Sunday, July 27, 2008

Edifice Complex

I toured the new Sacred Heart Medical Center at RiverBend campus last weekend. The facility is huge and features the latest in healthcare technology, spacious patient rooms, and an attractive park-like setting along the banks of the McKenzie River in north Springfield. It will no doubt provide the region with access to superlative medical care for many years to come. Nevertheless, the project fell short of my expectations. Despite PeaceHealth’s investment of $567 million and the best efforts of its design team (led by the Seattle office of Anshen + Allen), I left with the impression that the new hospital should be devalued because of what I characterize as lost opportunities.

The most significant of these lost opportunities has been thoroughly debated since PeaceHealth first announced its intention to develop a new state-of-the-art medical campus: its location. As many have already argued, the siting of the project is at odds with compact growth strategies, located as it is on the outskirts of the urban area rather than at its core. Developers are inevitably following PeaceHealth by choosing to build related facilities near RiverBend. In addition, the Lane Transit District is finalizing plans for its EmX bus rapid transit line extension to RiverBend and the Gateway area of Springfield. Ultimately, this will spur “nodal development,” wherein there arises a concentration (as planned or otherwise) of housing and employment centered around RiverBend, all supported by good public transit service. Unfortunately, this significant investment and development of infrastructure at the fringe of the urban growth boundary is occurring at a time when the downtowns of both Eugene and Springfield are desperately seeking to attract money, jobs, and residents to ensure their continued vitality and relevance as the historic centers of the communities. RiverBend is symptomatic of the longstanding trend towards urban dispersal that is at odds with the cities’ attempts to reinvigorate their downtowns.

The second lost opportunity was the potential to develop the new project in a way that would fundamentally alter and improve upon the prevailing hospital paradigm. The guiding principles for facilities development adopted by PeaceHealth’s board of directors in 2000 laid the foundation for how RiverBend has been realized. There is an emphasis in those principles upon long-term optimization of the site; future expansion; facility flexibility; and the collection of diagnostic, treatment, and therapy services under one roof. Undoubtedly, this model has proven to be the most efficient and cost-effective; hence, its perpetuation in new hospital projects around the globe. The problem is that the talent and skills of the best healthcare architects and planners cannot overcome the fact that large, regional medical centers like RiverBend are overwhelming, intimidating, and just plain big. The bottom line is that the new hospital does not represent a significant rethinking about how facilities for healthcare should be developed or indeed about how healthcare is best delivered.

Typical patient room (photo by Bruce Forster)

PeaceHealth stresses the importance of another of its guiding principles upon the design of the RiverBend campus. The notion of a “healing environment” was used in part to justify the selection of the outlying river’s edge site. A healing environment is easy to work in, nurturing, and designed to reduce the stress of illness and care for the patient, family, staff, and visitors. In many respects, the administrative strategies and design of the new hospital have produced facilities that do adhere to this principle. For example, all of the patient rooms are private, large, and comfortable, and many feature scenic views. All are attractively furnished and have in-room sleeping accommodations for family members who wish to be with their loved ones as much as possible.

Main Lobby

The desire for a healing environment also prompted the national park lodge aesthetic, which presents an architectural vocabulary that is familiar, visually appealing, and intentionally nonthreatening in its connotations. I have no quarrel with the use of such a vocabulary for a hospital: the relaxed asymmetry of the buildings; the use of warm, human-scaled brick, stone, and wood; and the clearly identifiable entries all serve to mitigate the massiveness of the complex. A large regional hospital isn’t the kind of project that lends itself to explorations on the fringes of current architectural theory. Again, the issue for me is that the functional paradigm has not been challenged. Underneath the faux-rustic Arts & Crafts veneer, there is a byzantine maze of corridors typical of many large hospitals, arrayed across eight floors and connecting countless departments, specialty clinics, and institutes. This is the case regardless of the fact that another of PeaceHealth’s guiding principles was clarity of circulation. I simply do not believe that this principle was put into practice successfully. The hospital would have been well-served by providing more effective way-finding cues, perhaps through the introduction of more frequent views to the exterior for orientation along primary circulation spines. The multistory main lobby, which has been the target of some criticism for its ski-lodge ambience and large size, may actually be smaller than necessary to serve as the center of gravity for the vast medical center.

Bemoaning these lost opportunities now is, of course, no more likely to make a difference than crying over spilled milk. The Eugene Weekly argues that the lesson to be learned is that Eugene should welcome a more modest, compact, and community-centered hospital downtown. Community Health Systems (CHS) has yet to select a site for McKenzie Willamette Hospital's relocation, so perhaps RiverBend’s placement by PeaceHealth at the northern edge of Springfield will prompt CHS to construct its new McKenzie Willamette in Eugene’s core. We shall see. At an estimated cost of $234 million, CHS proposes a much smaller facility than Sacred Heart Medical Center at RiverBend. Nevertheless, it would still be a very large hospital that conforms to the prevailing paradigm. It is reasonable to ask whether our metropolitan area really needs two enormously expensive full-service medical centers. The paradigm shift – the rethinking about how healthcare might best be delivered – may actually favor a greatly increased emphasis upon wellness and preventive medicine rather than critical care and the treatment of sicknesses. The mechanism for this paradigm shift would be a network of distributed, smaller, and relatively inexpensive health and wellness centers(1), as opposed to hospitals. The overall cost of medical care would theoretically be reduced if people were encouraged and could afford to maintain a healthy lifestyle. Unfortunately, our current medical system is antithetical to a healthcare delivery model based upon prevention and wellness; consequently, healthcare costs continue to rise and developments like RiverBend are considered a necessity.

(1) The 89,000 s.f. Wellspring Medical Center in Woodburn, Oregon (designed by Clark/Kjos Architects) is an example of a health and wellness center. The owner - Silverton Hospital - refers to it as a "lifestyle center" that promotes physical fitness, healthy lifestyles, and preventive care through integrative medicine, a spa, fitness center, health education center, immediate care, physical therapy/rehabilitation, a health retail store (featuring provider-recommended supplements, etc.) , and a "fresh & healthy" bistro.


sam paul said...

Beautiful combination of function and design! Thanks for posting this. Sam Paul

Becky Thomas said...

I toured the maternity floor last night and was a little taken back by how spread out everything was and how overwhelming just that floor was. At one point we had taken what seemed like 3 right turns and were completely lost. User feedback will be very interesting down the road.