Will sick people feel better in a hospital that looks like a mall?

THE BALTIMORE SUN

If the Rouse Company built medical centers, this would be its flagship.

Walking through its glassy front entrance and into its landscaped, skylit atrium, visitors may think they're in an upscale shopping mall or posh resort hotel rather than a place for sick people. Call it a festival hospital, perhaps, or the Suites at Medical Place. ("Having a wonderful operation," the gift shop postcards will read. "Wish you were here.")

Actually, this consumer-friendly environment is the Homer Gudelsky Inpatient Building, an $85 million, 149-bed clinical tower that the University of Maryland Medical System plans to build starting this spring at the northwest corner of Lombard and Greene streets.

Besides providing a new image for America's oldest teaching hospital, the nine-story structure will be a highly visible symbol for UniversityCenter, the west-side neighborhood that has become a focal point for Baltimore's efforts to become a center for the life sciences.

The Gudelsky building is also part of a national trend in which designers are exploring new ways that architecture can help speed medical recovery. Around the country, health care administrators are discovering not only that an improved environment may help their facility increase its market share, but also that patients get well more quickly when they feel good about their surroundings. If that means the normally sterile medical center ought to be more like a Rouse marketplace or Hyatt hotel -- a hospitable hospital -- who can argue with success?

It is no coincidence that preliminary designs of the Gudelsky building bear a striking resemblance to Rouse's Gallery at Harborplace retail center on Pratt street. Its lead designer is the Zeidler Roberts Partnership of Toronto, the same firm Rouse hired for the downtown gallery, and a specialist in designing medical and retail centers. Working with Edmunds & Hyde of Baltimore and Annapolis Associated Architects, Zeidler Roberts drew on its expertise in both fields to create a "shopping center for medical services," as administrators proudly describe it.

Although the design is still evolving, the architects have decided to wrap the addition around the corner of Lombard and Greene streets, providing space for different departments on different levels. But instead of putting it right next to the existing medical center, Zeidler Roberts left a 50-foot-wide circulation zone. It then enclosed that zone with a vaulted skylight to create a dramatic, 12-story atrium that will become the primary indoor space for the expanded facility. The current south hospital's brick exterior will become part of the interior, and corridors of the new building will overlook the landscaped area below like the balconies of an atrium-style hotel. Some patient rooms will also look directly into the atrium, and the existing cafeteria will eventually spill into the space to provide activity at ground level.

This organization is quite ingenius for several reasons. First, the atrium is a powerful orienting device. Although the entrance will remain off Greene Street, where it will be accentuated with a new glass facade, most visitors will have to venture into this new central space in order to reach upper-level clinics or patient areas.

The plan also facilitates expansion. The first building is being designed with the capacity to grow in linear fashion to the north and west. By providing a buffer between the new buildings and the existing facility, the circulation zone makes it easy to preserve the 12-story, 1933 hospital tower, which is being converted to house administrative functions as patient areas are shifted to new buildings on the periphery. The result will be an entirely new medical center -- with the old still very much its core.

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The designers' reliance on retailing principles is likely to trouble some architectural purists, who will see it as a further sign of the "malling of America."

Indeed, in recent years, the same people-oriented layouts and merchant-showcasing layouts that Rouse employed so successfully in urban markets such as Faneuil Hall and Harborplace have begun to show up in museums, hotels, nightclubs, even libraries.

Although this creeping festivalization of architecture has fostered a certain sameness of experience -- and underscored how much America has become a consumer-oriented society -- it has come to be regarded as an acceptable antidote to the coldness and sterility of modern architecture as practiced in the 1950s and '60s. Just last month, the American Institute of Architects bestowed its highest honor on Benjamin Thompson, the architect who pioneered the design formula behind Rouse's urban marketplaces.

But if any type of building stands to benefit by taking on more of the humanizing characteristics of a retail environment, it just may be the medical center. When people go to a hospital these days, often in a state of high anxiety, they look for convenience, safety, security. They want a comfortable, comforting place where it is easy to park, easy to get around, easy to find the clinic they need, free of long lines or other hassles. In short, they want exactly what shopping center patrons want.

In addition, the trend in acute-care teaching hospitals today is toward more and more specialization of services -- kidneys up here, heart over there, lungs down there. The shopping mall is the best precedent for accommodating this boutique-approach to health care delivery.

"We're not retailers. We're care providers," said John Ashworth, vice president of planning, marketing and program development for the medical system. "But in the process of care-giving, we have to be responsive in the same sense that a retailer is responsive. No longer can we be provider-driven. We need to be customer-driven."

"The first moment of entering a hospital is a shock to many people," said German-born architect Eberhard Zeidler. "You don't have to show them that it is a giant machine that is going to drill a hole in them. They know that. You have to show them that it will care for them. You have to make them feel comfortable. The retailers' environment is the most fluent at this because they react to the customer."

Some may wonder about the costs associated with such a setting -- maintaining the plants and cleaning the windows and heating the atrium. But Mr. Zeidler said the costs of construction and operation are not significantly greater than any other configuration he might have proposed. And he contends there is an even more fundamental issue at stake: the curative effect a more pleasant environment can have on patients.

Several recent studies of patient care, he said, show that when patients like their surroundings, they need fewer painkillers and end up getting released more quickly than if they dislike them. If health care settings could uniformly become a more supportive part of the healing process, care providers and insurers would both save money in the long run, he argues. "That's a major impact, when you think in terms of a national health program."

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Given the innovative direction the interior is taking, it is disappointing to see that the exterior is not equally strong.

Made of brick and stone in keeping with new campus guidelines, the building has been broken into smaller masses that pick up some of the lines of neighboring structures. But in its preliminary state, the design is overly robust and articulated, with a series of pop-out bays and other energetic moves but no overriding theme. Especially since it will set the tone for an entire megablock, this first phase needs to be less of a machine-like beast that will set hearts palpitating and more of a calm, reassuring symbol that conveys what a comforting place it is inside.

The most prominent feature is the carved-away corner that frames a curved glass winter garden topped by a lozenge-shaped roof. According to Mr. Zeidler and project manager Martin Fiset, this feature was intended to be a "tip of the hat" to Davidge Hall, the 1812 landmark by Robert Cary Long Sr. and historic symbol of the university. But it sends the wrong message in two ways. First, it seems to signal that the corner is the main entrance, which it isn't. Second, it competes with Davidge Hall more than it complements it. It would make more sense if the architects let Davidge be Davidge and focused on providing a less derivative expression for their own building.

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In the ever-changing health care field, nothing is more important than the care-givers themselves. All the glitz and glitter in the world won't make a difference if an institution doesn't have top-quality physicians, nurses and other dedicated staffers to provide first-rate care.

But Mr. Zeidler is no quack. His prescription for curing a sick health care environment, as part of a larger strategy for enhancing the healing process, is most persuasive. A spoonful of sugar can help the medicine go down. For a city that has already seen how much new retail development can help rejuvenate the downtown, and is now pinning its hopes on the life sciences, the Gudelsky building could be just what the doctor ordered.

New building is part of larger plan

Named after a patient whose family foundation donated $5 million toward its construction, the Homer Gudelsky Inpatient Building is the largest single component of a $210 million plan to reconstruct the University of Maryland Medical System's patient care facilities during the 1990s.

Besides replacing 149 of the medical center's 747 patient beds, the nine-story, 287,000 square foot building will house the University of Maryland Cancer Center, a neuroscience center, facilities for radiation oncology, nuclear medicine and surgical intensive care, an ambulatory surgery center, and clinical teaching space. Later phases will include more inpatient facilities and a new outpatient tower, all ringing the 1933 south hospital tower, which will be converted to administrative offices.

This is the second of three large-scale projects in Baltimore for Zeidler Roberts Partnership of Toronto, which won a competition seven years ago to design the 27-story Gallery at Harborplace complex at Pratt and Calvert streets for the Rouse Co. For the University of Maryland Medical Systems, it was selected over luminaries such as Pei Cobb Freed, Robert Venturi, and David Childs. Its team includes Edmunds & Hyde of Baltimore and Annapolis Associated Architects. In addition, Zeidler Roberts recently replaced British architect Richard Rogers as lead architect for the $164 million Christopher Columbus Center for Marine Research and Exploration on Piers 5 and 6.

Besides providing a new image for the medical center, the Gudelsky tower will be an anchor for the recently-christened UniversityCenter, the west-side neighborhood that also includes the University of Maryland at Baltimore campus. The 121-acre district will be the site of more than $500 million worth of new construction and renovation work over the next decade.

Although the area has never had a very high public profile, planners say it should be thought of as any other renewal district that is seeking to attract people and activity.

"This is a retail area," said Sandy Hillman of Trahan, Burden and Charles, a marketing consultant to the university. "It's just that its product is health care and health services and education and academic services."

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