On the en­dan­gered list

Ar­chi­tec­tural his­tory can’t save some health fa­cil­i­ties

Modern Healthcare - - Construction Digest -

W hen the In­ter­na­tional Olympic Com­mit­tee chose Rio de Janeiro over Chicago and two other fi­nal­ists for the 2016 Sum­mer Olympics last Oc­to­ber, ar­chi­tec­ture preser­va­tion­ists in Chicago were among those who wel­comed the de­ci­sion. Many of them hoped that the de­ci­sion would spare eight build­ings on the for­mer Michael Reese Hos­pi­tal cam­pus from the wreck­ing ball, as the cam­pus was des­ig­nated as the site of the Olympic vil­lage.

Those build­ings were de­signed by Wal­ter Gropius, a Ger­man ar­chi­tect who is con­sid­ered one of the fa­thers of mod­ern ar­chi­tec­ture and a founder of the Bauhaus school. Gropius was in­volved with the ex­pan­sion of the Michael Reese cam­pus af­ter World War II, al­though he did not de­sign all of the build­ings on the cam­pus, ac­cord­ing to the Gropius in Chicago Coali­tion.

Yet, even af­ter the Olympic snub, the city of Chicago went ahead with plans to de­mol­ish most of the Reese struc­tures, and only two Gropius-de­signed build­ings re­main, ac­cord­ing to Grahm Balkany, the coali­tion’s di­rec­tor. One of them, the Singer Pavil­ion, at least has a chance to re­main, al­though it is to­tally at the city’s whim, Balkany wrote in an e-mail.

The con­stant, rapid change in health­care de­liv­ery has his­tor­i­cally led to con­stant turnover in hos­pi­tal build­ings, ar­chi­tects and plan­ners say. But en­vi­ron­men­tal con­sid­er­a­tions and a gen­eral de­sire to re­use build­ings is tilt­ing against that re­lent­less drive for the mod­ern.

Of­ten, new is bet­ter

David Sloane is di­rec­tor of un­der­grad­u­ate pro­grams for the School of Pol­icy, Plan­ning and Devel­op­ment at the Uni­ver­sity of South­ern Cal­i­for­nia in Los An­ge­les. He also co-wrote a book with his late wife, Bev­er­lie Co­nant Sloane, called Medicine Moves to the Mall, which in­cludes an es­say chart­ing how providers have pulled ser­vices out of hos­pi­tals and scat­tered them to a va­ri­ety of com­mu­ni­ty­based lo­ca­tions, in­clud­ing malls, Sloane says.

Most of the coun­try’s 19th cen­tury hos­pi­tals were de­mol­ished in the 1920s and 1930s as re­place­ments were built, Sloane says. The orig­i­nal hos­pi­tals were built on a char­ity model— fa­cil­i­ties run by churches, other benev­o­lent or­ga­ni­za­tions or govern­ment—but as the germ the­ory of dis­ease took hold, it changed the way care was de­liv­ered and drew in more mid­dle- class pa­tients, he says, and hos­pi­tal build­ings changed as a re­sult.

“For a va­ri­ety of pol­icy rea­sons and chang­ing med­i­cal-care rea­sons, older build­ings have been en­dan­gered. I agree with that, ac­tu­ally,” Sloane says. “It’s one of those re­al­i­ties that older build­ings are dif­fi­cult to adapt to new needs, so they do get to the point where they be­come med­i­cal of­fices or other pur­poses or torn down.”

Joe Sprague, se­nior vice pres­i­dent and di­rec­tor of health fa­cil­i­ties with HKS in Dal­las, says the hos­pi­tal con­struc­tion guide­lines from the Fa­cil­ity Guide­lines In­sti­tute change ev­ery four years, and 40 states use those guide­lines in their li­cens­ing re­quire­ments.

“The theme, at least in my mind, is that it’s good that they’re en­dan­gered, be­cause they can re­ally be pa­tient traps if they are pre­served,” Sprague says. Pa­tient pref­er­ence means that pri­vate rooms are an eco­nomic im­per­a­tive, he says, but pri­vate rooms also help with in­fec­tion con­trol.

Tom Har­vey, also a se­nior vice pres­i­dent with HKS in Dal­las, ac­knowl­edges that hos­pi­tal ar­chi­tects have more work to do in find­ing ways to pre­serve hos­pi­tal build­ings, per­haps for other uses. The very na­ture of hos­pi­tals, how­ever, makes it tricky to re­use them for other pur­poses.

“Hos­pi­tals are so cus­tom-de­signed around the in­dus­trial work­flow ac­tiv­ity that hap­pens in health­care,” Har­vey adds. “These build­ings are a lit­tle more con­strain­ing than ware­house lofts or things like that. It is not as easy to do that with hos­pi­tal build­ings, it seems, or there would be more of them.”

Ones to watch

An­n­marie Adams is a pro­fes­sor in the School of Ar­chi­tec­ture at McGill Uni­ver­sity in Mon­treal and author of Medicine by De­sign: The Ar­chi­tect and the Mod­ern Hos­pi­tal, 1893-1943. Adams is skep­ti­cal of work­ing ar­chi­tects who con­tend that hos­pi­tals can’t be re­pur­posed.

“Of course they’re go­ing to pro­mote new con­struc­tion. Have you ever seen cats when you’re open­ing a can of cat food?” Adams says. “I think many old hos­pi­tals have the po­ten­tial for new use. It’s never re­ally ex­plored.”

Richard Longstreth, an ar­chi­tect and di­rec­tor of the grad­u­ate pro­gram in his­toric preser­va­tion at Ge­orge Washington Uni­ver­sity in Washington, ac­knowl­edges that rapid change in health­care de­liv­ery tends to make hos­pi­tal build­ings ob­so­lete, at least for their orig­i­nal pur­pose. The idea of so-called adap­tive re­use, in which a build­ing is al­tered to make it fit for a pur­pose dif­fer­ent from its orig­i­nal use, has been around for about 40 years and is be­com­ing more wide­spread in plan­ning gen­er­ally, Longstreth says.

“Depart­ment stores have be­come of­fices. Of­fice build­ings have be­come ho­tels. Lofts have be­come res­i­dences. Gas sta­tions have be­come of­fices. Schools have be­come apart­ments or of­fices. There’s no end to the cre­ative re­use of build­ings in that way,” he says. “There’s gen­er­ally a mind­set that re­place­ment is the prefer­able course. When there’s the money to do that, that’s the route taken.”

One cost con­sid­er­a­tion that is start­ing to tip in fa­vor of re­use in­volves the en­ergy im­pli­ca­tions of tear­ing down an old build­ing, cart­ing away the de­bris and con­struct­ing a new one, a con­cept known as em­bod­ied en­ergy, Longstreth says. It rep­re­sents the en­ergy that went into con­struct­ing the build­ing and that would be ex­pended to de­mol­ish it and re­mov­ing its re­mains. Ac­count­ing for this, along with the en­ergy ex­pended to con­struct the new build­ing pro­vides a more re­al­is­tic as­sess­ment of the en­ergy ef­fi­ciency of new build­ings.

USC’s Sloane men­tions one ex­am­ple that bears watch­ing in his own back­yard: the fate of the old Gen­eral Hos­pi­tal at 676-bed LAC/Uni­ver­sity of South­ern Cal­i­for­nia Med­i­cal Cen­ter, Los An­ge­les. The new fa­cil­ity opened in 2008, and the old hos­pi­tal sits empty to­day, Sloane says. “They say they’re go­ing to re­po­si­tion it, readapt it, but we’re go­ing to see,” he says. The old hos­pi­tal is well-known from its use as the ex­te­rior back­drop for the long-run­ning soap

The orig­i­nal Pren­tice Women’s Hos­pi­tal in Chicago is on one group’s watch list.

Sprague: “They can re­ally be pa­tient traps if they are pre­served.”

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