Building good bones


A new healthcare facility by global architecture practice HKS transformed a business park in an Atlanta suburb, and set the precedent for the care provider to invest $1bn in developing the wider site. Roseanne Field reports on this LEED Gold project

The Emory Executive Park covers 60 acres in the city of Brookhaven, located in the north eastern suburbs of Atlanta, Georgia. The site was formerly an “executive office park,” built in the 1960s on what was previously dairy farmland. It had slowly fallen out of favour over the past 30 years before being purchased by Emory Healthcare, part of Emory University, which is an “academic healthcare system” in the state.

The aim was to rejuvenate the area and redevelop the park into a medical office campus, with centres for orthopaedics, sports medicine, and ‘brain health.’ A masterplan was developed that placed the Musculoskeletal Institute “as the cornerstone of the plan, establishing a central greenway, new streetscape, and connecting disjointed pieces of the adjacent communities,” explains Teresa Campbell, studio practice leader and health principal at HKS. The practice was appointed after several rounds of interviews.

The entire $1bn project is anticipated to take 15 years, with the Musculoskeletal Institute the second building to finish on site. The institute will help people regain activity and motion through the diagnosis, treatment and repair of bones, joints, and connective tissue.

The brief

Emory Healthcare already had multiple facilities around Georgia, but wanted to bring its several orthopaedic clinics under one roof – in a “comprehensive, state-of-the-art Ambulatory Orthopaedic Centre of Excellence,” explains Campbell. Their client’s mission is to “improve health through integration of education, discovery and healthcare delivery.”

In terms of healthcare requirements, the design team was tasked with creating a patient and family-centred facility encompassing orthopaedics and spinal care, physical therapy, imaging, and ambulatory surgery. Equally important was the inclusion of research space – HKS was aware this was “at the core of Emory’s mission,” but it was also key to the client that the building included the sustainability features that would enable it to achieve LEED certification standards.

Although HKS has previous experience designing healthcare buildings, this project wasn’t without unique challenges from the offset. The site was brownfield, which meant a substantial amount of construction debris from a demolished office building had to be cleared before new construction could begin.

The site also had a challenging topography, sloping down a total of 25 metres from one end to the other. However, as Campbell explains: “This grade became an advantage, allowing the design team to locate the loading dock and delivery area one floor below the primary floor.” It also created an opportunity to recess the 750-space, six-storey parking structure into the lower portion of the site, reducing its visual impact on the campus.

There was a further design challenge, that of setting the design standard for future developments at the park. “It was important for the building to establish a focus on excellent patient care, reinforce innovation, and be a good steward of the site’s resources, restoring the natural ecology where needed,” Campbell says.

Much of the area’s native ecosystems had been lost due to development over the years, and so it formed an important part of the landscape design to reinstate as much of this as possible, including native deciduous trees. The Institute has been designed to control stormwater onsite and large oak trees were placed to eventually grow into a canopy of trees which will provide cover to maintain moisture during dry seasons, and control rainwater during wetter periods. “It promotes biodiversity and creates a self-sustaining landscape that won’t need regular irrigation after the first two years.”

This approach in turn also provides refuge for wildlife such as small animals and birds. Although the building has been designed with a large amount of curtain wall glazing, less reflective glazing and fewer mullions were specified in order to minimise bird strikes. External lighting was also designed carefully to limit uplight and glare on both local wildlife and communities, and this will be reduced further when the trees reach maturity.

Musculoskeletal inspiration

Emory was heavily involved in the design process from the outset in October 2018. In particular, Dr Scott Boden, chair of orthopaedics at Emory University’s School of Medicine, played a big part and influenced many of the key decisions. “He was a strong advocate for the functional layout, design expression, and the push for LEED Gold,” Campbell says. “His passion for creating a healthy environment for occupants, and environmental responsibility, led the design team to map out a path to achieve net zero.” Although not fully carbon neutral, the building does currently achieve 50% less operational and embodied carbon than the average healthcare project.

From the beginning, Emory made it clear they didn’t want the building to be a “plain rectangular box.” Fluidity of motion and the musculoskeletal structure were key influences, “referenced beautifully” throughout both the interior and exterior. “This ethos informed the overall design of the building and the expression of the curvilinear forms represented,” Campbell explains. “Furthering the concept, the interior abstractly reflects the symbiotic relationship between the four components of the musculoskeletal system: bones, cartilage, muscles, and nerves.”

A particular quote from Dr Boden was a great source of inspiration for HKS: “Every day we work together to give patients their lives back, innovate new treatments and inspire the next generation.” This, says Campbell, focused them on the fact they were designing something to make people’s lives better. “From the beginning, we recognised that the healing process benefits from a healthy building with clean air and natural elements that provide comfort and distraction from ills and pains.”

This way of thinking led the design team to incorporate physiological forms into both the architecture and landscape. “Interior elements mimic neuro ganglion and soft bone cells of the body, the exterior curtain wall alludes to bone structure, and the landscape incorporates vertebral forms for areas of respite,” says Campbell. “These forms were crafted to educate users about the body while adding a touch of delight and distraction for patients.”

The car park has been clad in perforated metal panels, “whose pattern recalls the microscopic structure of bone cell anatomy, in keeping with the project’s objective of embodiment,” Campbell explains. Architectural precast concrete wall panels and glazed curtain walling form the exterior of the institute itself. To combat overheating, electrochromic glass from SageGlass was specified for the building’s south facade, which automatically tints to prevent solar gain, while still allowing views out. This in turn reduces the energy consumption required to keep the building cool.

Internally, material choices were largely dictated by sustainability, with “environmentally responsible” choices including terrazzo flooring, sustainably harvested wood panels, gypsum walls, and composite decorative panels.

Continuing the theme of drawing inspiration from the building’s end use, the sixth floor design was inspired by the research that would take place within it. “Since research is used to inform future orthopaedic treatments, it was important for the research component to be located at the top of the facility,” explains Campbell. “It features a protruding triangular form, breaking out from the curvilinear facade, signifying cutting edge research.”

Patient experience & layout

The patient experience was placed at the heart of the design. “Strategies to ease wayfinding, such as orienting all public functions of the north side of the building, to co-locating registration on level one, to a close and proximal parking structure – each step of a patient’s journey was considered in the design,” Campbell explains.

Before working on the layout, HKS undertook a “design diagnostic” of an existing Emory healthcare space in order to inform this design. The process highlighted several areas for improvement, such as poor wayfinding, a decentralised check-in system, waiting areas with no windows, no collaboration between clinic pods, excessive travel distances, and a bottleneck at imaging.

Patient-family advisors were involved in all design committees throughout the design process, which took just over a year to finalise. Frontline staff – physicians, researchers, nurses, technicians, security professionals, and environmental service workers – were also heard in town hall meetings, “contributing their unique perspective to ensure the design met the vast array of user needs in a building of this complexity,” says HKS.

Emory’s mission was to locate all the services addressing the needs of an orthopaedic patient in one place, including surgery, imaging, physical therapy, the cafe, education, and physician practices. “The floorplans are organised in a way that maximises consistency in the patient experience while allowing for the maximum amount of flexibility in the future,” says Campbell. The fixed elements, such as lifts and stairs, and mechanical, electrical, and technology rooms – are located around the perimeter.

Simple wayfinding and clinical adjacencies were implemented, such as locating imaging, physical therapy, and surgery closer to the entrance for the benefit of mobility-impaired patients. Clinician examination space, on the other hand, is located on higher levels (three to five), to take advantage of the light-filled waiting spaces that run the length of the building.

Views of the natural environment were important – from a patient wellbeing perspective as well as wayfinding. Further wellbeing inclusions are ample waiting areas, a cafe, a centralised registration system, decentralised check-out points on each floor, and education and consultation rooms for patient and family training.

Natural light was important to the faculty and students using the education and research facilities, so elements such as lab, conference, and office spaces were located around the perimeter of the research floor. “At every floor the planning was optimised to allow for maximum visual access to views and natural daylight,” explains Campbell. As well as waiting areas being located adjacent to large glazed areas, corridors end with windows as opposed to enclosed spaces, providing users views out, even from the core of the building. “Research has shown views outside help maintain proper circadian rhythms and positively impact sleep cycles, which in turn contributes to healthier people.”

As well as lab and office spaces, the research floor also includes histology, biomechanics, molecular imaging, and administrative space. The building has also been set up to allow for cross-clinician collaboration where necessary. “This is most evident in the design of the clinical floors where a continuous row of clinician work areas criss-crosses the five patient examination corridors, allowing caregivers to exchange information,” says Campbell.

Building systems & LEED

HKS collaborated with various companies to include technological aspects to aid optimisation of patient flow. The institute is a test site for an app by Carrier that clinicians can use to interact with the building, such as opening doors, calling lifts, and setting preferences such as lighting and temperature. The system also monitors carbon dioxide levels, coming on automatically to provide additional oxygen supply when sensors show low levels. A ThyssenKrupp system monitors and moves lifts, and directs users to the one with the shortest travel time.

With LEED certification in mind from the outset, every detail relating to energy performance was carefully planned. “The LEED process challenged the team to evaluate the material selections for the building to meet environmental, ingredient and content requirements,” explains Campbell. “The design uses over 85 products with Environmental Product Declarations and Health Product Declarations, as well as satisfying seven
of the eight material emissions categories for LEED and potentially earning exemplary performance.”

A detailed lifecycle cost analysis was undertaken to ensure the HVAC system offered future flexibility, while not oversized. This showed an 18% improvement in building energy performance was possible by adding
heat pump chillers, with a 50% cut in whole-life running costs, so paying back in seven years.

Solar glare was minimised by the building’s east-west orientation, while still allowing clear views out to the trees. The north east corner of the building, housing the rehabilitation and physical therapy gym, sits in a “lush garden of trees and plants,” bringing biophilic benefits.

The layout located the noisier areas on lower levels, while each floor home houses rooms requiring more privacy, before ending at the top with the research floor. The building’s connections to the wider campus and the Peach Creek Greenway – a path connecting Atlanta and its many suburbs – encourage staff to do physical activity.

Beginning in January, photovoltaics will be installed on the car park roof, intended to offset 12% of the building’s operational energy. Energy and water consumption has also been reduced throughout via smart technology including touchless systems in communal areas.

Construction of the institute began in April 2020, though with strict testing protocols, limited site visits, and appropriate PPE, the team were able to keep to their scheduled construction timeline, with work completing in September 2021. Due to its use of technology throughout, the building has been hailed as a “first-of its-kind intelligent building.”

Since opening the institute has been well received by both Emory and the public alike, and has been given recognition in the World Architecture Festival, and received a Special Mention in the Architecture + Health Category of the Architizer A+ Awards, as well as receiving numerous US honours. “We’re incredibly proud of this building,” Campbell concludes. “It meets and exceeds the project’s initial goals of being visionary, embodying the restoration of health and movement, and being a good steward of the client and earth’s resources.”