Hospital[ity]: Hospitable Hospitals - The Place of Healing by Laura Helminski

[HOSPITAL]ITY Hospitable Hospitals: The Place of Healing

Laura Helminski

[HOSPITAL]ITY Hospitable Hospitals: The Place of Healing

Laura Helminski

[HOSPITAL]ITY Hospitable Hospitals: The Place of Healing

A thesis submitted to the Graduate School of the University of Cincinnati in partial fulfillment of the requirements for the degree of

Master of Architecture

in the School of Architecture and Interior Design of the College of Design, Architecture, Art and Planning by

Laura Helminski

B.S. Architecture University of Cincinnati June 2011

Committee Chair: J. Hancock

Abstract In all of its complexity, hospital architecture is merely a shell constructed around the scientific knowledge of human bodies and the technological instruments required to care for them. The traditional approach to hospital design has become so utilitarian that it has resulted in a loss of intimacy between humans and their environment and community, evoking moods of inhospitable estrangement and isolation. Governed by global economics and modern technology, the current mega-hospital model neglects the invisible foundation of human relationships and intuitive background experiences within the everyday lived world, explained by Heidegger as “the loss of nearness.” This thesis offers a more poetic language of hospital architecture, in order to turn our attention away from the utility of medical equipment and instead foreground the lived world around us with sensual experiences and sharpened understanding of the spiritual intimacy and layers of meaning inherent in life and death.

experience and traditions. This project explores the positive effects that comforting, intimate, and sensually engaging environments can have on the healing process of patients, seeking a welcome and embrace for the human spirit. The syncretic design deploys allegorical tectonics, poetic materiality, meditative lighting, invigorating landscapes, and intuitive wayfinding, creating meaningful environments that will restore the human need for placefulness, sensuality, and intimacy. A truly healthful and hospitable hospital must embed the factual objectivity of medical science within the patients’ and visitors’ truthful and subjective experiences of being.

The design of a small suburban hospital for seniors in Sylvania, Ohio will mediate between the objective world that science measures and the inexhaustible lived world of

iii

This thesis is dedicated to my grandfather Ronald Lorry Hadley, who understood life needs to be expressed through poetry.

And to my entire family who have offered their support and love. A special thanks to John E. Hancock for his patience and mentoring throughout the development of this thesis.

vii

Table of Contents Abstract

Dedication vii Illustrations and Images

Introduction 2 Chapter 01: [Hospital]ity Hospitable Hospitals Current Trends History of Hospitals Place of Healing Healing Through Architecture

Chapter 02: Who are the Baby Boomers?

Chapter 03: Aging in the Suburbs

Chapter 04: Hospital Programming

Chapter 05: Re-Presenting Hospitality

Expanded Works Cited

112

Illustrations and Images Cover 00.01

Helminski, Laura. “Sylvan Hospital: 1.” 2014.

Chapter 01: Hospitable Hospitals 01.01 Venhoeven, Ton. Core Hospital Model. 2004. Accessed 32 Aug. 2013. <http://en.nai.nl/platform/ innovation_agenda/item/_pid/kolom2-1/_rp_ kolom2-1_elementId/1_1272180> 01.02 Care About Your Care. Performed by Dave deBronkart. University of Cincinnati. September 19, 2013. 10.03 Helminski, Laura. “Extracting Special Functions.” 2014. Chapter 02: Who are the Baby Boomers? 02.01 Helminski, Laura. “Baby Boomer Infographic.” 2013. 02.02 Helminski, Laura. “A Timeline: Adapting to the Baby Boomer.” 2013. Chapter 03: Aging in the Suburbs 03.01 Helminski, Laura. “Aging in Ohio.” 2013. 03.02 Helminski, Laura. “Locating Sylvania.” 2013. 03.03 Helminski, Laura. “Serving the Community.” 2013. 03.04 Helminski, Laura. “Sylvania Homes: A Google Earth Snapshot.” 2013. 03.05 Helminski, Laura. “Site Selection.” 2013.

Chapter 04: Hospital Programming 04.01 Helminski, Laura. “Continuum of Care.” 2013. 04.02 Helminski, Laura. “Mapping Existing Facilities.” 2013. 04.03 Helminski, Laura. “Home Kit.” 2013. 04.04 Helminski, Laura. “Network of Care.” 2013. Chapter 05: Re-Presenting Hospitality 05.01 Helminski, Laura. “Massing Diagram.” 2014. 05.02 Helminski, Laura. “Sylvan Grid 1.” 2013. 05.03 Helminski, Laura. “Arboretum Planning.” 2014. 05.04 Helminski, Laura. “Sylvan Grid 2.” 2013. 05.05 Helminski, Laura. “Sylvan Hospital: 1.” 2014. 05.06 Helminski, Laura. “Sylvan Hospital: 2.” 2014. 05.07 Helminski, Laura. “Forest Structure.” 2014. 05.08 Helminski, Laura. “Nature Center: Exterior.” 2014. 05.09 Helminski, Laura. “Nature Center: Floor Plan.” 2014. 05.10 Helminski, Laura. “Nature Center: Classroom.” 2014. 05.11 Helminski, Laura. “Building Details.” 2014. 05.12 Helminski, Laura. “Forest Land.” 2013. 05.13 Helminski, Laura. “First Floor Plan.” 2014. 05.14 Helminski, Laura. “Second Floor Plan.” 2014 05.15 Helminski, Laura. “Third Floor Plan.” 2014. 05.16 Helminski, Laura. “Roof Plan.” 2014. 05.17 Helminski, Laura. “Autumn on Monroe.” 2014. 05.18 Helminski, Laura. “Vehicular Entrance.” 2014. 05.19 Helminski, Laura. “North Entry.” 2014. 05.20 Helminski, Laura. “Reception.” 2014. 05.21 Helminski, Laura. “Patient Rooms.” 2014. 05.22 Helminski, Laura. “Building Section.” 2014. 05.23 Helminski, Laura. “Roof Garden.” 2014. 05.14 Helminski, Laura. “Reflection Garden.” 2014. 05.25 Helminski, Laura. “Courtyard.” 2014.

Introduction

Hospitable Hospitals: Place of Healing Introduction

In 2011 the first of the Baby Boomer generation turned 65 years of age, marking the beginning of the generation’s transition into their epoch of retirement. Between now and 2050, the United States healthcare system will assist the largest generation to date, nearly 80 million citizens, through the delicate process of aging. Despite the fact that the healthcare industry in the United States is widely envied for its successes and advancements, it is currently under immense pressure to reexamine the scope of services and its role in the community as a quarter of the population becomes dependent on senior-focused care. The children of the post World War II Baby Boom will not choose to retire in a far off place or seek care in nursing homes; rather, as healthcare becomes costly and inaccessible, the majority of this demographic will retire in the comfort of the community in which they currently reside. Most Baby Boomers will age in place. Healthcare is only one component of what makes the system of aging in place successful. The Baby Boomers want to age in a place in a community that offers a variety of virtues such as being able to “carry out their daily lives with ‘walkable’ access to everyday commerce, participate in socially and intellectually stimulating intergenerational activities, and reflect the values of sustainability and environmental ethics in their life choices, to name a few of the most prominent

themes.”1 Although accessible high-quality healthcare is arguably the most sought after component within the aging in place continuum, the process cannot be successful without a comprehensive network that promotes seamless transitions through aging. This thesis project proposes a small suburban hospital in Sylvania, Ohio, an affluent suburb of Toledo, that will provide alternative medical care choices for seniors and their families. Sylvania already offers many of the amenities that Baby Boomers will require of their city; a strong sense of community, accessible shopping, a large park system, reputable public school systems for their family and grandchildren, and a growing inventory of senior health care facilities. A thorough assessment, which will be discussed below, has revealed the currently available hospital care as a prominent moment of neglect in the suburb’s existing senior care infrastructure. This proposal could act as an appropriate model of opportunity for similar suburbs across the country. The current model of hospital architecture is an efficient product of the healing-machine and technology within; however, it is imperative that design and architecture also recognize and offer hospitality to the human spirit through the delivery of intimate, comforting, engaging, and healing environments. Because aging is a delicate process, it is important that hospitals and healthcare infrastructure curate a 1 Hancock, John. “University-Linked Retirement Communities: UC and New Directions in Facilities for Aging.” (Cincinnati: Unpublished, 2006). 1.

Hospitable Hospitals: Place of Healing

balance between the efficient healing machine and the human spirit. Like so many articles and publications on healthcare, this architecture thesis is built on the foundation of a personal story. In 2011 I had spent nearly a week inside the walls of the Toledo Hospital in Toledo, Ohio. Within a 48-hour timespan, my family first deeply mourned the loss of a life, and then we celebrated as we welcomed a new life into our family and our world. I stood by my grandfather’s bedside during his most vulnerable, private, and last moments of life in this earthly world. Less than two days later, I swooned over my niece through the glass of the nursery windows. Reinforced again and again throughout my career as an architecture student is the difference between mere buildings and the poetics of architecture. Architecture moves beyond functional shelter as provided by buildings; it supersedes the world of reason and transforms the perception of the user so that the world can be understood in a new way. Works of architecture are embedded in our world in ways that expose the truth of our world and, therefore, deliver knowledge that contributes to a deeper understanding of our own existence as mortals on the earth, under the sky, and with the gods.2 2 Heiddegar

In searching for a deeper truth in the meaning of our existence, and in reaction to scientism and objectivism, prominent philosophers like Martin Heidegger have approached the inexhaustible poetics of art and life through the lens of phenomenology. Phenomenology is unlike any other “–ology” studies, for it neither characterizes the subject matter nor indicates the object of its research. Phenomenology does not merely seek the “correspondence truth” backed by inarguable facts and measurable data that is in demand by our Western culture. The conversation takes place through the truthing, or aletheia, of the inexhaustible memory and tradition of human existence. It is the process of letting things manifest themselves through the dialogue between us, as human beings, and the unconscious background of contextual relationships that contain the deeper meanings of our original, and yet pervasive, experiences. The world is inherently meaningful because we exist in it. Phenomenology has its origin in this basic state of human existence – within the primordial relationships that exist between human beings and their contextual world. This human condition of “being-in-the-world,” as stated by Heidegger, is prescientific, everyday, immediate, and original. Unlike the objectivist’s and positivist’s processes of seeking and collecting data, hermeneutic phenomenology leaves the

Hospitable Hospitals: Place of Healing Introduction

interpretive process open, or circular, so that the contextual background of both the object and subject remain key players in the dialog of questioning. Heidegger explains that the context of both the object and subject are inexhaustible, without fixity or finality, and that each entity is displayed against uncountable horizons relative in dialog with other entities. Gadamer calls this interpretive dialog a “fusion of horizons” because we already exist with the entities with which we engage and recognize them as something meaningful through our memories and traditions.

world and the vessel of the soul. They are constantly striving to foreground architecture through negotiation with the bodily senses. Peter Zumthor makes material, space, and time vivid in the human experience of a building and is able to project carefully curated moods onto the users. Kenneth Frampton defined tectonics as the poetics of construction, and James Corner layers moments of the past and present so that his work resonates across multiple levels of meaning. In common, these architects have created experiences authentic to the immediacy of human existence.

Architects too have designed through the lens of phenomenology in attempts to situate their buildings within the realm of the backgrounded and universal poetics of life. Architecture differentiates itself from buildings and the functional shed as it works to reveal an essential moment within the lived world. Architecture has the ability to affect us beyond the presentation of a superficial image, without belonging to style, or categorized within the carefully organized timeline of history. The architectural translation of the ordinary into poetic foregrounding can depart from the everyday world through, for example, attention-getting novelty, building form and function, character and mood, sensory engagement, and innovative engineering. Unlike buildings, architecture contributes to our mental health and pleasure.

I still reflect on the time I spent in the hospital in 2011 saying my final goodbyes to grandpa and holding my niece for the first time. I continued to grow more troubled by the realization that the architecture of the hospital was not in any way commensurable with the vast emotions I felt. I do not believe a better moment for a self-reflection on human existence could have been choreographed than the timely juxtaposition of Grandpa’s death and Amelia’s birth. The building merely enclosed the healing-machine inside and offered little, if any, hospitality. I think it is a fair assumption that this is not an isolated event that takes place only within the walls of the Toledo Hospital, but rather a phenomenon affecting the majority of hospitals across the country. This gives us a reason to forecast change in hospital design. Architectural philosopher Karsten Harries explains, “Not only the body but the soul too needs a house.”

Architects like Juhani Pallasmaa, Steven Holl, and Lisa Heschong curate the human body as the navel of the

Hospitable Hospitals: Place of Healing

[Hospital]ity

Hospitable Hospitals: Place of Healing

HOSPITABLE HOSPITALS Hospitality is defined by the Oxford English Dictionary (OED) as the “act or practice of being hospitable; the reception and entertainment of guests, visitors, or strangers, with liberality and goodwill.”1 Derived from the Latin word Hospes, identifier for both host and guest, hospitality describes a human relationship that occurs between strangers. Today the word hospitality is used to express the sensation of being welcome, friendliness, warmth, kindness, generosity, and comfort. The role of hospitality in architecture is defined as “a hospitable institution or foundation; a hospital.”2 Hospitals should be, according to this definition, a structure that receives guests with warmth; defined by the OED a hospital is, indeed, “a house or hotel for the reception and entertainment of pilgrims, travellers, and strangers; a hospice.”3 The 14th century hospital was an inn-like structure for travelers, then the 15th century hospital become a refuge for the homeless. It was not until the 16th century and the third definition provided by the OED that a hospital is defined in alignment with the contemporary connotation as being “an institution or establishment for the care of the sick or wounded, or of those who require 1 “hospitality, n.”. OED Online. December 2012. Oxford University Press. http://www.oed.com.proxy.libraries.uc.edu/view/ Entry/88730?redirectedFrom=hospitality (accessed January 21, 2013). 2 “hospitality, n.”. OED Online. 3 “hospital, n.”. OED Online. December 2012. Oxford University Press. http://www.oed.com.proxy.libraries.uc.edu/view/Entry/88724?rs key=wwDk17&result=1&isAdvanced=false (accessed January 21, 2013).

medical treatment.”4 Why is it then that hospitals of our contemporary culture are often perceived as cold and impersonal when it is vital, especially during our most private and vulnerable experiences, that the architecture of the medical institutions displays sensitivity towards the human spirit? The hospital should be a place where host and guest form a relationship. Hospitals are complicated buildings, and thus often regarded as one of the most unexplored and misunderstood typologies in architecture. Perhaps it is through this lack of exploration and understanding that stories of our personal experiences in the hospital have become the only way to illustrate that our most basic human needs, rendered a triangle by Maslow, are not being met. Although they are erected as public institutions and are supposed to represent social and cultural values, they have not been analyzed to the same depth of understanding and poetic mastery as other public institutions, such as museums, theaters, and educational facilities. Museums, theaters, and educational facilities alike are designed not only to serve communities, but also to strengthen communities by drawing people together through art, music, theatrics, ideas, and collaboration. In all of their complexity, hospitals are not more than the efficient products of the healing machine housed

4 “hospital, n.”. OED Online.

Hospitable Hospitals: Place of Healing

within. Shells are constructed around the scientific knowledge of human bodies and the technological instruments required to care for them. The current mega-model neglects the invisible foundation of human relationships and intuitive background experiences of the lived world. The language and poetry of hospital architecture must foreground the human situation of life and death while nurturing the associated natural rites and rituals. Michel Foucault explains, “It is in the perception of death that the individual finds himself… Death left its old tragic heaven and became the lyrical core of man: his invisible truth, his visible secret.”5 It is when man lays ill, his mind and body in conflict with one another, that the essence of his being becomes most vivid.

CURRENT TRENDS The highly institutionalized hospital building and mega-campus planning has a stigma of being a place of apathy towards its users and visitors, and is perceived as sterile and impersonal. Florence Nightingale explained “apprehension, uncertainty, waiting, expectation, fear of surprise, do a patient more harm than any other exertion.” The pure functionality and efficiencies of contemporary hospital design have prompted guerilla organizations that demand better care delivered on the human level. “Because health professionals can’t do it alone,” non-profit organizations, such as the

Empowered Patient Coalition and ePatients, advocate for partnerships between the patient and the medical industry (see Figure 01.02).6 The need for sensitive hospital architecture that renders a truly healthful place is compounding as our culture moves from an illness-society to that of a wellness-society. As the healthcare system in Western culture redefines the role of medical care, the architecture of hospitals and medical facilities will need to act as the primary tool in sustaining the functionality of the healing-machine model currently in place, and will be the forefront authority in defining societal wellness standards and incubating future industry trends. The medical industry has mastered the scientific healing process, and is refocusing market interests on illness prevention and passive healing techniques. Yet in their current state, the facilities lack any sensitivity towards the human spirit that is constantly seeking comfortable and engaging environments. The architecture of medical facilities can, and should, curate user behavior, comfort, sensory engagement, healing, and wellness. As the contemporary medical care industry in the United States faces an epoch that will largely consist of senior care, various organizations are attempting to redefine their fundamental purpose. Many are reassessing their current structure in an attempt to adapt to the demands of the 6 epatients.net

5 Foucault, Michel. Birth of the Clinic: An Archaeology of Medical Perception. (London: Vintage, 1973.) 171.

Hospitable Hospitals: Place of Healing

largely aging demographic. Some are moving and resituating themselves within neighborhoods while redefining their mission statement to be community oriented. Rebranding has also become an elastic attempt at survival. Others are reorganizing their scope and quality of services and specialties through new arrangements and methods of delivery such as medical tourism and boutique clinics. The dismantling and reorganization of the hospital as we know it today has induced anxiety throughout the medical industry; this is, however, a time for innovation and creative solutions for resiliency.

HISTORY OF HOSPITALS One must understand the history of hospitals and the past services they provided to society in order to discern the antonymous relationship between the essential meaning of ‘hospitality’ and the curt atmosphere of the contemporary hospital. Cor Wagenaar explains, “Although hospitals have always been designed to help people in their struggle against illness and injury, they have not always been medical institutions. Hospitals are used for the care and cure of the ill and injured.”7 Through the processes of healing 7 Cor Wagenaar, “Five Revolutions: A Short History of Hospital Architecture,” in The Architecture of Hospitals, edited by Cor Wagenaar (Rotterdam: NAi Publishers, 2006), 26.

and prevention, disease and illness have given rise to various cultural and social structures. The modern hospital as we know it has evolved from a long lineage of needs, advancements, and transfer of ownership. What many regard as the first “real” hospitals emerged in the 1st century AD from the Roman State’s need to provide services to the injured soldiers of their military.8 However, until religious cults in Ancient Greece began providing healing therapy, health care was very limited for the general public. Medicine provided by institutions like the 4th century Sanctuary of Asklepios at Epidaurus were dependent on religious rites and rituals.9 This enormous site - composed of temples, theaters, and hospital buildings - was entirely dedicated to the healing gods and practices of the Greek cult. The physical organization of the 16th century hospital ward was derived from the Christian monastery building program as religious institutions provided services for their ill brothers and other members of society.10 In the seventeenth century, it was tradition in early Western culture for women of a community, self-taught herbalists, midwives, and self-described

8 Thompson, John D. and Grace Goldin, The Hospital: A Social and Architectural History. New Haven and London: Yale University Press, 1975. 9 Cor Wagenaar, “Five Revolutions,” 26-29. 10 Thompson, John D. and Grace Goldin, The Hospital.

Hospitable Hospitals: Place of Healing

physicians, to care for their ailing neighbors. The delivery of health care was rooted in brotherhood, fellowship, and community.

Panopticon challenged the ideals of hiding away the sick or convicted by bringing them into full visibility of the institution’s eye.

The sick eventually were displaced, sometimes even exiled, from their world. A branding of humans as healthy/sick, sane/insane, et cetera, created binary divisions between the people of society and prompted the demand for medical institutions. The typology of medical institutions has always been closely related to the typology of the institution for imprisonment. In the 16th century, the Quakers designed the first penitentiary, a radical model that would transform the prison. The Walnut Street Jail in Philadelphia promoted reform, rather than enforcing punishment, for the incarcerated. The building provided environments that engaged the inmates in the healing process of repentance through reflection and self-discovery. Because it was one of the first institutions that relied on architecture as a mode healing, this jail eventually became the model for hospitals.

Jeremy Bentham’s Panopticon is regarded as one of the most successful architecture models for these disciplinary institutions. Although the model is often regarded as being optimal for prison architecture, it has proved to be a successful and efficient model for the medical industry. Upon its introduction, the visibility of the subjects was thought of as being a ‘trap’ and form of discipline; however, this raw form of visibility has since organized service efficiency, contagion control, security, and privacy within medical programming. Iterations of Bentham’s model are still used and implemented today.

Such institutions structure social order and often govern customs and behaviors. Michel Foucault explains that “if it is true that the leper gave rise to rituals of confinement, then the plague gave rise to disciplinary projects.”11 The

11 Leach, Neil, ed., Rethinking Architecture: A Reader in Cultural Theory. (London : Routledge, 1997).

It was not until the seventeenth and eighteenth centuries with the emergence of the mercantile economy that hospitals were introduced to society as a profitable labor industry.12 When patients are seeking medical care, their choice as to which hospital they can and will utilize is often dictated by the structure of ownership. In many countries, such as Canada, Australia, Norway, India, and the United Kingdom, the vast majority of hospitals are public institutions funded by the government through health insurance programs

12 Wagenaar, “Five Revolutions,” 26-29.

Hospitable Hospitals: Place of Healing

like Medicaid and Medicare. This structure provides healthcare free to its citizens as the point of use. However, in the United States, a hospital is likely to fall under one of three structures of ownership: public/government-supported, voluntary, and proprietary. A voluntary hospital is typically run by religious groups and non-profit organizations while proprietary hospitals function as commercial businesses forprofit and are often owned by hospital corporations. The scope and quality of medical services provided drastically varies among these three institutional structures.

THE PLACE OF HEALING Upon admittance into the hospital, the human being is extracted from their everyday life and the patient is grafted into the hospital environment as an object to be studied, a biological body, not a fully existential being. They exist in this realm only as something to be observed, poked, pinched, and measured. The hospital, although a familiar entity in the cityscape, is typically a place foreign to our spontaneous and ordinary experiences of the world. Our experiences with and in hospitals are always very deliberate and purposeful encounters and yet the invisible foundation of the patient’s being is destroyed and the familiar background world of meanings and relationships is made inaccessible. Harries explains the “technological spirit presiding over [modern medicine] threatens to reduce human beings to material

subject.”13 A truly healthful hospital needs to mediate between the world that science measures and the lived world. It must engage equal parts of factual objectivity in medical science and the user’s truthful and subjective experiences of being. As medical science and technologies developed throughout history, the advancements did not take place within the hospital walls. In fact, hospitals often catered to religious principles and were precisely programmed to incorporate natural elements, such as air and water, then believed to be the sources of healing. Healing qualities of hospitals came “not from medicine, but from being a purified and natural environment that provided clean air. [Hospitals] healed by architecture.”14 The incorporation of nature into hospitals was discarded as the extremely high price of technology inflated costs of medical services.15 The Paimo Sanatorium, a highly acclaimed tuberculosis facility in Finland realized by Alvar Aalto in the early twentieth century, demonstrates a deep understanding for the importance of a humanistic architecture. Aalto, like the Quakers who designed the Walnut Street Jail, considered the building itself a ‘medical instrument’ in the healing processes of ill patients and carefully married the built structure to

13 Harries, Karsten. “Building and Dwelling” in The Ethical Function of Architecture (Cambridge: MIT Press, 1997). 165. 14 Wagenaar, “Five Revolutions,” 29. 15 Wagenaar, “Five Revolutions,” 31-34.

Hospitable Hospitals: Place of Healing

natural elements that are intensely cherished by the Finnish culture, such as the day lighting, the pine forest, and the healing winds. Although the hospital was not modeled after the lost vernacular of the Finnish folk architecture, Aalto presented a building sensitive to the unique culture, climate, and site, and their capacity to contribute to the healing process.

in medical science and mobile technology allow widespread sharing of information, dismantling the necessity of huge, centralized medical institutions. The quality of care no longer need be sacrificed to the economic imperative. Healthcare services can, for the first time since in the introduction of technology, be physically dismantled from one another and moved from city centers.16

Unlike the Paimo, much of what is recognized as hospital architecture in the United States today is situated within the universal culture of placelessness since it depends instead entirely on the machinery within. The highly institutionalized mega-structures of contemporary hospitals building do not even so much as nod in recognition of the peculiarities of the place they occupy. Designed for operational efficiency, hospitals across the country are modeled according to universal programming and efficiency criteria. They have become anonymous and interchangeable with one another – upon entering this architectural typology; the user is not able to discern a sense of place distinct from another hospital environment. Even additions and expansions to contemporary hospitals often do not embrace the existing built conditions, but instead become tumor-like growths on the structure. These mega-structures are not only devoid of a sense of place, but they also do not utilize the surrounding environment and community ethos in the process of healing.

Noted scholar and specialist in design therapeutics and health architecture Stephen Verderber asserts the irony of hospital architecture as a juxtaposition of the healing machine and humanism in his essay “Hospital Futures – Humanism Versus the Machine.” He claims that architecture can and should play a crucial role in humanizing the hospital and he believes “the future of scientific discourse in healthcare architecture deserves no less” than an architecture that is sensitive to the human being and amenable to the community.”17 Verderber, too, proposes a network of health care facilities, decentralized from one another and reorganized throughout the city, that work together in cooperation.

Wagenaar suggests that the architecture of hospitals is on the cusp of a revolution in which the building design and function will be reminiscent of its healing origin. Advances

16 Wagenaar, “Five Revolutions,” 40-41. 17 Verderber, Stephen. “Hospital Futures – Humanism Versus the Machine” in The Architecture of Hospitals, edited by Cor Wagenaar, 87. Rotterdam: NAi Publishers, 2006.

The dismantling of the highly institutionalized medical campus and mega-hospitals is a worldwide phenomenon. A core hospital concept designed for the Netherlands Board for Healthcare Institutions by Ton Venhoeven, Peterine Arts, and Cecilia Gross in collaborations

Hospitable Hospitals: Place of Healing

with Itten + BrechBuehl Architects AG was an attempt to take the greatest advantage of city infrastructure, including transportation and proximity to the densest population areas. A compact hospital programmed with only the most essential and core elements of the current hospital model, usually constituting only 50% of the building’s square footage, is located within the city center. Other specialized functions are then dismantled from the core hospital. The architects and designers worked under the assumption that because technology is becoming more mobile and affordable, specialized functions could be removed from the core hospital programs and spread across the cityscape in the form of home care clinics, laboratories, and private care facilities.18 This model allows the medical industry to provide higher quality experiences to users while functioning more efficiently through strategic community-facility pairing. The architecture in this 2004 proposal is reminiscent of the old monasteries that were the forerunners of our contemporary hospital in which medical services are delivered within the community and on a level of caring for one’s brother and neighbor.

services across the landscape of community. Dismantling these hospitals and embedding the specialized wards within an area that best serves the demographic will help build a stronger relationship between the user and the healthcare system. The relocation of the wards will not only equip and enable patients, but will engage and empower entire communities and neighborhoods. Pat Mastors advocates for such a healthcare system in her recently published book Design to Survive. She translates the business model of the beloved furniture store IKEA into a healthcare model that the medical industry should embrace. Through a series of personal stories and testimonials, wellresearched facts and statistics, and partnerships with leading advocates and organizations, Mastors initiates a paradigm shift in the way hospitals currently operate. She proposes that, “like the IKEA furniture company, the entire model of healthcare

The extraction of specialized wards from the megahospital program allows the transplanting of specialized care 18 “Core Hospital,” Netherlands Architecture Institute, accessed April 10, 2013, http://en.nai.nl/platform/innovation_agenda/ bestpractices/item/_pid/kolom2-1_elementId/1_1272180.

VS.

Figure 01.01: Decentralizing the hospital

Hospitable Hospitals: Place of Healing

would be predicated on engaging patients to participate.”19 Patients should have partnership in their own care. This shift, by means of carefully and thoroughly designed systems, situates patients at the center of their own care and prescribes transparency between the healthcare industry and its patients.

HEALING THROUGH ARCHITECTURE In attempt to understand the less than life enhancing qualities of healthcare buildings that often leave the users feeling isolated and uncomfortable, we cannot ignore the insights from the phenomenology of architecture. In his short book The Eyes of the Skin, Juhani Pallasma critiques contemporary architecture as being only pleasing to the human sense of vision and expresses concern for our occularcentric culture and environments. He describes this current trend as one that places the highest importance on the image, or picture, of architecture – architecture as a stage set for the eye – resulting in a flat and immaterial human experience in which our body and spirit is disengaged from the many senses an experiential contexts of our lived-world. He claims that architecture alone is “the art of reconciliation between ourselves and the world, and this mediation takes

Participatory patients are ePatients. They are engaged, equipped, empowered, and enabled “because health professionals can’t do it alone,” ePatient Dave explained during a lecture at the University of Cincinnati in September 2013.20 He claimed that a pivotal force, the natural urge as human beings to care for our children and elders, will presence itself as the architect of change within the healthcare industry. Because patients are not a third party in their own healthcare, but rather the ultimate stakeholder, he predicts a growing engagement of patients and families. Time is not neutral for those that are aging. A cancer survivor, eDave understands the difference in the perspective of time between the patient and the industry. He learned first hand that time is of the essence for patients in a health care situation, facing their mortality. 19 Masters, Pat. Design to Survive: 9 ways an IKEA approach can fix health care & save lives. (New York: Morgan James Publishing, 2013). xxii. 20 Care About Your Care. Performed by Dave deBronkart. University of Cincinnati. September 19, 2013.

1.0 Institution

2.0 3.0

4.0

Individual Figure 01.02: ePatient Dave adovcates for a collaborative healthcare system between the patient and the institution

Hospitable Hospitals: Place of Healing

place through our senses.”21 Space should be experienced and perceived not only through our sense of sight, but by means of the collaboration of all of our senses. Pallasma finds it “thought-provoking that this sense of estrangement and detachment is often evoked by the technologically most advanced settings, such as hospitals and airports.”22 Hospitals must promote hygiene, cleanliness, and a sterile environment as the machine and technology within combat disease, infections, and sickness. Yet there is a much less technical component working alongside the healing-machine that must be addressed in the future of healthcare architecture. Patients and their visitors inevitably find themselves in their most private and vulnerable moments in these places, as they entrust their lives and loved ones to science and the healing-machine. As Verderber asserts, the megahospitals “represent the apotheosis of an unyielding belief in the power of medical science.”23 Yet within this same setting, patients must find comfort in some form of faith or deepened experience. It is for their failure to evoke this unseen human spirituality that hospitals are often experienced as cold, uncomfortable, and even inhumane.

21 Pallasma, Juhani, The Eyes of the Skin: Architecture and the Senses . (Chichester: Wiley, 2005), 72. 22 Pallasma, Eyes of the Skin, 19. 23 Verderber, “Hospital Futures,” 78.

Figure 01.03: Specialized programmatic functions are dismantled from the core hospital and spread across the cityscape.

Hospitable Hospitals: Place of Healing

Who are the Baby Boomers?

Hospitable Hospitals: Place of Healing

1938

1939

1940

1941

1942

1943

1944

1945

1946

1947

1948

1949

1950

1951

1952

1953

1954

1955

1956

1957

1958

1959

1960

1961

1962

1963

1964

1965

1966

1967

1968

1969

1970

1971

1973

The United States Census Bureau defines the Baby Boomer generation as the 76 million born between 1946 and 1964 during the post-World War II baby boom. The first Baby Boomer turned 65 years of age in 2011.

lion, more than double its population of

75 percent of Baby Boomers own their own home

In 2030, 1 in 5 residents with be 65+ years of age By 2050, the number of Americans aged 65 and older is projected to more than double its population of 2010 83 percent live in suburban towns... ...suburbs like Sylvania, Ohio where nearly 30 percent of the residents belong to the Baby Boomer generation ...suburbs like Sylvania, Ohio where:

We have just entered the epoch in which the Baby Boomer generation has begun their transition into dependency on medical care.

Generation Z 18.78%

Generation Y 20.34%

Silent Generation 20.34%

Baby Boomers 27.14%

(5,200)

Generation X 20.34%

Nearly 30 percent of residents belong to the baby boomer generation

2010 Dependency Ratio

2050 Dependency Ratio

AARP reports that because most Baby Boomers have lived their entire lives in the suburbs, most will age in place there.

Figure 02.01

Hospitable Hospitals: Place of Healing

There is an opportunity to reorganize the hospital as a network of satellite facilities as the Baby Boomer generation becomes the medical industry’s most demanding clientele over the next three to four decades. Baby Boomers are defined by the United States Census Bureau as being born between 1946 and 14964 and are often referred to as the “pig in the python” in generational history due to the 80 million head count. They are quickly approaching their age of retirement: 65 years of age currently marks a monumental birthday for Americans as they transition into their epoch of being ‘seniors.’ Although this birthday brings with it benefits, such as retirement from work, relaxation, and senior discounts at their favorite restaurants, it also requires much more devotion to health care and end of life preparation. The aging of the Baby Boomer generation will expose the lack of preparation by the medical industry for the imminent demand of senior care. Gerontologist Ken Dychtwald outlined the generational history of the Baby Boomers at the 2012 Aging in American Conference:

We weren’t prepared for the boomers. There weren’t enough hospitals or pediatricians. There weren’t enough bedrooms in our homes. There weren’t enough schoolteachers or textbooks or playgrounds. The huge size of this generation

has strained institutions every step of the way… It’s the same today with senior care and geriatric medicine and continuum of care. Its staggering how unprepared we are.1

The Crow Island School designed by Eliel Saarineen in collaboration with Perkins, Wheeler and Will in the 1940’s became the model that redefined the architecture of schools that would meet the growing demand for educational facilities for the Baby Boomer generation. An architectural model is needed now for the imminent demand by Baby Boomers on senior care and hospitals. The monumental 65th birthday not only officially brands every citizen as senior in the United States, but carries with it a stigma: burdensome social security payouts, disabilities and dependency, ailing health, and more frequent visits to the doctor. Our contemporary ethos portrays seniors as problematic members of society. Our ability to respond to the aging of the largest generation in our history is dependent on a paradigm shift. Aging is part of the life continuum; it is not a problem, but rather worthy of celebration. By demystifying the anxiety and stigma surrounding aging, dying and death, we shall discover that our elders are not burdens, but rather one of the greatest untapped resources of wisdom. If designed and situated 1 “Baby Boomers Will Transform Aging in America,” last modified April 2, 2012, http://www.huffingtonpost.com/2012/04/02/aging-in Wamerica-baby-boomers-arianna-huffington_n_1397686.html.

Hospitable Hospitals: Place of Healing

properly within a network of continuum care, a hospital ward designed for the Baby Boomers will facilitate this architectural typology’s ability to act as a public resource for the entire community. Architecture has the power to influence it’s community’s emotions, behaviors, and morals.

? ? Figure 02.02

The landscape of the built environment is continually shifting to meet the needs of the Baby Boomer generation; 1.hospitals and pediatric care, 2. family housing, 3. educational infrastructure, 4. daycare facilities for children of dual income Boomer families, 5. family housing, 6. senior healthcare facilities

Hospitable Hospitals: Place of Healing

Aging in the Suburbs

Hospitable Hospitals: Place of Healing

Aging in Place is defined by the Center for Disease Control as “the ability to live in one’s home and community safely, independently, and comfortably, regardless of age, income or ability level.” AARP reports that because most Baby Boomers have lived their entire lives in the suburbs, most will age in place there. Their expectations are vastly different from prior generations that chose to move to far off retirement communities. They prefer “to be active in a community, to interact with a variety of age groups, to participate in local events, learn new things, and to volunteer for local organizations,” many of which are already naturally occurring in their current neighborhoods.1

Ohio’s Aging Population The population of Ohians 60 years of age and older is projected to increase dramatically by 2020. 1 in 5 Ohians will be 60 and older, putting pressure on the health care systems. Percentage of population age 60 and older: 11.6% to 16.2% 16.3% to 19.2%

2000

19.3% to 22.1%

22.2% to 25.7%

2010

25.8% to 34.6%

2020 Source: AARP

Figure 03.01

Sylvania is a suburb of Toledo, Ohio, with a growing population of nearly 19,000. Established in 1863, Sylvania was named for the dense forest that covered the area, literally translating to forest land. Still, 150 years later, “Tree City USA” takes great care and pride in its parks and landscape, keeping accurate inventory of the forestry and enforcing strict rules and regulations on tree care. The 5.8 square mile city is a sanctuary for over 7,600 individual trees (1,300 per square mile) and has the densest canopy of any Toledo suburb. A 2013 census projected by suburbanstats.org revealed that 27.14 percent of Sylvania’s population belongs to the Baby Boomer generation. A series of simple math 1 Hancock, John. “University-Linked Retirement Communities: UC and New Directions in Facilities for Aging.” (Cincinnati: Unpublished, 2006).

Figure 03.02

Hospitable Hospitals: Place of Healing

equations reveals that there are 5,200 baby boomer residents (or 890 per square mile), meaning that there are approximately 1.4 trees per Boomer. If this suburb chooses to care for its aging population for the same care and pride as it does with its trees, it could serve as a prime incubator for the suburban model of aging in place. Sylvania’s motto is, after all, “Serving the Community.” Buildings act, inevitably, as a symbol read by society and its culture. Architecture, the poetics of building, is never only about its primary function – defined by Eco as program and utility – and completely devoid of representation. Architecture communicates. Healthcare architecture has always denoted a place of rehabilitation of the injured and recovery of the ill. “The most important aspects of architecture, however, are that it links the building designs to the culture that produces them. In the case of hospitals, that amounts to the re-integration of one of society’s most crucial functions, undoing what seems to have become a medical monopoly over people’s most private experiences: the need to overcome illness or injury.”2 Architecture has the power to influence its community’s emotions, behaviors, and morals.

2 Jaspers, Frans. “Preface” in The Architecture of Hospitals, edited by Cor Wagenaar. (Rotterdam: NAi Publishers, 2006.) 87.

Tree City, USA “Sylvania” literally means ‘forest land’ in Latin 7,600 registered trees / 5.8 square miles = 1,300 trees per square mile

City Motto: ‘Serving the Community’ 5,200 seniors / 5.8 square miles = 890 seniors per square mile

Figure 03.03

Hospitable Hospitals: Place of Healing

Following the current trend of dismantling the mega-hospital and offering an intimate hospital option for this aging suburban community, a strategic site has been chosen at the knuckle of institutional and residential zoning, and is just a short commute to and from commercial activity (see figure 03.04). Close proximity to prominent moments in the suburban fabric, such as the library, city hall, and Main Street, forgrounds the senior care hospital as an institution of importance within the community.

Figure 03.04: Google Earth screenshot of Sylvania, Ohio neighborhood

Hospitable Hospitals: Place of Healing

nro

Main Street

tree

Elementary School

City Hall Library

Monroe Street

High School Property

Figure 03.05

The new senior hospital is situated along one of the major thoroughfares into the suburb and on the knuckle of the residential zoning as the street transitions from institutional and commercial zoning.

Hospitable Hospitals: Place of Healing

Hospital Programming

Hospitable Hospitals: Place of Healing

vulnerability, such as falls, complications with medication, or scheduled surgeries. Upon thorough assessment, it is my belief that the continuum of care for the suburban Baby Boomer generation has a few moments of weakness that need to be addressed. Retirement communities, home nursing services, assisted living facilities, and nursing homes are springing up across the suburbs; however, little is being done to ensure that the existing housing stock within these communities are age appropriate, adequate for senior dwelling, and enabling for its aging population. The current stock of hospitals has been slow to adapt to the growing demand of senior care and emergency services. And although the other moments of care within the continuum seem, for the most part, to be doing a sufficient job, they are rarely networked together in such a way that allows the patient to make seamless transitions through the process of aging.

required hours of care

A better healthcare system must begin by equipping, engaging, empowering, and enabling the patient. Because this model is using the aging Baby Boomers as the platform and vehicle for discussion, the entire continuum of care must be assessed. I have identified three stages of care for the elderly, early care, moderate care, and intensive care, according to the number of hours required for care in proportion to any function limitations of the patient. Within these 3 stages, early care, moderate care, and intensive care, the hosting facilities required have been generalized into 6 typologies. The earliest forms of care begin first with the acknowledgment of oneâ&#x20AC;&#x2122;s aging body. Care is generally self-administered from home or through outpatient services. As the responsibilities of owning a home become too difficult, residents then tend to seek out assistance in the form of a retirement community where amenities can be shared and chores distributed. Moderate care is available when light-nursing help is brought into the home. Eventually the senior makes the decision to leave their home and community, and seek residency in an assisted living community where their responsibility for property management is non-existent and nursing assistance is available as needed. Seniors are usually transitioned into nursing home or hospice arrangements from their assisted living situations when 24 hour a day care is required. Patients are transported to hospitals during moments of emergency care or extreme

EARLY CARE no function limits

MODERATE CARE

INTENSIVE CARE limited function

Figure 04.01: The required hours of care relative to the functional limits and living situations of seniors

Hospitable Hospitals: Place of Healing

Existing senior care and educational facilities EXISTING SENIOR CARE FACILITIES The hospital will be fully integrated into the existing network of senior care; while the Sylvan Forest arboretum serves as an valuable landscape for the local educational system.

Figure 04.02

Hospitable Hospitals: Place of Healing

The solution requires several components:

1. A home kit could be developed, to be available from any big box store, that would include all the necessary components to adapt the existing housing stock to meet the physical needs of the aging suburbanite. It should defer the need for institutional care by ensuring the existing housing stock remains adequate for aging Baby Boomers as long as possible. Components are listed in figure 04.02. (Detailed design of this home-retrofitting kit is beyond the scope of this thesis.) 2. An intimate hospital for the aging, with an estimated 44,000 square feet and total occupancy of 150 persons, should be designed to function as a ward of the existing mega-hospital, although dismantled from the mega-structure and relocated within the fabric of the suburban community. This work of architecture will reveal the essence of the hospital as an institution of healing. It will stand on the original foundation and tradition of offering hospitality to the sick and injured. (This building design is the major outcome of this thesis project.) 3. An integrated network should bind the various facilities facilitated by technology. Because the Boomers are the most tech savvy generation, technology will be their equipment of choice while conquering the landscape of aging. It will promote transparency between the doctor and patient, and from doctor to doctor as the patient transitions across the continuum of care.

Home Adaption Kit Components: Door handles Shower, and Shower seat Shower head Bathtub grab bars Sink faucets, kitchen and bath Grab bars Cabinets Lighting, Natural and artificial Stairs, lighting and seating Bed rails Outlet adapter, raise off of floor Lift Systems, bathroom towel rack

â&#x20AC;&#x153;Aging in place really is ensuring that the basic housing stock of our country is adequate, is age appropriate, for a population thatBoomers is increasingly growing 75% of Baby own their own home older.â&#x20AC;? Henry Cisneros, 10th Secretary of Housing and Urban Development (HUD), 1993 to 1997 75% of Baby Boomer housing tenure is owner occupied housing units, while 25% live in renter occupied units Source:

U.S. Census Bureau, 2006 American Community Survey (ACS) http://www.census.gov/population/age/publications/files/2006babyboomers.pdf

Figure 04.03

Hospitable Hospitals: Place of Healing

The hospital itself will reveal the essence of the hospital as an institution of healing within this broader and more holistic understanding of life as lived in a community throughout the phases of aging. It will stand on the original foundation and tradition of offering hospitality to the sick and injured, and as a hub of other Aging in Place related needs.

Building Program for the ePatient: Equipped: Supply with the necessary items for a particular use, to supply with necessary tools or provisions, to furnish with the qualities necessary for performance; provide, furnish, supply, issue, stock, provision Engaged: Establish meaningful contact or connection with; occupy, attract, involve, capture, catch, captivate, hold, grip, committed, attached Empowered: Given authority or made stronger and more confident; authorize, allow, delegate, equip, liberate, emancipate, Enabled: Supplied with the means, knowledge, or opportunity to make able; allow, permit, let, equip, empower, give authority,

“Until such time as an IT solution is universal, used happily by everyone like her and running flawlessly, what kind of ownership of their health information can we give patients like her to ensure she can be the “constant” - the vessel of information continuity - between various care providers?”1

Figure 04.04

activate

1 Mastors, Pat. Design to Survive, 44.

Hospitable Hospitals: Place of Healing

Hospital Program: Reception 1,200 sf Transparent administration offices 2,000 sf Way finding and signage Cafe and Kitchen 2,000 sf Emergency care unit, 5,000 sf 8 private emergency rooms 300 sf Waiting room 1,000 sf Support and staffing 1,600 sf In-Patient Care, 15,000 sf 24 private in-patient suite, 400 sf each includes attached family suite 4 Nurses’ stations 200 sf each Storage and support Surgical unit 5,600 sf 2 Operating theater suites 600 sf each 4 Pre/PACU 150 sf each Nurses’ station 100 sf Family Waiting 150 sf Consultation 150 sf Anesthesia 400 sf Staff Locker 400 sf Storage and support Outpatient Care and Doctor’s offices 5,000 sf Doctor’s Offices Patient Rooms Chapel 1,000 sf Pharmacy 1,200 sf Utility (15%) Total Square Footage Estimate:

44,000 sf

Reception: 2 @ 600 sf each Equipped: Access to medical records and other necessary information Engaged: Welcoming, comfortable Empowered: Easy access to necessary information Enabled: Calming, tranquil, Administration offices Equipped: Patient accessibility Engaged: Conducive to open discussions between patient and staff Empowered: Transparency Enabled: Decentralized Way finding and signage Equipped: Simple and easily understood signage, Light, color, texture as means of leading/navigating Engaged: Architectural and programming clarity Empowered: Easy to navigate regardless of familiarity of spaces Enabled: Ability to move through the building independently; regardless of physical or mental disabilities Emergency care unit: 5,600 sf Equipped: Information sharing Engaged: Family involvement through information sharing Empowered: Partnership Enabled: Calming, tranquil, welcoming, comfortable

Hospitable Hospitals: Place of Healing

24 or 36 private in-patient suites: 400 sf each (based on staffing needs of 1-2-3-4), including visitor suite Equipped: Easy access to facilities, furniture, personal items, hygiene, medical records, staff, family and visitors, healing through visuals (nature) and sound (school children playing) Engaged: Presence of personal identities and ownership; memories, reflection Empowered: attached family and visitor suite, privacy, dignity Enabled: Independency through access to necessary equipment, facilities such as restrooms, and personal items 4 Nursesâ&#x20AC;&#x2122; stations: 100 sf each (based on staffing needs of 1-2-3-4) Equipped: Patient access, Engaged: Conducive to open discussions between patient and staff Empowered: Transparency, decentralized, Enabled: Collaboration Surgical unit: 5,600 sf (including support) Equipped: Hygiene, Information sharing, Engaged: Family involvement through information sharing Empowered: Partnership Enabled: Calming, tranquil, welcoming, comfortable Healing and therapy unit Equipped: Environments that provide access to nature, family, memories Engaged: Active Empowered: Provide a sense of dignity, independency Enabled: Collaborative

Cafeteria: 2,000 sf (Kitchen: additional 2,000 sf) Equipped: Accessible Engaged: Social space Empowered: Functional independency Enabled: Inviting Community space Equipped: Sharing of knowledge (event space), Engaged: Collaborative, partnerships Empowered: Provide a sense of dignity, ownership Enabled: Inviting (paradigm shift, view of seniors) Doctorâ&#x20AC;&#x2122;s offices: Equipped: Engaged: Empowered: Enabled:

3,000 sf Patient access to medical records Conducive to open discussions between patient and staff Transparency, decentralized Collaborative

Outpatient care and consultation rooms: 7,000 sf Equipped: Patient access to medical records Engaged: Conducive to open discussions between patient and staff Empowered: Privacy, provide a sense of dignity Enabled: Collaborative Chapel, sacred space: 1,000 sf Equipped: Scared space by use of light, texture, sound, Memory availability, Universally religious Engaged: Humbling, reflecting Empowered: Privacy, provide a sense of dignity Enabled: Gathering space, congregational

Hospitable Hospitals: Place of Healing

Re-Presenting Hospitality

Hospitable Hospitals: Place of Healing

THE DESIGN PROJECT One of the key strategies in designing a senior care hospitable hospital is to establish a strong sense of place. It is of utmost importance that the site and building design allow the users to feel at home and remain rooted in their community. In the spirit of Sylvania, the “forest land,” the design begins with an arboretum that will not only encompass the building site, but will extend far beyond property boundaries. Marching southeast from the site along Monroe Street, the arboretum extends through the elementary school property and onto the library and city hall sites. Although the host of the hospital, the Sylvan Forest Arboretum will be fully accessible to the entire community as an educational and recreational park that is fully integrated into the existing park system. By planting the trees in equally spaced rows perpendicular to Monroe Street, the arboretum reveals its own institutional facade. The uneven spacing of trees in the perpendicular direction provides appropriate privacy for the hospital and surrounding homes. Because trees are the “largest living architectural structures,” as described by landscape architect Gina Crandall, strategic planning will be required to obtain the desired effect and success of the everchanging landscape over decades of growth.1 Young trees

will be planted in closely spaced rows, and as the maturing plants require more space and nutrients, they will be eventually transplanted throughout the community. In total, nearly twothirds of the original saplings will be moved in attempt to restore and enhance the sylvan forest across Sylvania’s entire landscape. The Sylvan Forest will be supported by a community Nature Pavilion at the southeast corner of the site, programmed as a park information center and outdoor classroom. The 600 square foot building was incorporated into the site design as a means to establish the design principles for the hospital architecture with the sylvan grid as the driving force behind the massing and organization of the architecture. The intimate scale of the pavilion allowed me to mock-up the material and tectonic palette for the hospital; fossilized stone panels are used as the flooring material and at the base of the structure in order to anchor the building to the earth; the columnar spatiality seamlessly transitions from tree trunk to building structure; the lightweight roof structure speaks to the tree canopy and sky above. The combination of points, planes, and masses define circulation patterns and distinguish public and private spaces.

While the Sylvan Forest arboretum serves as a

1 Crandall, Gina. Tree Gardens: Architecture and the Forest. New York: Princeton Architectural Press, 2013.

Hospitable Hospitals: Place of Healing

valuable landscape for the entire community, it provides the hospital with a healing and invigorating landscape. The Sylvan forest offers a calming and regenerative atmosphere. Like the Nature Pavilion, the basic form of the hospital was generated from the sylvan grid of the arboretum. The program was divided into two subcategories of use; those that generate a lot of activity and noise such as the emergency care unit, and those that would benefit from a more quiet and intimate setting such as the in-patient rooms. The hospital was programmatically organized into two bars according to these criteria, and nested with the rows of trees. The eastern bar, which houses the east facing patient rooms, has been slightly bent around the centroid in order to capture the morning sun that will greet each patient each new day. Main entrances into the building are situated at the end of the bars. Entrance for the emergency care unit is directly adjacent to Monroe Street, and an entry on the northern facade of the hospital brings visitors into the main reception lobby from the parking lot.

Sylvan Grid Arboretum

Hospital program separated into 2 bars (left: emergency, right: patient rooms)

Right bar bent around its centroid, every patient room captures the morning sun

Main entrances located at the end of the bar

A cloister-like corridor binds the two bars together, and creates a simple and intuitive circulation pattern around an internal courtyard. A roof top garden, fully accessible to all patients and visitors, also reinforces the presence of the forest and provides another healing garden. Circulation cloister binds the bars together and creates a courtyard

Basic building form

Figure 05.01: Generating the basic building form for the hospital

Hospitable Hospitals: Place of Healing

Figure 05.02

The arboretum will extend southeast along the street from the hospital site, through the elementary school, and onto library and city hall property. The arboretum will become part of the local park system and work to restore and enhance the sylvan forest.

Hospitable Hospitals: Place of Healing

0 Years 100% of total trees 330 ft3 soil per tree 5 ft on center

5 Years 90% of total trees 380 ft3 soil per tree 6 ft on center

30 Years 60% of total trees 3 630 ft soil per tree 10 ft on center

75 Years 20% of total trees 1260 ft3 soil per tree 20 ft on center

Saplings (Nursery) 3 x 6 ft spacing 8750 trees

Semi-Mature 9 x 16 ft spacing 1336 trees

Mature 18 x 30 ft spacing 450 trees

Strategic planning is required to obtain the desired effect and success of the ever-changing and growing landscape. Figure 05.03

Hospitable Hospitals: Place of Healing

View from Monroe Street

View from residential neighrborhood on Parkwood Blvd

View from northwestern approach on Monroe Street

By planting the trees in equally spaced rows perpendicular to Monroe Street, the arboretum reveals its own institutional facade. The uneven spacing of trees in the perpendicular direction provides privacy for the surrounding homes. View from southeastern approach on Monroe Street Figure 05.04

Hospitable Hospitals: Place of Healing

â&#x20AC;&#x153;Fluidity in architecture is not new to this region. In historical Islamic architecture, rows, grids, or sequences of columns flow to infinity like trees in a forest, establishing non-hierarchical space ... establishing seamless relationships and blurring distinctions between architectural elements and the ground they inhabit.â&#x20AC;? - Zaha Hadid Architects, ZHA Heyder Aliyev Center Design Figure 05.05

Hospitable Hospitals: Place of Healing

The essence of the hospital: an architecture hosted by the Sylvan Forest.

Figure 05.06

Hospitable Hospitals: Place of Healing

Figure 05.07 The basic form of the building was derived from the structure of the forest: the dense edge that appears to be an impenetrable mass, the columnar eventually transitions into the clearing in the woods.

Hospitable Hospitals: Place of Healing

Situated in the southeast corner of the site, the Nature Pavilion provides a small informational center for the hospital arboretum and is part of the existing local park system. It was designed to structure the tectonic DNA for the hospital; fossilized stone is used as the flooring material and at the base of the structure to anchor the building to the earth; the columnar spatiality reflects the ambiance of the forest scape; the lightweight roof structure speaks to the tree canopy and sky above.

Figure 05.08

Hospitable Hospitals: Place of Healing

Par k

woo

lvd

5. 4. 2. 1.

Mon

roe S

treet

Nature Pavilion Floor Plan 1/8” = 1’-0” 1. 2. 3. 4. 5. 6. 7.

Entry Porch Nature Center Outdoor Classroom Circulation Cloister Courtyard Alle from Visitor Parking Alle to hospital

Figure 05.09

Hospitable Hospitals: Place of Healing

The pavilionâ&#x20AC;&#x2122;s semi-enclosed porch provides outdoor classroom space for the adjacent elementary school. See (3.) on floor plan in Figure 05.04 .

Figure 05.10

Hospitable Hospitals: Place of Healing

Details developed for the Nature Pavilion, and translated into the hospital architecture Left: Wood and stainless steel column design Right: Copper and stainless steel door handle

Figure 05.11

Hospitable Hospitals: Place of Healing

The senior hospital will give back to the community. The hosting arboretum, which will become part of the existing city park system, provides appropriate levels of privacy for the hospital and surrounding developments and will become a central moment of education for both the public and private k-12 education systems and Lourdes University.

Figure 05.12

Hospitable Hospitals: Place of Healing

First Floor Plan 1/32” = 1’-0” 1. North entry from parking

15.

2. Main reception

17.*

3. Coffee Cafe 4. Cloister 5. Vertical circulation

16.

6. Courtyard 7. Emergency unit drop-off 8. Emergency care unit

9. Ambulance arrival 10. Emergency reception

11. Chapel 12. Reflection garden 5.

13. Surgical unit 10.

14. Surgical reception

15. Outpatient and testing 16. Kitchen 11.

17. Laundry

14.

*Morgue in basement

12.

Figure 05.13 13.

Hospitable Hospitals: Place of Healing

Second Floor Plan 1/32” = 1’-0”

1. Patient room

2. Patient file station 3. Nurses’ stations

4. Family room 5. Vertical circulation

6. Courtyard balcony 3.

7. Cloister

8. Patient rehab gym

9. Staff locker room

10. Staff break room 6.

2. 5. 1.

9. 4. 2.

10. 2.

2. 2.

Figure 05.14

Hospitable Hospitals: Place of Healing

Third Floor Plan 2.

1/32” = 1’-0” 1. Patient room

2. Patient file station 3. Nurses’ stations

4. Family room 5. Vertical circulation

6. Courtyard balcony 3.

7. Cloister

2. 1.

2. 6.

2. 5. 1. 4. 2.

3. 2.

2. 2.

Figure 05.15

Hospitable Hospitals: Place of Healing

Roof Plan 1/32” = 1’-0” 1. Covered roof top healing garden 2. Open air roof top healing garden 3. Vertical circulation

Figure 05.16

Hospitable Hospitals: Place of Healing

View of the hospital while driving southeast on Monroe Street.

Figure 05.17

Hospitable Hospitals: Place of Healing

View of the emergency care unit entry canopy from the vehicular approach to the parking lot.

Figure 05.18

Hospitable Hospitals: Place of Healing

100

The main entry on the northern facade of the hospital brings visitors into the main reception lobby from the parking lot.

101

Figure 05.19

Hospitable Hospitals: Place of Healing

102

Main reception lobby from the parking lot.

103

Figure 05.20

Hospitable Hospitals: Place of Healing

104

All patient rooms have East facing windows in order to capture the morning sun rise

Figure 05.21

The majority of medical equipment is stored in the built-in cabinetry at the head of the bed Nurses have a secondary entrance into each room from other patient rooms through the door located nearest to the exterior wall

105

Hospitable Hospitals: Place of Healing

106

Section through the in-patient tower, chapel, and emergency unit.

107

Figure 05.22

Hospitable Hospitals: Place of Healing

108

Rehabilitation garden on the roof of the in-patient rooms.

109

Figure 05.23

Hospitable Hospitals: Place of Healing

110

Figure 05.24 Reflection garden accessible from the chapel

111

Hospitable Hospitals: Place of Healing

112

Figure 05.25 Central courtyard

113

Hospitable Hospitals: Place of Healing

114

Workes Cited Expanded Annotated Bibliography

115

Hospitable Hospitals: Place of Healing

116

Beck, William and Ralph Meyer. Health Care Environment: The User’s Viewpoint. Boca Raton: CRC Press, 1982. William Beck and Ralph Meyer explore the functionality and spirit of medical architecture through the eyes of the patients, their families, and the medical staff. Betsky, Aaron. Architecture and Medicine: I. M. Pei Designs the Kirkland Clinic. Lanham: University Press of America, 1992. A series of interviews with the architect and the surgeon reveal this case study, the Kirklin Clinic, as a world-class medical facility. Cadwell, Michael. Strange Details. Cambridge: MIT Press, 2007. Cadwell explores the construction detailing and composition of materiality in the works Carlo Scarpa, Frank Llyod Wright, Mies van der Rohe, and Louis Kahn in attempt to forefront architectural strange making backgrounded by the building norm. Cammock, Ruth. Primary Health Care Buildings: Breifing and Design Guide for Architects and their Clients. London: The Architectural Press, 1981. Presented as a handbook for healthcare design, Ruth Cammock explores the relationships of medical activities and the spaces which within they occurs. She outlines the basic programming and technical needs of healthcare buildings and offers a look into the future of health care design. Care About Your Care. Performed by Dave deBronkart. University of Cincinnati. September 19, 2013. Basing his discussion off of the idea that “Patient” is not a third party word, Dave deBronkart encourages patients and medical staff to work as a team throughout the complicated process of medical care.

117

Corner, James. “A Discourse on Theory II: Three Tyrannies of Contemporary Theory and the Alternative of Hermeneutics.” Landscape Journal, 1990. 115-133. Landscape architect James Corner critiques contemporary landscape and architectural theory that seeks certainty and control. He argues that a hermeneutic approach to architectural theory is a way of returning our built world to the powers of the tradition and memory of the everyday. Crandall, Gina. Tree Gardens: Architecture and the Forest. New York: Princeton Architectural Press, 2013. The author explores the architectural expression of spaces formed by masses of trees. Through a series of case studies, she celebrates the dynamic quality of these tree gardens as they change over time. De Swaan, Abram. “Contraints and Challenges in Designing Hopsitals: the Sociological View” in The Architecture of Hospitals, edited by Cor Wagenaar, 88-95. Rotterdam: NAi Publishers, 2006. Eberhard, John. Architecture and the Brain: A New Knowledge Base from Neuroscience. Atlanta: Greenway Communications, 2007. John Eberhard discusses the relationship between neuroscience and architecture as he explores the way in which architectural spaces affect the human experience and behaviors. He looks to neuroscience as framework to the architect’s intuition. Foucault, Michel. The Birth of the Clinic: An Archaeology of Medical Perception. London: Vintage, 1973. Michel Foucault explores the roots science and medicine has situated in our social and culture attitudes.

Hospitable Hospitals: Place of Healing

118

Foucault, Michel, Discipline & Punish: The Birth of the Prison. New York: Vintage, 1977. Although this reading focuses on the typology of prisons, Foucault explores the capability for modern architecture influence not only the human body but also the human soul. Foucault, Michel. Foucault, Michel. Madness and Civilization: A History of Insanity in the Age of Reason. New York: Vintage, 1988. This essay critiques the medical construction of ‘madness’ in the examination of the phenomenology and social structures. Frampton, Kenneth. “Introduction: Reflections on the Scope of the Tectonic” in Studies in Tectonic Culture. Cambridge: MIT Press, 1995. 1-12. Hancock, John. “Between History and Tradition: Notes Toward a Theory of Precedent” in Precedent and Invention. New York: Rizzoli, 1986. Hancock, John. “The Earthworks Hermeneutically Considered” in Hopewell Settlement Patterns, Subsistence, and Symbolic Landscapes, eds. A Martin Byers and DeeAnn Wymer. Gainesville: U. Press of Florida, 2010. John Hancock explores how architecture arises across time and through the cultural world using the interpretive process hermeneutic phenomenology. He explores the human experience and environment as it is laden with meaning, memory, and tradition. Hancock, John and Patricia Mezinskis. “University-Linked Retirement Communities: UC and New Directions in Facilities for Aging.” Cincinnati: Unpublished grant proposal, 2006. The authors discuss the current demographic trends and themes in retirement living of the Baby Boomers. The expectations of this unique generation are carefully articulated.

119

Harries, Karsten. The Ethical Function of Architecture. Cambridge: MIT Press, 1997. Philosopher Karsten Harries explores architectural theory and asserts that architecture should help us find our way in the world. He expands on arguments made by other prominent philosophers and architectural theorists like Vitruvius and Martin Heideggar. Heideggar, Martin. “Being and Time” in Basic Writings, ed. David Ferrell Krell. New York: HarperCollins, 1977. Heideggar, Martin. “The Origin of the Work of Art” in Basic Writings, ed. David Ferrell Krell. New York: HarperCollins, 1977. Heschong, Lisa. Thermal Delight in Architecture. Cambridge: MIT Press, 1979. Lisa Heschong offers background information on the thermal experience of architecture as a design tool for architects. Heschong focuses on the social, experiential and emotional significance of thermal architecture. HKS Inc. The Architecture of Healing. Dallas: Heritage Publishing, 1994. This book discusses the growing demand within healthcare for an increased emphasis on efficiency and cost containments. It offers a new direction in health facility design and planning that dismantles and decentralizes the current model of huge, institutional hospitals. Steven Holl, Juhani Pallasma, and Alberto P. “An Architecture of the Seven Senses” in Questions of Perception: Phenomenology of Architecture. New York: William Stout, 2006. 26-37. Pallasma claims that the task of architecture is to create a metaphor that structures man’s being in the world. In doing so, the architectural experience should embody all of the senses.

Hospitable Hospitals: Place of Healing

120

“hospital, n.”. OED Online. December 2012. Oxford University Press. http://www.oed.com.proxy.libraries.uc.edu/view/Entry/88724?rs key=wwDk17&result=1&isAdvanced=false (accessed January 21, 2013). “hospitality, n.”. OED Online. December 2012. Oxford University Press. http://www.oed.com.proxy. libraries.uc.edu/view/Entry/88730?redirectedFrom=hospitality (accessed January 21, 2013). King Komiske, Bruce. Designing the World’s Best Children’s Hospital. New York: Images Publishing Dist Ac, 1999. Specializing in hospitals for children, Komiske offers a reference for the design of hospitals as he encourages architects to create places of healing through creativity and family-oriented care. King Komiske, Bruce. Designing the World’s Best: Children’s Hospitals 2 – The Future of Healing Environments (Volume 2). New York : Images Publishing Dist Ac, 2006. Specializing in hospitals for children, Komiske offers a reference for the design of hospitals as he encourages architects to create places of healing through creativity and family-oriented care. Leach, Neil, ed. Rethinking Architecture: A Reader in Cultural Theory. London : Routledge, 1997. Luijpen, William A. “Poetry, Language, Thought” from Phenomenology and Humanism, trans. Albert Hofstadter. Pittsburgh: Duquesne University Press, 1966.

Marberry, Sara, ed. Improving Healthcare with Better Building Design. Chicago: Health Administration Press, 2006. The design of the healthcare environment greatly influences patient healing, family satisfaction, employee performance, and performance outcomes. Mastors, Pat. Design to Survive: 9 ways an IKEA approach can fix health care and save lives. New York: Morgan James Publishing, 2013. Pat Mastors believes that the healthcare system can do better. She offers strategies that could improve upon the current health care model to patients, their families, and healthcare providers through the framework of the business model of IKEA. Mayhew, Leslie. Urban Hospital Location. London: George Allen and Unwin, 1986. Leslie Mayhew explores the relationship between hospital locations and the health care services provided. She offers insight on the advantages and disadvantages of the urban hospital. Merleau-Ponty, Maurice. “Sense Experience” in Phenomenology of Perception, 1945. New York, Routledge, 2002. Merleau-Ponty, Maurice. “The Theory of the Body is Already a Theory of Perception” in Phenomenology of Perception, 1945. New York, Routledge, 2002. Meuser, Philipp. Medical Practices Construction and Design Manual. Berlin: DOM Publishers, 2010. Philipp Meuser explores the most successful case studies in the architecture of medical facilities.

Malkin, Jane. Medical and Dental Space Planning: A Comprehensive Guide to Design, Equipment, and Clinical Procedures, 3rd edition. New York: John Wiley & Sons, 2002. A specialist in healthcare design, Malkin discusses the effects that the built medical environment has on patients and medical staff.

121

Hospitable Hospitals: Place of Healing

122

NBBJ. Change Design: Conversations About Architecture as the Ultimate Business Tool. Atlanta: Greenway Communications, 2006. This book follows the journey of organization leaders as they transformed their business through architectural design. NBBJ offers many successful case studies in the medical industry in which architecture and planning created effective and competitive organizations.

Pallasmaa, Juhani, The Eyes of the Skin: Architecture and the Senses. Chichester: Wiley, 2005. Juhani Pallasmaa critiques modern architecture as pleasing only to the human sense of vision and expresses concern for our ocularcentric culture and environment. He argues that space should be experienced and perceived not only through our sense of sight, but by means of the collaboration of all of our senses.

Nickl-Wheeler, Christine and Hans Nickl. Healing Architecture. Salenstein: Braun Publish, Csi, 2013. This text discusses the fundamental principals behind the conception and design of built space and their effect on coping with illness. One of the key questions to be answered is how architecture can contribute to healing. It is due for release March, 2013.

Palmer, Richard. “Gadamer’s Critique of Modern Aesthetic and Historical Consciousness” in Hermeneutics. Evanston: Northwestern University Press, 1969. 162-193.

Nickl-Wheeler, Christine and Hans Nickl. Hospital Architecture (Architecture in Focus). Salenstein: Braun Publish, Csi, 2012. The idea that patient healing benefits from the environment is not a new concept; this book emphasizes the growing trend and necessity for medical architecture to facilitate healing with exciting and innovative concepts. Norberg-Schulz, Christian. Genius Loci: Towards a Phenomenology of Architecture. New York: Rizzoli, 1979. 6-40. Norberg-Schulz explores man’s relationships with the world and the places that he inhabits. Claimng that for man to belong and to live richly and deeply with thought and care, man must dwell poetically.

123

Relph, Edward. “Geographical experiences and being-in-the-world: The phenomenological origins of geography” in Towards a Phenomenology of Person and World, eds. David Seamon and Robert Mugerauer. New York: Springer Netherlands, 1985. 15-31. Shirazi, M. Reza. Towards an Articulated Phenomenological Interpretation of Architecture: Phenomenal Phenomenology. New York, Routledge, 2014. The author presents phenomenology as a “discourse,” rather than as a fashionable movement. Balancing theory and practice, philosophy and architecture, he uses phenomenological exploration and thought as a road map for concrete design and architecture. Thompson, John D. and Grace Goldin. The Hospital: A Social and Architectural History. New Haven and London: Yale University Press, 1975. This study combines modern thinking of healthcare architecture with a thorough understanding of the social, medical, and cultural history of the hospital from the earliest known hospital wards through the 1960’s.

Hospitable Hospitals: Place of Healing

124

Verderber, Stephen and David J. Fine. Healthcare Architecture in an Era of Radical Transformation. New Haven and London: Yale University Press, 2000. Wagenaar, Cor, ed. The Architecture of Hospitals. Rotterdam: NAi Publishers, 2006. This collection of essays explores a wide range of subject matter within medical architecture, from the history of hospitals and its location within the urban fabric to new and innovative design concepts for the ever-changing health care system. Zumthor, Peter. Thinking Architecture. Basel: Birkhauser, 1998. 83-45. Peter Zumthor reflects on architecture and his own commitment to making architecture. He carefully articulates that architecture should, and does, have a sensuous connection to life.

125

Hospitable Hospitals: Place of Healing

126