A Healing Art

As our business has evolved through the years, more and more often we’ve found ourselves involved in designing, engineering and installing waterfeatures associated with hospitals, medical centers and other healthcare institutions. These projects usually fall under the heading of “wellness gardens” or “healing gardens” – that is, spaces set aside for patients, families and staff to decompress, meditate or simply take a break.

While these watershapes are generally simple in concept, there’s typically more to the way they’re designed and built than meets the eye – a fact that adds an extra layer of complexity to these projects. As we at Outside the Lines (Anaheim, Calif.) have built our credentials in this sector, we’ve learned a great deal and now bring significant experience to the table when we’re asked to participate.

In the project covered here, however, there was a special, elevating sense of prestige added to the mix: We’d been invited to work on the grounds of the world-famous Cedars-Sinai Medical Center in Los Angeles.

A ROOFTOP SPACE

Ideally, we get involved in projects during the very earliest phases, where our expertise comes into play in offering design assistance, feasibility assessments and cost projections. In this case, however, we joined the distinguished project team relatively late in the game – a slight drawback in this case because of the ambition and technical details of the design.

We were called in by the general contractor, Hansel Phelps (Irvine, Calif.), based on our participation with them in several previous projects. We joined a team that also included three Los Angeles firms: AHBE Landscape Architects; Joma Design Studio, a specialist in fountain and waterfeature design; and Frank Webb Architects. Our role consisted of taking a thoughtful approach to the practicalities of the waterfeatures while also keeping a sharp eye on the medical center’s healing mission.

The medical center’s original entry plaza was well planted but had a rigid, institutional look hospital administrators wanted to transform into a more welcoming, soothing space. The demolition process stripped away the old planters and decking all the way down to the slab that served as the rooftop for medical offices that continued to function all through the project team’s construction of an all-new healing garden.

As a key part of the overall landscape program, we were to make and install 15 separate water basins throughout the project area, with each one meant to serve as a pausing place or gathering spot for patients, visitors and staff. Working with a familiar fabrication shop, we provided the basins in 316L stainless steel (coincidentally the material used in making surgical tools) because of its long-term durability, corrosion resistance and suitability for use with sanitized water.

Most of these basins had a circular form, but one was a long, narrow, sinuously curved reflecting pool intended for use adjacent to the overall composition’s dramatic centerpiece: a towering, walk-through shade structure designed by Ball-Nogues Studio (also based in Los Angeles).

The main challenge in all of this is that the old plaza space allotted to the project was actually a rooftop above medical offices. It had always been used for pedestrian access to the medical center from the adjacent parking lot and would continue to play that role – only with a sharply altered appearance and a revised traffic pattern.

Although the circular basins were small, there were 14 of them operating on a single circulation system, so the runs of piping and conduit multiplied quickly and occupied a large portion of the limited subgrade space. A fifteenth and final basin was fully engaged with the elaborate shade sculpture – a relationship that required close coordination as various components were positioned and locked into place.

It was, in other words, a very public space, which put an emphasis on professionalism, site appearance and awareness of curious passersby as our work unfolded. It’s not that we aren’t always mindful of such things, but the fact that this was part of a medical complex being crossed by people in need of care or concerned about loved ones certainly elevated consciousness of the need to be courteous, efficient and businesslike while on site.

There were also strict limitations placed on working hours, general noise levels and coordination with hospital representatives when anything particularly loud or percussive was going to happen so staff could be alerted and prepared.

For the most part, our own work fit within the project’s shallow, relatively flat profile without much trouble – at least by comparison to the landscaping crews that had to worry about accommodating root zones in often-shallow spaces. Indeed, we played our part without a great deal of pounding or shaking beyond the occasional need to crane things into place.

WORKING WITHIN LIMITS

That’s not to say there wasn’t a good bit to do in placing the basins around the site. Each needed to be leveled and welded into place, for example, and they all ran on just two circulation systems – a relatively simple one for the long, sweeping reflecting pool, the other 14 in an intricate, plumbing- and cabling-intensive system that saw the subdeck become a maze of pipes and conduits running to an equipment pad placed at deck level to avoid any penetrations of the existing roof structure.

An Emerging Tradition Water has been used for centuries to aid in meditation and overall psychological health. In recent times, in fact, scientific studies have shown that even the sound of water has positive effects on the brain. It’s also true that gardens and waterfeatures enhance the ability of medical facilities to perform their missions of healing and hope. Scientists have been studying the positive effects of these “healing gardens” and similar landscape elements since the mid-1980s. Their studies show that offering patients the ability to look out windows to see healing gardens or giving ambulatory patients access to these spaces to see trees, flowers and water can and do have positive effects by reducing recovery time for patients, reducing reliance on pain medications during recovery and also relieving stress for hospital staff, thereby improving their performance. This quantifiable connection between aesthetics, experience and healing has prompted many healthcare property owners to seek the assistance of specialists in developing their own healing gardens – many of which include water as a signature element in the design package. They know that making a subliminal connection to water as a cornerstone of life and well-being will reinforce the nurturing qualities of these gardens. They also recognize the beauty and environmental benefits of blending plant life with these water elements. To be sure, the primary purpose of healthcare facilities is to take care of patients, but it’s also a fact that these are businesses – and that the healthcare sector is becoming more competitive as new state-of-the-art healthcare facilities emerge and consumers gain easier access to information about these new options. In a special way, wellness gardens and their water elements support these facilities’ primary mission while enhancing the consumer experience, attracting patients and decreasing recovery time. It’s a winning formula in all sorts of ways. — J.W.Z.

With both systems, there were two big constraints: Whatever noise the water might make had to be kept at an extremely low decibel level to avoid any disturbance of the meditative nature of the space. The water also had to move in the circular basins in such a way that it did not splash and thereby create any atomized water vapor that might be inhaled by anyone passing by.

That last point has been a large concern for years in the construction of wellness gardens: It would be tragically ironic if a recovering patient became compromised because of sensitivity to the content of airborne vapor while taking a walk or riding a wheelchair through a healing garden! To that end, we used small bubbler nozzles set well below the water surface of each basin to produced ripples without any turbulence or spray.

In laying out the basins, we followed plans developed by Joma Design Studio once the old plaza was demolished down to the slab roof. We also set up the twin circulation systems for the reflecting pool and basins – each with a cartridge filter, a brominator and an ozonator – placing the equipment in a compact, stainless steel vault.

We inserted the stainless-steel components and set parameters for the Ipé-clad walkway, then awaited installation of the sculptural tunnel/shade structure, which arrived in pieces and was welded together on site. Once the welds were ground, chased, primed and painted, we were on our way in bringing our part of the project to its conclusion.

Of course, the healing garden is intended for use and operation 24 hours a day, so lighting was a large component of the plan. Each of the basins we installed includes an individually controlled RGB light, all of them programmed to establish a soft, soothing nighttime experience.

Once everything was up and running, we trained staff in basic operation and system maintenance. Since then, only one issue has arisen: The system had been running for a while when we received a call telling us that the basins had started to rust. We knew that was effectively impossible given the 316L stainless steel we’d used, but in fact it appeared that some of the basins seemed to be deteriorating.

With a bit of investigation, we found that there was indeed “rust” on the surface but that the underlying material was unaffected. We tested the water and found iron – then tested the irrigation system and determined that it was the source of a ferrous intrusion that accessed the basins via sprinkler spray and precipitated onto the steel surface. We worked with the landscape crew to redirect the spray patterns; once that was done, we cleaned the stainless steel surfaces and the problem vanished.

STAYING FOCUSED

As mentioned at the outset, a project of this nature is relatively simple in concept but fairly complex in execution.

In California in particular, there’s an agency known as OSHPD (the Office of Statewide Health Planning and Development) that imposes a large number of requirements unique to construction of medical facilities. On this project, for example, a number of anchors were affixed to the concrete roof slab to support and secure added components including the basins. OSHPD performed pull tests on fully 75 percent of those anchors – a high sample size seldom encountered in ordinary commercial construction.

Between these rigorous inspections (basically ongoing for the duration of a project), the restrictions on work hours and the complex scheduling involved in moving crews on and off site while keeping the project moving forward, what seemed straightforward became an ongoing juggling act with innumerable balls in the air.

Stepping well beyond its former role as a sterile pedestrian plaza, the medical center’s new healing garden serves patients, visitors and staff as a beckoning source of tranquility – a place to pause, decompress and recover. Water plays a key, revitalizing role in the composition both day and night, but it shares the stage with carefully chosen plantings and what is sure to become an iconic sculpture.

Through it all, we maintained our focus on the project’s goal of creating a calming, serene, meditative space – a quiet area punctuated by slow-moving water effects set amid drought-tolerant plantings that offer a pleasing array of colors, textures and wind-aided movement.

From end to end and side to side, we thought constantly about creating moments for observation. We put ourselves in the shoes of those who would eventually use the new plaza, thought about reflections, considered the character of water, projected traffic patterns, created contrast and interest by intermixing plants and water – and basically became advocates for those who would enter the space looking for a break from the stresses inherent in healthcare environments.

It’s about as satisfying as can be when it all works out for the best – as it has for anyone passing through the wellness garden on the way into or out of Cedars-Sinai Medical Center.

J. Wickham Zimmerman is Chief Executive Officer of Outside the Lines, Inc., a design/build construction company that specializes in creating one-of-a-kind rockwork, waterfeatures and themed environments for retail entertainment, hospitality, gaming and golfing projects around the globe. Contact him at [email protected].Chris Roy is Director of Creative Design at Outside the Lines. Contact him at [email protected].