Clinica Delgado

Clinica Delgado

An iconic structure points to the future while drawing inspiration from the past Clinica delgado

In their competition-winning design for Clinica Delgado, the GS&P team drew inspiration from the massive rock outcroppings flanking the 15th century Incan ruins of Machu Picchu.

The designers translated these primal forms into a dynamically faceted glass skin that serves as a metaphor for contemporary healthcare. Upwardly angled cantilevers float the building over the site. The clinic’s shard-like “prow” reinforces the sense of buoyancy in defining the street corner. Vegetated roof gardens and living walls echo techniques used by pre-Columbian builders while also recalling the ruins’ plant-covered stone formations.

The overall effect is an iconic structure that becomes a focus for the surrounding neighborhoods and a symbolic landmark for progress.

Client

Auna Location

Lima, Peru Market

Healthcare Services

Architecture Interior Design Space Programming Conceptual Design Space Programming Parking Garage Design PRoject executive

Orlando Lopez-Isa, AIA, LEED AP Principal-in-charge

Alba Lopez-Isa, A. AIA PROJECT MANAGER

Matthew G. Harrell, AIA, ACHA, LEED AP Project Designer

Gregory J. Wieland, AIA Programming:

Frank Swaans, AIA, ACHA, FHFI, LEED AP, EDAC Project architects

David R. Goodspeed, AIA, CSI Angela Holcomb, AIA, NCARB Project coordinators

Jin Choi, AIA, LEED AP+BD&C Ramon Cruz, A. AIA, LEED AP+BD&C interior designer

Emily Farrell Competition Design Team

Ramon Cruz, A. AIA, LEED AP+BD&C Rebecca Dodson Jeffrey W. Kuhnhenn, AIA, LEED AP J. Brent Hughes, AIA, NCARB, EDAC, LEED AP + BD&C Ray Wong, AAIA, LEED GA, EDAC Assisted

Rebecca Dodson Lynn R. Pachano, A. AIA Ana U. Praskach, A. AIA, LEED AP+BD&C Awards

2011 AIA Tampa Bay - Honor Award for Architecture, Unbuilt Category 2011 AIA Tampa Bay – People’s Choice

17

showcase 4

U

sing ancient and organic forms to express cutting edge technology seems an unusual approach to hospital design. Explain how the concept evolved.

Alba Lopez-Isa: Dr. Luis Pinillos led the client group after he and his investors decided that their city needed an oncology-focused acute care facility. We were one of seven firms invited to participate in an international competition.

Greg Wieland: A competition was staged because the client group was looking for a signature, high-profile facility to make a statement about the cutting edge healthcare they want to bring to the community.

The timeframe was very short, so we had to develop a concept quickly and go with it. Machu Picchu came to mind as an iconic South American image. Then we asked ourselves, if we could combine this history with the latest and best technology in healthcare medicine, what would that look like?

When you see pictures of Machu Picchu, it’s anchored by a mountain form overlooking the structures below. The clinic shape became informed by the notion of this large mass with angular edges acting as a focal point for the surrounding community.

Pushing the design envelope to make the clinic unique and special responded to the general civic aspiration. The city recently developed a number of buildings — commercial skyscrapers and the like — to better define the whole community as a competitor in the world market.

Alba: And we won because the iconic architecture of our building was unique.

Is it significant that the clients hired an American company to create the program, rather than develop one themselves?

Alba: Yes. They are interested U.S. healthcare standards, partly to advance the civic aspiration and pride, but also because they want this clinic to be viewed as a medical tourism destination.

David Goodspeed: The clients expect patients from adjacent South American countries and perhaps the United States. People in the U. S. are flying all over the world to have surgery because it’s cheaper elsewhere.

We have specific understanding of designing facilities that are intended for medical tourism, and the project benefited from that experience.

Ramon Cruz: We’re also an American firm that designs to internationally

gresham, smith and partners

18

ABOVE: The patient tower helps to define the street corner and gives the new facility a dynamic presence from ground level.

19

showcase 4

ABOVE: The moss-covered rock formation of Machu Picchu’s Incan ruins inspired the clinic’s living walls and vegetated roof garden, as well as the shard-like forms and opposing lines and tension.

LEFT: Aggressive cantilevers and skin treatments give the building a sense of floating.

accepted standards, so our knowledge and experience was an important influence in their decision to choose us.

The site is flat, but it’s slightly less than two acres. How did you meet this challenge in organizing the various functions?

What is the site context, and how did this begin to influence the design?

Greg: The site constraints were extremely challenging, and we really had to squeeze the building onto the site. We designed five levels below grade. These house service, storage, a staff cafeteria, labs and the cancer treatment center, and parking— functions that don’t need, or in some cases don’t want, windows.

Greg: The surrounding area is a dense, low-rise fabric of properties, similar to the low-rise village standing at the base of Machu Picchu. We chose to make the clinic contrast with the neighborhood rather than blend in—to make a statement about the high level healthcare they’re providing.

Alba: The area is in transition, with a very high-end commercial district and nice residences close to the site.

A major west/east four-lane boulevard edges the southern side of the site. A much quieter local street lies on the site’s eastern edge.

Greg: That’s where we put patient drop-off, emergency access and the entrance to the lobby, which runs the length of the building.

The central four story atrium that forms a fissure in the building structure brings in natural light. The atrium divides the in-patient programs from the out-patient programs, is surrounded by waiting areas and circulation, and visually connects the main lobby level to the upper garden terrace located on the fourth floor.

A portion of the main entry lobby is open to the oncology family waiting level below. A waterfall feature along the stone-surfaced wall follows a suspended stairway to the the lower-

gresham, smith and partners

20

Early renderings illustrate native woods, battered stone walls and undulating planes that define the lobbies and corridors.

21

showcase 4

JUDGES’ COMMENTS

“The concepts and the metaphors are awesome.”

level waiting area. Combined with a large skylight that opens to allow natural ventilation, the features provide a mixture of natural light, sound and a cooling atmosphere as people circulate through the space.

Alba: The taller tower—ten stories above-grade—contains 144 beds for inpatient functions. The lower structure houses the outpatient component and provides medical offices to support 200 doctors. Between these two segments, in the middle of the building, is the entrance into the main lobby with reception, next to the atrium.

Were there other design constraints caused by the site?

David: We needed to park almost 900 cars but didn’t have space for surface parking. That meant placing all parking underground, with one entrance for staff and another for patients. The engineering challenge was that one had to slip under the other for both to fit.

Greg: We had to create a special support system so the cantilever above the entrance wasn’t too long. You can’t have columns in your driveway path, so we created a unique structure using angled transfer columns to hold the building up.

Was engineering this building especially difficult because of the lack of right angles?

Alba: Absolutely. The challenge was to translate the design concept into

regular 2-D drawings and put them flat on paper.

Greg: We were challenged by this every day. We usually rely on conventional ways to inform the contractor on how things must join together. We had to use a system of spatial coordinates to dimension the building.

David: The exterior façade isn’t flat; it’s like broken glass. It has multiple facets and planes. At any given point on the façade you can pick a point that has an X, Y and Z coordinate.

Greg: But if you move one fraction away from that point, all the dimensions are different so you need to supply a different set of coordinates.

What are ways the design inspiration infused the natural environment into the project?

Greg: Since the building is inspired by a stone formation, the atrium became a natural fracture or fissure in the stone when opened wide enough to become a focal point for

the building. What emerged was lots of undulating planes with faceted and battered walls.

The glass curtain wall skin informed by the rock formation concept allows an abundance of natural light and views of the surrounding area. Some of the skin is completely transparent, and some is patterned frit glass.

The frit glass improves solar control performance and allows natural light to enter the interior spaces without limiting exterior views.

Alba: In addition to natural stone, we added native mahogany and cedar to add warmth to the interior spaces.

These provide soothing contrasts to the concept of a facility carved in stone.

Were there any specific challenges to incorporating the natural environment into the project?

Greg: The climate is typical of the Pacific Rim — temperate and dry air like San Diego — but the outside air has quality issues. This posed a problem because facilities in the region are typically ventilated

...if we could combine this history with the latest and best technology in healthcare medicine, what would that look like?

gresham, smith and partners

22

section: 11- ICU/CCU

2- PHARMACY

12- CARDIAC REHAB

3- LABORATORY

13- LABOR & DELIVERY

4- INFORMATION TECHNOLOGY

14- INFUSION

5- ADMISSION

15- CAFETERIA

6- EMERGENCY DEPARTMENT

16- ADMINISTRATION

7- ATRIUM

17- OBSTETRIC UNIT

8- CLINIC

18- IN-PATIENT UNIT

9- ENDOSCOPY

19- IN-PATIENT UNIT & VIP SUITES

10- CARDIOVASCULAR

20- PARKING SPACES

Parking

1- RADIATION ONCOLOGY

ABOVE: The new hospital is located on a small site in an urban setting. Site constraints made surface parking an impossibility. Public and staff parking as well as logistical and service functions are located on subterranean levels.

LEFT: Basement Level 1 illustrates the complex issues involved in the building’s programmatic density. Functions that need little to no access to natural light are positioned below-grade.

floor plan:

23

showcase 4

1- Physician Parking

7- Information Technology

2- Storage

8- Pharmacy

3- Maintanence

9- Radiation oncology

4- Cafeteria

10- CentrAl Sterile Processing

5- Environmental Services

11- Morgue

6- Mechanical/Electrical Rooms and Shafts

12- Laboratory

fifth Level: Obstetrics Department

naturally. Even the government hospital doesn’t have mechanicallydriven air-handling equipment.

Alba: Natural ventilation is culturally accepted. This acceptance is also reflected in their building codes.

Greg: Because regulations were designed for natural air, it limited which functions we could place next to each other and still protect the patients.

How did you overcome this limitation?

third Level: Labor and Delivery Suite, NICU, Cardiac Rehab and Clinics

Greg: The intent with the clinic was to introduce U.S. quality standards, which meant the building should be completely pressurized.

Angela Holcomb: A fully pressurized healthcare facility allows for different departmental adjacencies and design options. For example, natural airflow would not allow placing a lab next to the morgue, but pressurized systems allow everything to be ventilated separately.

first Level: Reception, Imaging and Emergency Department

plans above: 1- Roof Garden/Plaza 2- Atrium Roof 3- Atrium

The project has a long way to go, but what has been the most fulfilling to date?

and subcontractors. Coordination and follow through will be essential.

With this said, working on a project that is as complex as this one is very rewarding seeing it through completion of each of the development phases. If the design remains intact, the end result will be iconic and collectively rewarding for all that have had a part.

Angela: Greg and Frank have designed numerous projects abroad but this project was my first. They gave our team some guidelines that helped us move forward in producing design development drawings, and the best part of this project, besides working on a great design, was working with such an integrated team. Every team member took on different responsibilities to add the information to the drawings that would complete Greg’s vision for the building. I look forward to seeing the building realized in its completed form.

Greg: It’s most fulfilling for me that the project is under construction and that the design — and everything that went into it — will be realized. This is a major accomplishment for the client, the community and GS&P. 

David: The project design was intricate in detail, interior as well as exterior. The process of completing the construction while maintaining the design vision will take a team effort from the local architects and engineers, the contractor, the owner,

gresham, smith and partners

24

ARCHITEC TURE

ENGINEERING

INTERIORS

PLANNING

Gresham, Smith and Partners provides design and consulting solutions for the built environment that contribute to the success of national and international clients. For more than 40 years, GS&P has focused on enhancing quality of life and sustainability within communities. GS&P consists of industry-leading professionals practicing architecture and engineering design as well as scientists and highly specialized planning and strategic consultants in Aviation, Corporate and Urban Design, Environmental Compliance, Healthcare, Industrial, Land Planning, Transportation and Water Services. GS&P consistently ranks among the top architecture and engineering firms in the United States.

showcase.greshamsmith.com

Š Gresham, Smith and Partners 2011