Hospital Structure Details

Kaiser Permanente
Small Hospital Innovation

Competition
THE MODULAR HOSPITAL
Entry 99031
2011 Kaiser Foundation Hospitals
Executive Summary
Our Design Concept
Design Challenge
To meet the challenges and objectives of the competition, we have created a design
concept that utilizes a single universal module that can be aggregated and networked
in a variety of ways to create small hospitals at a variety of scales. By utilizing a
single universal module that can accommodate acuity adaptable nursing units of 25
beds each, we can efficiently create small hospitals that range in size from 25 beds
to 200 beds. In addition to nursing units, the universal module can accommodate
ancillary services, support services and medical office buildings at scales that
are complimentary to the number of nursing units and the bed capacity. This is
accomplished by altering the universal modules internal floor plan while maintaining
its structural, mechanical and electrical grids. The interior of the universal module
can in turn be designed to enhance the total patient experience (both humanistic and
therapeutic) while providing efficient and affordable healthcare.
Kaiser Permanente has built a successful

health care delivery model with medical
campuses that typically include a large
hospital and supporting outpatient
buildings. As Kaiser Permanente moves
into new communities, it must replicate
this success with a small hospital.
But Kaiser Permanente is not just
looking for dynamic building designs.
The Small Hospital, Big Idea competition
seeks fresh ideas on how Kaiser
Permanente can reshape its current
medical delivery model to provide
even more exceptional, effective, and
convenient care to its members.
The Small Hospital, Big idea
competitions challenge is to
conceptualize a new approach to
delivering inpatient care to Kaiser
Permanentes members in new or
underserved communities. The
ideal model will use technology and
innovative design to remove barriers to
care, increase collaboration among staff
and between clinicians, patients and
their families. It should foster innovation,
and create staffing efficiencies that allow
Kaiser Permanente to deliver care to
patients effectively and affordably.
Design Objectives
As stated in the Design challenge, Kaiser
Permanente is searching for innovative
ways to flexibly rescale its success
in providing healthcare in its larger
urban inpatient hospitals into ways
that provide effective and affordable
healthcare in smaller communities. In
addition, Kaiser seeks to innovatively
transform healthcare delivery by
providing facilities that focus on the
total patient experience. This focus

should encourage provider, patient and
family collaboration while respecting
human dignity. These two objectives,
flexible scalability and the total patient
experience, have given shape to our
design concept.
Flexible Scalability
To efficiently provide flexible scalability
we must consider the initial range of
possible sizes (number of beds) the small
hospital program may need to address.
In addition we must consider the initial
range of program functions and building
components (ancillary services, support
services, medical offices, etc.) that will
constitute the small hospital. We must
also consider future expansion as the
Kaiser small hospital evolves with the
community it serves (figure 1).
Total Patient Experience

To address the total patient experience
we must consider altering two concepts
that have traditionally been central to
the design of hospitals; first, the concept
of independent departmental silos that
divide the hospital into functionally
separate areas that may not work well
together as a system; and second, the
concept that these departmental silos
are designed to efficiently house a
particular technical process that is often
in conflict with a patient and family
oriented therapeutic environment that
respects human dignity.
Figure 1- Hospital
Scalability considers
specific needs and
future expansion
The Universal Module

Building on concepts employed in the Kaiser Template Hospital program we have
designed a universal module (figure 2) that can house all components of the Kaiser
small hospital and its associated medical office building and related functions. The
universal module is comprised of a grid of twenty-five 30 ft x 30 ft squares arranged
to create a larger 150 ft x 150 ft square. Utilizing various internal layouts, all
inpatient and outpatient functions can be accommodated in multiple interconnected
combinations of the universal module square (22,500 SF/module). At the smallest
scale, a 25-bed hospital would require three modules (1-nursing, 1-ancillary services
and 1-support services), while at the largest scale, a 200-bed hospital would require
24 modules (8-nursing, 8-ancillary services and 8-support services). These hospital
modules can be combined with the medical office building version of the same
universal module to create a complete Kaiser healthcare campus. The use of this
single universal module for all campus functions represents
an120advancement
upon
120
120
the Kaiser Template Hospital design where different modules were used for nursing
units (triangles), ancillary services (extruded rectangles), and medical office buildings
(various shapes).
120
Figure 2- The
Universal Module
can be aggregated
in multiple
interconnected
combinations
150
150
150
150
30
150
30
150
150
150
30
Aggregating the Universal Module
30
120
30
The universal modules can be efficiently aggregated
in a number of ways, both
horizontally and vertically. Horizontally, the universal modules can be combined in
120
a variety of patterns (checkerboard, linear, diagonal, etc.) to accommodate required
hospital and medical office building functional needs, as well as respond to specific
site constraints. These horizontal patterns can enclose courtyards and provide entry
30
30
separation as well as provide way-finding orientation and create a hierarchy of internal
circulation (figure 3). Vertically, the universal modules can be stacked to provide
more compact departmental adjacencies and increased density for smaller sites. The
connectivity of the modules is simplified by the regularized 30 ft square grid and
standardized 150 ft module edge condition.
150
150
30
150
150
Figure 3- Aggregating
and connecting the
Universal Module
SMALL HOSPITAL INNOVATION COMPETITION
ENTRY
99031
Networking the Universal Module
Sustaining the Universal Module
The aggregated universal modules that form the small hospital can be networked
together with Kaiser Members at home, health related community resources, and
other Kaiser Permanente facilities to create a comprehensive healthcare delivery
system. The network system would simultaneously be virtual (referrals) and physical
(IT linkages). Local Kaiser Members are linked at home to the small hospital via
the Internet to enhance access and education. Regional Kaiser high cost / high
technology clinical services and providers can be linked to the small hospital to
leverage scarce staff and equipment resources. Regional Kaiser support service
centers can be linked to the small hospital to provide lower cost support services
(food, supplies, drugs, etc) from centralized hubs. Health related community
resources can provide a variety of education and outreach programs to the small
hospital through the network as well.
An important benefit of the small hospitals universal module is its inherent

sustainability. The compactness of the plan and its use of extensive prefabrication
reduce the environmental impact of the initial construction. Long term operational
sustainability is designed into the universal module as well utilizing both active and
passive measures. Extensive implementation of innovative IT systems and networking
with other facilities will further reduce on-going environmental impact.
Experiencing the Universal Module

The universal module divides the hospital into smaller, repetitive, more
comprehensible components that are more easily understood and navigated by Kaiser
Members. The modules can be aggregated to form amenities such as courtyards
and roof gardens. Circulation spines can be segregated into on-stage and off-stage
corridors. Corridors can parallel the module edges providing natural light and
view orientation. Building systems can be zoned to allow higher ceilings in public
and patient areas. Smaller, more compact nursing units will be quieter and less
intimidating to Members. The exterior enclosure of the modules can be tailored to
fit a specific site context allowing the small hospital to more pleasingly exist within
a neighborhood. Landscape design around the modules can include medicinal and
culinary plants that reinforce the wellness focus of the campus. Lastly, the universal
module can become a recognizable symbol to Kaiser Members and reinforce Kaisers
brand identity.
Staffing the Universal Module

The universal module permits Kaiser to leverage limited small hospital staff resources
in a number of ways. Compact universal nursing units with acuity adaptable patient
rooms allow staff to be cross trained with flexible assignments that can quickly
respond to variations in census and utilization. Same-handed patient rooms will
reduce medical errors and their concomitant demand on staffing. Networking the
modules with centralized regional Kaiser clinical resources permits the use of remote
telemedicine providers. Creation of an interventional platform in lieu of traditional
surgery and imaging departments allows significant consolidation of PACU/Preprecovery and support staff. The utilization of a variety of linked virtual services such as
greeters, admitters and educators will further leverage staff resources (figure 7).
Designing the Universal Module

By creating innovative partnerships among project stakeholders the various iterations
of the universal module can be designed more effectively. Designing with Building
Information Modeling technologies and an Integrated Project Delivery process will
together foster the collaboration among participants needed to speed up the design
process and limit errors and omissions (figure 4a). Utilization of these technologies
and processes simplify the adaptation of the universal module into its various
functional components and foster easy replication of the Kaiser small hospital.
Figure 4a- Designing

the Universal
Module using BIM
to achieve high level
of coordination and
efficiency
Figure 4bPre-fabricated offsite building system

components
Entitling the Universal Module

With the repetitive nature of the small hospital universal modules (figure 5), State
agencies (such as OSHPD in California, CON agencies in other states) can review the
design and construction documents for individual modules and provide entitlement
approvals in advance. These pre-approved modules can then be arranged and site
adapted to address a specific locations programmatic needs. The resulting plan is
then given a streamlined final entitlement review and plan approval.
Figure 5Pre-approved modules

can be arranged and
adapted to address
a specific locationss
programmatic needs
Beds
MOB
Diagnostics & Treatment Modules
Building the Universal Module

Constructing the small hospital is made significantly faster and less costly by utilizing
universal modules with their repetitive components, materials and construction
details. The universal module also lends itself to a greater use of prefabrication.
Entire rooms (figure 6) and building system components (figure 4b) can be
prefabricated off-site with higher quality control and more rigorous schedule
compliance. By limiting the work on site to the installation of the modules and their
building systems, the impact on-site of construction is minimized (traffic, noise,
manpower, etc).
Figure 6Interior of an
Operating Room
Figure 7Staffing the

Universal Moldule in
an efficient way to
leverage resources
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Key Design Ideas

The Kaiser Small Hospital program will transform healthcare design nationally by
creating facilities that are both humanistic and therapeutic, while pioneering the use
of flexible building systems that welcome and adapt to change as demand, treatment
modalities and medical technologies evolve.
The hospital will have new architectural forms that encourage wellness and healing
while respecting human dignity. It will reinvent the often rigid programmatic and
regulatory requirements that constrain hospital design today.
The key ideas that give shape to our vision of the new Kaiser Small Hospital include:
Figure 8- ACU Patient

Room: humanistic and
therapeutic patient
experience
Figure 9Active Health

Promotion through
an enhanced
healthcare
accessibility and
wellness education
1. Enhanced Member Experience

The Kaiser Small Hospital will be an important asset to the community it serves by
being welcoming, convenient, and accessible to all of its members, and also provides
an opportunity for Kaiser Permanente to physically demonstrate its focus on well
being and total health. The hospital will accomplish this by:

Conveniently locating hospitals near members.

Consolidating outpatient, inpatient, wellness education, and health promotion
into a single site campus.
Extending clinical services to patient family members and advocates.
Establishing health education resource centers with on-line services.
Networking hospital IT services to make them accessible to members at home.
Creating welcoming public spaces that evoke confidence and caring.
Utilizing all private rooms.
Bringing a humanistic and therapeutic approach to the design of nursing units
and clinical areass (figure 8).
Increasing transparency to specific clinical outcomes.
Installing bedside patient/family information and entertainment system.
Providing patient meals on a room-service basis
Segregating on-stage and off-stage interior circulation for enhanced patient
privacy.
2. Active Health Promotion
3. Innovative Clinical Operations

By efficiently leveraging staff capabilities and productivity, the Kaiser Small Hospital
will innovatively improve outcomes and foster accountable care. This is achieved by:

Acuity adaptable patient rooms and nursing units.

Interventional services platform (with uniform OR/IR suites) and a centralized,
combined PACU/Prep-recovery.
Robust telemedicine program linked to Kaiser tertiary hospitals (figure 10).
Utilization of minimally invasive robotic treatment modalities linked to a
centralized Kaiser tertiary center.
Utilization of centralized offsite clinical laboratories.
Reduction in medical errors due to a standardized floor plan (identical, same
handed patient rooms).
Nurses stations modified to become multi-disciplinary care team centers.
Utilization of virtual services for certain clinical functions (greeters, admitting,
medical records).
Reliance on a centralized Kaiser regional center for tertiary care service referrals
(cardiac catheterization, cardiac surgery, neurosurgery, radiation therapy, etc.).
Reliance on centralized Kaiser regional center for sub-acute care (skilled nursing,
long term care, etc.).
Expanded use of hospital based physicians (hospitalists, Intensivists, laborists,
etc).
Provisions for point of care wireless information access (tablets linked to EMR,
PACS, etc.).
4. Efficient Support Service Operations

By efficient leveraging of staff capabilities and productivity the Kaiser Small Hospital
will innovatively improve service quality and efficiency. This is achieved by:

Utilization of a centralized regional off-site bulk food service provider.

Utilization of a centralized regional off-site materials management provider.
Utilization of a centralized regional laundry service provider.
Standardization of maintenance procedures and processes.
Implementation of medical equipment inventory controls and utilization systems
(RFID tags, tracking, etc.).
Through enhanced healthcare accessibility and wellness education, the Kaiser Small
Hospital will be the physical manifestation of Kaiser Permanentes Thrive campaign
(figure 9). It advocates this by:
Figure 10Telemedicine
network connects
small hospitals with
regional and
tertiary hubs
Access to health education resource centers with on-line services.

Access to interactive health education programs.
On-site member and staff fitness center.
Various kinds of alternative medicine, preventive medicine and wellness services.
Increased education and outreach partnerships with community-based
organizations and government agencies (screening, monitoring, etc).
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5. Flexible Scalability
8. Collaborative Design Process
The modular design of the Kaiser Small Hospital allows it to function at a variety of
scales ranging from 25 beds to 200 beds (figure 11). The scale of the hospital can
change over time as utilization and membership within a community evolve. This
flexibility is accomplished by:
By creating innovative partnerships among stakeholders, the Kaiser Small Hospital will
be programmed, designed and entitled faster and with fewer errors and omissions
than a traditional hospital. This is accomplished by:
50 Beds
Figure 11- Flexible
Scalability

200 Beds
Universal 150 ft x 150 ft hospital module that can accommodate all hospital
functions.
Universal module composed of (25) 30 ft x 30 ft components.
Regularized structural, mechanical, electrical, and plumbing grids.
Universal 150 ft x 150 ft medical office building module that can accommodate
all clinical functions.
Scalable / expandable central plant.
Scalable / expandable parking grid.
6. Nimble Evolution
The utilization of the Kaiser Small Hospital will change over time as member
demographics, treatment modalities and medical equipment evolve so the facility
must welcome internal change (figure 12). This evolution will be accommodated by:
Figure 12- The
modular system
anticipates the
evolution of the
hospital
Utilization of horizontal and vertical interstitial spaces and floors for building
utilities.
Provisions for a technology dock for mobile equipment use.
Predetermined levels of building system redundancy.
Utilization of an interior planning grid for the modular layout of clinical and
support services (including corridor systems, procedure room layouts and utility
grids).
Utilization of a Building Information Modeling (BIM) design program.

Value Analysis during all design phases.
Utilization of an Integrated project delivery process.
Early partnership with entitlement agencies.
Agency pre-approval of repetitive building modules and components.
9. Rapid Construction Delivery

The collaborative approach to the design and construction of the Kaiser Small
Hospital and its repetitive modularity will reduce the cost of construction, improve
construction quality and speed project completion. This outcome is achieved by:

Off-site prefabrication of repetitive building components and systems (figure 14).

Universal modularity.
Subcontractor involvement in the design process.
Partnership with entitlement agencies.
Elimination of deferred approvals.
Reduction of on-site construction work force.
7. Inherent Sustainability
Figure 13- Naturally

ventilated public
spaces and landscaped
gardens over D+T
modules
Figure 14Rapid construction

delivery due to prefabrication and BIM
coordination
As a steward of the environment with an awareness of its impact on health and

wellbeing (figure 13), the Kaiser Small Hospital will have a minimal impact on the
environment. It will achieve this by:

Life-cycle costing.
Green construction processes.
Active and passive energy efficiency programs.
Creative alternative energy usages.
Robust recycling program (materials, water, etc.).
Member home internet connectivity to reduce vehicle trips.
Provisions for public transit, ride share and alternative fuel vehicles.
Restructured waste streams and hazardous bio-waste provisions (on-site and
off-site).
ENTRY
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Right-Sized and Shaped Components for a Small Hospital
The Module
Template Hospital
Modular Hospital
When planning a building program of multiple buildings sharing common

components, an appropriate relationship between the sizes of the components and
the sizes of the complete buildings must be carefully considered.
174 to 270 beds
24 beds to 192 beds (and beyond) in 24-bed increments
3-story D&T block + 3- or 4-story Inpatient Nursing Blocks = 340,000 sf to 470,000 sf
1-story, flexible Module = 22,500 sf
The success of the Template program is based on the close fit between the size of
the hospitals and the size of the Template - a combination of a three-story rectangular
D&T block and three- or four-story triangular inpatient nursing blocks, approximately
300,000 sf and 200 beds, that were repeated over several hospitals in California.
Template - a program-specific building block allows connections and growth in one

direction.
Flexible modular unit allows connections and growth in multiple x-y-z directions.
Large increment and specific or fixed configuration and stacking of Template is not
facile enough for the smaller hospital development over time.
System based on a smaller module is more nimbly adaptable to a wide range of site
configuration, program, and phasing requirements of each small hospital.
Just as the pyramids were built with large stone blocks and houses are built with
bricks, an appropriate size of components should be selected for the building
program.
The small hospital program will require smaller building components - components
of a smaller dimension that are adaptable to the varying scope and program of the
hospitals that will be constructed in a wide range of small under served communities.
The importance of the standardized configuration is best illustrated by the success
of LEGO blocks, which have a virtually infinite capacity to be used to build almost
anything. Their three-dimensional connectivity and coordinated dimensions allow for
their flexibility.
These right-sized and right-shaped components, standardized in dimension and
configuration, will become the building block of the small hospital. This component
we call the Module.
174 Beds +
25 to 200 Beds+
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Development of a Universal Module

Nursing Unit as the Basis of Module Design
Common Nursing Unit Types:
S PER NURSE STATION

In our search for the flexible modular unit, we first examined the design of the
inpatient nursing unit. The bed units regularly occupy the largest portion of any
inpatient hospital, and finding the best combination of unit size and configuration is
the key to the success of a flexible modular system.
2
Circular Unit
1
Nursing units are typically assembled of smaller blocks of inpatient
bedrooms that are
under 1the supervision of a nursing station / team. Distance
and
visibility typically limit
3
2
ROOMS
PER NURSE
STATION
the optimal6block
to about
1 six to eight beds. The diagrams below demonstrate the
development of the six-bed nursing block into several larger configurations that make
up an 2Acute Care Unit (ACU) or Intensive Care Unit (ICU).
6 ROOMS PER NURSE STATION

6-bed Nursing Block
1
1
3
2
12

1
Back-to-Back, Parallel
4
(12 beds)
Circular (24 beds)
1
1
1
3
1
42
2
2
3
1
Corner (12 beds)
5,256 sf
Core/Shaft:
941 sf
Perimeter Area:
8,580 sf
Perimeter Area
to Floor Ratio:
47 %
Area per Bed:
765.2 sf
3
4
Triangular (18 beds)
Rectangular (24 beds)
24 Patient Rooms:
24 beds :
Support Space:
7,247 sf
4,835 sf
Core/Shaft:
936 sf
Perimeter Area: 11,010 sf

Perimeter Area
to Floor Ratio:
53 %
Area per Bed:
870.5 sf
In comparison with the circular and triangular units, the square units have
the following advantages:
As in the Template Hospital, the triangular units are always used in

combination with an adjacent rectangular D&T block, with triangular
courtyards in between.
20,892 sf
Square Unit
1
2
3
Total area:
Elongated Triangular (24 beds)
3
4
1. Limited support area contained within the triangle for meeting

increasing support space demand in modern medicine.
2. Predetermined connections to adjacent bed units and a D&T
block, always in-line, limits flexibility of building layout
and expansion options.
3. 2Awkward geometry at unit corners and resulting courtyard
between units.
1
4. Irregular column grid incompatible
with the D&T program.
3
The triangular unit offers an excellent combination of efficiency and

connectivity that makes them popular in contemporary hospital design.
The limitations of the triangular units are:
Support Space:
8,111 sf
Triangular Unit
24 Patient Rooms:
18,365 sf
24 beds :
TATION
1. Awkward geometry and associated inefficiency.

2. Poor connectivity to adjacent building blocks.
3. Circular geometry limits program flexibility.
1
1
Total area:
Because the circular unit is generally unfit to contain other hospital

programs, inpatient bed units of this configuration almost always occur
as towers placed above or adjacent to a rectangular D&T block.
The circular unit is very efficient in that it has the smallest perimeter to
area ratio. The obvious drawbacks of this type of unit are:
1. Contains large area of support space unencumbered by

irregular geometry.
2. Column grid compatible with the D&T program allows stacking
3
4
and program flexibility,
including
parking.
3. Connectivity in x-y-z and diagonal direction.
4. Low perimeter to floor area ratio for cost and energy efficiency.
Total area:
22,500 sf
24 Patient Rooms:
24 beds :
Support Space:
Core/Shaft:
7,451 sf
6,843 sf
936 sf
Perimeter Area:
9,000 sf
Perimeter Area
to Floor Ratio:
40 %
Area per Bed:
937.5 sf
7
3
ENTRY
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Programmatic Flexibility
ADMIN
EXAM/TREATMENT
OB TRIAGE
ADMIN
LDRP 6
The Module
AMENITIES
ATRIUM
PHYSICIANS/
PROVIDERS
C-SECTION
C-SECTION
SUPPORT
RECOVERY
LDRP 7
AMENITIES
LDRP 5
PHYSICIANS/
PROVIDERS
LDRP 8
LDRP 4
AMENITIES
AMENITIES
LDRP 3
LDRP 9
NURSERY
LDRP 10
LDRP 2
LDRP 11
EXAM/TREATMENT
LDRP 1
MOB-Clinic
Layered and departmental layout

for outpatient clinics.
MOB-Office
Shallow-floor, courtyard plan for

physicians and administrative
offices.
Entry Pavilion
For larger hospital and expansion.
LDRP 16
LDRP 15
LDRP 14
LDRP 13
LDRP
Labor-Delivery-Post-partum for the

Mother-Baby-Family experience.
Flexible Modular Unit, One-story, 150 x 150, 22,500 sf.
OB TRIAGE
Fundamental to the modular approach is the idea that a building with complex and
changing functional requirements can be designed using intelligent multiplication
and aggregation of a basic modular unit that has the sufficient dimensions and
infrastructure to flexibly accommodate diverse programs.
ULTRASOUND
SUPPORT/
FUTURE IR
SUPPORT/
FUTURE IR
IR 1
IR 3
IMAGING
SUPPORT
SUPPORT
OR 1
IR 1
SUPPORT
CONFERENCE
ROOM
SUPPORT
WAITING
ULTRASOUND
IR 2
IR 4
OR 2
CONFERENCE
ROOM
LDR 6
C-SECTION
C-SECTION
CONFERENCE
ROOM
CONFERENCE
ROOM
This approach embraces the anticipated variety in site configurations and program
requirements, as well as the uncertainty of the future of medicine and science, with
the resulting building being highly adaptable not only to the different site and
program conditions, but also to the future changes and incremental growth of the
Small Hospital.
SUPPORT
RECOVERY
LDR 4
SUPPORT
SUPPORT
EMERGENCY
N
B3
B4
B5
B6
B23
SUPPORT
OR 1
IR 1
OR 2
IR 2
OR 3
IR 3
SUPPORT
SUPPORT
Shared Interventional / PACU

module for the Small Hospital.
OPEN LAB 2
SUPPORT
B8
B22
Conference
Conference rooms ranging from

600 sf to 3,600 sf.
NURSERY
PP 13
PP 12
LDR 2
PP 11
PP1 PP2 PP3 PP4
PP5 PP6 PP7 PP8
PP 10
PP 9
LDR
Post-partum rooms are separate

from the Labor-Delivery rooms.
OFFICES
SUPPORT
B9
SUPPORT
SUPPORT
B21
OPEN LAB 1
PREPARATION/RECOVERY
SUPPORT
LAB SUPPORT
54 PARKING
SPACES
OPEN LAB 3
B10
B20
B11
N
B19
B18
B17
B16
B15
B14
SUPPORT
SUPPORT
B12
B13
Nursing (ACU or ICU)
Standard 24-bed Acute Care Unit

or (2) 12-bed Intensive Care Unit.
SUPPORT
Combined Interventional
PP 14
N
B7
B24
B2
CONFERENCE
ROOM
LDR 3
LDR 1
Shared ED/Imaging module for

the Small Hospital.
PP 16
PP 15
CONFERENCE
ROOM
CONFERENCE
ROOM
N PREP/RECOVERY N
Combined ED/Imaging
The following diagrams demonstrate the capacity of the flexible space module to
accommodate all major programs that constitute the small hospital.
SUPPORT
PP 19
PP 17
SUPPORT
IR 2
PP 20
PP 18
LDR 5
CONFERENCE
ROOM
B1
LDRP 12
Interventional Suite
6 universal OR / IR rooms in a suite

with a sterile / tech core.
OFFICES
Prep/Recovery-PACU
Universal layout allows alternate use of

prep/recovery and PACU suites.
Laboratory
OPEN LAB 4
Suitable for Surgical / Pathology, Transfusion, or Pharmacy.
Parking
Technology / Loading Dock
The column grid is compatible with

parking allowing stacking flexibility.
New technology can be provided

through a mobile imaging program.
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Strategies for OSHPD and State Approval

Template Hospital
Template Hospital
Modular Hospital
A combination of a 3-story D&T block and a 3-story, 200-bed inpatient nursing block
were reviewed for approval by OSHPD. The design of this pre-approved Template
was repeatedly used to design multiple mid-size hospitals in California to expedite
OSHPD review and approval for their construction.
Pre-Approved
Template
+/- 200 Beds
Modesto
248 Beds
50 Beds
200 Beds
Antioch
174 Beds
50 Beds
200 Beds
Vacaville
174 Beds
50 Beds
200 Beds
Pre-Approved
Modules
Beds
MOB
Diagnostics & Treatment
Modular Hospital
Multiple types of 1-story, 22,500 sf modules are reviewed and approved by OSHPD
to create a pre-approved kit-of-parts for multiple small hospitals. This approach
allows the Modular Hospital more flexibility in adapting to each hospitals scope and
program requirement which will vary depending on site, location and demography.
Different combinations of pre-approved modules will be assembled in different small
hospitals. The Modules small increment (25 beds) facilitates fine customization of
scope and program.
OSHPD review and approval of the 22,500 sf modules will be expeditious compared
to the review and approval of a 200,000 sf + hospital of multiple combined programs.
With the pre-approved D&T and nursing modules, OSHPD review of a Modular
Hospital will focus on how the modules are assembled, and not on the design
of modules themselves. This will dramatically speed up the OSHPD review and
approval time for a large number of Modular Hospitals that share the same modular
components.
In other regions of the U.S., a number of states still mandate that a CON (Certificate
of Need) and DON (Determination of Need) be submitted from health management
systems, to regulate actual need and to control over-building. In these instances,
having a flexible size and phasing capability with a modular approach will enable
Kaiser Permanente to right-size their hospital quickly and in-turn accelerate the
approval processes in these new market sectors.
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Aggregation Patterns for the Modular Hospital

The universal modules can be aggregated in several distinct patterns for different
purposes, and a modular hospital will likely be developed in a combination of more
than one of these patterns to reflect a variety of functions within the new hospital.
10
Linear
Mat
Checkerboard
In this pattern, the modular building blocks are linearly

deployed for a good balance of connectivity and perimeter
exposure. This configuration is suitable for many different
uses.
This configuration maximizes the floor area per perimeter,

and allows for the most flexible floor layout with an
efficient circulation within. This configuration is suitable for
an Interventional / OR, Imaging, and Emergency programs.
However, because of its extremely wide floor plate, special
consideration must be made to ensure strategic daylight
penetration and ease of way-finding.
This pattern of development maximizes the perimeter

exposure per floor area, and is therefore effective in
integrating the building interior with exterior landscaped
spaces. Suitable for inpatient bed areas where the number
of bedrooms that require exterior exposure must be
maximized per combined floor area.
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Modular Connectivity
Connectivity Options for Inpatient Nursing Units

The bed modules in the Modular Hospital will be connected in a checkerboard
pattern described in the previous section in order to create a layout that maximizes
perimeter exposure for the required number of inpatient bedrooms. Contained within
the checkerboard pattern are several basic layout variations that can be applied to
the Small Hospital.
Variations of the checkerboard-based layout include the Cross, Alternating, the
Dogleg, and the Diagonal.
Dogleg
Cross
Cross
Alternating
Dogleg
Diagonal

Diagonal
Alternating
120
Module Distance and Segregation of Circulation Types

The four basic plan configurations can further be elaborated and differentiated by
changing the module-to-module distance and the resulting relationship between
public circulation and service circulation. This variable can be adjusted to achieve
the correct balance between the floor area efficiency and the level of circulation
segregation that is appropriate to each Small Hospital.
Overlap

Efficient floor plan with shortest walking distances and smallest area per bed.
Limited ability to segregate circulation through connection nodes at module
corners.
One of four beds in each module

faces inward.
Defines a four-sided courtyard and
two-sided exterior spaces.
Loop provides convenient
connectivity with shortest walking
distances.
120
120
120
30
30
All beds face outward.

Defines three-sided and
two-sided exterior spaces.
Spine provides clear
sense of organization and
directionality with short
walking distances.
120
120 120
150
120 150
150 120
120
120
120
120
120
120
150
150
150
150
30
30
120
30
150
150
150
150
3030
150 150
150
150
30 30
150
150
150
30
30
30
150
150
150
150
30
30
30
150
150
150
150
30
30
30
30
150
150
30
Overlap
Touch
Separate
11
30
150
Separate
Extra zones between modules allow for by-pass corridor.
Highest level of separation is achieved with the largest floor area per bed.
150 150
120
150
30
150
150
30
120
Larger nodes at module corners allow for more spaces for vertical and horizontal
circulation.
Improved ability to segregate circulation with good serviceability.
150

Defines six equal two-sided
exterior spaces.
Diagonal spine provides clear
sense of organization and
directionality but long walking
distances.
30
Touch

150

Defines three-sided and twosided exterior spaces.
Dogleg spine provides
picturesque but disorienting
organization with long walking
distances.
120 x 120
Modules overlap by 30
150 x 150
Modules touch at corners
180 x 180
Modules separated by 30
ENTRY
99031
BI
Modular Layout / Circulation
DI Variations
Layout
Cross
Alternating
CI
Dogleg
Diagonal
Overlap
Square modules can be combined in many configurations; when used as inpatient

nursing units, they are most efficient arranged in a checkerboard pattern connected
at module corners. This allows for the maximum number of inpatient bedrooms by
taking advantage of all four exposures of the module.
DII
CII
BIII
AIII
DIII
CIII
Separate
In addition to the cost, zoning-related floor area limitations and the specific
configuration of the building site may also dictate which module spacing will be used
to plan a Modular Hospital within a given site.
BII
Touch
The tighter spacing (120 ft) of modules results in higher efficiency and the least cost
of construction. However, this also results in a limited ability to segregate circulation
types. Conversely, looser spacing (180 ft) of modules allows for complete separation
of service and public circulation, but at a cost of significant additional area and
expense.
Module Distance and Segregation of Circulation Types
When aggregating square inpatient nursing modules into one of the checkerboardbased layouts, it is critical to examine the relationship between module spacing (120
ft, 150 ft, 180 ft, etc.) and the degree of segregation between public and service
circulation achieved.
12
ENTRY
99031
Structural Module
The Modules dimensions are based on a 30 ft x 30 ft planning grid, a flexible
dimension for most hospital programs.
The structural design adds further flexibility to the Module by eliminating the columns
in the center and the corner of the inner 90 ft x 90 ft square area. This makes
possible 1) an extremely flexible column-free space that can accommodate changes
in the equipment and layout that will accompany future development of medical
technology, and 2) diagonal corridors that create an internal service circulation.
This is accomplished by the use of two-way steel trusses, 6 ft deep with open webs
that allows for the passage of MEP infrastructure. A floor-to-floor height of 18 ft
anticipates the increasing MEP requirements of the contemporary hospital. Bottom
chords of the trusses are conveniently located to support a secondary grid of beams
to suspend ceiling mounted equipment.
Structural Module Plan
Integration of Structure and MEP
13
Structural Module Section
Structural Module Stacking
ENTRY
99031
MEP Module
Integrating Sustainable Strategies
Modular MEP Integration
The design of the MEP infrastructure is deeply tied to the design of the Module.
With efficiency and future flexibility in mind, MEP infrastructure spaces are created
both in plan and in section within the modular assembly.
MEP
Mechanical spaces are located in three areas in section: 1) above inpatient nursing
units to serve the stacked bed floors, 2) above D&T units on lower floors serving the
D&T program and basement, and 3) in the basement in centralized MEP rooms. In
this way, the mechanical units are modularly located closest to the area served by the
units, and the shaft space on each Module floor is minimized.
BEDS
BEDS
MEP
Vertical shafts are strategically organized at the perimeter of the 90 ft x 90 ft clearspan interior to maximize flexibility of the interior layout. Floor trusses create an
interstitial space on each floor in which major MEP systems are distributed.
The centralized placement of the MEP spaces allows for the creation of roof gardens
upon the freed roof planes, interspersing green spaces vertically throughout the
building. The roof surfaces that are not best suited for greenery will be fitted with PV
arrays to provide solar energy generation.
D&T
D&T
SUPPORT
MEP Shaft Layout
MEP Shafts and Spaces
Modular Stacking of MEP
Beds
MEP
Fitness
Center
Cafeteria
BEDS
ROOF
GARDEN
Stacking Options for MEP

Spaces
BEDS
ROOF
GARDEN
MEP
PVs
Public roof garden with integrated amenities
Strategies for Overall Energy Efficiency

14
Maximization of passive solar opportunities with site layout

Optimization of building envelope
Natural ventilation where possible (cross ventilation and stack effect in offices,
family areas)
Water heat reclamation for kitchen and laundry
Incorporation of new technologies where feasible: fuel cells, frictionless bearing
water chillers, e.g.
Gray water recycling with on-site secondary water treatment to potable
standards for reuse on site
Possible black water recycling with on-site secondary and tertiary treatment to
potable standards for reuse on site (requires a packaged wastewater treatment
facility on site, possible producing methane as part of the anaerobic process)
Integration of passive solar and active solar energy generation (both PV and
thermal)
Facility electric vehicles, Facility/worker/public electric vehicle charging stations.
ROOF GARDEN WITH PUBLIC AMENITIES
MEP
PVs
D&T
D&T
MEP
D&T
D&T
D&T
D&T
PVs
SUPPORT
PVs
MEP
PVs
BEDS
MEP
ROOF
GARDEN
MEP
BEDS
BEDS
BEDS
MEP
BEDS
D&T

MEP
PVs
BEDS
MEP
D&T
MEP
D&T
D&T
D&T
D&T
D&T
Stacking: Horizontal
D&T
Stacking: Vertical
PVs
MEP
PVs
BEDS
MEP
BEDS
BEDS
BEDS
BEDS
PVs
MEP
BEDS
BEDS
MEP
ROOF GARDEN WITH PUBLIC AMENITIESBEDS
D&T
BEDS
MEP
MEP
PVs
MOB
PVs
D&T
D&T
D&T
MOB
MOB
D&T
D&T
MOB
PVs
ROOF GARDEN
&
COURTYARD
PVs
ROOF GARDEN
&
MOB
COURTYARD
MOB
PVs
ROOF GARDEN
&
COURTYARD
PVs
ROOF GARDEN
&
COURTYARD
PVs
ROOF GARDEN
&
COURTYARD
MOB
PVs
ROOF GARDEN
MOB
&
MOB
COURTYARD
MOB
PVs
MOB
MOB
Stacking: Combined
ENTRY
99031
Pre-Fabrication and Assembly

Prefabrication of building components is an essential aspect of a standardized
modular building program. Hospitals, with their repetitive room types and building
components, make for an ideal application of prefabrication. Extensive use of BIM
technology allows for pre-construction coordination of in-ceiling systems throughout
the hospital. A standardized modular approach further makes prefabrication attractive for the Modular Hospital.
1. Pre-Fabrication Off-Site
Pre-Fabricated Steel Structure
Prefabrication of building components in an off-site factory, with controlled climatic

conditions and facilities dedicated to the fabrication of specific types of building
components, is efficient and can produce consistently high-quality products that are
tested before they are shipped and installed at the project site. By moving production off-site, on-site construction and congestion is minimized and construction time is
reduced.
Structural steel elements are always prefabricated at

a factory, providing a high level of quality control and
a resulting high speed of erection once they arrive
on site.
Pre-Fabricated Ducts and Pipe Racks

2. Transportation to Site
When considering prefabrication of building components, the cost and efficiency
advantage of prefabrication must be balanced against the cost and efficiency of
transporting the prefabricated components to the project site. Right-sized components will follow the roadway regulations of dimensions and weights.
Mechanical ducts and plumbing pipes are already

routinely prefabricated off-site. Pre-assembling the
pipes and ducts into large (30 ft-long) prefabricated
modules coordinated with structural supports
dramatically speeds up MEP installation.
3. Assembly and Installation on Site
Pre-Fabricated Rooms
Prefabricated components are hoisted into place by cranes. Fewer and larger components generally results in a lower cost of installation. However, optimum sizing of
heavier and bulkier components must be determined to avoid transport and maneuvering issues.
Repetitive rooms with high level of MEP services

are candidates for prefabrication. In addition to
the prefabrication of patient bathrooms, head walls
assembly, casework etc., prefabrication of entire
rooms will be considered. A 15 ft-wide patient
bedroom can be shipped in two segments and
hoisted into place. A 30 ft x 30 ft Operating room, or
Interventional radiology room, with RF and magnetic
shielding in walls, ceilings, and floors, can each be
made in three transportable segments at the factory.
15
ENTRY
99031
Applying the Module

In the concluding portion of this submission, the modular approach is applied to the following seven hypothetical sites and
programs. This demonstrates the full range of the flexibility and adaptability of the Module.
Schemes 1 - 3: The Minimum Hospital

Flexible Scalability and Configuration
The three configurations below represent the various ways to arrange the minimum number of modules on a neutral site for a small
hospital. Each scheme has a set of unique spatial qualities and possibilities for future scalability.
Modular Hospital 1
Modular Hospital 2
Modular Hospital 3
In-Line
Courtyard
Schemes 4 - 7: The Growing Hospital

Nimble Evolution
The modular nature of the small hospital allows for flexible growth over time for a variety of site conditions. The four schemes
below illustrate ways in which the small hospital can expand and evolve over time to meet the needs of specific communities.
Modular Hospital 4
Modular Hospital 5
Modular Hospital 6
Modular Hospital 7
Phase 1:
50 beds
Phase 1:
75 beds
Phase 1:
75 beds
Phase 1:
100 beds
site = 30 acres, suburban / rural.

can grow from 50 beds to 150 beds in 50-bed increments.
Phase 3:
150 beds
16
site = 600 ft x 600 ft urban city blocks.

Phase 3:
225 beds
site = 21 acres, suburban, split into two sites by roadway.

Phase 3:
175 beds
site = 23 acres, suburban / rural, irregularly shaped.

Phase 3:
200 beds
ENTRY
99031
Modular Hospital 1
Level 2 Floor Plan
Level 3 & 4 Floor Plan
One of the smallest possible

configurations of the modular hospital,
this 50-bed hospital has two modules
of inpatient nursing units, two modules
of D&T, and two modules of MOB clinic
/ offices. In addition, it also has two
modules of basement support areas.
The building base forms an L, defining
a drop off plaza with diagonal access
into a two-story entry lobby.
MEP
Cafeteria and Fitness pavilions are

located on the Level 2 roof garden, and
form a multi-purpose public facility used
not only for meals and fitness, but also
for community meetings and health
education events.
Cafeteria
Roof
Garden
Fitness
Nursing
(ACU / ICU)
Admin.
MOB
Office
The Medical Office Building is

connected with the hospital and
accessible through the main lobby.
Inpatient beds are stacked on two floors

above the D&T base, with a mechanical
space and a helipad above.
Basement Level Floor Plan
A Combined Interventional Module with

four OR/IR rooms and a Combined ED/
Imaging Module occupy Level 1 of the
hospital.
MH
MGT.
SPD
Kitchen
Staff
Ground Level Floor Plan
MEP
Combined
Interventional
Combined
ED/Imaging
Loading
Lobby
10
MOB
Office
7
9
8
4
5
Parking
Nursing
Interventional
MOB
Parking
2
3
Modular Hospital 1
50 Beds
D&T

Beds

Lobby/Atrium
Basement
Total
MOB
CUP
17
45,000 sqft (2 Modules)

8,000 sqft
143,000 sqft
16,500 sqft
Lobby
Combined ED/Imaging
MOB Offices/Clinic
Nursing
Cafeteria
Fitness
Helipad
Mechanical
Loading Dock
Section B - B
CUP
Loading Dock
Nursing
Interventional
ED/
Imaging
10 CUP
11 Combined Interventional
Section A - A
ENTRY
99031
Modular Hospital 2
Level 2 Floor Plan
Fitness
In-Line
Roof
Garden
Similar to Modular Hospital 1, this InLine scheme has a linear organization

instead of an L layout. The building
faces its drop-off plaza in a more frontal
and axial relationship. A two-story entry
lobby laterally extends to access the two
D&T modules and the MOB.
Cafeteria

hospital.
Amenities

located on the Level 2 roof garden, and
education events.
This 50-bed hospital also has two

modules of inpatient nursing units, two
modules of D&T, and two modules of
MOB clinic / offices. It also has two
MEP
Nursing
(ACU / ICU)
Lobby
Admin
MOB
Office

MEP
Combined
ED/Imaging
Staff
Kitchen
Combined
Interventional
SPD
10
Loading
Lobby
Mtl.
Mgt.
MOB
Office
8
2
Fitness/ Cafeteria
ED/ Imaging
4
11
Nursing
Interventional
MOB
1
3
Modular Hospital 2
50 Beds
D&T

Beds

Lobby/Atrium
Basement
Total
MOB
CUP
18

2,000 sqft
137,000 sqft
16,500 sqft
Lobby
Combined ED/Imaging
MOB Offices/Clinic
Nursing
Cafeteria
Fitness
Helipad
Mechanical
Loading Dock
Section B - B
CUP
Loading Dock
Nursing
Interventional
Lobby
10 CUP
Section A - A
ENTRY
99031
Modular Hospital 3
Level 2 Floor Plan
Courtyard
Nursing
(ACU / ICU)
MEP
Although using the same modular

components, this hospital is developed
uniquely from the first two examples;
four modules on the ground level form a
cross, creating a courtyard in the center.

hospital. One-story MOB clinic / offices
modules are located side-by-side.
The hospital and MOB modules are

located across the courtyard from
each other. This layout allows for two
separate entry lobbies, each dedicated
to an Inpatient or Outpatient function.
This 50-bed hospital also has two
modules of inpatient nursing units, two
modules of D&T, and two modules of
MOB clinic / offices. It also has two

located at grade in the courtyard, and
education events.
Admin.
MEP

Mtl.
Mgt.
SPD
Staff
Combined
Interventional
Loading
Lobby
10
Cafeteria
Kitchen
Combined
ED/Imaging
MEP
MOB
Office
Courtyard
Fitness
Lobby
9
3
MOB
Office
4
1
11
Nursing
Interventional
Cafeteria/
Fitness
MOB
Modular Hospital 3
50 Beds
D&T

Beds

Lobby/Atrium
Basement
Total
MOB
CUP
19

8,000 sqft
143,000 sqft
16,500 sqft
Lobby
Combined ED/Imaging
MOB Offices/Clinic
Nursing
Cafeteria
Fitness
Helipad
Mechanical
Loading Dock
Section B - B
ED/Imaging
Courtyard
MOB
10 CUP
Section A - A
ENTRY
99031
Modular Hospital 4
This hospital is designed to be constructed on a rural / suburban 30-acre site. Using the standard modular kit-of-parts,
this hospital can be built with 50 beds, 100 beds, or 150 beds. Alternatively, its construction can be phased in three
phases to meet the growing demand of the community.
Hospital 4 - Phase 1
Rectangular Site
50-Bed Hospital
Rectangular Site
100-Bed Hospital
Rectangular Site
150-Bed Hospital
Site Area
Site Area
Site Area
30 acres
35,550 sqft
440,550 sqft
30 acres
30 acres
D&T
Beds
Lobby/Atrium 13,050 sqft
Basement
Total
170,550 sqft
D&T
Beds
Basement
Total
260,550 sqft
D&T
Beds
Lobby/Atrium
Basement
Total
MOB
CUP
16,500 sqft
Surface Parking 173,800 sqft (580 Stalls)
MOB
CUP
26,500 sqft
Garage Parking 147,600 sqft (490 Stalls)
MOB
CUP
26,500 sqft
6
5
3
6
2
4
6
1
Lobby/Atrium
D&T
Bed
MOB
CUP
Surface Parking
Parking Garage
Roof Garden &

Public Amenities
Parking
20
Atrium
Parking
Parking
D&T / Beds
Atrium
Parking
Parking
D&T / Beds
Atrium
D&T / Beds
Parking
ENTRY
99031
Modular Hospital 5
Sited in an urban, 600 ft x 600 ft city block, this hospital has a higher density and lot coverage, with three floors of beds
over a D&T base. A significant area of the MOB is integrated with a parking garage. This hospital can be constructed
in three phases in 75-bed increments from 75 beds, to 150 beds, and to 225 beds.
Urban Block Site
75-Bed Hospital
Urban Block Site
150-Bed Hospital
Urban Block Site
225-Bed Hospital
Site Area
Site Area
Site Area
8.3 acres
8,100 sqft
527,100 sqft
8.3 acres
D&T
Beds
Lobby/Atrium
2,000 sqft
Basement
Total
195,500 sqft
D&T
Beds
Lobby/Atrium
8,100 sqft
Basement
Total
338,100 sqft
D&T
Beds
Lobby/Atrium
Basement
Total
MOB
CUP
Surface Parking
Garage Parking
MOB
CUP
18,250 sqft (Basement)
MOB
CUP

52,800 sqft (170 Stalls)
D&T
Bed
MOB
CUP
Surface Parking
Parking Garage
Roof Garden &

Public Amenities
21
Lobby/Atrium
8.3 acres
4
4
7
7
Drop-Off
D&T
Parking/MOB
Atrium
D&T
D&T / Beds
Parking/MOB
Atrium
D&T
D&T / Beds
ENTRY
99031
Modular Hospital 6
To demonstrate the adaptability of the Modular Hospital concept to diverse site conditions, this hospital is envisioned
on a 21-acre area that is split into two sites by a roadway. Modules are aggregated in a linear configuration to respond
to the narrow site dimensions. An MOB module bridges over the roadway to connect the two sites. The diagrams
describe a three-phase construction, with the hospital growing from 75 beds to 175 beds in 50-bed increments.
Divided Site
75-Bed Hospital
Divided Site
125-Bed Hospital
Divided Site
175-Bed Hospital
Site Area
Site Area
21 acres
Site Area
21 acres
D&T
Beds
Lobby/Atrium
2,000 sqft
Basement
Total
159,500 sqft
D&T
Beds
Lobby/Atrium
Basement
Total

9,900 sqft
369,900 sqft
D&T
Beds
Lobby/Atrium
Basement
Total

11,700 sqft
506,700 sqft
MOB
CUP
MOB
CUP
21 acres
MOB
CUP
18,000 sqft
3
5
3
2
1
4
4
Drop-off
22
Road
Lobby/Atrium
D&T
Bed
MOB
CUP
Surface Parking
Parking Garage
Roof Garden &

Public Amenities
7
4
4
D&T / Beds
Atrium
Road
MOB
D&T / Beds
Atrium
Road
MOB
ENTRY
99031
Modular Hospital 7
The design of this hospital responds to the irregular shape of a 23-acre site using a diagonal layout of modules. MOBs
and parking garages flank the hospital on two sides The diagrams describe a three-phase construction, with the hospital
growing from 100 beds to 200 beds in 50-bed increments.
Irregular Site
150-Bed Hospital
Irregular Site
200-Bed Hospital
Site Area
Site Area
Site Area
23 acres
D&T
Beds
Lobby/Atrium
Basement
Total

67,500 sqft
495,000 sqft
23 acres
23 acres
D&T
Beds
Basement
Total
225,000 sqft
D&T
Beds
Lobby/Atrium
Basement
Total
MOB
CUP
MOB
CUP
11,400 sqft
5
6
Irregular Site
100-Bed Hospital

45,000 sqft
337,500 sqft
MOB
CUP
18,900 sqft
7
2
8
7
4
6
D&T / Beds
23
D&T / Beds
Lobby/Atrium
D&T
Bed
MOB
CUP
Surface Parking
Parking Garage
Roof Garden &

Public Amenities
D&T / Beds
D&T / Beds
D&T / Beds
D&T / Beds
D&T / Beds
D&T / Beds
D&T / Beds
ENTRY
99031
Selection Criteria
Kaiser has identified the following criteria for evaluating the competition entries. Our
design concept addresses the criteria as summarized below:
Innovation
Both the concept of a repetitive universal small hospital module and its specific
design offers numerous innovations including:
Universal module for all inpatient and outpatient building components.
Modular scalability that can be utilized to create small hospitals that range from
25 beds to 200 beds (in 25-bed increments).
Interventional Services Platform that combines Surgery, Interventional Imaging
and PACU/Prep-recovery departments.
Integration of patient and family education into the care process to foster health
promotion and illness prevention.
Robust telemedicine program linked to regional Kaiser tertiary centers to
leverage provider resources.
PACS, etc.).
Reduce Building Life Cycle Costs

The design of our universal small hospital module offers the following opportunities
to reduce building life cycle costs:
Modular adaptable building systems that simplify change over time.
Acuity adaptable nursing units and patient rooms that reduce staff duplication
and increase utilization flexibility.
Active and passive energy conservation program.
Site dependent creative alternative energy usage.
Member home internet connectivity to enhance access and reduce vehicular
trips.
Provisions for public transit, ride share and alternative fuel vehicles.
Restructured waste streams and hazardous bio-waste provisions (on-site and offsite).
Incorporate Ways to Improve Health Care

The improvement of healthcare delivery is fostered by our small hospital design
concept in the following ways:
Creation of a total health environment (figures 1 and 2).
Interventional Services Platform that combines surgery, Interventional Imaging
and PACU/Prep-recovery departments.
Integration of patient and family education into the care process to foster health
promotion and illness prevention.
Robust telemedicine program linked to regional Kaiser tertiary centers to
leverage provider resources.
Utilization of minimally invasive robotic treatment modalities linked to a
centralized Kaiser tertiary center.
Expanded use of hospital based physicians (hospitalists, intensivists, laborists,
etc.).
24
Flexibility
Our design for a universal small hospital module is inherently flexible and welcomes
change in the following ways:
The regularity of the universal module building systems (structural, mechanical,
electrical and plumbing grids) creates flexibility
Modular scalability that can be utilized to create small hospitals that ranges from
25 beds to 200 beds (in 25-bed increments)
Utilization of horizontal and vertical interstitial spaces and floors for building
utilities.
Implementation of an interior medical planning grid for the modular layout of
clinical and support services (including corridor systems, procedure room layouts
and utility grids).
Efficiency
The efficiency of our design concept for a universal small hospital module exists on
multiple levels including:
Interventional Services Platform that combines surgery, Interventional Imaging
and PACU/Prep-recovery departments
Streamlined in-hospital Pharmacy linked to regional Pharmacy hub.
Streamlined in-hospital Clinical Laboratory linked to regional Laboratory hub.
Streamlined in-hospital Diagnostic Imaging department linked to regional
Imaging hub.
Streamlined in-hospital Materials Management department linked to regional
Materials Management hub.
Streamlined in-hospital linen service linked to regional service provider.
Implementation of medical equipment inventory control and utilization system
(RFID tags, tracking, etc.).
Utilization of off-site regional bulk food service provider.
PACS, etc.).
Streamlined waste management systems utilize regional recylcing and disposal
methods.
Figure 1- Labyrinth on Roof Garden for quiet contemplation
Figure 2 - Cafeteria and Fitness Pavilions on Roof Garden create a total health environment
Environment of Care
The design of a universal small hospital module that focuses on creating humanistic
and therapeutic spaces (figure 3) that respects human dignity offers the following
improvements in the environment of care:

Family member involvement in the care process.

Welcoming public spaces that evoke Member dignity and confidence.
Integration of healing gardens and courtyards into the care environment.
Access to interactive health education programs.
Increased education and outreach partnerships with community-based
organizations and government agencies (screening, monitoring, etc.).
Segregation of on-stage and off-stage interior circulation for enhanced patient
privacy.
Figure 3- Patient rooms designed to be humanistic and therapeutic spaces allowing family
involvement and interaction
ENTRY
99031

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Kaiser Permanente

Small Hospital Innovation

THE MODULAR HOSPITAL

2011 Kaiser Foundation Hospitals

THE MODULAR HOSPITAL

Our Design Concept

Kaiser Permanente has built a successful

total patient experience. This focus

Total Patient Experience

The Universal Module

Aggregating the Universal Module

SMALL HOSPITAL INNOVATION COMPETITION

THE MODULAR HOSPITAL

Networking the Universal Module

Sustaining the Universal Module

An important benefit of the small hospitals universal module is its inherent

Experiencing the Universal Module

Staffing the Universal Module

Designing the Universal Module

Figure 4a- Designing

Figure 4bPre-fabricated offsite building system

Entitling the Universal Module

Figure 5Pre-approved modules

Diagnostics & Treatment Modules

Building the Universal Module

Figure 7Staffing the

SMALL HOSPITAL INNOVATION COMPETITION

THE MODULAR HOSPITAL

Key Design Ideas

Figure 8- ACU Patient

Figure 9Active Health

1. Enhanced Member Experience

Conveniently locating hospitals near members.

2. Active Health Promotion

3. Innovative Clinical Operations

Acuity adaptable patient rooms and nursing units.

4. Efficient Support Service Operations

Utilization of a centralized regional off-site bulk food service provider.

Access to health education resource centers with on-line services.

SMALL HOSPITAL INNOVATION COMPETITION

THE MODULAR HOSPITAL

8. Collaborative Design Process

Utilization of a Building Information Modeling (BIM) design program.

9. Rapid Construction Delivery

Off-site prefabrication of repetitive building components and systems (figure 14).

Figure 13- Naturally

Figure 14Rapid construction

As a steward of the environment with an awareness of its impact on health and

SMALL HOSPITAL INNOVATION COMPETITION

THE MODULAR HOSPITAL

Right-Sized and Shaped Components for a Small Hospital

When planning a building program of multiple buildings sharing common

174 to 270 beds

24 beds to 192 beds (and beyond) in 24-bed increments

3-story D&T block + 3- or 4-story Inpatient Nursing Blocks = 340,000 sf to 470,000 sf

1-story, flexible Module = 22,500 sf

Template - a program-specific building block allows connections and growth in one

SMALL HOSPITAL INNOVATION COMPETITION

THE MODULAR HOSPITAL

Development of a Universal Module

Common Nursing Unit Types:

S PER NURSE STATION

6 ROOMS PER NURSE STATION

6 ROOMS PER NURSE STATION