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General hospital: Lunder Building, Massachusetts by NBBJ

Joan Saba of NBBJ explains how the practice used BIM to maximise the number of rooms and still allow light deep into this Boston hospital

Serving nearly 1.4 million patients a year, Massachusetts General Hospital (MGH) needed to significantly expand its facilities to maintain standards of care. Demand for outpatient procedures, emergency-department visits and acute-care inpatient beds had grown far beyond its existing capacity. This led MGH to scrap an original plan for a smaller outpatient building, deciding instead to construct a larger facility housing core hospital services.

As one of the United States’ largest academic medical centres, MGH exhibits typical characteristics of these institutions: a tight, urban campus with buildings from different eras; complex programmatic demands; and the need for high-level co-ordination and communication between facilities and campus operations. Located at the heart of the campus, the Lunder Building had to facilitate the integration of teaching, research and patient care by enabling connections between existing buildings. We used circulation modelling to develop the ideal connections for ease of facility access, patient transport to services elsewhere on campus and materials flow. Due to constrictive floor-to-floor heights within existing buildings, connections were limited to five floors, where pedestrian traffic and logistical connections to existing buildings were most critical.

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The Lunder Building is incredibly complex and not only makes external connections to existing infrastructure on campus, but also links different programmatic elements internally. The 14-floor building houses a five-storey patient tower, high-tech procedural floors, an emergency department, receiving dock, a sterile processing department, and new emergency and radiation oncology units. The challenge was to stack this varied programme on to an extremely compact site in a way that would maximise future flexibility and minimise disruption to the hospital’s services elsewhere on campus.

The design team employed BIM technologies to navigate the complexity of the site and explore programme alternatives during the design and documentation phases. A working 3D model was created enabling each team member to layer-in trade-specific details as the design progressed, to ensure that all the building’s components and connections fitted and worked within the site. Clash-detection systems facilitated the early identification of problems, and their solutions, prior to construction. The 3D model was used to develop core elements of the building, including architecture, interiors, and structural, mechanical and electrical systems. BIM was also used as a communication tool for sharing >> ideas with building users, obtaining planning consent and demonstrating how construction was phased.

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The brief identified a need for more beds to meet increases in patient volume, and a shift from double- to single-patient rooms for the benefit of infection prevention, privacy and greater patient/family-centred care. However, adding more single rooms typically increases the floorplate size, and therefore travel distances for nurses. It also further separates clinical collaborators who work in close proximity to one another.

MGH’s massing reflects this brief. The five-storey bed tower is articulated from the procedural floors below, and the exterior responds to the horizontality and verticality of the adjacent buildings. Fritted fins along the lower levels provide privacy for patients and staff, and break down the exterior mass. At street level, a paved walkway, stairs and a canopy create a distinct place and pathway for visitors, directing them to the main entrance.

Site constraints and the square floorplate of the patient tower also made it challenging to give everyone daylight, which was a major design goal, as a connection to the outdoors and natural light is known to speed up the healing process, as well as increasing patient, family and staff satisfaction. Naturally lit spaces also yield operational and sustainable benefits by decreasing reliance on electrical energy.

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To meet these objectives, we developed numerous options for maximising daylight and the number of patient beds per floor, while minimising staff travel distances. The big ‘a-hah!’ moment was in fracturing and shifting the floorplate to break apart the nursing pods, and create a central circulation spine that traverses the floorplate diagonally. The spine creates a direct link between an interior atrium and exterior garden, improves wayfinding and enables deep daylight penetration into the core of the building. Rather than creating a square loop of patient rooms along the perimeter and a central nursing core, the resulting plan yields two interlocking C-shaped groups of beds, which allows for more rooms per floor, increases clinical connection and minimises staff travel times to patient rooms, central supply and support areas.

Patient rooms have full-height windows, and a five-storey garden atrium and exterior bamboo garden bring daylight deep into the patient tower, providing rooms along the core of the building with access to natural light and views of the outdoors. The result is a patient-centred care facility that should meet the needs of MGH, and the community, well into the next century. n
Joan Saba is a partner at NBBJ

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