'Change design' heralds new era for healthcare projects.

Designing a major, 21st-century medical facility poses unique challenges for the architectural community. One of those challenges is the rapid pace at which medical technology is changing.

If cutting-edge medical facilities are to distinguish themselves by their high-tech devices, the design process must enable doctors and other medical personnel to introduce this vital new equipment into their space. In some cases, the evolution of new medical technologies is moving faster than our ability to design spaces around these tools. Medical devices are not all that is changing. Care and treatment practices are evolving in ways that can affect the physical layout of a medical center. To remain efficient, medical institutions need to function in a physical environment that does not preclude implementation of new service alternatives and new approaches to healthcare delivery.

Under these circumstances, how can architects design a highly technical building that can readily adapt to new technologies, new institutional needs, and new "best practices" in care delivery?

The answer lies in a concept known as "change design," a strategy that allows global design firms like NBBJ to deliver some of the world's most complex and structurally efficient medical developments.

At its heart, "change design" means the delivery of structures that are performance-driven, humanistic and sustainable.

In the past, new technology was forced to adapt to old design. Many hospitals were unable to house large-scale machines such as MRI scanners because of floor-load and ceiling-height limits. Space limitations meant that these hospitals missed out on some of the newest technologies.

An efficient, 21st-century medical center cannot function in this limiting way. If its configuration forbids an institution from internalizing cutting-edge medical machinery, would-be patients will find other centers to accommodate them.

Moreover, academic medical centers are under a great deal of pressure to maximize revenue by leveraging as much value as possible from every square foot of available space. Designing the most effective, high-performing space for today and tomorrow is a paramount concern.

As an illustration of the principle of "change design" in action, our firm's New York City studio recently designed the newly opened, $275 million Ashley River Tower, a performance-driven, humanistic and sustainable medical center at the Medical University of South Carolina (MUSC) in Charleston. As the first step in a multiphase replacement and expansion program, NBBJ had been hired to design a facility that had served as a teaching hospital for roughly 50 years.

The Ashley River Tower consists of a four-story, high-tech diagnostic and treatment building plus a seven-story hospitality bed tower. A garden conservatory atrium connects the two buildings.

"Change design" was integrated into the overall design of the project in many ways:

The technology building and the hospitality tower were purposely separated from one another to allow for the former to be free from the multitude of columns and shafts that typically are necessary for inpatient towers sitting above. This key design decision not only made the property more flexible over time; it also saved substantially on construction costs.

Flexibility of space is a cornerstone of the "change design" process. For this reason, clinical spaces within the Ashley River Tower are all standardized for added operational efficiencies while also being flexible so that they can adapt to future needs.

Even operating rooms are designed as flexible spaces. For example, most of the equipment in operating rooms is suspended from ceiling-fused booms that take up no space on the floor. This configuration makes replacing equipment much easier. The hospital's flexible design approach also allows for the quick conversion of patient rooms into additional ICU beds if the need arises.

At the humanistic level, Ashley River Tower was designed around the patient experience. Various amenities help reduce the anxiety of hospitalization, including spacious, private rooms with family day space, wireless Internet access, family lounges on each floor, valet and concierge services, and other features. The exterior design is primarily made up of glass to afford patients access to natural light, which is proven to positively impact the healing process. New technologies enhance patient safety, reduce infection and promote a "green" environment.

As the MUSC example demonstrates, "change design" enables architects and medical institutions to create massive complexes that remain nimble enough to leverage future advancements and best practices for many decades to come. Such centers will be well positioned to attract and retain professionals--and attract new clients--for the long run by providing effective therapies and delivering first-rate care.

On the healthcare front, "change design" helps ensure that a medical center's technologies will remain current. This vital strategy maximizes the cost-effectiveness of healthcare capital by ensuring that medical facilities stay productive and relevant over their full life span.

JOAN SABA, AIA, FACHA, NCARB, PARTNER, NBBJ