By Dan Gordon; Photography by Tom Bonner
FOR YEARS, THE VIEW FROM WILSHIRE BOULEVARD between 16th and 15th streets of the new UCLA Health - Santa Monica Medical Center was obscured by tall mesh and green-plastic fencing. The sounds of construction filled the air, but there was no visual clue as to the transformation that was taking place on the other side.
And then the barriers came down and the public got its first look at the gleaming red-brick face and broad green plaza of the new hospital. Now, some 12 years after ground was broken, the revitalized Santa Monica campus of UCLA Health System is open for business.
What were once two architecturally undistinguished buildings on a single block is now a campus spanning several blocks around Wilshire Boulevard and 16th Street. Like Ronald Reagan UCLA Medical Center in Westwood, which opened in 2008, the buildings were designed to create a warm environment with ample natural light and views of green spaces. But as construction of the 510,000-square-foot hospital complex unfolded, another kind of change was taking place: the transformation of a once-small community hospital that originally opened in 1926 into a major academic medical institution.
When the 1994 Northridge earthquake precipitated the rebuilding, the facility was known as Santa Monica Hospital Medical Center. A year later it was acquired by The UC Regents, and today it is an integral part of UCLA Health System.
"This is more than a hospital," says David T. Feinberg, M.D., M.B.A., president of UCLA Health System. "We have outpatient clinics in Santa Monica, we have research going on in Santa Monica and we have world-class care going on in the hospital. It really is a new campus for the University of California, in Santa Monica."
Completed at a cost of $572 million, the new campus marries the warm, communal feeling of a long-established community hospital with access to the latest technology, research and subspecialty care of a world-class academic medical center.
"Often, when a university says it has a community hospital that is part of its health system, there are two standards of care — one at that community hospital and another at the academic medical center," says James Atkinson, M.D., medical director for the Santa Monica campus. "We, however, are delivering one very high standard of care at all of our hospitals. The Santa Monica campus is every bit as much an academic medical center as is our Westwood campus."
The first stage of the rebuilding project was completed in 2007 with the opening of the campus' southwest tower, which houses the Nethercutt Emergency Center and The BirthPlace, featuring hotel-like labor, delivery and recovery rooms and a 16-bassinet Neonatal Intensive Care Unit. In addition, a 50,000-square-foot ambulatory building across 16th Street from the hospital's main entrance will feature an outpatient surgery suite, a radiation oncology facility, an outpatient pharmacy and clinics and medical office space. Facilities at the new campus include:
Over the past several years, a number of services have been relocated from Westwood to Santa Monica, further bolstering the hospital's role within the broader UCLA Health System. The choices of which services to move have been largely based on a continuum of care, says Posie Carpenter, chief administrative officer for the Santa Monica campus.
"Santa Monica is home to most of our primary, secondary and bread-and-butter tertiary care — uncomplicated cardiac surgery, general surgery, solid-tumor oncology, urology, etc.," Carpenter explains, while care involving higher levels of acuity has largely remained in Westwood.
This does not mean, however, that patients who are treated at Santa Monica give up any of the quality that comes with UCLA care. As Dr. Atkinson notes, there is one standard of care throughout UCLA Health System, and patients in Santa Monica have access to all of the subspecialty expertise and leading-edge technology medicine that the system has to offer. Whether that means a patient is transferred to the Westwood campus if necessary or receives consultations from top specialists who are based in Westwood, that level of coordinated care is within reach.
Pediatricians at Santa Monica, for example, now have access to not only the expanded services available there, but they also can access all pediatric subspecialties available at Mattel Children's Hospital UCLA such as pediatric pulmonology, endocrinology, hematology/oncology and immunology. Similarly, patients undergoing inpatient cancer treatment at Santa Monica can be sent to Ronald Reagan UCLA Medical Center in Westwood, if necessary, to receive more complex or specialized therapies.
The broader availability of these subspecialty services is reflected in the number of physicians who now have privileges at Santa Monica — approximately 1,100, nearly double the number from five years ago, Dr. Atkinson says.
Not long after Denise Sur, M.D., arrived at Santa Monica Hospital Medical Center, in 1991, she became part of a committee that examined ways to reduce the hospital's size and scope. This was four years before Santa Monica affiliated with UCLA, following the Northridge earthquake, and Dr. Sur is grateful that nothing much came of her committee's efforts. "It would have been very difficult to make it in the current healthcare environment as a strictly community hospital," she says. "Becoming part of UCLA Health System was what helped us to survive, and in the process, it has given us the ability to excel in a way that would never have been possible without that relationship."
But though it now has achieved a level of excellence that sets it within the highest ranks of academic medical centers, Santa Monica still strives to hold on to some of its original flavor. "The hi-tech is here, but we still retain some of that community-hospital ambiance," says Dr. Sur, who today is chief of staff for UCLA Health - Santa Monica Medical Center and director of UCLA's family residency program. "We weren't ever trying to become a tertiary/quaternary care center, but rather one that sees the typical things patients would come to a hospital for in a community." At the same time, she notes, the availability of far more services and specialists means that for all but the most complex cases, patients can remain in the community for the high-level care they would expect from an academic center.
"There are a lot of advantages to the academic community hospital concept," says Dr. Atkinson. The education and training that are part of the teaching hospital's mission ensure that the latest evidence-based care is practiced, he says, and the connection to the tertiary and quaternary services at the Westwood facility allows patients to be easily transferred, or resources to be brought to them, if their need escalates.
Maintaining a community feel and connecting with the architectural character of UCLA were two central goals in planning the Santa Monica campus, says Robert A.M. Stern, the internationally known New York architect who oversaw the design of the new hospital campus with the local firm of CO Architects.
The hospital incorporates the modified Northern Italianate style of the original buildings on UCLA's Westwood campus. "We wanted them to look similar, so that people coming to Santa Monica perceive through the architecture that they are in the care of staff who are part of one of the world's great medical centers," Stern explains.
In seeking to create a campus environment, Stern and colleagues organized the hospital as a "village of buildings" rather than as a monolithic structure. The look is accentuated by the more than 25 percent of the campus that is dedicated to green and open spaces. The 18,000-square-foot Harman Garden Plaza that faces Wilshire Boulevard serves as a gathering place for patients, visitors and staff to enjoy sunshine, fresh air and ocean breezes. A new cafeteria features both indoor and outdoor seating areas, invoking the healing elements of fresh air and abundant natural light for patients, staff and visitors.
Inside, the hospital's design also strives to make patients and families feel more comfortable, with features such as high ceilings, wide hallways, warm wood and art inspired by nature to instill a sense of restoration and hope. "Most hospitals are designed from the clinical point of view, and they often look like factories in which the hi-tech equipment has been manufactured," says Stern. "I have often said that if you weren't feeling ill when you pulled up in front of them, you might actually become ill because the environment was so unfriendly." Stern sought, instead, to create a welcoming rather than intimidating environment.
With the high ceilings, ample light and warm wood, "I think patients are going to come in and think they have arrived at a five-star hotel," Carpenter says. "We now have a beautiful place of healing."
As with the Westwood facility, the welcoming feel extends to patient rooms, with natural light flowing through large windows overlooking the green spaces. Most of the rooms are private and feature family space and comfortable sleeper chairs for rooming in.
"We see the environment as contributing to the patient's healing," says Dr. Sur, noting that the family is an integral part of that process. "Hospitals used to have limited visiting hours. They almost saw the family as an imposition. Now, we recognize that family members, as well as the physical environment itself, are a huge part of recovery for many patients."
Founded 85 years ago by two local physicians, Santa Monica Hospital had a long tradition of providing outstanding primary care, as well as housing a freestanding family medicine training program long before it was acquired by The University of California Regents in 1995 to become part of UCLA Health System. Originally, the move was seen as a way of bolstering UCLA's primary-care teaching credentials. "We were getting a fantastic family residency program at a time when there was a growing emphasis on the need to train more primary-care providers," says Carpenter.
While primary-care and family medicine training has remained an integral focus in Santa Monica, it wasn't long before the mission expanded. The newly acquired hospital began to evolve from a purely community hospital to an essential part of the clinical, research and educational missions of UCLA Health System.
In 1998, Los Angeles Orthopaedic Hospital became affiliated with UCLA Health System, agreeing to bring its inpatient services to Santa Monica. Throughout its history, the downtown Orthopaedic Hospital, which is 100 years old, has provided care to both poor children and those of movie stars and heads of state. Now, says James V. Luck Jr., M.D., who stepped down in October 2011 as president and CEO of Los Angeles Orthopaedic Hospital, "those children are going to have fantastic care here in Santa Monica in a wonderful, warm and welcoming environment. We couldn't ask for more." Dr. Luck also noted that the new facilities at Santa Monica will help to advance research and education into orthopaedic care, "and that is one of the main reasons we entered into this alliance with UCLA."
The UCLA Geriatrics Program, ranked No. 2 in the nation, was among the first academic programs to move west, and now approximately two-thirds of the ambulatory offices and inpatient programs of the Department of Medicine are in Santa Monica as well.
Amidst the programmatic evolution to academic-community hospital, construction of what was deemed by California's Office of Statewide Health Planning and Development (OSHPD) to be "the most complicated hospital project in the state" proceeded - slowly.
As with Ronald Reagan UCLA Medical Center, the rebuilding project was necessitated by damage from the 1994 Northridge earthquake. But unlike the Westwood facility, which was constructed while patient care continued at the old Center for the Health Sciences complex across the street, building in Santa Monica took place as the hospital remained open for business.
Construction began in 2000, and by completion this year, it will have unfolded over approximately 20 phases. "It was like dominos," says Dr. Atkinson, who headed the hospital team overseeing the construction. "You would build a segment of the new construction, move patients and programs into that space, demolish the old buildings and then move on to the next phase. It all required careful planning by the engineers, architects and state authorities to make sure patients were kept safe as well as comfortable from the standpoint of noise and dust. As a result, it's taken much longer than if we were doing this on a clear field without these constraints."
The delicate process has continued right up through the final phase — tearing down the old patient-care tower, which remained intact as the new complex was built around it. With patients moving into the new hospital in January, demolition of the nine-floor tower — to be replaced by green space — could begin. But because of its juxtaposition alongside several new buildings, the structure could not simply be imploded; instead, the teardown is occurring one floor at a time, with care taken not to affect operations of the surrounding new hospital.
Beyond the inconvenience and safety issues, the lengthy construction time raised many administrative challenges. How much time and effort, for example, should be spent on maintenance and upgrades of a building slated to be torn down? But the larger concern was building a facility over such a long period when biomedical equipment and technology are constantly changing.
"This is why hospitals aren't rebuilt very often," observes Dr. Sur. "For every piece of advice we got about something when we began planning in 1995, the recommendations have changed twice, at least." She laughs when she thinks back on some of the original plans. "It was before the widespread use of wireless technology," she recalls. "We thought we were going to be so hi-tech with our conference center that everyone would be able to plug their computers into a landline." Add to that the evolving mandate for the Santa Monica facility within UCLA Health System. Bringing in Los Angeles Orthopaedic Hospital in 1998 was too good of an opportunity to pass up, but it meant a major revision in the original building plans.
In a sense, though, the building project's slow pace — along with lessons gleaned from the Reagan hospital construction, which was proceeding concurrently but ahead of Santa Monica's — served as an ally. "We were able to make a lot of interventions in the construction to be sure that we would be able to accommodate the most recent equipment," says Dr. Atkinson. "As a result, we will be opening with the latest versions of all of the imaging technology and operating-room systems."
Community engagement has become such an important part of the lexicon of major academic medical centers that it's almost a cliché. But as UCLA Health System's Santa Monica campus opens in earnest — not tucked away but smack-dab in the middle of the community, facing bustling Wilshire Boulevard — it is clear that in this case it's not empty rhetoric.
"The sense of community in Santa Monica runs deep," observes Dr. Feinberg. "There is a long history before we purchased the hospital, and we have to respect that and make sure we are good neighbors."
So at the dedication ceremony in September 2011, the medical center served fresh fruits and vegetables as one might find at the Santa Monica Farmers Market. Santa Monica campus administrators have worked closely with local politicians, police and firefighters to make certain that they are prepared to work together in the event of a disaster. "When you step out on our sidewalks, we are in the City of Santa Monica," says Carpenter. "We see ourselves as an important community resource, and we strive to be well-integrated into the local community, while also serving as an important academic setting for UCLA Health System."
Toward that integration, the Santa Monica campus has begun collaborating with Santa Monica College to support curricula and training programs for health professionals, as well as holding blood drives to support community needs. "The community's involvement with the hospital has been integral from the beginning," says Chui Tsang, Ph.D., superintendent/president of Santa Monica College and a member of the hospital's Board of Advisors. "This is a milestone for Santa Monica — a beautiful facility that will not only provide the best care, but also will house top research."
Laurel Rosen, president of the Santa Monica Chamber of Commerce, believes the presence of the Santa Monica campus has an effect that extends beyond the services provided within the hospital. "When you think about how many people come from very far to receive their healthcare here, we are fortunate to have it within our community," she says. "But more than that, this helps to create a city that stands out from the crowd. Santa Monica is a culturally rich, thriving community, known to be on the cutting edge in many industries, whether it's healthcare, technology or sustainability. Having UCLA here puts out the message that we are doing things right."
"Here in Santa Monica, we pride ourselves on leading on the important issues of our day," adds Richard Bloom, the city's mayor. "Excellence in healthcare and providing added value to our local residents are both high on that list. So, we are blessed to have UCLA Health System's newest state-of-the-art medical facilities in our midst, as well as community access to a lovely, contemplative courtyard that provides a counterpoint and respite to our busy daily lives. Generations of Santa Monicans, as well as people from throughout the region, will benefit from this incredible investment in our community."
Dan Gordon is a regular contributor to UCLA Medicine.