction will be greater than that. In the short term, the more important aspect is reducing energy demand in our existing buildings and finding renewable on-site and off-site sources of energy. In the longer term, the more sustainable and the more energy efficient we construct our new buildings and the more on-site renewals we incorporate into those new buildings, the smaller our carbon footprint will be.

It is our expectation that our design and partners and consultants will help us get to LEED Gold with no additional first costs. We think this should be the standard in the building industry, and not something we pay a premium for.
 

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