The decision to include these biophilic elements is tightly coordinated with the institutions’ broader mission of delivering safe and efficient medical care, maintaining patient comfort, and ensuring staff satisfaction. For example, the steel-framed Lunder is configured so that its five acute-care floors, typically with 32 private rooms each, stack on top of a four-story base containing the lobby, emergency room, and procedural rooms. An intermediary mechanical zone effectively “liberates” the structure of the upper-portion building from that of its base, allowing an unconventional layout for the patient-room floors, explains Jay Siebenmorgen, design lead for NBBJ, Lunder’s architect. The plan features two interlocking C-shaped groups of rooms—all with views of the city, the atrium, or the bamboo garden—and a diagonal circulation spine that connects the two green voids. The arrangement yields the maximum number of beds within Lunder’s tight footprint, yet allows daylight to penetrate into the core of the building, and serves to break the typical central nursing station into two pods, minimizing staff travel distances between rooms and support areas.

An undulating 1.5-acre living roof at Palomar Medical Center West covers a two-story wing for diagnosis and treatment. The green carpet of more than a dozen native plant species is supported by a series of long-span trusses. This structural strategy should allow the hospital to replace outmoded equipment and change room layouts. Renderings courtesy CO Architects

At Palomar, similarly practical considerations prompted the decision to locate the equipment-intensive diagnostic and treatment functions in a dedicated wing: Designers wanted to accommodate expected advances in medical technology and control retrofitting costs. The wing’s structure—with its rolling roof supported by a series of trusses more than 100 feet long, without intermediary columns—is intended to facilitate the replacement of outmoded equipment and permit changes to room layouts, explains Frances Moore, an associate principal at CO Architects, the project’s designers. The space directly below the waveform roof provides a zone for the wing’s copious mechanical infrastructure.

To bring daylight into the interior of the diagnosis-and-treatment wing’s vast volume, CO has provided “skywells.” These planted courtyards, defined by ground-to-roof glazing, provide a link between the outdoor environment and surgery-prep areas, operating rooms, and recovery spaces. As part of its participation in the Pebble Project—a research initiative administered by the Center for Health Design—Palomar plans to document the effect of the skywells on staff productivity and medical errors.

On top of the two-story wing, the green carpet of native herbs and grasses, chosen by landscape-architecture firm Spurlock Poirier for their ability to thrive in the roof’s hills and valleys, provides environmental benefits such as creating habitat for birds, helping control storm-water runoff, and mitigating heat-island effect. It is a so-called “extensive” green roof—a lightweight system with only a few inches of growing medium appropriate for plants with shallow roots (those with deeper soil designed for a wider variety of vegetation are described as “intensive”).

Unlike the rolling roof, which was designed to be viewed but not occupied, gardens included in the patients’ tower at Palomar were conceived as planted terraces where family members and other visitors can sit surrounded by ferns, shrubs, and flowers, and take in the view of surrounding hills and mountains. The design team staggered the floor plates to create double-height spaces tall enough for trees, and provided planting beds with sufficient soil depth for the trees’ root systems. The sensory stimulation—the sound of rustling leaves, the textures and aromas of the different plants, and changes in light levels—should prove therapeutic. “A connection with nature can provide a distraction from one’s immediate problems,” says landscape architect Andrew Spurlock.

In contrast, the goal for the bamboo garden at Mass General’s Lunder, which can be seen from adjacent patient rooms and circulation areas but is not accessible, was to create a composition that would provide visual interest in all seasons, explains Herb Sweeney, a senior associate at Michael Van Valkenburgh Associates (MVVA), the project’s landscape architect. Designers chose a type of evergreen bamboo that will eventually grow as tall as 40 feet, flowers such as daffodils and hellebores, and a species of dogwood with red branches that are especially noticeable when it is leafless in the winter.