RESILIENT HOSPITALS
Climate change is causing bigger, stronger and more frequent storms than ever before. Healthcare facilities, particularly those in coastal areas, are among the most vulnerable typologies in terms of safeguarding patients and facilities at all acuity levels while maintaining access during an emergency.
During Hurricane Florence, Wilmington, NC was isolated from surrounding areas for over a week. With the city effectively an island due to flooding, the only way in or out was by boat or helicopter. In the wake of this disaster, a large regional healthcare system commissioned an in-depth study on resilient hospital design. Its purpose was to better understand inherent challenges and opportunities and to explore innovative concepts to inform future design and construction. The study explores what it means to design and build coastal resilient healthcare facilities not just in NC, but in coastal and low-lying communities everywhere.
In high performance sustainable design, every building element must serve multiple purposes. In the case of this resilient hospital concept, elements that support a more resilient building
also create energy efficiency and a better patient experience. Strategies for hardening the structure and maintaining emergency access in severe weather included perforated metal panels, which protect the building from projectiles up to 200 MPH while allowing filtered natural light into the patient spaces; nonessential spaces positioned at lower levels with patient floors elevated above potential flood levels; a rooftop solar array which allows the building to operate if the power grid goes down; three entry points at ground level, the secondstory bridge, and the helipad; and greatly reduced energy loads, which allow the building to operate much longer on solar power than a typical hospital could. High performance, rightsized mechanical systems are located on a protected floor instead of exposed on a rooftop. The resulting concept allows 50% more natural light and reduces energy use by 50% over a typical hospital design.
Supporting a more resilient building, creating energy efficiency and a better patient experience.
In addition to being impact resistant, the façade doubles as a key strategy for energy performance, identity, and patient experience. The perforated screen functions in various configurations supporting green roofs, fritted glazing, recessed glazing, and R-40 wall construction depending on location. The screens also support privacy, control glare, provide a connection to nature, and eliminate the need for blinds.
In terms of patient experience, the concept incorporates biophilic design principles to establish views and connections to nature. From the initial approach to the building, the design reduces patient stress through native year-round LID landscaping, sheltered exterior spaces, uninhibited views in and out of the building, soft edges, and a beautiful façade for visual interest. Patient rooms are designed for optimal efficiency for providers and better healing for patients. The building form supports the necessary choreographed rigidity for critical spaces while allowing flexibility and creative massing in public, communal, and patient support spaces. This holistic approach to resilient design creates the potential for better places for healing, safer access during disasters, and better building performance both in significant weather events and for year-round use.
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At the Intersection of Healing and Resilience DESIGNING
FOR INTEGRATION
The overarching goal of the study was to develop integrated strategies to improve resilience, maintain access, and allow continuous operations and passive survivability for a hospital during and after a disaster while also creating a welcoming and inspiring place to heal. The study was commissioned by a particular client for a particular region prone to hurricanes; however, in order to serve the broadest purpose, the strategies the design team explored will directly translate across geographies to provide more durable facilities everywhere.
Access and Engagement DESIGNING FOR EQUITABLE COMMUNITIES
This study addressed a critical human need: access to healthcare, especially in the event of an emergency. Recognizing that the ongoing impacts of climate change in coastal or lowlying regions are likely to pose increasing risks to communities, this study acknowledges that future facilities which are critical to public health will need to be designed for continuous access, continuous operations, and passive survivability during a disaster.
Close collaboration with the primary stakeholderan established regional hospital systemidentified the need to intricately understand use, access, parking, entry, and level of safe care desired for a region that gets yearly hurricanes.
During the study, the design team and owners consulted with facility administration, hospital and system leadership, care providers, and key user groups. The resulting study is applicable not only to the Wilmington area’s diverse population, but also to hospitals across the globe seeking strategies for more resilient facilities.
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3 NESTLED WITHIN THE ECOSYSTEM DESIGNING FOR ECOLOGY
The building takes a deep dive into the bioclimatic region to work with prevailing winds, harvest maximum daylight for healing, and shield itself from severe storms. Landscape and solar carving in the first three levels provide much-needed daylight into diagnostic areas that are typically dark. The rooftop garden provides habitat for insects and birds.
4 EBB AND FLOW DESIGNING FOR WATER
The project integrates the latest technology in low- flow fixtures to reduce the overall usage of indoor water. Exterior landscaping is irrigated by harvested water from the rooftops, so no potable water is used for irrigation. Due to the potential for flooding in the future, the first floor and surrounding site are designed specifically to handle water infiltration onsite; to safeguard against worst-case scenarios, critical patient services are located above the first level.
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EVERYTHING SERVES MORE THAN ONE PURPOSE DESIGNING FOR ECONOMY
The building layers in many modular material and glazing options that are used in creative ways to maintain limited construction costs. This includes the exterior hurricane debris screening which also minimizes solar heat gain and offsets the costs through smaller HVAC needs. The patient tower is rightsized for ultra-efficient space use and includes modular bathroom systems that minimize onsite construction cost and waste.
6PLANNING FOR WISE USE DESIGNING FOR ENERGY
Hospitals are traditionally one of the largest energy-consuming building typologies, and are operational 24/7 with many technological, lighting, and fresh air loads. This study included extensive energy modeling using typical / traditional building models as a baseline along with code minimums. This concept achieves a 38% reduction in energy through passive measures only including massing, siting, façade shading, and façade assemblies, allowing for the design of more efficient HVAC systems at a smaller scale. These energy savings combine withe solar energy harvested from a relatively small roof to reach a 50% reduction in energy as compared to the baseline hospital tower.
A HEALING PLACE DESIGNING FOR WELLNESS
Wellness and healing are central to the purpose of a hospital, and this concept acknowledges the benefits of biophilic design in the healthcare environment. Two main design features promote interaction with nature: a healing rooftop garden, and the hurricane debris screening. These design features are integral to both resiliency and a positive patient / staff experience. The healing garden provides a secluded space for staff, family, and patients to promote a calming experience, reducing stress while accelerating healing. The hurricane screens allow for more open windows without the need for interior blind treatments while offering reduced heat gain, privacy, and glare control and views to the exterior during all seasons.
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8 PLANNING FOR LONGEVITY DESIGNING FOR RESOURCES
The concept focuses on durability, with hurricane screens and an enclosed mechanical floor designed to minimize damage from high winds and prevent elements of the building itself from becoming debris during a storm. The same strategies that contribute to durability and resilience should reduce the need for maintenance and replacement of building elements over time.
PREPARING FOR CONTINUOUS EVOLUTION DESIGNING FOR CHANGE
The building is meant to serve as part of a large campus, and the siting allows for minimal demolition of surrounding structures while tying into critical circulation elements. The patient floor layout is designed to accommodate change in medical use over time if certain services are moved on or off campus. The mechanical level is a complete floor located within the building to allow for complete removal of dated equipment and easy access to update or change spaces above or below.
This strategy also provides an integral protective layer to the critical utilities that will serve the building during large storm events. The entire façade is designed to allow the building to operate through Category 5 storms or future flooding events. Helicopter access, strategic placement of services above the ground level, and the harvesting of water and solar onsite all contribute to continuous access and passive survivability during a disaster.
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A HEALING JOURNEY DESIGNING FOR DISCOVERY
The building’s processional sequence leads patients and staff deliberately through biophilic spaces that reduce the abruptness of the typical transition into a healthcare environment, and conceptual design focused on the entire journey from the car to the patient room. This sequence is a symbolic gesture to help reorient the mind to a place of holistic healing.
Many states in the southeastern coastal region will continue to grapple with the impacts of natural disasters moving forward, as the projected 50% population growth in the coming decades will be coupled with the increased frequency of super storms. Hurricane resilient healthcare on the coast will be integral to life safety and economic prosperity, not only for clients but also the region. Strategies from this study have the potential to save billions of dollars in damages while providing the general public with the highest level of safety in the worst possible conditions.
First and foremost, the project improves patient care and staff performance by allowing the building to remain accessible and operational during a disaster when emergency needs are greatest. The biophilic design and connection to nature, however, creates a welcoming and healing environment for the hospital’s ongoing work. These deliberate connections to nature have been shown to increase productivity, promote good mental health, lead to faster healing, and reduce turnover among staff members. Continuously re-orienting patients to nature during the visit reduces stress, focuses
the mind on healing, promotes a feeling of safety even in stressful situations, and leads to a better overall perception of the hospital experience.
This project takes a deep dive into a regional problem with global applications. In combining traditional models of healthcare performance such as efficiency and program resolution while focusing on ephemeral poetic design narratives, the study explored strategies to enhance perceptions of healthcare and advanced patient experience. These goals merged with the existing research into strategies for hurricane resilience, and the science behind engineering spaces that can function beyond building code. The resulting proposal takes a critical approach to improving the status quo by injecting art and performance into the future of technological care.
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