"Designing for Health" is a monthly, web-exclusive series from the healthcare interior design leaders at Perkins+Will that focuses on the issues, trends, challenges, and research involved in crafting today's healing environments.
On the Boston waterfront, within the Historic Charlestown Navy Yard, the new state-of-the-art, eight-story Spaulding Rehabilitation Hospital is emerging. Affiliated with Partners HealthCare and Harvard Medical School, this innovative building is a unique merging of program and place to create a high performance hospital that is civic, humane, and sustainable.
Spaulding is a model for healthcare as civic architecture. The hospital, located on a constricted promontory site at the junction of Boston Harbor and Little Mystic Channel, actively engages the local community, both through participating in the revitalization efforts within the Charlestown Navy Yard and by providing amenities that can be utilized by the occupants of Spaulding as well as the local community. The Boston Redevelopment Authority imposed strict development conditions that Spaulding realized would completely dovetail with its mission to rehabilitate adults and children in a non-institutional, inspirational, and normalized setting. Harbor view corridors and pedestrian access from the adjacent streets are maintained, while 50 percent of the site area and 75 percent of the ground floor are publicly accessible functions. The city HarborWalk crosses the site at the water edge.
“The design of the building and site reflects Spaulding’s mission to provide world-class holistic patient care, conduct innovative research and teaching, and improve quality of life for people with disabilities and their families,” states David E. Storto, Spaulding’s President and CEO. The project incorporates sustainable and universal design principles to realize a facility that is utilized as a therapeutic tool and one that can measure the progress and achievements of a patient within an environment that is boundless. These principles “act as a transitional place for patients to build their confidence and independence in preparation to rejoin the broader community,” according to Storto.
The 228,300-square-foot building is organized on a three-level pedestal containing public amenities and outpatient clinics, clinical research, an inpatient gym, and two accessible roof terraces with views to the harbor. The balance of the building is the 132-bed inpatient tower, planned by sub-specialties. The relatively narrow floorplate maximizes openness and transparency to capture natural daylight and dynamic views of the city to inspire and orient patients to the building, their place in the community, and the environment.
A human-centered patient experience—centered on restoration and health—is a key design driver. The average length of stay for a patient is 20 days. The facility becomes a medical home, where both family and staff play a major role in the wellness and recovery. Building design supports the healing process by evolving the patient experience during the course of treatment. The bed floor is the patient’s initial encounter with clinical staff and therapies and their first introduction to socialization within the patient community. As the patient progresses, the physical limits of the patient’s routine treatment expands to utilize the additional programmed amenities that enhance the therapeutic process—such as large inpatient gym, aquatic center, and café—and the family resource center.
Patient rooms respond to the needs of the patient, family, and caregivers. Gracious, hospitality-focused patient rooms accommodate both the patient and family while the clinical functions are thoughtfully integrated into the space. Families are encouraged to participate in the rehabilitation process, so particular attention is given to creating a comfortable, varied, and stimulating environment for all. Expansive views to the harbor offer connections to nature and social activities that occur at the water’s edge. The room design promotes wellness, control, and independence through support systems such as interactive digital media, motorized patient lifts, bedside controlled automatic shades, and lighting. Furnishings are mobile in order to allow patient and family to configure the space.
Inpatient floors offer a variety of community and small-group experiences for patients to support, interact, and encourage each other with the recovery process. Family lounges provide non-structured activity space, multipurpose rooms provide activity and dining space for patients, and therapy spaces provide physical training and education opportunities while digital media nodes highlight information on specialty related issues as well as planned facility related events. These amenity spaces offer sensory stimulation through automatic operable windows that allow for natural ventilation and sunlight where patients can experience the nearby harbor activity, sounds and smell of the ocean, and the feel of wind on the face.
The Ground floor includes public amenity functions, including the main lobby, café, meditation rooms, medical retail, therapeutic aquatic center, conference center, and a family resource center. Direct connection to the landscaped grounds from these public amenity spaces within the building links the exterior environment and neighborhood to the hospital and its occupants. The dining plaza is directly adjacent to the café where patients, family, and staff can enjoy dining outdoors in a fully accessible garden setting. This restaurant/dining venue is open to the public.
In addition to the ground-floor program, patients are encouraged to interact with the community at large through the experience of the harbor walk, therapeutic trail, and other recreational amenities, such as a putting green and water- and land-based activities. The environmental plaza, as an interpretive element, offers insight and education into water management and habitat on a coastal New England site. The therapeutic garden has been designed with native plantings and walkways that offer patients the opportunity to navigate across a variety of surfaces while providing areas for respite within native plantings and views of the harbor.
Walkways throughout have been subtly patterned to measure the travel distances and delineate major pathways through the site. The landscaping offers program flexibility in uses of the planned spaces, such as farmers’ markets and art shows, while promoting alternative transportation—Hubway, for example, is a public bike rental company. Together, these serve to strengthen Spaulding’s inter-relationship with the community.
Finally, each of these strategies contributes to Spaulding’s sustainability goals. First, the site is a former abandoned industrial brownfield, the first connection to a mission to rehabilitate people. A combined heat and power plant, coupled with a high-performance building envelope, reduces energy demand and carbon emissions. Vegetated roofs reduce storm water runoff; native plantings eliminate irrigation needs. Narrow floor plates and skylights prioritize day lighting. The hospital is Boston’s first waterfront building to anticipate sea level rise and extreme weather event vulnerability, with a raised ground floor. All significant mechanical and electrical infrastructure is located on the roof, out of harms way in extreme weather events. Operable windows in patient rooms and all major treatment spaces allow the building to remain operational and to potentially provide a safe haven for the immediate community if mechanical systems are interrupted.
Hospitals no longer can afford to be perceived as islands that stand apart from their surrounding communities. It is increasingly critical for hospitals and healthcare providers to act as role models for wellness and healthy lifestyle strategies within the community through education and social interaction. Through the inspired site selection, innovative programming, and resilient and sustainable building practices, Spaulding Rehabilitation Hospital demonstrates how hospitals themselves can be transformed to serve the broader community and meet wellness goals.
Jessica Stebbins, Associate Principal
55 Court Street 2nd Floor
Boston, Massachusetts 02108
Robin Guenther, Principal
215 Park Avenue South 4th Floor
New York, NY 1003
Past installment of "Designing for Health" include (click on the title to access the full article):
Exploring Collaboration in the Consolidated Interventional Platform
The Differences between U.S. and U.K. Clinical Planning Models
Widening a Circle of Natural Inclusion
Mentoring the Next Generation of Healthcare Design Professionals
When the Professional Becomes the Patient--An Insider's Perspective