Hopkins Medicine prescribes a new self
Attitudes, as well as buildings, are critical to improvements on medical campus

By Edward Gunts
Originally published in The Baltimore Sun on May 12, 2002

The landscape of East Baltimore is sure to change as a result of Johns Hopkins Medicine's $1 billion plan to rebuild its 52-acre medical campus, but the most far-reaching improvements won't necessarily be visible from the street or on the skyline.

A master plan developed to guide the rebuilding effort calls for Hopkins to transform - and in many cases, reinvent - virtually every aspect of its teaching, research and clinical systems, from the size and location of patient rooms to the way food is prepared and delivered.

The plan is designed to make Hopkins even more of a leader in medical practice and education, while creating a more humane and welcoming environment for the 20,000 staffers, students, visitors and patients who are there on any given day.

It also would make Hopkins a stronger anchor for revitalization efforts in East Baltimore, complementing recently announced plans for a nearby biotechnology park and forging better links between the medical campus and the city's revitalized waterfront and downtown business districts.

In many ways, it's a blueprint for the medical campus of the future - a fully integrated and surprisingly compact facility that will build on Hopkins' role as a proving ground for ideas, promote interdisciplinary collaboration, shorten the distance between lab and bedside, and serve as a model for others to emultate.

"We really are on the threshold of a new era," says Edward Miller, Baker dean of the medical faculty and chief executive officer of Johns Hopkins Medicine.

Plan for entire campus

The area targeted for rebuilding is bounded roughly by Madison, Washington, Fayette and Caroline streets. It includes the Johns Hopkins Hospital and Health System, Hopkins' schools of medicine, nursing and public health, and the Kennedy-Krieger Institute. This is the first time one coordinated plan has been developed for all of those entities.

As prepared by David McGregor of Cooper Robertson & Partners in New York, the master plan represents a substantial departure from the hospital's 19th century layout, in which patient buildings were spread out in a linear fashion and kept relatively low as a way to give each ward plenty of fresh air in the days before modern air conditioning.

Under the Cooper Robertson plan, new buildings would be tall and close together. A new main entrance court would be created on Orleans Street, between Broadway and Wolfe Street.

The plan calls for construction of 2.2 million square feet of space over the next seven to 10 years, including research facilities, a children's and maternal building, and a cardiovascular and critical care tower, plus the upgrading or demolition of many other structures and a potential increase in the amount of green space on campus. The children's center and cardiovascular tower would be among the largest on campus, comparable in size to the eight-level, 350,000-square-foot Harry and Jeanette Weinberg Building at the northeast corner of Orleans Street and Broadway.

Many of the ideas in the plan are not about specific buildings but better ways to care for patients in general. They include:

• Maintaining a higher percentage of private rooms. This will be increasingly important, planners say, as Hopkins' East Baltimore campus is used more often to care for the sickest of patients, including those with infectious diseases.
• Creating larger patient rooms, with more square footage and a longer "head wall" to accommodate the increased number of machines brought to the bedside. Planners suggest lockers for family members and room for a lounge chair or banquette where a relative can stay overnight - a "nurse-extender," particularly valuable in times of a nursing shortage.
• Taking a new approach to cooking and delivering food - the No. 1 source of patient complaints at Hopkins. At present, planners say, food is prepared in a 1960s-era kitchen and often gets cold before it reaches patients. Planners recommend that Hopkins adopt new "cook-chill" technology that enables food to be prepared off-site and "rethermalized" close to the bedside shortly before serving.

Planners also have stressed the need to make buildings as flexible as possible, so a space designed for one purpose, such as a medical oncology unit, might be altered some day to address another need, such as intensive care, without an expensive overhaul.

Compact thinking

One unexpected outcome of the planning process is that it didn't require Hopkins to consume any more land than it already controls. The only new property in the plan is an eight-acre parcel south of Orleans Street that Hopkins is acquiring from the city in a previously-arranged swap for the former Church Home and Hospital tract on Broadway.

McGregor said the plan does not promote sprawl largely because doctors and researchers want to limit the amount of walking they do. "The most important resource we have here is people's time, so you have to bring the facilities as close together as possible."

Individual buildings haven't been designed because Hopkins is still in the fund-raising stage. McGregor explained that it's not wise for a medical center to hire architects too far before construction begins on a building, because its design won't benefit from the latest advances in technology. As a result, the Hopkins plan is essentially a land-use study at this point, with few specifics about architectural design.

Chance to lead the way

When the $1 billion building campaign was announced at a trustee luncheon last weekend - the 113th anniversary of the hospital's opening - university president William Brody and others noted that it gives Hopkins an opportunity to set the pace for health care in the 21st century, just as it did in the 20th.

"Because we are Johns Hopkins Medicine, we are raising the bar not just for ourselves, but for the entire medical profession," said Ronald Peterson, president of the Johns Hopkins Hospital and Health System. "Everyone is watching what we do."

Hopkins has an opportunity to raise the bar for health-care architecture as well.

By starting from the inside out, Cooper Robertson has produced a well-reasoned and highly workable master plan for growth. The present campus is full of "solo act" buildings that reflect a wide range of architectural approaches but don't always sit together well. It's not too soon to start thinking about ways to create a more cohesive and inspiring ensemble of buildings that will both usher in a new era of medicine and herald Hopkins' leadership role in it, even to those who never set foot inside for medical treatment.

It's a mammoth undertaking. But given Hopkins' reputation for excellence, one would expect nothing less.

--Reprinted with permission of The Baltimore Sun