After 14 years of planning and construction, Ronald Reagan UCLA Medical Center opens its doors with a21st-century building that is both cutting edge and humane.
By Dan Gordon • Photography by Benny Chan/Fotoworks
FOR ALL OF ITS GRAND SCALE and cutting-edge technology, the heart of the newly opened Ronald Reagan UCLA Medical Center is its humanity. The 530-bed medical center, situated on four acres at the southwest corner of Westwood Plaza and Charles E. Young Drive South, “embraces the idea that good architecture is an integral part of the healing process,” says C.C. Pei, who, with his father, the Pritzker Prize-winning architect I.M. Pei, was a principal designer for the project. “We aimed to design an environment for people, not just machines.”
Open spaces that include plazas, fountains and gardens surround the complex, which encompasses Ronald Reagan UCLA Medical Center, Mattel Children’s Hospital UCLA and Stewart and Lynda Resnick Neuropsychiatric Hospital at UCLA. The exterior is clad in travertine marble that was imported from the same quarry in Tivoli, Italy, as the stone used for the Getty Center in Los Angeles. Outdoor terraces on the fourth and fifth floors enable patients to enjoy the open air and mountain views, encouraging therapeutic interaction in a beautiful environment. Inside, the design allows abundant natural sunlight. Even at more than 1-million square feet, with 23 acres of floor area and nearly 300,000 square feet of corridors, the overall feel of the building evokes several smaller hospitals instead of a single overwhelming structure.
“What is the true impact of space, light and nature on wellness?” asks I.M. Pei. “I believe the design of Ronald Reagan UCLA Medical Center will affect the people who work, visit and receive care here. The principal objective is to create an environment of healing.” Achieving that balance between the high-tech and the humane was a central goal of the project from its inception in the wake of the 1994 Northridge earthquake.“Today we have a very modern facility with an environment geared to providing a healing and soothing atmosphere for our patients and their families,” says Dr. Gerald S. Levey, vice chancellor of UCLA medical sciences and dean of the David Geffen School of Medicine at UCLA. “When compared to the old hospital, which was rapidly becoming out of date structurally, it is wonderful to contemplate how our patients will benefit from being in such a facility.”
IT HIT WITH A JOLT AT 4:31 A.M. on January 17, 1994, and registered 6.7 on the Richter scale. Seventy-two people died in the Northridge earthquake, thousands were injured and the shaking caused an estimated $12.5 billion in damage. UCLA Medical Center was among the dozen hospitals in the region that were significantly damaged by the quake. When it came time to consider how to respond to the damage, UCLA’s leadership embarked on an ambitious mission to bring the finest in hospital technology and design to Los Angeles. With $432 million in earthquake relief from the Federal Emergency Management Agency and $44 million from the State of California – and the groundwork laid for a philanthropic campaign that eventually would raise nearly $300 million in private donations, including a $150-million gift pledged in honor of Ronald Reagan by a group of prominent civic and cultural leaders – the Peis were brought in to conceive a facility that would marry the best ideas in design, medical science and patient care.
The two-year planning process – from 1997 until the first shovel of dirt was turned on December 7, 1999, to begin what, at a cost of $830 million, would be the single-largest construction project in the history of the University of California – included a series of focus groups that brought patients and their families together to talk about what they liked and disliked about the current hospital. More than 500 physicians, nurses and designers also were consulted, offering their insight into how to execute a design that would ultimately best serve the patients. Meanwhile, I.M. and C.C. Pei spent hours atop an adjacent parking structure studying the site for the new building before visualizing a design.
The result is a hospital that is functional but also beautiful and stylish. To adapt to the changing needs of healthcare over the next century, the design team emphasized openness and flexibility, creating a technologically smart building with the capacity to be upgraded on an ongoing basis. And the building also is incredibly strong – perhaps one of the strongest public buildings in California. As one of the first hospitals built to the state’s strict new seismic-safety standards, Ronald Reagan UCLA Medical Center was constructed to withstand an 8.0 earthquake and remain structurally sound and fully operational independent of outside resources for up to 72 hours. Literally a pillar of strength, its skeleton is a 26,000-ton web of steel – more than 17 times the amount found in the average office building. Each large-scale weld required about 20 hours to complete, double the time of a standard weld.
RONALD REAGAN UCLA MEDICAL CENTER opened its doors on June 29, 2008. “As we moved in the first patient, we realized … we’ve turned on the building and it’s on forever,” recalls Richard Azar, the director of transition planning. “It is a building that will never shut down.” Visitors entering the new building will immediately notice the sense of spaciousness, both in the public areas on the first floor and on the upper patient floors. They also will notice the natural light, which streams through the multitude of large windows – the hospital incorporates more than 80,000 square feet of window glass. Light is a key element of the hospital’s design. “It really helps both patients and staff to be able to experience light from the outside world rather than artificial light,” says Azar.
At 10 stories, with eight above ground, Ronald Reagan UCLA Medical Center is the same height as the old UCLA Medical Center, but it is much more compact. To walk from one end to the other requires half the steps it took in the old facility, Azar notes. Space was saved and efficiency maximized by clustering related activities on a single floor or by stacking them in vertical cores. Among those happiest with the new design are the hospital’s nursing staff. “Fifty years ago, the typical hospital design featured long corridors, so our nurses have had to walk great distances to get what they needed, whether it was linens, pharmaceuticals, or, more recently, to get to a computer station,” says Heidi Crooks, senior associate director of operations and patient-care services. “With the new design, everything required to care for the patient is located in the center of each pod, easily accessible to the staff.”
Other efficiencies go a long way toward improving patient care. The 154 intensive-care beds, for example, are designed to allow caregivers 360-degree access to the patient. A movable overhead power column delivers electricity, essential gases and other necessary functions. Equally important at a facility that treats some of the sickest and most-complex patients, all rooms outside the ICU are equipped with outlets and connections necessary to convert those rooms to ICU suites if necessary, reducing the need to transfer patients from one room to another. All patient rooms, except for a few on the Mattel Children’s Hospital UCLA floor, are private, and each provides space for family members to stay overnight in the room with their loved one.
TECHNOLOGY NOTE YET INVENTED when planning for the new hospital began is now woven into its fabric, giving clinicians new ways to monitor patients, fight disease, track information and survey patient progress. It includes wireless access to reports, lab results, clinical imaging and patient vital signs; audiovisual communications; diagnostics; robotics; imaging systems; and advanced audio and high-resolution video-conferencing capabilities. With both medical technology and information technology advancing at warp speed, the planning team was challenged to ensure that when the nearly decade-long construction process was complete, aspects of it wouldn’t already be out of date. Magnetic resonance, computerized technology and other equipment used for imaging and in the interventional catheter labs are huge pieces of machinery with a half-life of a few years. “You wouldn’t have wanted to select that equipment back in 1997 and be installing it in 2007,” says Dr. James B. Atkinson, chief of pediatric surgery and senior medical director of transition. Thus, in many cases both selection of the equipment and the building design around it were put off until the project was closer to completion.
Likewise, the way medicine is practiced is constantly changing. For example, Dr. Atkinson notes, cardiologists today perform heart-repair procedures that were once the sole province of surgeons, and vascular surgeons are using diagnostic and therapeutic techniques once confined to interventional radiologists. With that in mind, the new hospital was designed and built to provide for maximum flexibility. “We felt that the building needed to outlast current trends,” Dr. Atkinson says. In response, space was not specifically designed around particular patient populations, diseases or programs, and planners strived to include maximum infrastructure to support future advances in technology. The goal, Dr. Atkinson says, was to “optimize spaces around generalized concepts of patient care so that we could adapt to changes without major remodeling.”
The state-of-the-art technology is prominently on display on the second floor, where the hospital’s 23 operating rooms and 17 interventional-procedure suites boast the most-advanced equipment available. Ronald Reagan UCLA Medical Center is also the only hospital in the world with a comprehensive neuroimaging unit immediately adjacent to, and integrated into, a neurosurgical ICU. On the sixth floor, the Singleton Clinical Neuroimaging Research Center is equipped with state-of-the art brain-imaging devices (PET/CT scanner and 3.0 Tesla MRI scanner) to provide the highest level of care for patients with brain injury, stroke, hemorrhage from aneurysm rupture, brain tumors and epilepsy. The center also allows for unprecedented noninvasive neuroimaging research into the nature of neurological disorders.
The new building includes a robust IT system with both wireless and wired connections and a single network through which all of the systems run. Data centers operate on different levels on opposite sides of the building to provide redundancy in case one goes down. Computers on carts are available in every patient room for clinicians, and every nursing area has multiple stations.
A SINGULAR GOAL was behind all of the architectural and technological decisions: to provide a patient experience that emphasizes compassion and healing. Clustered in nursing-unit pods of 26 beds each around the perimeter of the building, the large, private patient rooms benefit from an abundance of natural light and a sense of plentiful space, with views through large windows that overlook gardens, green spaces and gathering places. Each includes a visitor’s nook so families can spend time in the room comfortably, without crowding the patient or interfering with care. The rooms come with residential-style furniture and a window seat with a daybed that can be pulled out for sleeping. Family members and patients alike have Internet access, along with on-demand hotel-style meal service. There are no longer visiting hours – family members can be with their loved one 24 hours a day.
“Families are an important part of healing,” says Dr. David T. Feinberg, interim associate vice chancellor and CEO of UCLA Hospital System. “We felt that what was important was not only the physical structure but also the ability for the family to take part in the process.”
One of the main conclusions to come out of the focus groups held with families and patients was their desire for more privacy. Beyond the private rooms, the new hospital delivers in several other ways. Absent the traditional long corridors, patients no longer experience the bustling hallways with people walking by their door. Instead, the design minimizes foot traffic going past rooms. “Every ward is like a cul-de-sac off of the main circulation grid from the elevators,” Azar explains. Because they are far-more plentiful than in the previous hospital, there are now elevators for patients and visitors and separate “core” elevators for support staff.
UCLA HAS BEEN A LEADER in patient care, medical research and teaching for more than 50 years. Today, UCLA Health System physicians provide an array of cutting-edge and research-based primary- and specialty-care services in four hospitals on two campuses, and in more than 75 clinic locations. U.S.News & World Report has ranked UCLA Medical Center the No. 1 hospital in the western United States for the past 19 years, and the publication’s 2008 survey ranked UCLA Medical Center among the top-three hospitals in the country. That was before the move. There are many reasons to believe that in Ronald Reagan UCLA Medical Center, the quality of care UCLA delivers will be even better, says Tod Barry, director of quality-management services. The most-obvious advantage comes from the shift to larger, single-occupancy rooms, he says.
“The rate of hospital-acquired infections is a national concern,” Barry notes. “Certain infections can jump from patient to patient even with the best hand-washing techniques. With private rooms, however, that risk should be dramatically lower.” The larger room size also means there will be decreased need to move patients within the facility for services that would otherwise require more space. The ability to bring ICU-level monitoring capabilities to every patient bed also reduces the necessity of transferring many of the sickest patients. With computers available at every bedside, access to patient information will be at the point of care, lowering the likelihood of miscommunication among clinicians – the leading cause of errors in U.S. hospitals, Barry says. A newly implemented electronic medication-management system using bar-coding technology reduces the risk of medication errors.
“The new hospital will enhance our ability to deliver care safely, efficiently and with compassion,” asserts Dr. Feinberg. “And when you think about it from the patient’s perspective, that is by far the most-important thing. Patients don’t really care as much about fancy technology or the physical structure of the hospital. They want care that is effective and delivered in the most-humane way.” “The bottom line is that this hospital will markedly enhance the quality of care we deliver and enable us to continue doing what we do best,” adds Dr. Levey. As the opening in June of the new facility neared, he reflected on all of the people who rallied around the idea of a top-notch new hospital being built in Westwood, including the many donors whose generosity ultimately made the project possible.
“To have seen this beautiful hospital evolve from that first shovel that went into the ground on what used to be Parking Lot 14 has been very rewarding,” Dr. Levey says. “Thinking about all of the people whose lives will be better because of the care they receive in this hospital is a very humbling, satisfying and exciting prospect.”
Dan Gordon is a regular contributor to UCLA Medicine.