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A New Model of Health Care

Vertical metal panels on new outpatient facility celebrate San Diego’s landscape

Koman1 Building Profile Nov18
Photo: Tom Bonner

The Koman Family Outpatient Pavilion is the last project in an unprecedented, multiyear expansion and development phase at the University of California, San Diego, Health Sciences Campus in La Jolla, Calif.

Designed by Los Angeles-based CO Architects, the $140 million, 156,000-square-foot facility opened in March 2018. The four-story facility establishes a new model for health care delivery within an academic setting. It also centralizes and integrates several outpatient services to support all elements of the patient journey.

Gina Chang, AIA, EDAC, associate principal at CO Architects, says the facility is meant to be the front door of the campus, both in location and operationally for the health system.

A Collaborative Work Environment

As a teaching, research and clinical institution, Chang says UC San Diego Health was pushing the envelope toward having a more collaborative and interdisciplinary way of working. “One of the big things about the new model is looking at the collaborative work environment in a way that’s different than it’s been done before,” she explains.

In a more modern take on the workplace, everyone is used to the doctors having offices. Here, Chang says there are so many people and students, that it’s hard to collaborate when everyone has an office. Therefore, “in the light zones, there’s this great collaborative environment with a bunch of open stations, where different departments can actually see each other and talk to each other, which was one of the things they wanted to do.”

The new model also has a very standardized patient experience. As Chang explains, many of the tenants in the new building came from different parts of the campus. “In coming to this building, the process had to be standardized,” she explains. “Whether you are an orthopedics patient or a stem-cell patient, you check in the same way, go to the waiting room and then the exam room. This is done in a standardized and streamlined way so people aren’t just getting stuck in the waiting room or exam room, and people keep moving.”

One way the building design helps with the patient experience is that it’s made up of modules that are all the same. Chang notes that things can be changed around in the module, but the organization stays the same, where there is a front end, which is the on-stage zone where the patients are seen, and consists of the waiting and exam rooms. Then there’s this off-stage zone, which is staff only.

“Keeping the patient experience short and standardized,” Chang says, “and keeping the off-stage zone collaborative, is the way the clinic module ended up, and I think that really helped satisfy the goals.”

Photo: Tom Bonner

Celebrating San Diego

The Koman Family Outpatient Pavilion celebrates San Diego and its landscape, which is made up of deep ravines that plateau at the top. As a result, there are also vertical bluffs that are a rust, or dirt, color. “The project site happened to be adjacent to one of the ravines, which is actually a nature preserve,” Chang says. “The building language is about these ravines, so it has this verticality and these random patterns, which are a nod to those bluffs.”

To celebrate San Diego’s temperate climate and the sun always shining, Chang notes that the forms of the building crack open, and in between each of the forms is a light zone. To minimize heat gain and glare, the east and west façades are more solid and feature strategic punched openings.

“If you look at the building, there are these four bars, and some of them jut past each other,” she explains. “In between each, there’s a crack, and the light comes in between. Most of the east and west sides are pretty solid, with the light coming in from the top.”

One of the project’s biggest challenges was the metal skin. Since this was the last project in a long series of projects, Chang says it was imperative that it remained within budget. “We really had to stick to the budget, and the users wanted everything that they wanted, so we had to find solutions that had to do with the skin and the finishes.”

Chang says they originally were going to use glass fiber reinforced concrete (GFRC), made up of eight patterns randomly put on the building. When they came in over budget, they changed the exterior to metal, which was lighter, allowing the structural system to be more efficient and less expensive. As for the metal panels, Chang says, “we were able to use the off-the-shelf products and just randomize them. It was a product not normally used in this fashion, but by creatively mixing it up, we got the same effect that we wanted with the bluffs.” By using metal wall panels from Metal Sales Manufacturing Corp., Louisville, Ky., the designers were able to cut the overall project budget.

The vertical metal panels emulate the bluffs, and the pattern and randomized look allowed it to look more organic. The color was reviewed by UC San Diego, and a color consultant who looked at actual images of the bluffs, to find something that got the concept across, while matching the rest of the campus. “We had a lot of back and forth about the color, which is darker than a lot of the other buildings on campus,” she says. “It has two tones to it.”

Photo: Tom Bonner

Maximized Energy

The Koman Family Outpatient Pavilion is expected to receive LEED Gold certification. The facility was designed to minimize energy consumption by maximizing daylight, and is expected to outperform the California Energy Code requirements by more than 30 percent.

“The whole building concept is about the light,” Chang says. “We wanted good light, which there’s plenty of, but we didn’t want glare, and patient privacy was a concern, so we couldn’t have windows in a lot of the spaces.”

To meet the requirements, the east and west sides are solid. “The way the metal panel runs on the east and west sides, with the pretty solid wall, ends up being powerful,” she adds. “It really looked more like the concept we were going for with the bluffs, rather than if it had a bunch of glass in it. It has this pattern that runs a pretty long length, and then the light came from the top, so we were able to get more beneficial light.”