This Issue

Preventive Medicine

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A discussion with HOK’s Henry Chao on what makes a healthy building.

By Jeff Harder

Healthcare in the United States is undergoing major changes, with the underpinnings of the system shifting away from simply treating incidents of illness toward promoting overall health and well-being. And for architects like Henry Chao, design principal for the global healthcare practice at the international firm HOK, this shift provides an opportunity to create hospitals and facilities that contribute to this broader purpose. Chao’s most notable projects have included the Ohio State University Wexner Medical Center Expansion in Columbus, Ohio; the Cleveland Clinic Miller Pavilion in Cleveland, Ohio; Kuwait University College of Science in Kuwait; and Ng Teng Feng (Jurong) General Hospital in Singapore. Here, he speaks about subtle design decisions that change perceptions of illness for the better, the parallels between planning hospitals and planning cities, and LEED’s role in fostering a 21st-century sense of what it means to be healthy.

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No one would ever make a fuss if someone was going to a city library. No one would make a fuss if someone was just going to the neighborhood park. If you heard that someone went to the hospital, why should that be a big deal? It shouldn’t be. And [we need] to make sure it isn’t.

A hospital by itself can easily have 12 to 16 different individual departments. Each department has five or six different sections. And healthcare architects need to understand what they do, how they do it, how they relate to each other, how they connect with each other. It is an incredibly functional constraint. The beauty of a hospital is that the architect needs to take the essence of medicine, take the essence of healing, and the essence of science, interpret it, adopt it, express it in a way that it can communicate with its surrounding in a reciprocal manner… it is a two-way dialogue. Each hospital needs to speak about health in a manner that the community can accept and understand.

If you think about the inside of a hospital, a floor plan can be [the same size as] one or two football fields. There’s the circulation, the wayfinding—people always talk about hospital wayfinding being bad and I don’t blame them, because it’s such a complex environment. With each block and each department, it’s like a mini-city. I’ve found that a lot of times, between a hospital space planner and a city planner, there’s a lot of similarity in terms of the amount of information that has to be juggled, balanced, and negotiated. Basically, it takes a designer who is not afraid of a lot of data to tackle a building like a hospital.

After I joined HOK, one of my larger projects was at Ohio State [the Ohio State University Wexner Medical Center Expansion], where we’re dealing with a 1.2-million-square-foot cancer center, with the vision not to treat cancer patients as though they have done something wrong or made a mistake, but to treat cancer as just part of a stage of life. And in fact, that’s what it is. That notion coincides with a major shift in the healthcare environment—and I want to take away the word “care”—the health environment in the United States that’s happening right now. We’re trying to switch from a solely episodic disease treatment health system into preventive and health maintenance and a healthy living society. That’s a tremendous thing, and we as architects have a tremendous opportunity to contribute.

When I was a young architect, the first thing I ever learned about cancer center design is that we need a separate doorway in and out for cancer patients. For years, in healthcare architecture for cancer centers, it was always a separate door. Not only a separate door, but separate parking, separate everything—you don’t want to embarrass these people right? But Ohio State thought that when you have a separate door, you’re actually stigmatizing [cancer patients]. As if they’re so different—almost like, “I have cancer—I can’t even go through the front door. I have cancer—I look so bad that I have to be hidden from public view.” So Ohio State said no to that. They actually put very simple, convenient parking access for everyone. They put a waiting lounge for the people to have a little privacy, but it’s the same entry, everybody comes in and goes out in the same place. And that actually inspired me. 

Rendering courtesy of HOK/Moody-Nolan.

Rendering courtesy of HOK/Moody-Nolan.

At Ohio State, the chemotherapy center has great views of open spaces. We created a family and conversation area because a lot of times, when one person gets sick, it’s like their entire family gets sick. Having those conversations becomes important. So when the patient and family want to connect with each other, we don’t isolate them. I actually thought that was a tremendous breakthrough. The building will probably be completed by this fall, I think, and I can’t wait.

When I was growing up, I didn’t understand so-called preventive care. I didn’t go see my dentist, didn’t get an annual check-up. But my daughter, growing up in this society, knows she needs to go see her dentist every so often to make sure her teeth are good, go to her annual check-up to make sure her health is good, and she takes the responsibility to do that. I think that’s great. I think this generation is going to fundamentally change how we perceive health and healthcare. And they’ll understand that getting proper healthcare is our civic right, and keeping proper health is our civic obligation. In the so-called care environment, whether it’s a hospital or a clinic, now it’s taking on a fundamental shift in identity: the big white elephants, the big grey buildings that sit in the community now need to be seamlessly linked, connected, weaved into the fabric of community life on a daily basis.

I see LEED as a means to an ultimate objective. LEED is never the objective [itself]. The ultimate objective is a healthy environment. Even saying a healthy environment is very limiting—I’d say LEED’s objective is to be responsive and responsible in an environment—responsible behavior, responsible architecture. Health just happens to be part of it. My feeling is that LEED has been a very effective tool: it’s become a mechanism that is to a great extent measurable, and it’s in the marketplace. If our client wants to have that recognition, that becomes an incentive to push our industry to move toward responsible architecture and responsible design, and I think that’s wonderful.

Healthcare facilities deal with the most traumatic moments of people’s lives: when you’re born, when you’re sick, and when you’re actually leaving the world. It’s an emotion-filled environment. But by doing work for a healthcare facility, when you sit down across the table from the healthcare providers—the doctors and nurses—you are talking to a group of very smart, well-educated, well-read people. When I sit down with them, the conversation is always about how I can make an environment the most conducive to better their practice—which is, in general, saving people’s lives. That is absolutely fascinating to me.

To be a healthy person, you need to be in a healthy environment. And a healthy building is just part of it.

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HOK’s $1.1 billion revitalization of the Ohio State Wexner Medical Center campus includes construction of the new 276-bed James Cancer Hospital and Solove Research Institute and Critical Care Center. Aiming for LEED Silver certification, the design integrates space for research and education on each patient floor.

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