In Billings' Footsteps

By Edward D. Miller, M.D.

When The Johns Hopkins Hospital opened in Baltimore in the spring of 1889, the design overseen by John Shaw Billings spurred a revolution in hospital planning. Billings had the building pre-wired for electricity, even though municipal power lines hadn't yet reached the site. He had the structure equipped with central heating--a first for an American hospital. He created a unique ventilation system designed to prevent the airborne spread of disease. He even organized the hospital to facilitate clinical work.

Today, 114 years later, Johns Hopkins is again looking to set the pace in medical center construction. Over the last year, we've put together an ambitious new master plan that actually rethinks the look and feel of the whole East Baltimore campus. And though the designs for the buildings and landscape that will evolve from this plan will be drawn up by architects, the layouts this time will be very much a collaborative effort. In keeping with the Hopkins tradition, the ideas that are shaping our vision are coming from hundreds of administrators, faculty and staff members.

I predict that well before this decade ends we will have transformed our East Baltimore campus. Besides the cancer care

and research buildings (Weinberg and Bunting© Blaustein) that opened two years ago, there will be a new Broadway Research Building (now well under way). We will have put up a cardiovascular disease and critical care tower, constructed a children's and maternal hospital and erected two more basic research buildings. We'll also have created a new, parklike front entrance to the medical campus on Orleans Street. And there will be room for future expansion.

Naturally, every building that is erected on this new campus must be a place where physicians, nurses and technicians can work with easy access to equipment and well-thought-out traffic-flow patterns. But bricks and mortar tend to last a long, long time, and medicine is changing daily-and dramatically. Many of Hopkins' existing structures, despite extensive renovations, are obsolete. They don't serve the needs of today's more acutely ill inpatient population; they weren't designed to handle new outpatient care specialties, or an aging America, or patient care that is driven by information technology. In designing our new campus, what we create cannot soon become outdated. The structures must adapt easily to evolving ways of treating patients, teaching and conducting research.

To help us meet that challenge, our first big step was to engage a master planner. David McGregor, managing director at Cooper, Robertson & Partners, reviewed the entire East Baltimore landscape-the hospital, the schools of Medicine, Nursing and Public Health, and The Kennedy-Krieger Institute. Then, he opened a dialogue with 120 people on campus about what Johns Hopkins Medicine needed to succeed over the next half-century. As Dave McGregor went about seeking advice from medical directors and department staff, one requirement became quickly apparent. In this age of genomics, medical researchers need buildings designed to draw faculty, researchers and clinicians together and encourage cross-departmental cooperation.

Taking that concept one step further, we began considering an education building where students and faculty from the schools of Medicine, Public Health and Nursing could mix. And to encourage joint activities that strengthen all three institutions, we began planning spaces where people could meet informally: small conference rooms, a convenient lounge area, a coffeehouse.

I'd be less than frank if I didn't say that we've already learned a number of hard lessons about reconceiving an academic health care campus. Here are just a few:

• The era of building to serve a single department is over. A complex medical center must group core resources for efficiency and integration.
• A professional master planner is essential. Mistakes aren't acceptable, and designing for the future is no place for amateurs.
• Maximum flexibility is the mantra. The worst thing Hopkins or any other major health care facility could do is impede the next generation's ability to adapt a building to evolving technologies and new standards of care. Walls must be constructed to be easily removed.
• Operating rooms will need to accommodate MRIs and other imaging equipment, and patients must be easily transported between imaging and the surgical tables.
• Patients' rooms for the most part should be private (we've learned this from patients themselves) and big enough to accommodate bulky bedside equipment or family members who'd like to stay overnight.

Finally, as part of our drive to avoid mistakes, George Dover, pediatrician-in-chief of the Children's Center, set aside an entire floor to experiment with different configurations and discover which ones work best for patients and staff. Which pieces of equipment, we wanted to know, for example, are best placed at a patient's bedside? We'll apply the lessons learned from George's experiment in designing our new buildings.

Above all, in shaping this vision for the Hopkins Medicine of the future, we've come to appreciate this: dramatic changes in medicine must be matched by dramatic changes in our physical plant. Interestingly, John Shaw Billings understood that concept. We can do no better than to follow his lead.