The 1994 Northridge earthquake significantly damaged UCLA’s Center for the Health Sciences and paved the way for construction of the multihospital Ronald Reagan UCLA Medical Center. It took 14 years of planning and construction to complete the job, and Richard F. Azar was there most every step of the way.
From his first days at UCLA, Richard F. Azar was at the epicenter of the planning for and construction of Ronald Reagan UCLA Medical Center. He arrived in 1998, as principal project manager, and later was named director of transition planning. In that essential and complex role, Azar was responsible for overseeing the migration from the old UCLA Medical Center in the Center for the Health Sciences (CHS) to the new hospital that would open across the street on Westwood Plaza.
“Moving into a new hospital is like orchestrating a symphony,” Azar said at the time. “It is crucial that everything be perfectly coordinated.”
Ronald Reagan UCLA Medical Center opened its doors on June 29, 2008. At more than 1 million square feet, the new hospital complex — including UCLA Mattel Children’s Hospital and the Stewart and Lynda Resnick Neuropsychiatric Hospital at UCLA — was, at the time, the single largest construction project ever undertaken by the University of California.
In the 10 years since it opened — from July 1, 2008, to June 30, 2018 — 252,662 inpatients were admitted; 19,954 babies were born; 8,253 transplants were performed; and 412,363 patients were treated in the ER. Azar, who today is chief operating officer for UCLA Health, talked with David Greenwald, editor of U Magazine, about what went into the design and building of Ronald Reagan UCLA Medical Center.
Let’s start by talking about some of the key conceptual elements that went into the design and construction of Ronald Reagan UCLA Medical Center. The bywords were natural light, openness, community space, patient-friendly. Where did those concepts that framed the development of the hospital come from?
Richard Azar: These were the guiding principles that the committee established for the direction in which it wanted to take this new hospital. The concept of creating a “healing environment” came from the UCLA leaders and clinical department chairs who were involved in the master planning. The interpretation of what is a healing environment came from the architect I.M. Pei: abundant natural light.
How did this approach differ from more traditional hospital design?
Azar: The goal was to create an environment that was patient- and family-centric. In the past, hospitals primarily were designed around functionality. Not that our hospital is not functional, but its design is about more than just function. It was designed to make our patients and their families — anyone who enters the building — more comfortable and calm, with broad open spaces and lots of natural light. Making every patient room private was a new concept in the late-’90s. I think every hospital that is being built new today incorporates private rooms in their designs. And there was the idea of bringing the outdoors indoors with larger, oversized windows and exterior spaces. The building’s shape, with the semi-circular towers, allows for natural light while maximizing exterior views. Putting the patient experience at the forefront of the planning is really what drove a lot of the decisions that were made during the design process.
Ten years ago, when we spoke with the hospital and UCLA Health System leaders at that time, Dr. James B. Atkinson, the senior medical director of transition, called the new hospital “the right kind of building.” What makes this the right kind of building?
Azar: The building where we came from — the Center for the Health Sciences — worked great for the 50 years we were there. It allowed for the synergies between research, education and clinical care. But that complex of buildings had 83 doors around its perimeter and there’s about 26 miles of corridor. It was a very busy and chaotic place, and even before the Northridge earthquake, it was no longer conducive for the way we provide patient care today, with privacy, modern amenities and up-to-date IT infrastructure. Ronald Reagan UCLA Medical Center, on the other hand, reflects input and perspective from many different stakeholders: physicians, patients, nurses, managers and support staff — really, from just about everyone throughout every level of the organization. We heard about their own experiences and what worked, what didn’t work and what can be done better. We looked at this building not just from the perspective of what was required by the various regulatory codes, but also from other perspectives, such as operational work flows, which led us to think about how things move around within the hospital — how patients and visitors and staff and material interact and move through the building. And the building was designed and constructed so that it can incorporate the latest in technology infrastructure. All of these elements were brought together around the concept of making the new hospital both efficient and patient-centric.
The opening of the hospital faced numerous delays. It originally was to open in 2004, but it wasn’t completed and opened until 2008. What was the effect of those delays on the hospital when it finally did open?
Azar: Often a positive can come out of a negative. For example, a lot of the medical equipment that we purchased originally for the new hospital was analog-based. During the duration of the construction, analog equipment became digital, so, in large part due to the delays, we were able to stay on top of the changes and upgrade all of our medical equipment to the most current technologies and bring this facility into the digital age. That really put us at the forefront as a state-of-the-art facility.
Dr. Gerald S. Levey, the vice chancellor of UCLA medical sciences and dean of the David Geffen School of Medicine at UCLA at the time, said that he underestimated how complex a project this would be.
Azar: Hospitals are very complex structures. There are many, many regulatory and building codes that don’t apply to other building types that must be adhered to in an acute-care facility. The complexity is not necessarily what you see on the outside, or, in some cases, what you see on the inside, of the building. The complexity involves everything that largely is hidden from view — that which is above the ceilings and behind the walls that most people will never see. There is so much structural integrity — this hospital was built to withstand a magnitude 8.0 earthquake — and so many bells and whistles that keep this building functioning 24/7, 365 days a year. We have to be operational at all times; we can never shut down.
The hospital is now 10 years old. What are the challenges for the next 10 years?
Azar: Capacity is a significant issue. This is something we address on a daily basis. By closely monitoring our throughput — how we move our patients through our system safely and efficiently so that we can treat that next patient — we assess and evaluate on an hour-by-hour basis. In addition, we are now starting to replace all of our medical equipment. Since all of our medical equipment was new and installed at the same time, we are facing major capital investment to replace imaging, surgical and monitoring equipment, in addition to building systems.
When the new Ronald Reagan building opened, all the patients from the old hospital in CHS had to be moved to the new facility in a single day. It was an incredible accomplishment. What went into making it go so smoothly?
Azar: What made the move successful was years of detailed planning. It was definitely a team effort, a group of people who thought of every possible thing that could go wrong. And that’s what we planned out — not just the how, but also the what-ifs and the worst-case scenarios. Our move-day committee was engaged for three-plus years prior to the move, with input from nursing, the emergency department, surgery, the clinical lab, radiology and more. Every department was represented on this committee, and the team was highly engaged and focused. In fact, we completed the patient move in one day without a glitch and ahead of schedule. The bulk of the move started at 7 am, and by around 2:45 pm, we were finished. There were tears of joy when it was all over. It was amazing, simply amazing.
There was some heavy-hitting architectural talent involved in this project.
Azar: Yes. I.M. Pei, the principal designer, and his son C.C. Pei. Perkins+Will were the executive architects, and RBB Architects, who were consulting architects, have done many hospital designs. It truly was incredible to watch the collaboration that went on among the three firms and the user groups over months and months of planning and discussion and their interpretation and thought processes that were leading to the creation of this great, legacy building. The collaboration was fantastic. And the end result was even more amazing.
Did it turn out as expected?
Azar: I truly believe so. The patient rooms are exactly how we wanted them to function. They provide appropriate space for safe patient care, while enabling a friend or family member to stay in the room with the patient around the clock, which truly contributes to the healing process. Our interventional floor, where we co-located integrated operating rooms and interventional procedure rooms on one platform that share pre- and post-treatment recovery bays, has become the model for many other institutions.
What are your aspirations for this facility over the next five or 10 years?
Azar: Capacity will continue to be an issue, but my aspiration is that we will always be able to find ways to accommodate all patients who trust their care to UCLA Health and come to Ronald Reagan UCLA Medical Center and that we continue to create a place that our clinicians and staff are proud to call their home. Our facility was designed to be flexible and easily adaptable, so we are proactively ready for whatever changes we face in health care.