How to Make a Hospital Resilient: A Tour of Spaulding Rehab

Posted by on Feb 3, 2015

Spaulding Rehabilitation Center in Charlestown, Massachusetts, completed in April, 2013, sets a high bar for resilient design. Photo: Steinkamp Photography, courtesy Partners Healthcare

Spaulding Rehabilitation Hospital in Charlestown, Massachusetts, completed in April, 2013, sets a high bar for resilient design. Photo: Steinkamp Photography, courtesy Perkins + Will

Several weeks ago, when I was in Boston teaching at Boston Architectural College, I took several hours to tour the remarkable new Spaulding Rehabilitation Hospital at the Boston Navy Yard in Charlestown, just across the Inner Harbor from Boston.

I had visited Spaulding Rehab once before, in October, 2013, not long after it opened, when I spoke at a morning symposium the hospital hosted, Building a Resilient City: Preparing Our Buildings for Climate Change. Spaulding was the perfect setting for the program, because the hospital incorporated dozens of features that make it one of if not the most resilient hospital in the country. Another of the speakers, David Burson, AIA, Senior Project Manager at Partners Healthcare, described some of those resilience features, and I had to get back to see them for myself.

Spaulding Rehab is one of America’s leading hospitals for rehabilitation of survivors of strokes and accidents, particularly those involving spinal cord injuries. When Partners Health Care, which owns Spaulding, set out to build a new hospital a decade ago, they wanted a site on the water, because water activities, including kayaking, comprise a key part of the rehab program. Hurricane Katrina occurred just as planning was beginning for the hospital, but Partners Healthcare remained committed to the waterfront site they had found at the old Boston Navy Yard (a contaminated brownfield site before clean-up), despite its vulnerability to flooding.

Partners Health Care addressed the flooding risk head-on. With the design leadership of Robin Guenther, FAIA of Perkins + Will, the design team embarked on a program to create a hospital that would be not only resilient to flooding, but far better prepared to cope with the many other predicted impacts of climate change.

Spaulding Rehab is on the water where the Little Mystic Channel meets the Inner Boston Harbor. Many of the hospital's resilience features were implemented in response to flooding risk. Photo: Steinkamp Photography, courtesy Partners Healthcare.

Spaulding Rehab is on the water where the Little Mystic Channel meets the Inner Boston Harbor. Many of the hospital’s resilience features were implemented in response to flooding risk. Photo: Steinkamp Photography, courtesy Perkins + Will.

Physical therapy with a view! Extensive daylighting and views of the water dominate rehab spaces and patient rooms at Spaulding. Photo: Anton Grassl-Esto

Physical therapy with a view! Extensive daylighting and views of the water dominate rehab spaces and patient rooms at Spaulding. Photo: Anton Grassl/Esto, courtesy Perkins + Will

A bank of large operable windows in a hospital lounge. Photo: Alex Wilson

A bank of large operable windows in a hospital lounge. Photo: Alex Wilson

Protection from flooding a keystone of Spaulding’s resilience

The leadership at Partners Healthcare was deeply influenced by the experiences of hospitals in New Orleans during the Hurricane Katrina disaster. The building was raised much higher than required by code; the first floor is 30 inches above the 500-year flood elevation, keeping water out even with a catastrophic flood. Partners recognized that sea level rise would change those flood elevations in the decades ahead.

There are extensive berms to deflect flooding from Boston Harbor and the Little Mystic River; these berms are constructed of large blocks of granite uncovered during the site excavation. An extensive drainage network will allow floodwaters to dissipate quickly if and when such flooding occurs. To access the underground parking garage, you have to drive up over a berm that will help keep water out of the garage—though in advance of a predicted flood, the garage would presumably be emptied of vehicles.

Very significantly, the entire first floor of the building could be flooded with only minor damage and while enabling the upper floors of the building to remain fully occupied and operational. Occupancy uses on the first floor, including a large space for physical therapy, a swimming pool (no problem with flooding there!), cafeteria, lobby, and community meeting spaces, are all fairly temporary, and equipment can be stored out of harm’s way in advance of a major storm.

To comply with this goal, the Perkins + Will team incorporated some radical strategies into the building. All the mechanicals were put on the roof or a penthouse floor above the eight hospital floors. A concrete chase was created to bring high-voltage electricity all the way up to the top of the building after convincing the local utility company, NSTAR, that the company’s primary switchgear vault could be in the penthouse, rather than on the ground. This utility service—at 13,000 volts—extends up through a chase to a portion of the penthouse that only NSTAR has access to.

A patient room at Spaulding. The smaller window on the left is screened and operable, though with key-controlled access. During suitable weather conditions or when an extended power outage occurs the window can be opened for ventilation. Photo: Anton Grassl-Esto, courtesy Partners Healthcare

A patient room at Spaulding. The smaller window on the left is screened and operable, though with key-controlled access. During suitable weather conditions or when an extended power outage occurs the window can be opened for ventilation. Photo: Anton Grassl/Esto, courtesy Perkins + Will

A detail showing the key-controlled window in a patient room. All windows in the hospital are triple-glazed. Photo: Alex Wilson

A detail showing the key-controlled window in a patient room. All windows in the hospital are triple-glazed. Photo: Alex Wilson

Paula Hereau, Vice President for Hospital Operations at Spaulding, in front of one of the operable windows in a meeting space. Photo: Alex Wilson

Paula Hereau, Vice President for Hospital Operations at Spaulding, in front of one of the operable windows at Spaulding. Photo: Alex Wilson

Operable windows and passive survivability

Along with an ability to survive flooding, Spaulding is designed and built to provide for sheltering in place. A key part of this strategy is the inclusion of screened, operable windows in patient rooms, lounges, offices, and other spaces. In New Orleans when power was lost and patients weren’t able to evacuate, nurses had to use furniture to break windows for fresh air, because temperatures rose to well over 100°F with the loss of air conditioning.

Windows are key-controlled and are only used when appropriate, but the nursing staff can unlock patient windows to afford a connection to the outdoors. This access to the outdoors provides a very significant—and discouragingly rare—amenity in healthcare facilities. Roger Ulrich was the first researcher to show that a connection to the outdoors promotes faster healing with less need for pain medications, and hospitals are beginning to incorporate biophilic design features.

Passive survivability—an ability to maintain liveable conditions in the event of lost power or heating fuel—is achieved not only with the operable windows, but also with a highly energy-conserving building envelope. Triple glazing is used throughout the building, and insulation values in the building are far higher than those of typical healthcare facilities. The energy use intensity (EUI) of the 262,000 sf, 132-bed hospital is 150 Btu/sf/yr, roughly half that of the average American hospital.

Glass partition walls on eighth-floor offices provide daylight into the spaces, minimizing the need for electric lighting. Photo: Alex Wilson

Glass partition walls on eighth-floor offices provide daylight into the spaces, minimizing the need for electric lighting. Photo: Alex Wilson

Exterior shading blocks direct sun from the largest exposures of glass. Photo: Alex Wilson

Exterior shading blocks direct sun from the largest exposures of glass. Photo: Alex Wilson

Superb daylighting

Effective use of high-performance glass delivers superb daylighting throughout much of the building. The eighth-floor offices are fully daylit, with glass partitioning in the corridor (see photo), patient rooms have huge windows, and all lounges, physical therapy areas, and other public spaces have both superb daylighting and splendid views to the Harbor and City.

Should there be an extended power outage, daytime electric lighting could be kept to a bare minimum, helping to conserve fuel used by the hospital’s two emergency generators—and allow them to operate well beyond the called-for four days’ of operation without power.

Exterior shading shields much of the building’s glass from direct sun, yet retains views out over the Harbor.

One of two emergency generators located on a penthouse floor above occupied hospital floors. Most of the diesel fuel for for generators is stored in a watertight tank in the basement, but a pump keeps a 150-gallon tank in generator room filled. Photo: Alex Wilson

One of two emergency generators located on a penthouse floor above occupied hospital floors. Most of the diesel fuel for for generators is stored in a watertight tank in the basement, but a pump keeps a 150-gallon tank in generator room filled. Photo: Alex Wilson

The 250 kW gas-fired CHP plant on Spaulding's roof. Photo: Alex Wilson

The 250 kW gas-fired CHP plant on Spaulding’s roof. Photo: Alex Wilson

The gas-fired CHP generator supplies power and heat during peak demand periods, saving the hospital money and reducing its carbon footprint. Photo: Alex Wilson

The gas-fired CHP generator supplies power and heat during peak demand periods, saving the hospital money and reducing its carbon footprint. Photo: Alex Wilson

This gas booster supports the CHP unit to optimize winter operation when gas loads are in peak demand. Photo: Alex Wilson

This gas booster supports the CHP unit to optimize winter operation when gas loads are in peak demand. Photo: Alex Wilson

Redundant power and heating systems

A significant portion of my tour at Spaulding was with Leroy Wallace, the Facilities Manager. Among the mechanical equipment that is located on the penthouse floors and roof are two back-up diesel generators, either of which could carry the entire building’s electrical load in the event of a power outage. The generators can come up to full power in less than three seconds. The building also has a gas-fired, combined heat and power (CHP) system that can be operated not only in the event of emergencies, but during normal building operation as well.

Boilers, chillers, air handlers for ventilation…all of these systems are located high in the building to ensure operation during flooding. Only the primary diesel storage tank is in the basement (as per fire code), but it is housed in a submarine-like bunker and a pump will be able to deliver the fuel to a buffer tank in the penthouse to power generators for at least four days—a lot longer if electrical loads are conserved.

Not all of the resilience features are designed just for emergencies. The 250 kW gas-fired CHP plant on the roof generates power whenever called for—to reduce the hospital’s demand charges during peak periods, for example, or help out NSTAR during periods of exceptional demand. The captured waste heat from the power generation is used in the hospital for water heating and other uses.

Either of these two high-efficiency, 600-ton chillers is capable of running entire building, providing full redundancy. An enhanced free cooling (economizer) system provides most of the winter cooling load to save energy. Photo: Alex Wilson

Either of these two high-efficiency, 600-ton chillers is capable of running entire building, providing full redundancy. An enhanced free cooling (economizer) system provides most of the winter cooling load to save energy. Photo: Alex Wilson

Three high-efficiency, 200-horsepower, gas-fired-boilers located in the penthouse mechanical room operate on a rotating schedule (to equalize run time). They use condensate water from mechanical equipment to preheat make-up water for additional savings. Photo: Alex Wilson

Three high-efficiency, 200-horsepower, gas-fired-boilers located in the penthouse mechanical room operate on a rotating schedule (to equalize run time). They use condensate water from mechanical equipment to preheat make-up water for additional savings. Photo: Alex Wilson

Leroy Wallace, Spaulding's Facility Manager standing in front of the concrete electrical supply chase that brings high-voltage (13,000-volt) utility power directly up to the penthouse where only the utility company can access it. Photo: Alex Wilson

Leroy Wallace, Spaulding’s Facility Manager standing in front of the concrete electrical supply chase that brings high-voltage (13,000-volt) utility power directly up to the penthouse where only the utility company can access it. Photo: Alex Wilson

The medical vacuum system for patient care at Spaulding is also located in one of the penthouse mechanical floors. Thompson Consultants, Inc. of Marion, MA designed the mechanical and electrical systems at Spaulding. Photo: Alex Wilson

The medical vacuum system for patient care at Spaulding is also located in one of the penthouse mechanical floors. Thompson Consultants, Inc. of Marion, MA designed the mechanical and electrical systems at Spaulding. Photo: Alex Wilson

Sustainability and mitigating climate change

While Spaulding Rehab is well adapted to the expected climate and sea level rise of the future, it is also doing its part to reduce carbon emissions. The highly energy-conserving building envelope, natural daylighting, gas-fired CHP, and other features combine to keep the carbon emissions of the building far below those of most hospitals.

Some other features, like the green roofs, absorb rainfall and help to reduce runoff that would contribute to flooding. One of the green roofs includes a theraputic garden for Spaulding patients.

The therapeutic pool at Spaulding is located on the first floor. Photo: Spaulding Rehab Hospital

The therapeutic pool at Spaulding is located on the first floor. Photo: Spaulding Rehab Hospital

This beautiful bench was crafted from one of many live oak logs, left over from ship building, found during the excavation for the hospital. The bench is designed so that a patient in a wheelchair can sit next to visitors. Photo: Alex Wilson

This beautiful bench was crafted from one of many live oak logs, left over from ship building, found during the excavation for the hospital. The bench is designed so that a patient in a wheelchair can sit next to visitors. Photo: Alex Wilson

The hospital is certified Gold by the LEED Rating System, and the plaque is prominently displayed in the first-floor lobby, along with informational signage that describes many of the sustainability and resilience features.

As for cost, the total came to $140 million, according to David Burson. Of that, he estimates that one-half of one percent, about $700,000, went toward resilience features—and a significant chunk of that was the concrete chase to bring power up to the penthouse mechanical rooms.

Hospitals of the future will likely go beyond Spaulding Rehab in terms of resilience and sustainability, but the hospital sets a high bar. Guenther is very proud of the outcome, but gives much of the credit to Partners Health Care. “We had, clearly, a remarkable opportunity with a great client,” she told me.

Many thanks to Paula Hereau, Vice President for Hospital Operations at Spaulding for the wonderful tour!

Along with founding the Resilient Design Institute in 2012, Alex is founder of BuildingGreen, Inc. To keep up with his latest articles and musings, you can sign up for his Twitter feed. To receive e-mail notices of new blogs, sign up at the top of the page.

One Comment

  1. Alex: what a tremendous case study that puts so many resilient design strategies in place so well. Kudos to the client and Perkins+Will. This definitely sets a new standard for resilient design thinking.

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