On the endangered list
Architectural history can’t save some health facilities
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.”