We interviewed Stanford University School of Medicine’s Assistant Dean for Facilities Planning and Management, Niraj Dangoria and WRNS partner and project designer, Kyle Elliott about the new building.
Q: How are current trends in healthcare informing medical research?
Niraj: Medical care is currently based on a one-on-one relationship between you and your doctor: you go to your doctor, receive a diagnosis, get treatment, go home, and get well.
Medical care reform aims to move away from this diagnosis-treatment model towards a more global one based on prediction and prevention that takes into account your genetic proclivities, socio-economic situation, lifestyle, and other factors.
Kyle: And even as treatment becomes globalized it also becomes more personalized. If you have a particular configuration of clogged arteries, say, practitioners can digitally map your arteries and take a virtual dry run through the surgery before they perform the real thing.
The other thing that’s going to happen as treatment and clinical therapies become more personalized is that the FDA’s role in approving therapies is bound to change, which will affect the whole process of multi-stage clinical trials.
Q: What drove this project?
Kyle: Right now researchers are scattered all over campus, and may or may not be adjacent to someone else who is researching the same topic. We are pulling research teams together into their own dedicated clinic, where they can form groups based on disease commonality or what we like to call “communities of disease-focused translational research.”
Q: What is the advantage of this consolidation?
Niraj: The primary researcher is going to be right here in this building with the rest of his or her team. This will enhance communication and hasten the bench-to-bedside treatment delivery process.
Q: Will the pressure to get a trial in this building be intense?
Niraj: We think so. Right now, most clinical trials are coming out of the Cancer Center, which is just one of five research Institutes at Stanford School of Medicine. Once research from the various Institutes matures to the Phase 2 stage, which involves human research subjects, all clinical trials will happen in this building. The Stem Cell Institute just got a new building up and running for the Phase 1 stages of research. The other three Institutes are just getting started, and as they begin generating results, they will feed the pipeline of activity that’s going to come through this building.
Q: How long will a team work here?
Niraj: It will vary greatly. The research teams will be together for a while, and then disband when that particular trial is over, so the building will have to be flexible.
Q: How is that flexibility realized?
Kyle: The biggest strategy was to pull the private offices to either side to create an open floor plan that runs north/south through the building. This large, contiguous area avoids isolated islands of space that can be hard to reconfigure as teams change.
Q: What are some specific spaces that encourage interaction across different teams?
Kyle: Basically, the movement strategy of the building places the stairs at the exterior, in the space through which most people will travel. There is also a large terrace, which serves as a gathering place for researchers, and an interesting entry sequence.
As architects we like a studio workspace, but researchers need acoustic and visual privacy for all the confidential information they are handling. For meetings, there are two dedicated conference areas on each floor and a big conference area on the ground floor.
Q: What were some of the early design decisions?
Kyle: We considered some two-story schemes. Our critical move was to add a third story and to separate clinical and research spaces.
Niraj: We put the clinic on the first floor, which is the ‘front door’ that interacts with the community and the world. The upper floors are for research and offices and are internally organized for clinical trial teams.
Q: How does the design offer a comfortable place for clinical trial patients?
Niraj: A clinical trial participant might be a perfectly healthy individual who doesn’t want to go into a hospital-like environment. Yet right next door there may be a very sick cancer patient whose survival depends on long-term, experimental treatment. These two users are in different mindsets and we have to accommodate them both.
Kyle: It’s more of a hospitality environment than a hospital, which allowed some freedom with the interiors.
Q: What were the biggest challenges in developing the design?
Niraj: The basic design idea was simple: put everything a clinical research team needs in one place. But this hasn’t been done before, so there was no coherent model to reference and say, “Look, I want one of these.”
Q: Is this project taking design cues from other places on the medical campus? Conversely how does the FCTR inform those places?
Kyle: If you go back to the original Stanford quad design you’ll find lots of outdoor movement and spaces for chance encounters. It was much more formalized than it is now, but the campus has a long tradition of exterior circulation that avoids creating hermetic interiors. The Clark Center, the LKSC, and the new Lokey building for stem cell research have established an identity for the School of Medicine for us to draw upon. There was a very conscious move to make this place feel like a campus building and not a suburban office block These parcels on Welch Road are under long-term lease from the University and have been developed as stand-alone medical office buildings, surrounded by surface parking. One aim in designing a new translational research center for the School of Medicine was to reclaim this land from suburban, parcel-by-parcel zoning and incorporate them into the campus plan concept.
Q: Have you worked on the Stanford Medical campus before?
Kyle: While at NBBJ I worked on the Li Ka Shing Center, which created a new front door for the Stanford School of Medicine. The client wanted us to use a similar design strategy for parcels on Welch Road.
Q: What are the main materials, and how do they respond to the campus’s architectural tradition?
Kyle: Limestone, terra cotta and metal panel. While the Li Ka Shing Center employs a big red roof, we used terra cotta walls to incorporate that color and reinterpret the traditional terra cotta roof tiles.
Niraj: We want to make sure that it looks contextual, but not copied.
Q: Let’s talk about the overall landscape idea.
Kyle: It’s a microcosm of the larger campus. Upon entry, you come into an enclosed courtyard with a water feature that generates white noise, signaling your arrival in a place that’s distinct from the outside world.
Q: Will the patients go outdoors?
Kyle: If they want to. Some of the patients can use the entry courtyard to relax alone or with their families.
Q: How many client groups were involved at Stanford?
Niraj: The University Architect’s office was responsible for master planning and defining the overall aesthetic of the building. The School of Medicine was responsible for developing the program. There was also an executive committee and a working committee that represented the groups that would be housed in this building.
We also faced a time crunch for an NIH grant opportunity, so we had to make some quick decisions early on to define the project’s fundamental concept.
Q: What are some of the key sustainability measures, and how do they relate to the building’s mission?
Niraj: Sustainability is always very important for Stanford. Some strategies are basic, like orienting the building for maximum daylight, or placing stairs in a prominent location so that people don’t use the elevator. We’re also using sophisticated control systems that minimize energy use.
In healthcare, sustainability will continue to be an over-arching concern in terms of how we manage medical waste, recycle chemicals and instruments, and limit the amount of packaging. There are many things to consider on the operational end.
Kyle: Managing all of our onsite water also remains a big issue. From a user perspective, allowing patients to control their personal environments and connect to the outdoors is very important.
The Jill and John Freidenrich Center for Translational Research opened its doors in June 2012, and The CJ Huang Asian Liver Center & Academic Medical Office Building in August 2014.