Shanghai International Medical City

Shanghai International Medical City

Master plan creates a unique urban landmark and innovative healthcare system Shanghai International Medical City

An innovative rethinking of the conventional hospital campus captured the commission for a brand new medical complex in Shanghai’s Hongqiao district.

Intended to serve not just local residents but a national and international clientele, the campus is super scale: a 77-acre site, five million square feet, 3,000 beds, five hospitals and specialty clinics.

Central to the master plan is the core support facility, which will enable the site’s private and public medical groups to share state-of-the-art diagnostic equipment, and eliminate the expense of each hospital and clinic providing its own. With strategies to deliver a gardenlike setting and design breakthroughs that will provide a carbon neutral site, the campus establishes an oasis of healing and a civic amenity in an intensely urban environment.

Client

People’s Republic of China Location

Shanghai, China Market

Healthcare Services

Architecture Engineering Planning

PRINCIPAL-IN-CHARGE

Kevin K. S. Kim, AIA Project Manager

David J. Stewart, AIA, NCARB, LEED AP Project Designers

Jeffrey W. Kuhnhenn, AIA, LEED AP Gregory J. Wieland, AIA Samuel Chunfu Lin Project Planner

Frank Swaans, AIA, EDAC, ACHA, FHFI, LEED AP PROJECT Professional

J. Brent Hughes, AIA, NCARB, EDAC, LEED AP BD+C Project coordinator

Claire Wallace Project Engineer

David V. McMullin, P.E., LEED AP

Awards

AIA Middle Tennessee – Design Award – Unbuilt Award

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et the stage. Why Shanghai?

Kevin Kim: The Chinese government wants Shanghai, which is becoming a truly international city, to replace Hong Kong as their center of finance and technology. To make this happen, they have to attract top-level talent from all over the world, as Hong Kong does now. That means providing a higher standard of living in the city.

Compared to Hong Kong, Singapore and other major Asian cities, Shanghai, and really all of China, is lacking quality healthcare services.

When ex-pats, especially well-to-do foreigners, get sick, they usually fly out of the country for care. The goal of the Shanghai medical city is to be an experimental showcase for China’s healthcare future.

Beyond the healthcare-related goals, the government also wants a landmark—not just another medical center, but something unique. Part of achieving that goal is creating a park-like campus that minimizes the institutional feel and dispels the idea that hospitals are only places for the sick.

What are the components of the medical city?

David Stewart: There’s an administration building for personnel who will oversee the whole campus, and

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then there are the separate hospitals. Huashan, an existing Shanghai hospital, will have a facility here focusing on neurological medicine, neurosurgery and dermatology, as well as a minor portion that acts like a general hospital.

Kevin: Another hospital is for cancer treatment. Then there’s an international hospital that serves as a general hospital for medical tourism or those who are privately insured.

David: One thing we’ve learned is that medical tourism isn’t just people coming from the United States or other countries to have surgery because they can do so for a lower cost in China. It’s also people coming to Shanghai from other cities within China for special procedures. The campus is about five miles from a central transportation hub with an airport, highspeed rail and other transit modes, which improves accessibility.

Explain the role of what you call the “shared facility” at the center of the site.

Kevin: Let’s say the Chinese government wants to bring in a worldrenowned orthopedic hospital or cutting-edge heart hospital someday.

If the specialty hospitals have to build a complete facility from scratch, the large investment in capital and time would make it a very unattractive proposition.

The master plan calls for the development of approximately five million square feet of healthcare space to accommodate 3,000 beds and support space dispersed among five hospitals, multiple specialty clinics and a core support facility.

The campus shares boundaries with multiple transportation hubs.

Studies of traffic and circulation patterns have been addressed through facility placement and interior roadway designs.

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1A - Shared Facility

The shared facility is the central distribution point for all logistical services—food, laundry, supplies—as well as the location of the latest diagnostic technology, treatment centers, even surgery. The orthopedic hospital would simply need to send experts and doctors, and build out a medical office in the specialty clinic building.

They will use the shared facility for diagnostic and treatment needs and won’t need their own MRIs, x-ray and CT scan machines. The advantage is that you can have cutting-edge, expensive technology—something that maybe an individual hospital could not afford on its own—and everyone can share it.

This sounds very rational for medical cost controls, which is perhaps why it also sounds revolutionary.

Kevin: Having multiple hospitals plug into a shared service facility is a new concept. I don’t think there’s a similar case anywhere in the world.

What’s especially difficult is figuring out how this would work because the Shanghai campus will be a mixture of public and private hospitals.

In the United States, all the hospitals would have to come together voluntarily and create a shared facility.

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1B - Huashan Hospital

It would be an unusual and difficult scenario. It’s possible in China because the government there is very strong and does a lot of central planning.

Huashan is public?

Kevin: Yes, but the cancer, international hospitals and shared facilities would be private. All the specialty clinics would be private. The question is how do you mix public and private, non-profit and for-profit?

How do you manage this thing? It’s a good idea, but what’s the liability and how do you share the profit?

These are real life issues, and that’s what they’re in the process of figuring out.

Have you had experience with a medical operation this big?

1C - Cancer Hospital

usually piece-by-piece additions over 20 years. Here they’re condensing all that into a very short time period—a ten-year build-out from scratch.

GS&P was awarded this project as the result of a competition. I assume it was international?

Kevin: Yes, there were four teams: one from Japan, one from Germany and one Swiss.

David: The Chinese thought our scheme was the best, but a lot of it is also developing relationships.

Our first involvement was a feasibility study two years ago that was featured in Showcase 2. Since then we’ve developed the site master plan and worked through more detail on the specifics of the project, so it has evolved over time.

David: We work on medical campuses of this size all the time, but

...a shared facility is a new concept... ...there’s [not] a similar case anywhere in the world.

1D-G - Specialty Hospitals

2 - International Hospital

3 - Long-Term Patient Care and Retail

The master plan is organized to allow for phased design and construction over a ten-year span.

The platform or public plaza is essentially a roof garden that slopes up from the edge to three stories above street level, with two functioning stories and parking beneath.

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ABOVE: The shared facility lobby connects diverse public spaces like education and convention functions. RIGHT: Road entrance shows ramping to the entry platform and sky bridges.

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TOP: Outpatient lobbies are highlighted by skylights and a curtainwall that provide an abundance of natural light and a strong connection to the campus’ park-like setting.

ABOVE:Luxurious VIP suites include private nurses, a concierge, special food service and suite space for families.

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f all building types, hospitals are among the highest in terms of energy consumption. Shanghai International Medical City strives to be the world’s most energy efficient healthcare campus by generating, conserving and recycling energy.

GENERATE the campus is designed to generate its own energy utilizing photovoltaic panels, geothermal heat exchange and biomass systems.

CONSERVE it will conserve energy by utilizing high performance lighting, hvac equipment, building envelope and a vegetative roof system.

RECYCLE energy will be recycled by capturing and reclaiming energy from building exhaust, rainwater harvesting, gray water and turbine exhaust.

the platform concept, in which the five main facilities connect on subterranean levels topped by a public plaza, seems to have been key to the organization of the site. how did the concept evolve?

Brent Hughes: We were having a lot of trouble organizing site circulation strictly in plan. We didn’t have enough acreage to accommodate separate inpatient and outpatient entrances and paths, nor for separate parking for staff, inpatients and outpatients without then having no space left for public and park space.

Frank Swaans: Chinese building codes also mandate more stairs and elevators than the United States, which increases the space needed for circulation.

Brent: Separating inpatients and outpatients isn’t a big deal in the Unites States, where we have many freestanding outpatient facilities. In China, however, it’s a major concern because these tend to be grouped with hospitals, so there’s a very large number of outpatients coming to a hospital for treatment. Separating those two circulation paths was important, and the only way we could effectively accomplish it was with a sectional solution—by layering.

Kevin: The platform or public plaza is essentially a rooftop garden that slopes up from the edge to three

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JUDGES’ COMMENTS

“...sustainability aspects are phenomenal.”

stories above street-level, with two functioning stories and parking beneath, below-grade. The spaces under the platform are for functions that don’t need windows: surgery, diagnostic equipment, storage, cooking, laundry, etc.

Explain the circulation basics.

Kevin: Outpatients enter at streetlevel and are kept to the perimeter as much as possible. Inpatients enter from the platform to the shared facility at the center. They can then move to the surrounding hospitals via paths underneath the platform.

Medical staff and service workers also move underneath the platform.

This “off-stage” circulation is out of public sight to minimize the institutional feel and maximize the park-like setting.

Frank: We estimate there will be 18,000 workers on the site at full buildout. Paired with the thousands of outpatients, this is a lot of people.

Kevin: That’s why the circulation solution is so important. We need to keep all the facilities connected, but we don’t want people to feel like they’re under the platform. So we cut light wells into the platform to provide natural light to a large sunken garden. We organized most of the offices and patient circulation along this sunken courtyard.

Frank, as the planner on the team, what challenges kept you up nights?

facility, period. In the United States we have isolation rooms.

Frank: Well, certain idiosyncrasies in programming for Chinese medicine.

In a Chinese hospital, for example, 50-60% of revenue comes from the pharmacy. This percentage is much greater than in the United States, so we have to account for a considerably larger pharmacy in the program.

The Chinese also sometimes express a desire for natural ventilation; in the United States all buildings are fully pressurized.

Another cultural difference is that in China, it’s very common to offer a multi-care delivery system in which you have very luxurious VIP suites as well as three- and four-bed wards. The high-end care is much different than in the United States: private nurses, a concierge, special food service, suite space for families.

In the United States it’s generally equal access.

China requires separate kitchens for patients, staff and public that cannot be shared. In reaction to the SARS scare of some years ago, all infectious patients, inpatient or outpatient, must go to a separate

So it’s a balancing act between their codes requirements and what the Chinese want to import from western medicine, to push the envelope in healthcare delivery. It really challenges your creativity.

Speaking of a balancing act, how does your master plan harmonize distinct design identities for each facility with the sense of a unified campus?

Kevin: The biggest unifier is the park setting—the common platform with its trees and landscaping.

Was the park part of the Chinese program?

Kevin: No, we promoted the park to them, and it’s not just for medical staff and patients. It’s open to the

...the clients want you to push the envelope. They allow you to plan and design with freedom...

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JUDGES’ COMMENTS

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The Shanghai International Medical City will serve as a landmark project for the city of Shanghai. The new campus seeks to dispel the idea that a hospital is a place for the sick by creating a serene garden-like environment that instead creates an oasis for healing.

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JUDGES’ COMMENTS

“...the design is bold and powerful in its expression.”

public, especially on the north side with the administration building and the plaza. Adjacent to this side the city is developing a commercial center with lots of offices and a retail street. We expect some of these people will come to the site, maybe during their lunch hour, and use the plaza. There will also be a food court on top of the shared facility.

David: ...as well as a conference center, classrooms and general retail.

So the medical campus will look very green. How green will the site be in terms of sustainability?

Brent: We proposed, and the client agreed, to plan for a carbon neutral site. We got to a 77% reduction in energy usage. Then we paused because we didn’t think we could go further in ways that were economically feasible.

captured waste. For example, we will re-utilize rainwater from heat systems. Instead of treating garbage as typical waste product, it was used to our advantage, using the methane gas it produces as a fuel source. It’s tried and true technology but we’re using it in a new application.

We ultimately got to a 95% reduction.

How much of that will survive the real costs phase, I don’t know, but it’s a good starting point.

financial sense of what’s feasible and what’s not, but they’re willing to push the limits significantly more.

Kevin: In China, there’s another motivation: an expression of status as a form of nationality. Look at how much they spent on the Olympics in Beijing. This is very similar—a unique healthcare campus they can show off to other countries.

David: They’re putting their stamp on the world. 

What about this project could have applications outside of China?

Kevin: Not only are we designing a much larger-scale campus than is typical, but the concept of the shared facility could apply elsewhere. How that could potentially bring together a wide variety of expertise without necessarily building separate hospitals for each is definitely pushing the envelope in healthcare delivery.

For example?

Brent: Photovoltaics—solar panels— where we were looking at a 30-year payback on 20-year technology.

Kevin: And Shanghai is usually overcast.

Frank: From my perspective, what’s special about the Shanghai project is that the clients want you to push the envelope. They allow you to plan and design with a freedom that we’re not often given in the U.S. Why is that true?

Brent: But the client consensus was: Try to do the most that you can anyway. If this is going to be a landmark project, pull out all the stops. So we added cutting-edge elements with

David: In the U.S., whether the client is for-profit or non-profit, all are looking at the bottom line and the schedule. In China, they have a

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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.

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Š Gresham, Smith and Partners 2011