Just across the Golden Gate Bridge from San Francisco, Marin County offers a spectacular natural setting that has long lured city dwellers seeking more space and a direct connection to nature. Marin’s district hospital, MarinHealth Medical Center (formerly Marin General) in Greenbrae, Calif., benefits from those exceptional surroundings with views of Mount Tamalpais, the county’s highest peak; Corte Madera Creek; and an adjacent 27-acre park.
When it came time to address California’s 2030 earthquake-compliance standards, the healthcare organization decided to replace its outdated hospital with a new 265,000-square-foot facility called Oak Pavilion, relocating the majority of the hospital’s essential services and inpatient beds here while still connecting to some of existing campus buildings. The new acute care facility would be designed to improve and enhance the patient and staff experience through larger rooms, modern material and color palettes, and clinical spaces designed to accommodate new technology and treatments, all while enhancing connections to the natural beauty outside through biophilic design. “The uniqueness of Marin’s location speaks a lot to why biophilic design had to be a part of this project,” says Jason Haim, principal and executive director at Perkins Eastman (Los Angeles), which served as the architect and healthcare planner for the project. “Afterall, people move to Marin to be connected to nature, so you can’t take that away from them in a building in which they are seeking care.”
The healthcare organization was on board with the goal, as well, working closely with the architects to bring the outdoors in. “MarinHealth is committed to providing an exceptionally healing environment, so harnessing the healing power of nature was always central to the design process for the Oak Pavilion,” says Vernon Moreno, vice president of support services at MarinHealth Medical Center.
The new $315 million facility, which opened in August 2020, includes 171 private patient rooms, six operating rooms/interventional suites, new radiology and imaging services, and a larger emergency department and trauma center. The four-story building is divided into two sides and features nature-inspired design details throughout. “Connecting to nature has been proven to be effective in patient healing and well-being in the hospital setting,” says Joe Runco, principal at SWA Group (San Francisco), the project’s landscape architects. “The design of the new hospital ensures that patients and staff can view and/or access nature both in the spectacular natural setting of the site as well as more controlled rooftop garden spaces.”
Beginning on the exterior, the building is clad in glass and metal panels distinguished by front-facing balconies and a multilevel green roof terrace between its two sides that’s accessible to patients and staff and features raised planting beds and seating. Located on all the patient units, indoor/outdoor solariums are light-filled “living rooms” that are topped by rounded skylights and connected to the balconies, giving patients and their families the option to go outside even when tethered to an IV pole, says Haim. Located next to the solariums, spacious staff lounges are a sunny contrast to those found in the old buildings, which included small windows, and likewise offer nurses the opportunity to quickly step outside for a breath of fresh air via the solariums.
In patient rooms, floor-to-ceiling windows bring in natural daylight and unobstructed views to the surroundings or the gardens and terraces. “Anywhere you look out of a patient room you will not see anything other than green,” says Haim. To amplify views even more as well as help patients, staff, and families orient themselves in the building, the project team incorporated extensive glazing throughout public spaces, even at the ends of corridors.
On the north side of the building, a 6,300-square-foot garden on rooftop of the loading dock provides views of plantings from adjacent hospital rooms, while a tiered sunken garden incorporates natural boulders, which function as retaining walls, as well as lower and upper patios with seating and a variety of plantings. “We staggered all of the waiting rooms for imaging, surgery, maternity care, and patient units around that area to activate it,” says Haim.
Look and feel
Beyond softening the clinical environment by turning the focus to the natural environment, the interior design supports the biophilic principles through the use of finishes like natural wood tones and nature-inspired colors, such as greens and browns inspired by the Marin headlands, says Barbara Best-Santos, principal at ForrestPerkins (San Francisco), the interior design studio that merged with Perkins Eastman in 2016 and acted as a consultant on the project. “It’s very calming,” says Best-Santos. “You don’t see glaring pops of color.” Furthermore, furniture is arranged in groupings rather than rigid line formations to “create more of an inviting, almost hotel-like layout,” she says.
An extensive art program was also integral to the design, incorporating 240 pieces by 52 artists (many of whom hail from Marin), in public spaces as well as in staff lounges. “The surrounding landscape and environment is one of Marin’s greatest assets and one of the elements that makes MarinHealth in its design and tone so special and unique,” says Jody Brunk Knowlton, principal at Artsource Consulting (San Francisco), the art consultant for the project. “The art celebrates and enhances these assets.” Among the broad range of works is “Bloom” by Katy Stone, which the artist says suggests a hillside bursting with California poppy blossoms, or a site-specific series of 50 individual paintings by Bay Area artist Michael McConnell that depicts the animal life found in the area.
Beyond aesthetics, the project also worked to improve operational efficiency, taking advantage of the seismic upgrade to “right-size” the hospital’s clinical and staff areas, we well. “In the old building, we were on top of each other,” says Karin Reese, chief nursing officer and chief administrative officer at MarinHealth Medical Center. Most of the existing patient rooms are 50 percent of what they [should be] by current size standards, adds Haim, and also semiprivate. As a result, the new building houses 114 private patient rooms, with 1,150 square feet per medical/surgical bed. Additionally, the size of the emergency department nearly tripled to 17,500 square feet with five trauma bays and 20 private patient rooms, including negative pressure and decontamination rooms to safely care for highly infectious patients. Three new operating rooms, two of which can accommodate robotic-assisted procedures, and a comprehensive recovery area were added to the existing surgical suite. Effort was also made to place interrelated departments close together to improve patient flow, such as radiology and imaging next to the ED, while separate hallways and elevators for the public and staff were created to address infection control and patient privacy.
Biophilia is the future
Over the next few years, improvements to MarinHealth Medical Center’s campus will continue. A future lobby addition will incorporate a rock garden in the front designed in concert with the existing one in the Oak Pavilion’s sunken garden “to allow the visitor to feel as though the hospital was placed into the natural environment of Marin,” says Haim. Once realized, the lobby and its front garden will complete the projects team’s overall biophilic vision.
“A connection to nature, we believe, provides a direct benefit to wellness and stress reduction; clearly an important factor in patient care and family management during stressful times,” Haim says. “Our focus on biophilia helps the MarinHealth Medical Center buildings impact patients in a positive way.”
Up on the rooftop
Part of the design focus for the MarinHealth Medical Center’s Oak Pavilion was energy savings. Along with an aluminum sunshade system on the façade, three rooftop gardens contribute to the building’s ability to use 51 percent less energy than the previous facility. Green roofs contribute to energy savings in several ways, says Joe Runco, principal at SWA Group (San Francisco), the project’s landscape architects. First, he says, the natural greenery is less reflective and reduces glare and heat typically emitted from conventional roofs. Second, because the roof is covered with living, water-transpiring plants, there’s a natural cooling effect from the transpiration/evaporation of water from the plants. Finally, the layers of soil, and plants provide additional insulation as compared to conventional roofs. As a result, Runco says, “The roof stays at a more constant temperature than the often high fluctuations with other roofing types.”
Project name: MarinHealth Medical Center Oak Pavilion
Project completion date: September 2020
Owner: Marin Healthcare District
Total building area: 265,000 sq. ft.
Total construction cost: $315 million
Cost/sq. ft.: $1,190
Architecture: Perkins Eastman (design architect, architect of record, healthcare planner)
Interior design: IA Interior Architects, ForrestPerkins
Design Build Contractor: McCarthy Building Company, Inc.
Structural Engineers: KPFF
MEP: Mazzetti Engineers
Civil Engineers: KPFF
Geotechnical Engineers: Fugro
Design Build Contractor: McCarthy Building Company, Inc.
Art consultant: Art Source
AV equipment/electronics/software: JCI/Wood Harbinger
Carpet/flooring: Johnsonite, Shaw
Ceiling/wall systems: Armstrong Ceiling Systems, USG
Doors/locks/hardware: Assa Abloy
Handrails/wall guards: Inpro
Lighting: Lighting Design Studio (interior lighting), DSA (site lighting)
Signage/wayfinding: Propp + Guerin
Surfaces—solid/other: Corian, Avonite
Wallcoverings: Sherwin Williams
Landscape Architect: SWA Group
Medical Equipment Planning: CallisonRTKL, McCarthy Building Company, Inc.
Shielding Consultant: Therapy Physics
consultants: Thorton Tomesetti