With new hospital’s distinctive ‘W’ design, form follows function – and function reflects vision

UT Southwestern Medical Center is proud to be adding a new architectural, as well as medical, landmark to Dallas with the William P. Clements Jr. University Hospital. But as distinctive as the facility’s W design is, and as appealing as the facade will be, they both are examples of “form following function.”

Architectural aesthetics were not the primary focus of the planning process set in motion by Dr. Daniel K. Podolsky, President of UT Southwestern. Rather, he charged everyone involved with achieving three overriding goals for the new hospital:  it was to be patient-centric, innovative, and integrate UTSW’s research, educational, and patient care missions.

The hospital’s W-shaped design is distinctive and functional. Dispersed workstations will place nurses in close proximity to their patients; research areas on each patient floor will integrate clinicians and scientists into patient care teams; and teaching spaces will provide areas for health care teams to collaborate.

The Question That Drove Everything – ‘What’s Best for the Patient?’

“The question, ‘What’s best for the patient?’ drove decisions about virtually every aspect of the hospital,” said Dr. John Warner, CEO of UT Southwestern’s University Hospitals. “The W shape is distinctive, but we got to it from listening to nurses talk about what allows them to provide the best patient care.”

As Dr. Warner noted, “One major consideration was that the shorter hallways provided by the W shape will reduce the distance that caregivers must walk to perform tasks. Simulations we ran demonstrated that nurses typically walk more than six miles a day in a traditional facility. Obviously, less time walking means more time spent with patients – and the shorter hallways create the ability to get to patients faster when needed.”

Shorter hallways also protect patient privacy and are appreciated by visitors. As community participants in the planning process pointed out, with fewer rooms to walk by, visitors won’t feel as if they are trespassing, as they often do in walking down long corridors of patient rooms. 

The design, by architectural firm RTKL, also made it possible to create patient care floors that offer a quieter and cleaner environment, since it allowed many routine functions involving supplies, meals, and medications to be located “back of house.” This design element was borrowed from Disney theme parks, where visitors don’t see (or hear) behind-the-scenes delivery, provisioning, and preparation activity. 

And for families and visitors, the W design will enhance comfort and ease. Color-coded twin patient towers (comprising a north wing and a south wing) will make it simple to navigate intuitively through the building. In addition, as John Castorina, the lead architect on the project and Senior Vice President of RTKL, noted, “All public areas face the outside, so you always know where you are. You’re not going to get lost.”

As part of the emphasis on designing a healing environment, the architectural team looked for opportunities to provide natural light and interaction with nature, while still offering protection from the effects of sun and heat.

Being mindful of energy efficiency as well as patient and visitor comfort, solar studies indicated that only the “tips” of a W-shaped building would receive the most direct sunlight. Careful siting of the building so that it faces northeast further reduces exposure, while allowing ample natural light to fill the facility through the walls of glass. In fact, much of the building will have some shade by 11:30 a.m. on most days. Even the outdoor dining area will be shaded and protected by the design, allowing patients, families, and hospital staff to enjoy it on most days.

Although not directly related to the W shape, one of the major and most innovative patient-centric features is the technology in each patient room. Interactive, flat screen board  technology allows physicians to confer with colleagues and show patients images to better understand their illness and treatments, and it also enables patients to stay in direct, visual contact with their families. Families will be able to say good night to hospitalized loved ones, and children at home will be able to see their mothers and newly born babies.

Innovation – Another Driver of the Planning Process and the New Facility

The hospital planning process was unprecedented for UT Southwestern, involving more than a dozen work groups and ultimately more than 600 people. Physicians, nurses and other clinicians, staff from every sector of the hospital, patients, and members of the Dallas community all participated as work group members, resources to work groups, or as stakeholder “reactors” to recommendations and mock ups. Importantly, the planning process also involved the architects, who, from the beginning, listened carefully to discussions and input.

“In more than 30 years as an architect, I have never experienced the level of involvement by an organization’s people in the planning, design, and layout of a building,” Mr. Castorina said. “The design of the Clements University Hospital is really UT Southwestern’s design, not mine. The people of UT Southwestern had authorship of this – the most authorship of a building that I’ve ever seen.”

The W shape evolved naturally from extensive discussions about what a modern hospital should provide, now and in the future, and what every hospitalized patient would want, Mr. Castorina said. For the first month of his firm’s involvement, the architects did no drawings. “It was all gathering ideas, ideas, and more ideas,” he reported.

In addition to the ideas and insights of all those who participated in the planning process, the discussions – and the decisions – were informed by a series of site visits to hospitals around the country. For example, a group of UT Southwestern nurses visited a recently constructed hospital at the University of Alabama to learn from nurses there what they thought worked well and what could still be improved upon.

Aziza Young, Nursing Manager of the Neonatal Intensive Care Unit (NICU), said, “We sat down with nurses and managers there and had lots of meetings and ‘show and tells’ with them. Then we came back and had more meetings here. We were honored that so much attention was paid to our input, and we were very impressed that our leaders not only invited us to be part of this process, but truly empowered us. We were encouraged to offer input, and we were allowed to repeatedly examine blueprints as the design process evolved.”

Michael Medina, Associate Vice President of Clinical Ancillary Services, participated in several hospital planning work groups. In describing the planning process discussions, he noted, “People on the committees were very engaged because we knew the architects and our leaders were listening to us. They wanted our perspective. They wanted to hear our ideas about making the building patient-centered. And they listened to our thoughts about providing wonderful views, enabling caregivers to get to the patient quicker, and designing spaces that promote the best possible care. Those were our priorities.”

Dr. Bruce Meyer, Executive Vice President for Health System Affairs, said, “We wanted a healing environment. We understand that being a patient in the hospital is not fun. It’s very hard to get rest. People wake you up during the night, and there is some noise all night long. We thought of ways to increase privacy and reduce noise – including where to place the bathroom in each room and at what angle the door should open. Thought was also given to public areas and lobbies, which will be located outside patient units for security and noise control.”

In terms of day-to-day operations, one important goal was to reduce congested hallway traffic. Typically in hospitals, every hour is “rush hour.” On patient care floors, busy caregivers are constantly taking supplies, meals, medications, and bulky medical equipment to patient rooms and nurse stations – all while patients are trying to rest and visitors are navigating the hallways, searching for the room where their loved one is recuperating.

At Clements University Hospital, locating as much of this activity as possible at the “back of the house” meant designing dedicated elevators to bring materials directly into supply areas and eliminating the clutter and noise of supply carts rolling down hallways where patients and families walk. It also resulted in creating secured cabinets outside each room (“nurse servers”) to house supplies and medications needed for each patient, and building in documentation areas outside each patient room that allow nurses to remain nearer their patients while keeping  charts current.

In addition, there are rounding rooms and “touchdown areas” tucked away on patient care floors that will allow care teams to come together – moving conversations out of the hallway and into a private environment where caregivers can discreetly meet with family members or confer with colleagues on how best to meet the needs of patients.

Like most hospitals, Clements University Hospital will use a pneumatic tube system to rapidly transfer specimen samples, such as blood, to the pathology lab, allowing nurses to stay at their stations attending to patients, rather than walking specimens to the lab. That approach to speed, efficiency, and patient safety was extended in the new hospital by incorporating an innovative chute system that will quickly transport trash and used linens from patient floors to an area outside the building. This will further reduce hallway traffic and will contribute to a safer, cleaner environment by quickly removing these items – and their risk for harboring infection – from patient care areas.

Cleanliness also will be enhanced by a sophisticated air circulation system that enables more frequent air exchanges and double filtration in all areas of the hospital, providing fresher, cleaner air throughout the facility.

A much-debated – but ultimately widely endorsed – decision was to take an innovative approach to adjacencies, which is a major dimension of hospital planning. For example, it was determined that putting all the operating rooms on one floor (to achieve horizontal adjacency) would result in an area almost the length of a football stadium. But, after considerable discussion, it was agreed that “stacking” the operating rooms on separate floors (achieving vertical adjacency) would increase efficiency by reducing staff travel time and the time spent waiting for the delivery of supplies.

The same approach was used for Intensive Care Units. Stacking the units vertically allows the smaller team of physicians overseeing ICU patients at night to move quickly and efficiently between floors, rather than traversing long hallways to get to patients in need. 

New Hospital Integrates Missions – Education, Research, and Patient Care

Academic medical centers are defined by their commitment to the tripartite  missions of education, research, and patient care. We are proud that UT Southwestern’s Clements University Hospital will set a new national standard as an academic medical center that not only reflects education and research in its approach to patient care, but is designed to integrate both into the physical structure of the facility.

The new hospital will have 35,000 square feet of space dedicated to research and learning. Every patient care floor will have space to support clinical research – areas where patients, staff, faculty, and others can participate in cutting-edge research projects, and where patients who need more than current therapies can have access to the most advanced efforts to create new, more effective therapies for their diseases.

Every patient care floor is designed to include conference rooms with Smart Board technology and videoconferencing capabilities, facilitating the ability of care teams to gather and confer on cases. Where appropriate, physicians can use these areas to meet with patients, their families, and other members of care teams. The spaces also will offer students a place to convene for instruction, to discuss cases with UT Southwestern faculty, or to participate in videoconferences with experts based anywhere in the world. 

Several floors will offer simulation rooms, skill labs, and active learning centers, strategically placed in interior pods that are easily accessible and also close to patients. This enables students, residents, and fellows utilizing these spaces to be back at the bedside in seconds if patient care issues arise.

A 10,000-square-foot Education and Conference Center will provide a venue for staff education and training, as well as opportunities for outreach, support, and education for the community.

The Patient and Family Resource Center, located just inside the main entrance to the hospital, will be yet another area focused on education and research. Designed to provide patients and their families with access to the most up-to-date information and materials about the causes, treatments, and cures of diseases, the Center will also highlight UT Southwestern’s history of bench-to-bedside discoveries and therapies. The resources in this area are being planned with guidance from the staff of the Perot Museum of Nature and Science in Dallas and the consultants used to design the exhibits for that facility.

In summing up the approach that was taken in designing the new hospital – as well as the ultimate outcome – Dr. Podolsky noted, “Just as the architect listened, we listened. We listened to our patients, their families, and our staff – all of whom told us what matters most to patients. 

“Naturally, there were hard choices to be made during the planning process, but our decisions were consistently informed by what would make the patient’s care and experience better. Some ideas and features didn’t make the cut. But using that vetting process allowed us to plan a hospital capable of supporting the complete integration of UT Southwestern’s three missions of education, research, and patient care.

“The Clements University Hospital will be a place where the intellect, skill, and science of UT Southwestern are translated into the delivery of high quality, state-of-the-art, and compassionate patient care.”

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Dr. Podolsky holds the Philip O’Bryan Montgomery, Jr., M.D. Distinguished Presidential Chair in Academic Administration, and the Doris and Bryan Wildenthal Distinguished Chair in Medical Science.

Dr. Warner holds the Jim and Norma Smith Distinguished Chair for Interventional Cardiology, and the Audre and Bernard Rapoport Chair in Cardiovascular Research

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