FEATURE ARTICLE, AUGUST 2008

HEALTHCARE EMBRACES ‘CHANGE DESIGN’
Charleston’s newest medical development, Ashley River Tower, serves as a case study in the latest design trend.
Timothy Johnson & Joan Saba

Healthcare design requires a nimble, flexible approach with an eye turned toward the future. Propelled by relentless advances in medical research, technology and methodology, some of 2008’s most favored clinical styles and configurations will soon be passé.

Healthcare design practices that focus on large and complex academic medical institutions situated in vibrant urban settings must include the capacity to change or those projects will be constrained to follow emerging clinical practices and markets, becoming outdated even before they are built.

Today’s healthcare designer must successfully incorporate adaptability in the institution’s blueprint. It usually takes from 5 to 7 years to build a modern healthcare complex, further adding challenges to the design. Academic medical centers also typically face ongoing pressure to maximize revenue by leveraging as much value as possible from each square inch of available space. This makes it paramount to design effective high-performing spaces both for today and tomorrow.

Increasingly around the architecture and design world — both in healthcare and across the board — the most promising answer lies in the principles and practice of change design. The term, which is intended to stand in contrast to traditional form-driven design, refers to developing buildings and environments that are performance-driven, humanistic and sustainable.

The progression from form-focused to change-focused architecture has been described as a quiet revolution transforming the design professions in recent years. Change design adherents believe that innovation is critical to competitiveness and growth, and that design itself is critical to innovation.

Traditionally, designers focused on form, underserving their clients by failing to integrate design with business performance. Change design unites business and institutional leaders with designers. Together, through a co-creation design process, they leverage the power of design to build transformative, effective and competitive organizations.  Learning from each team member’s strengths and experiences is the key to today’s design process.

One way healthcare designers help clients think through these issues is by dividing the facility’s components into two basic categories. First, there is space that cannot change as time passes, such as stairways, elevators, mechanical shafts and utility areas. There is also space that must change as time passes, such as waiting rooms, treatment areas and procedure rooms.

Ashley River Tower is part of a multi-phase hospital expansion.

Our firm’s New York City studio has recently been privileged to work in partnership with the Medical University of South Carolina to create the newly opened, $275 million Ashley River Tower in Charleston. The complex was built to replace a facility that had served as a teaching hospital for 50 years, marking the first step in a multi-phase hospital replacement and expansion plan.

Ashley River Tower consists of a four-story, high-tech, state-of-the-art diagnostic and treatment building, a seven-story patient hospitality bed tower and a garden conservatory atrium connecting the two buildings. The technology building and hospitality tower were purposefully separated to allow the former freedom from the columns and shafts that inpatient towers necessitate. This was a key move in the overall concept of the building  that made the building’s design not only more flexible over time, but also saved substantially on construction costs. 

The 641,000-square-foot facility focuses on heart and vascular diseases as well as digestive diseases. It has 156 beds, including 32 ICU beds, nine operating rooms, catheterization laboratories, interventional radiology laboratories, state-of-the-art endoscopy suites, imaging suites, outpatient clinic space and a dedicated, around-the-clock chest pain center for rapid diagnosis and treatment.

When it made the decision to build a health complex along change design principles, MUSC enhanced its image within the Charleston complex. The hospital is distinguished by a gently curved curtain of glass that evokes a billowy sail. Ashley River Tower won praise from Charleston’s architectural review board, which is well known for its critical eye and fierce protection of the city’s storied skyline. In fact, driving into town from the airport, one can see MUSC-boosting billboards featuring the curved, sail-like image.

In the true spirit of change design, flexibility of space and the recognition that future needs and technology would change were key design elements. For example, Ashley River Tower’s clinical spaces are standardized for increased operational efficiencies and are able to adapt to future needs. In the operating room, most equipment is suspended from booms in the ceiling rather than taking up space on the floor, making it easier for equipment to be replaced. All patient rooms can easily be converted to house additional ICU beds.

“Even with the best planning in the world, we don’t know what the future will bring,” says Fred Crawford, MUSC’s chief of cardiothoracic surgery. “What a cath lab is today might need to be used to house a CT scanner tomorrow. The hospital is being built so things can be moved around very flexibly without disrupting the rest of the hospital.”

As an academic medical center, MUSC particularly needed to be able to steadily adapt to medical advancements. Such centers are hotbeds of new discovery and ideas that must support up-to-the minute research and technologies. MUSC offers this technological flexibility, which is key to attracting and retaining top doctors and researchers. Each operating suite has multiple flat-screen monitors that allow surgeons to view surgical images with ease. Anything on the patient’s electronic record — whether it is an image from a catheterization, lab results or an echocardiogram — can be brought up on a monitor in the operating room with the touch of a button. The hospital is one of the first in the United States to have this capability in the operating room.

On the patient-facing front, MUSC took many steps to focus Ashley River Tower on the patient experience by delivering care in a comforting environment. Patients enjoy amenities to reduce the stress and anxiety of hospitalization, such as private rooms with family day space, wireless Internet access and family lounges on each floor. Every major public circulation route is ended by access to natural light, which allows patients and family to quickly get oriented to their surroundings. Access to the natural environment is also provided in a garden conservatory that offers a place of respite that healthcare providers agree is necessary in healing environments.

Change design enables architects and medical institutions to create massive complexes nimble enough to take advantage of future advancements and best practices for many decades.  Such centers will be well positioned to attract and retain professionals — and attract new clients — for the long run by providing effective therapies and delivering first-rate care. 

Furthermore, this design strategy maximizes the cost-effectiveness of healthcare capital investments by ensuring that medical facilities remain productive and relevant over their full life span.

©2008 France Publications, Inc. Duplication or reproduction of this article not permitted without authorization from France Publications, Inc. For information on reprints of this article contact Barbara Sherer at (630) 554-6054.