The Garden Hospital Reinventing the Healthcare Landscape using Principles of Gardens and Sustainability to Create a Visual Guidebook for Human Design By Caitlin Jeffs Table Of Contents Introduction 1-14 Design: The Redwood Forest 39-54 Design: The Wildflower Field 69-78 • Preface 3 • Location 41 • Planting Plan 71 • Abstract 4 • Planting Plan: Main Entrance and Access • Classification and Elevations 73 • Project Introduction 5 Road 43 • Section 1: Adding to Biophlia 75 • The Problem with Medical Spaces 7 • Approaching the Main Entrance 45 • Section 2: A Scenic Landmark 77 • How Medical Landscapes are Changing 9 • Inside: The Lobby and Cafe 47 • Biophilia 9 • The Vertical Forest Floor 49 Design: The Coastal Bluff • The Gap in Healthy Landcapes 10 • The Miniature Redwood Forest 51 Healing Garden 79-94 • Precedents: Designing for Nature in • Planting Plan 81 Healthcare Landscapes 11 Design: The Oak Grove Garden • Classification and Elevations 83 • Defining the Garden Hospital Typolgy 13 Park 55-64 • Section 1: A Joyful, Quiet Room 85 Closing Remarks 95-100 • Research Question 13 • Location 57 • Section 2: Entering the Coastal Bluff 87 • Discussion: The Garden Hospital Typology • Planting Plan 59 • Section 3: The Cypress Seating Circle 89 in the Design 97 Site Selection and Analysis 15-26 • The Bocce Ball Courts 61 • Section 4: Approaching the Bluff’s Edge 91 • Conclusion: The Garden Hospital • Overview 17 • The Healing Garden 63 • Section 5: A Stunning Ocean View 93 Experience 99 • Amenities and Residential 19 • Bicycle Access and Green Spaces 21 Design: Introduction to Green References 101-104 • Bus Access 23 Roof Design 65-68 • Existing Design, Opportunities, and Constraints 25 Design Introduction 27-38 • Plan View Program Concept 29 • Vertical Program Concept 31 • Analysis 33 • Planting Concept 35 • Ground Level Planting Plan 37 i. ii. Introduction 1 2 Abstract Healthcare landscapes, such as hospitals, medical complexes, and clinics, are not known for being pleasant spaces for the human user to engage with. Often, these spaces are associated with sickness, loss, and death, and are sources of significant stress for their users. The western concept of medical spaces is in need of a redesign, with the increased incorporation of nature and community showing great promise in reducing stress and improving health outcomes. This project seeks to explore this concept further through design, investigating the role of Landscape Architecture in developing the Garden Hospital: medical landscapes that are designed for multi-functionality, biophilia, and community. The site for this design project is the Kaiser Permanente Medical Office Building in Santa Cruz, Ca. The full hospital landscape will be transformed, including facades, rooftops, interior and outdoor spaces to explore the Garden Hospital typology and demonstrate theoretical ways in which it could be accomplished. In doing so, the Preface Kaiser Permanente site will go beyond a medical space, becoming a central point in the lives of the local community. This shift in healthcare, backed by research into human health and wellbeing, could not My journey to my Master’s Design Project, only improve our experiences within and relationship “The Garden Hospital,” began during my to medical landscapes, but help to improve the undergraduate degree. Prior to beginning my path into health outcomes of the community. Landscape Architecture, I was a pre-medical student at the University of Redlands. As someone with the goal of becoming a doctor, I spent a lot of time interacting with medical landscapes; as a volunteer, medical shadow, or tourist. However, despite my passion for healing and love of science, I could never find myself feeling at ease within these spaces. I always wondered to myself, couldn’t there be a better way to design these spaces? Is it inherent in the nature of healthcare for these spaces to feel stressful and alien? This project was born from my interest in medicine and my belief in its potential to become better not just for patients and healthcare workers, but the surrounding community and ecosystem as well. 3 4 Project Introduction When one thinks of a hospital or other medical “Healthcare landscapes are where life landscape, it is uncommon for thoughts of is on pause, where we hold our breath, and comfort, fun, beauty, or joy to enter one’s mind. On the contrary, they are frequently stifling, barren, where we hope to never have to be... What and alien landscapes. The redesign of healthcare if medical landscapes were designed to be spaces is necessary and urgent to promote rest and places where life continues? Where there is healing, as well as to reduce stress and infection in reason to be in this space even when one is patients (Khullar, 2017). Additionally, there is room to well...” address the significant climate impact of healthcare, namely its contribution to greenhouse gas emissions (Schwartzman and Allaben, 2023). Especially in contemporary times, in which post-pandemic and here is a compelling argument for Landscape climate change related challenges to healthcare are TArchitects to take on a greater role in the design of becoming increasingly important, there is a need to healthcare infrastructure. This includes designing for rethink the concept of a hospital. Evidence-based universal access to nature, however, the reformation research is showing the huge potential of nature, of healthcare could go even further, incorporating such as healing gardens or biophilic design, to benefit community. Creating a sense of community and hospital staff, visitors, and patients (Cooper Marcus, fostering interpersonal relationships benefits mental Barnes, 1995; Cordoza, et al., 2018; Healthcare Facilities and emotional health, which in turn reduces stress and Today, 2013; Jesus, 2017; Jo Kreitzer, 2016; Journal of promotes healing (Becker et al., 2022; Cousson-Gelie et Biophilic Design, 2022; Khullar, 2017; Moreno, 2018; al., 2007; Ozbay et al., 2007; Reblin and Uchino 2008). Parris, 2019; Planterra; Riva Ras, 2019; Viray, A., 2018; If we could design a hospital as a “garden space,” then Warshaw, R., 2017; Wisconsin DNR Forestry News, 2017; couldn’t there be room in healthcare for socialization, Ulrich et al, 2020; Yang, et al, 2013). Hospitals featuring recreation, and education as well? This addresses a very green spaces often require less energy, and can real issue in how we construct healthcare landscapes in contribute to the biodiversity of their region (Chris Van western society which excludes normalcy and everyday Uffelen, 2017; Post Carbon Institute, 2014; Schropfer et life. Healthcare landscapes are where life is on pause, al., 2020 ). While incorporating nature into healthcare where we hold our breath, and where we hope to never is gaining in popularity, there is an opportunity to take have to be. Being in these spaces is often accompanied hospital landscape design to a more encompassing by a sense of wrongness and fear. It could be argued approach that addresses contemporary climate, mental that designing for a more biophilic, aesthetically health, and multi-functionality concerns. pleasing experience within medical landscapes is not enough, although it is indeed important and will be explored further in this Masters Project. What if medical landscapes were designed to be places where life continues? Where there is reason to be in this space “While incorporating nature into even when one is well, to engage in social, cultural, healthcare is gaining in popularity, there is recreational, or educational opportunities. While there is an opportunity to take hospital landscape a movement in healthcare to design for the patient, and design to a more encompassing approach to reduce the stress of healthcare workers and visitors alike, my Masters Project hopes to take this approach a that addresses contemporary climate, step further. Rather than designing medical landscapes mental health, and multi-functionality in isolation, instead I hope to integrate them into the concerns.” community, culture, and ecological context in which they sit. 5 6 The Problem with Medical Landscapes There is a need for systemic change within Healthcare-Related Stress Levels (above). Half of the public reports high healthcare. Since the 2020 pandemic, stress levels of anxiety in medical spaces, amongst the public and burnout in healthcare workers with one third of those avoiding these spaces as a result. As many as 10% of in medical landscapes is at an all time high (Cordoza et people have nosocomephobia, or a al., 2018). Additionally, there is a need to address the phobia of medical spaces (Clevland Clinic, 2021; Cleveland Clinic, 2022; significant climate impact of medical infrastructure as Fritscher, 2023; Murphy, n.d.). Stress the consequences of climate change become more also impact healthcare workers, with half reporting burnout and 25% apparent, with a call to action within the healthcare becoming depressed and anxious industry becoming more urgent (Schwartzman and in these spaces (Rotenstein et al., 2023). Designing for stress reduction Allaben, 2023). There is opportunity for landscape in healthcare is, therefore, highly architects to step in to healthcare design, addressing important for improving care and the experiences within medical landscapes. these concerns to improve the human experience within medical landscapes, and to make them more Greenhouse Gas Emissions of Healthcare Infrastructure (left). sustainable. Showing data on the greenhouse gas emissions from medical infrastructure, Contribution to Greenhouse Gas Emissions: including hospitals, clinics, and medical research facilities (Schwartzman and 4.4% from Medical Infrastructure Allaben, 2023). How Infrastructure Leads to Healthcare Problems (right). Many elements in how healthcare infrastructure is designed, how it operates, and how it is perceived contribute to stressful, unpleasant experience that have a negative impact on patients, visitors, and staff alike. The result of the stress this creates leads many to avoid medical spaces. And within these spaces, this stress creates burnout among workers, reduces the potential quality of care, and results in Amongst the Public: Amongst Medical Staff: worse patient outcomes. 50% Anxiety in Medical Spaces 50% Burnout Medical landscapes are often not conducive to with anxiety and sadness. These same emotions impact No significant No significant response 33% Avoid response a peaceful or comfortable human experience. healthcare workers as well. Although historically preva- Medical Patients frequently find themselves unable to adjust lent in healthcare, rates of burnout have increased since Spaces to their new surroundings, enduring anxiety and the pandemic, indicating a need for systemic change <10% 25% Also have depression (Alzahrani, 2021). The lack of nature, (Abramson, 2022; Khullar, 2017; Levine, 2021). It is im- Have Anxiety and sunlight deprivation, poor ventilation, and noise within portant to reduce the stress of healthcare employees to Nosoco- Depression hospitals lead to increased exhaustion and stress in reduce job turnover, shrinking of the workforce, and to mephobia patients (Khullar, 2017). Visitors and healthcare workers, increase the quality of service. By addressing the clear too, are not exempt from the negative impact of the problems with the human experience in hospitals, there typical medical environment (Cordoza et al, 2018; is phenomenal room for promoting healing and relax- Rotenstein et al., 2023). Visitors find few places of ation in this historically unpleasant space. comfort or privacy, making it difficult for them to cope 7 8 How Medical Landscapes Are Changing The Gap in Healthy Landscapes: Benefits From Designing For... Community A huge body of research is showing the healing Biophilia Communitypower of nature (Chris Van Uffelen, 2017; Cooper Sustainability he gap I identified in my research into healing Marcus, 1995; Cordoza et al., 2018; Healthcare Facilities Tgardens and biophilic design was that, largely, By reducing energy needs, creating wildlife habitat, stormwater By creating additional opportunity for multi-functionality and Today, 2013; Jesus, 2017; Kamp, 2016; Jo Kreitzer, 2016; management, and improving environmental quality. land use intensification. medical landscapes are separate from the community. Khullar, 2017; Moreno, 2018; Parris, 2019; Planterra; Unless one has reason to visit a medical space, they Identity of Place Riva Ras, 2019; Viray, 2018; Warshaw, 2017; Wisconsin will likely never go. However, there are a multitude of DNR Forestry News, 2017; Ulrich, et al, 2020; Yang et By responding to local ecosystem context and in creating a By making a space that reflects and engages with the locals, as reasons why this could greatly improve the function of unique experience within architecture. well as creates a space for intergenerational exchange. al, 2013) . This beneficial connection we humans have and experiences within medical spaces. By increasing to nature is biophilia, which is the human tendency Access to Nature the opportunity for social support, this type of design to seek connection with nature and to derive a sense By creating universal physical or visual access to greenery and By adding additional, accessible park space with recreational, could benefit users mental and physical health (Becker of wellbeing. Increasingly, medical landscapes are natural sunlight. educational, and leisure activities. et al., 2022; Ozbay et al., 2007; Reblin and Uchino taking advantage of our innate connection to nature, Human Experience 2008). By fostering a more social environment, there and are being remodeled or built to provide access By reducing stress and making it easier for users to adjust to By reducing the stress of users by making the medical is evidence to suggest that patients will have better to green spaces. This might be in the form of healing and even enjoy their surroundings. landscape a garden/park experience and part of everyday life. coping mechanisms, health outcomes, and even survival garden spaces, or in a more universal, biophilic design Quality of Care rates in the case of cancer (Cousson-Gelie et al., 2007). throughout the medical infrastructure. This next step Similarly, healthcare workers are likely to benefit from By reducing stress in patients, burnout in healthcare workers, By continuing to reduce stress levels in patients, staff, and in healthcare design too could address sustainability increasing productivity, and reducing errors. visitors by adding to the sense of normalcy. the opportunities social landscapes present, allowing concerns, pushing medical infrastrucure towards being for a better quality of care. Humans are inherently social Patient Outcomes both more sustainable (Post Carbon Institute, 2014; beings, and by designing space for everyday recreation Schropfer and Rowe, 2020) and more human. The sum total results in fewer complications, less By complimenting the effects of biophilia, but also and socialization within the Kaiser Permanente inflammation, less pain medication, and a 10% faster recovery. contributing to improving the health of the community. Medical Complex, it is possible to greatly improve the Economics human experience within the landscape, and to make By reducing healthcare spending, and by reducing costs By providing space for local business, and continuing to reduce healthcare more effective for healing. related to staff burnout, absences, errors, and turnover. costs that are also prevented by biophilia. Environmental Quality reating spaces for the community, and by doing By mitigating the impacts of air pollutants, noise, heat, and By reducing the negative environmental impacts near Cso creating a more social environment within the climate-related health risks. communities and providing public green spaces. healthcare landscape, also stands to boost public health. Public green spaces reduce health issues within Biophilia a community by encouraging socialization and physical activity (Becker and Browning, 2021) Additionally, “The human tendency to seek increasing the sense of normalcy by making the connection with nature and to derive a healthcare landscape a less intimidating, pleasant part sense of wellbeing.” of the everyday experience can encourage people to seek medical attention sooner by combating healthcare avoidance and stress. Benefits of Biophilic and Community Legend: Design in Healthcare. There are many Key themes benefits to creating biophilic hospitals that also have space for communities to Biophilic exist. Nature and community are vital in Community human health, and designing for both Both can improve the role and efficiency of healthcare systems. 9 10 Precedents: Designing For Nature In Healthcare Landscapes Some of the key precedents I found in my research are shown here, including Mayo Clinic (lower left), Khoo Teck Puat Hospital (upper right), and Maggie’s Clinics (lower right). These healthcare landscapes stood out to me for their biophilic design that merged with the regional ecosystems. Additionally, I was inspired by their healing philosophies, which were reflected in their design, that put the health and well being of the patient first. From these, I noted some common features of a successful, biophilic design: natural color palettes, accessibility, improving environmental quality, physical and visual access to nature, abundant natural light, air flow, curving shapes, and spaces for human comfort (Guenther and Vittori, 2013; Jesus, 2017; Kamp, 2016; Matheson, 2014; Mayo Clinic, n.d.). There was also The Mayo Clinic in Phoenix, AZ (below). This hospital is designed evidence of creating artistic “garden” experiences that with the patient in mind, and ceased to feel clinical, such as in Khoo Teck Puat and the features sunny, spacious waiting areas and healing gardens that Maggie’s Clinics. And, seen only in the Khoo Teck Puat allow for visual and physical Hospital, was space for public socialization, recreation, access to the desert landscape. and education. Khoo Teck Puat Hospital in Maggie’s Clinics in Europe, Singapore (above). This hospital various (below). These cancer features an incredible abundance clinics are designed to harness the of tropical greenery in its many healing influence of biophilia in its walkways, garden terraces, and patients, turning the clinic into a surrounding landscaping, some stunning, artistic, garden space. of which is open to the public for recreation and socialization. 11 12 Defining the Garden Hospital Typology ommunity SpC ace hile investigating healing gardens and biophilic ~ Creation of a “park” space with W Community Space Examples: recreational, educational, and leisure design, I found myself questioning what a garden This could include recreational spaces, such as opportunities. was, and how a medical space could more fully embody sports/game courts, outdoor gyms, running tracks, and ~ Good access to public transit and bike a garden. Gardens are also multi-functional spaces more. Educational or cultural spaces could also suit paths. where we go to relax, play, isolate or socialize. So, some sites, including stages, ampitheaters, or other couldn’t the healthcare landscape embody a garden to spaces where events could be held. ~ the full potential of the word? From this, the concept Healing Space Examples: t Fh ee els R was born; the Garden Hospital as a biophilic design for Including healing gardens, chapels, water features, com wem lc medical landscapes that creates a space of gathering oBiophilic Design Examples: un mit ing and community. For while nature is healing, normalcy y Including elements that contribute to universal . and and community too are pillars of individual health. The access to nature throughout the healthcare experience. famil intent of the Garden Hospital is to design a site so that it iThis could include indoor and outdoor planting, ar to responds to the ecological, environmental, and cultural windows, skylights, material choices, natural airflow, systems of a site, bringing the spirit of the landscape outdoor terraces, organic forms, ways to engage the and its people into healthcare infrastructure in a way five senses, and much more. that encourages it to become a part of everyday life, Sustainability Examples: and not just when life is interrupted by illness. This includes elements that reduce energy needs, produce resources on site, contribute to mulit- There are five main goals in my typology for a Garden functionality, and are made using more sustainable The Garden HospitalHospital design. My intent for this new healthcare materials. Some examples might be solar panels, landscape format seeks to create a biophilic design improved structural insulation, reducing plastic and that is in context with the landscape in which it sits and metal usage, water-wise planting or irrigation, and can provide space for local community. These goals all more. support each other and the philosophy of my design, Response to Local Context Examples: which supports the health and wellbeing of its users. Taking inspiration from the local culture and The main goals are as follows: landscape, this might involve works from local artists, spaces for religion, local business inclusion, community event spaces, and more to fit the design within its context. Research Question What could a medical landscape that fully integrates biophilic design, sustainability, and local culture, community, and ecology into its The Main Goals of a Garden Hospital Typology. The Garden infrastructure and healing philosophy look like? Hospital has 5 main goals; community space, healing space, biophilic design, sustainability, and response to local context. This diagram shows how these goals blend and support each other, showing how the Garden Hospital can create a landscape of healing. 13 14 Healin ~ g Qu i Se p.~ U t, sec ase o l cneu f u t dh ee d spa erol s ce gn ogic e sa nl s r ee s t f o o c r i spo r r e ea ds n t us ce e a in. p go stres ic De sitive s proves ure im Access to nat s and re duces ~ tcome health o u nts, staff , and tress in patie ~~ s C re visitors. ~ C R o a t e m ti he d m on u u o m c fe i ni a d ng ty seica a he n l nxi a se s p la ec t i y n g o e fo . f no . r r c mo am lcin y.g to bili ty on ~ arb ~ Cr B ina er c I g c m e io s p ati p a les tin ~ on ro nra d v g hu i wit h a ne Re ie d ti in n l s d g u o c n g a is ver eria l an in . ir fl sal at eed s g a ow am c m c ing gy n an es os er ~ Us bing regionally a . ppropro ia d t n e ient n s a to Ch rint g e e. plan ~ n ts c p reates no tur na ot uci -sit habitat is a tu fo d n opporto u e. lnity. lig rh e Re t . ~ erg y ~ Micro-forestry techniques en o Local Co se T ntex n plants t po and es s, mate rials, heme . colors , t a the ar e rtists t o be a ~ Using gional to re s and a hat are al busi nesse e. t ng loc are lan dscap iti hc S~ Inv alt u art of t he he s p t ~ Design that s i rt ee s’s p r oe ng dio s n to is t hm eo re sustainable. Site Selection and Analysis 15 16 Site Selection Santa Cruz County Line: Overview The site for this Master’s Design Project, the Kaiser Permanente Medical Complex, is located in Live Oak within Santa Cruz County, Ca. Santa Cruz is a popular tourist destination with a proud, local community. The culture here is centered around the county’s abundant and diverse natural landscapes, with surf, skate, mountain biking, hiking, and outdoor fun being a well loved part of life here. Any design at the Kaiser Permanente Medical complex should reflect the colors, themes, ecosystems, and local culture of Santa Cruz. Soquel Live Oak Aptos Capitola Seabright Rio Del Mar Santa Cruz Pleasure Point Larkin Valley La Selva Beach Legend: Watsonville Project Site Santa Cruz County Boundary Scenic Highway (Hwy 1) 0 mi 1 mi 2 mi 17 18 Site Selection 1 mile radius Existing Site Plan: Amenities and Residential The site for the Kaiser Permanente Medical Complex is surrounded by largely residential areas, which makes up around 80% of the built environment within a 1 mile radius. Approximately 15,000 people live within walking distance of the site (United States Census Bureau, n.d.). However, within the area examined, there are very few restaurants or cafes. Even fewer 0.5 mile radius of these are within pleasant walkable areas with easy pedestrian access or seating. This presents an opportunity at this site to design for a local eatery or cafe to take up residence at the Kaiser Permanente Medical Complex. Not only would it provide a local flare to the cuisine available at the site, replacing a standard “clinical cafe,” but it could serve as 0’ 200’ 400’ a hub to the local residents near the site. Legend: Project Site Radius Residential Area Cafe Restaurant 0 mi 0.25 mi 0.5 mi 19 20 Site Selection 1 mile radiu Existing Site Plan:s Bicycle Access and Green Spaces Bicycle access to the site is already good, and connects the surrounding neighborhoods to various parks and serves as a mode for daily commuting. However, bicycle access to the site was set to improve. 0.5 mile radiu The Santa Cruz Planning Department required Kaiser s Permanente to improve the existing bike paths along Soquel Ave that take bicyclist to the entrance at the northern end of the site. The existing, unprotected bike lane was set to be upgraded to a protected lane. As a result, the site already meets some of the sustainability criteria that is in the main goals of the Garden Hospital 0’ 200’ 400’ typology. In addition to the parks within one mile of the project site, the Rodeo Gulch Ecological corridor runs less than 0.25 miles away from the eastern edge of the site. This corridor provides habitat for and facilitates the movement of several species of birds, bats, and insects that could potentially utilize the Kaiser Permanente site. This presents another opportunity in design to connect to this ecosystem and to provide resources that these species could utilize. Legend: Project Site Radius Rodeo Gulch Ecological Corridor Public Park Existing Bicycle Route Future Coastal Rail Trail New, Unprotected Bike Lane New, Protected Bike Lane Bicycle Storage 0 mi 0.25 mi 0.5 mi 21 22 Site Selection ile rad Existing Site Plan:1 m ius Bus Access Bus access to the site is currently very poor, with the only bus stop being a 1.5 mile walk away. However, the Santa Cruz Planning Department required the Kaiser Permanente Medical Complex to include a bus stop within their site plan. As a result, there was intended to be direct bus assess to the site. This makes access to the site without a personal vehicle easy, 0.5 mile radius which provides better access to the site at a county- wide scale, and in a way that greatly benefits low income and elderly users of the site who are outside a walkable radius. The excellent bus access continues to build up the sustainability potential of this site, but also brings more importance to the community space included in 0’ 200’ 400’ the Garden Hospital typology. This design opportunity for creating an inviting space that people can utilize in addition to or outside of their medical needs, has the potential to serve all of Santa Cruz county’s residents. Legend: Project Site Radius Existing Bus Route Future Bus Route Existing Closest Bus Stop Future Bus Stop 0 mi 0.25 mi 0.5 mi 23 24 Site Selection Existing Design, Opportunities, and Constraints The Kaiser Permanente Medical Complex is an existing design that went through the permit process with the Santa Cruz County Department. However, due to uncertain circumstances, it will never be built. However, all analysis and site plans have been made, providing this project with a solid starting point to work from. This existing design comes with several design opportunities and limitations, which are outlined 6 below. Where No Change is Needed: 3 Opportunities: 6 Bus Access - This site already has direct 1 Main Entry - This space could connect to access by bus 7 the outdoors in its design. 7 Bicycle Access - The development would 2 Cafe - There is a cafe planned near the main include bike lane improvement, and there 1 entry that could be made a local business. is space for about 36 bicycles in the parking structure. 2 3 Rooftops - The rooftops of the Medical Office Building could be improved by green 8 Energy Generation - The entire rooftop roof designs. surface area of the parking structure is shaded by solar panels. 4 Healing Garden/Recreation Space - There is room for a small recreational “park” space 3 and healing garden space within the current Constraints: 8 garden area. Layout - I cannot significantly alter the Circulation - It would be possible to make layout of the roads, sidewalks, access points, more of this space appealing to users, and etc. to encourage more circulation around the site. Architecture - I cannot significantly alter the layout of the buildings, especially where there are supporting beams. Accessibility - All of my designs must follow ADA regulations. 5 Existing Trees - I must preserve all existing 4 native trees that were kept in the original Bigley, 2018; PMB et al., 2019. design. 0’ 50’ 100’ 5 25 26 Parking Structure Medical Office Building Design Intro Concepts 27 28 Design Legend:1 Green Roof Community Space 2 Main Lobby and CafeConcepts Peaceful Space3 Quiet Seating Area Leisure Design was centered around the Garden Hospital 4 Coastal Bluff Healing GardenTypology, as described on page 11, with the Recreation intent to create an ecological, healing space that 5 Ocean view Seating Area Site Boundary could be utilized as both a healthcare and community 6 Staff Outdoor Patio Pedestrian landscape. 7 Bocce Ball Courts Circulation Bicycle Circulation Plan View Program Concept: 8 Trails 9 Trailside Nook/Pergola Seen in plan view, there are several key attractions for Bus Stop both community and healthcare programs: Cafe Main Entrance and Lobby: The primary entrance to Bicycle Lock Area the Kaiser Permanente Medical Complex. This space is designed to feel like a forest both inside and out, reducing stress and making the environment feel 7 less “clinical.” It is also a nexus for accessing the other programmatic elements of the building, such as the cafe, rooftop healing garden, and leisure areas, or accessing healthcare services at the various clinics. 2 Cafe: Hosting a local chain, the cafe is a place for locals, 4 3 patients, staff, and other visitors to get food and drinks, 5 to relax, and to socialize. Medical Clinics and Waiting Rooms: Not intended for public access outside of healthcare needs. Various services exist in this complex, including physical 6 therapy, chemo, optometry, pharmacy, radiology, urgent care, and more. 8 1 Oak Grove Garden Park: Providing a space for 9 interacting with nature, light exercise, socialization, meditation, and stress relief that is accessible to healthcare-associated users of the site and the community. This Includes features such as the bocce ball courts, the trail, and the pergola. Staff Area: A private, pleasant space for staff to take a break from the bustle within the complex. Coastal Bluff Healing Garden: An ADA accessible healing garden with multiple points to relax, socialize. Wildflower Field Green Roof: Making a previously underutilized rooftop an ecological hub and creating access to nature via skylights. 0’ 60’ 120’ 29 30 Design Concepts Vertical Program Concept: The program and circulation for the designed portion of the site extends vertically as well. Guided by signage within the Main Entrance Lobby, accessed 2 by the stairs or elevator, visitors might ascend to the Coastal Bluff Healing Garden. At the top of the Kaiser Permanente Medical Complex, there are additional spaces within a healing garden to relax and socialize. Legend: 1 Main Lobby 2 Quiet Seating Area 3 Seating Circle/ADA Turnout 4 Ocean view Seating Area Cafe 1 Community Space Peaceful Space 0’ 15’ 30’ Pedestrian Circulation Leisure 2 3 4 1 0’ 25’ 50’ 31 32 Design Concepts Analysis: To determine the placement of the planting themes, each representing a regionally native plant community, a shade analysis was completed and compared to the available planting areas. Shade Analysis (Left) - Much of my site has low sun exposure as a result of the 4-5 story tall buildings. In particular, the space between the parking structure and medical complex is frequently shaded. The southern portion of the site, however, receives full sun. Planting Areas (Right) - There is an abundance of plant-able space at my site. These will be planted with native, drought-tolerant plants following themes determined by sun exposure Legend: Planting Areas Sun Exposure Low High 0’ 75’ 150’ 33 34 Design Concepts Planting Concept: The planting themes in my design are regionally native, canonical parts of the Monterey Bay Area’s landscape. Placement of each theme was decided by sun exposure or by physical factors such as viewshed opportunity and access. By using a diversity of planting themes from distinct plant communities, my design responds to local context and creates a garden experience that is rooted in the place. Legend: Coastal Terrace Prairie - Grass filled fields with low shrubs along windy bluffs. Native and endangered in Santa Cruz. Dry Grassland/Wildflower Field - Seasonally very dry, but bursting with annual wildflowers. Existing in hot, dry places in the inland parts of the Monterey Bay Area. Coastal Bluff Scrub - Existing on the dry, steep bluffs bordering the ocean and featuring a diverse array of perennials, shrubs, and trees that can withstand salt and wind. Redwood Forest - Abundant within the Santa Cruz Mountains, this cool, damp forest is a huge part of the local experience. Towering redwoods shade a lush under story of redwood sorrel and ferns, with occasional small trees and shrubs. Oak Scrub - A common, but stunning community within the Santa Cruz landscape. Featuring twisting oaks surrounded by a diverse carpet of drought- tolerant shrubs, grasses, and wildflowers. 0’ 50’ 100’ 35 36 Design Planting Plan Home to the Redwood Forest and Oak Scrubland planting themes, the ground level of the Kaiser Permanente Medical Complex is heavily planted. The borders between the themes blend together, creating a pleasant, gradual transition not unlike how these plant communities exist in the local landscape. On the rooftops, plantings mimicking Dry Wildflower Fields, Coastal Terrace Grassland, and Coastal Bluff Scrub exist. Together, the recreate the sensation of a day spent in nature, similar to some of the hiking trails within Santa Cruz County. It is intended for this design to fit the ecological and climate context of the site. The lush planting is all drought tolerant, and will not require regular irrigation once established. This is perfectly suited to the dry summers and typically short wet season experienced on the central Californian coastline. The diverse planting palette creates habitat for native species, including a multitude of birds and insects. Humans, too, can thrive in this landscape. There exist many points of interest Toyon, Heteromeles arbutifolia within the design. While holding mainly evergreen Howard McMinn Manzanita, Arctostaphylos structure, seasonal blooms bring ephemeral splashes of ‘Howard McMinn’ color to this landscape. Wooly Sunflower, Eriophyllum staechadifolium Pt Reyes Ceonothus, Ceanothus gloriosum Plant Palette: Coyote Bush, Baccharis pilularis Deer Grass, Muhlenbergia rigens Existing Arroyo Willow, Salix lasiolepsis Salifornia Sagebrush, Artemisia californica Coastal Bush Lupine, Lupinus arboreus Existing Coast Redwood, Sequoia sempervirens Seaside Buckwheat, Erigonum latifolium Seaside Daisy, Erigeron glaucus ‘Wayne Coast Redwood, Sequoia sempervirens Roderick’ Sea Thrift, Armeria maritima rubrifolia California Bay Laurel, Umbellularia californica Red-Flowering Currant, Ribes sanguinium California Fuscia, Epilobium callum Coast Live Oak, Quercus agrifolia Norfolk Pine, Araucaria heterophylla Western Sword Fern, Polystichum munitum Flannel Bush, Fremontodendron californica Coastal Woodfern, Dryopteris arguta Blue Elderberry, Sambuccus mexicana California Maidenhair Fern, Adiantum jordanii Douglas Iris, Iris douglasiana Coast Silktassel, Garrya eliptica Orchid Vine, Callaem marcropterum California Lilac, Ceanothus thrysiflorus Bluff Lettuce, Dudleya farinosaSeed Mix, native grasses and wildflowers Black Sage, Salvia melifera Redwood Sorrel, Oxalis oregana Coffeeberry, Frangula californica Carmel River Watershed Stewardship Manuel, n.d.; Holland, 1986; Keator and Middlebrook, 2007; Santa Cruz County Native Plant Oceanspray, Holodiscus discolor 0’ 50’ 100’Society, n.d.). 37 38 Design The Redwood Forest 39 40 The Redwood Forest Location Upon entering the Kaiser Permanente Medical Complex’s site, the visitor will first experience the Redwood Forest. The whisper of grass in the breeze, speckled generously with blooms of iris, elderberry, and California Lilac lead the visitor deeper into the site. As they near the buildings, towering Coast Redwoods might give the illusion that they are standing in the shade of a local forest, rather than that of the medical complex. The line between the natural and healthcare landscape in intentionally blurred, providing visitors with an immediate and ubiquitous connection to nature. Even after the visitor has stepped inside the Kaiser Permanente Medical Complex, the forest is still tangible and close. Plantings within the main lobby and visual access to the plantings outside through an abundance of tall windows preserve this biophilic experience. Reaching most windows of the complex, even at the highest floor, the visitor might find that the Redwood Forest is always accessible. This serves to reduce the stress of all who interact with the Kaiser 2 Permanente Medical Complex, improving healing and the human experience. 1 1 Areas Planted in the Redwood Forest Theme. Shown within the saturated areas of this image, the Legend: Redwood Planting theme can be found surrounding the parking 1 Main Entrance and Lobby structure and in the space along the access road. Additionally, the 2 Cafe Seating theme extends into the medical complex at the main entrance, including the lobby and cafe Cafe space. Bus Stop 0’ 50’ 100’ 41 42 The Redwood Forest Planting Plan - Main Entrance and Access Road Within the Redwood Forest, tall Coast Redwoods help to shift the often shady conditions to feel more like the experience within a local forest. While Plant Palette: the plantings are intended to resemble a forest with a lush, blooming meadow, the typically moisture-loving species were replaced with drought-tolerant plants that Coast Redwood, Sequoia sempervirens Oceanspray, Holodiscus discolor fulfill the same visual role. This allows for this planting theme to not require regular irrigation once established, Toyon, Heteromeles arbutifolia despite its inspiration coming from a temperate rainforest. Deer Grass, Muhlenbergia rigens Once the visitor reaches the main entrance, the California Bay Laurel, Umbellularia californica Norfolk Pine, Araucaria heterophyllaforest will seem to expand into the building as well. Western Sword Fern, Polystichum munitum A planting hosting a living, miniaturized forest uses Coastal Woodfern, Dryopteris arguta indoor plant species, such as Norfolk Pine, to represent Outdoor (above) and Indoor (right) Plant Palette Bouquets. Blue Elderberry, Sambuccus mexicana Douglas Iris, Iris douglasiana their larger counterparts outside. The Redwood Forest A visual comparison of the plant California Maidenhair Fern, Adiantum jordanii is also visually accessible at all levels of the buildings. palettes outside and inside the Kaiser Permanente Medical Redwood Sorrel, Oxalis oregana The eventual height of the redwood trees means that as Complex within the Redwood California Lilac, Ceanothus thrysiflorus they mature, they will contribute to the universal access Forest themes. While some plant species are found in both areas, to nature at the Kaiser Permanente Medical Complex. each feature a largely different mix of plants. However, there is Coffeeberry, Frangula californica still a resemblance between these planted areas. 0’ 50’ 100’ Carmel River Watershed Stewardship Manuel, n.d.; Holland, 1986; Keator and Middlebrook, 2007; Santa Cruz County Native Plant Society, n.d.). 43 44 The Redwood Forest Approaching the Main Entrance The Bus Stop (Upper Right). When the visitor arrives at the Kaiser Permanente Stepping off the bus, the visitor is greeted by the meadow within Medical Complex, they will first go through the the Redwood Forest. In the Redwood Forest. A lush meadow of billowing Deer springtime, vibrant Douglas Iris and soft Oceanspray blooms Grass, with seasonal Iris and California Lilac, creates a create a garden-like scene. Wood soothing whisper and sets the stage for a unique garden benches tuck into the planting, creating a pleasant space to experience. A backdrop of Coast Redwoods helps shift wait for the next bus. Within the feeling of being in the shade of tall buildings to this biophilic design, the anxiety of coming and going from a standing within a local forest. Perhaps the stress of healthcare landscape might be being in a medical space can be softened by the lush lessened. planting. Approaching the Main Entrance (Lower Right). As the visitor approaches the Main The progression of experience from the meadow Entrance, the Redwood Forest to the heart of the Redwood Forest sets the stage begins to reach towards the sky. A thick carpet of Redwood for the biophilic experience at the Kaiser Permanente Sorrel and ferns with bright white Medical Complex. The visitor will be struck by both splashes from Oceanspray give the impression of a forest grove. the beauty and familiarity of this iconic Santa Cruz A Bird’s Eye View overlooking landscape, which will help to break down the anxiety the Redwood Forest (Lower that is commonly felt when going into healthcare Left). Looking South at the Kaiser Permanente Medical Complex, landscapes. one can see much of the Redwood Forest planting theme. 45 46 The Redwood Forest Inside: The Lobby and Cafe Stepping into the Kaiser Permanente Medical able to see the central “clearing” similar to those scatted sylvan ambiance and the smell coming from Verve Cafe. Complex, the visitor will feel as though the throughout the hills of Santa Cruz. Rather than a generic “hospital cafe,” a local chain has Redwood Forest followed them inside. Greenery, taken up residence in the Kaiser Permanente Medical natural materials, organic forms, and the sound of While abundant windows provide visual access Complex. Perhaps visitors will come to enjoy all of the running water will create an immediate sense of calm, to nature, the walls of the main lobby bring experiences this re-imagined as part of their daily life, counteracting the anxiety that often accompanies the forest floor to central view. Mosses and ferns are and not just when they need medical services. medical spaces. arranged into intriguing patterns , creating an art installation inside that further contribute to the biophilic A lush planter filled with a living, miniaturized forest experience. will give a sense of the Coast Redwood trees and ferns outside, with a lush groundcover of Redwood All of this creates a space to linger, rather than just to Sorrel. If one were to circle this element, they would be pass through. The visitor might be tempted by the Perspective of the Main Lobby. Looking into the Kaiser Permanente Medical Complex from just inside the Main Entrance. Shows the Verve Cafe, signage, vertical forest floor, elevator, “stream” paving, water feature, indoor planter, and open ceiling. 47 48 The Redwood Forest The Vertical Forest Floor Contributing to the sense of being within a Redwood The Vertical Forest Floor Elevation (Above). Forest inside the Kaiser Permanente Medical This shows the relationship of the Complex, the green walls within the main lobby vertical garden to the Verve Cafe and elevator. This also shows how resemble the forest floor. The Vertical Forest Floor the moss and ferns can be used to uses actual plants that have been preserved using a create an intriguing art piece that is also a biophilic element. method employed by the firm, Garden on a Wall, in their designs. This method harvests plants at their prime and then fills them with a biodegradable substance that keeps them looking as though alive (Garden on the Wall, n.d.). This installation is low maintenance, requires no soil, light, irrigation, or fertilizer, and has a lifespan guarantee of more than 10 years. Additionally, this technology meets the WELL building standard, and is considered to be safe and beneficial for healthcare interiors. Additionally, it meets LEED standards and is considered to be sustainable. At the Kaiser Permanente Medical Complex, the Vertical Forest Floor uses primarily ferns and mosses to create patterns and textures. Although non- living, this art installation creates a point of interest for visitors and contributes to biophilia. Fidessa Offices by Garden on a Wall. 49 50 The Redwood Forest The Miniature Redwood Forest The Miniature Redwood Forest Planter uses species alongside it on an adjoining bench. This large, living that are frequently used as indoor plants to create element of the Kaiser Permanente Main Lobby provides a representation of the planting outside. This planter is a living, beautiful element to present a tangible forest designed to be in-ground, giving a more immersive feel that helps to break down the stress of entering a to visitors who walk up to gaze at this installation or sit medical space. Elevation of the Miniaturized Redwood Forest Planter. Showing the indoor “forest” as an aesthetic and biophilic element within the Kaiser Permanente Main Lobby. 51 52 The Redwood Forest The Miniature Redwood Forest The planter housing the Miniature Redwood Forest is design to have efficient water usage and for safety. Using a re-circling, sub-irrigation system, the amount of water that this planting uses is reduced. Additionally, this keeps the surface of the growing media, which is sterile and inorganic (Planterra, n.d.), relatively dry. This design choice means that this design will not significantly increase airborne soil microbes (Surial et al., 2022; Thakulla et al., 2021; Urquhart, 2022). While this poses no risk to the average visitor, this removes a concern about indoor gardens in medical spaces for immunocompromized or post-operative visitors to the Kaiser Permanente Medical Complex. Legend: 1 Porcelain Pavers 2 Dry-set Mortar 3 Cementitious Backer Unit 4 Cork Underlay 5 Concrete Sub floor 6 Concrete Planter with Rebar Mesh Reinforcement 7 Caulk 8 Overflow Pipe 9 Perforated Pipe 10 Transition to Solid Pipe. To pump. 11 Mona Plant Sipper Linkable Tanks 12 Inorganic Growing Media (Includes pumice, expanded clay, vermiculite, and surfactant) 13 Filter Fabric 14 Drainage/Reservoir Layer (1/4” gravel) 1 15 2 7 15 Plantings 3 2 4 6 8 16 Leveling Concrete 5 11 12 13 9 14 10 53 16 54 Design The Oak Grove Garden Park 55 56 The Oak Grove Garden Park Location The Oak Scrubland planting theme exists within the sunniest parts of the Kaiser Permanente site. This includes the plant-able space at the Northern end of the site where it border Soquel Ave, and the Southern end of the site. This planting theme includes several programmatic elements, such as the Bocce Ball Courts, a healing garden with a trail and pergola, and a private staff area. 1 2 4 3 Legend: 1 Bocce Ball Courts 2 Trail 3 Pergola 4 Staff Area 57 58 The Oak Grove Garden Park Planting Plan Plants for the Oak Scrubland theme were selected based on several considerations; drought-tolerance, Coast Live Oak, Quercus agrifolia Oceanspray, Holodiscus discolor Orchid Vine, Callaem marcropterum blooms, pollinator-friendliness, native, and their presence within Oak Scrub plant communities or similar Red-Flowering Currant, Ribes sanguinium dry, full sun conditions. Neurological responses to color Toyon, Heteromeles arbutifolia was also used in this design to reinforce the energy California Fuscia, Epilobium callum and programs of this space (Ghuman, 2023; Ry et al., Flannel Bush, Fremontodendron Howard McMinn Manzanita, Seed Mix, native grasses and wildflowers 2021). Surrounding the Bocce Ball Courts, a vibrant californica Arctostaphylos ‘Howard McMinn’ palette of ornamental natives with flashes of bright red Pt Reyes Ceanothus, Ceanothus California Melicgrass, Melica Californica indicate a more energetic space. However, around the gloriosum ‘Anchor Bay’ Purple Needlegrass, Stipa pulchra trails and the pergola within the healing garden, blues, Red Fescue, Festuca rubraCoast Silktassel, Garrya eliptica Coyote Bush, Baccharis pilularis greens, lavender, and pale yellows are more abundant Giant Wildrye. Elymus condensatus to suggest a more peaceful space. This design also uses Deer Grass, Muhlenbergia rigens California Poppy, Escholzia californica gentle earth mounds, planting, and a winding trail to Common Yarrow, Achillea millefolium create a sense of hide-and-reveal, as well as creating Black Sage, Salvia melifera California Sagebrush, Artemisia Miniature Lupine, Lupinus bicolor more visual and auditory separation of space within the californica Common Tidy Tips, Layia platyglossa healing garden. Healing Garden Plant Palette: Bocce Ball Courts Plant Palette: 0’ 25’ 50’ Carmel River Watershed Stewardship Manuel, n.d.; Holland, 1986; Keator and Middlebrook, 2007; Santa Cruz County Native Plant Society, n.d.). 59 60 The Oak Grove Garden Park The Bocce Ball Courts Vibrant blooms, the crunch of decomposed granite underfoot, and the cheerful hollers of visitors defines the experience at the Bocce Ball Courts, and even that of the site itself. This recreational area is positioned so as to be within the line of sight from road leading into the site, giving this unusual, recreational element a clear presence. This creates a more lively and welcoming first impression to the Kaiser Permanente Medical Complex, and may be a draw to the local community. This game with intergenerational popularity gives locals a reason to utilize this space for socialization, recreation, and everyday life. Additionally, it continues to reduce the “clinical” feel of the site while improving a sense of community and normalcy, further reducing stress and promoting healing. 61 62 The Oak Grove Garden Park The Healing Garden If the visitor wishes to seek a quiet space to reflect, meditate, or simply relax, just a short walk into the healing garden will lead them to a quiet, natural space. Plants and earthen mounds quickly help the visitor to feel as though they have left the medical complex behind and are now enjoying a separate, native garden experience. Fragrant blooms and the sound of birds and insects engages the senses, and soothes the soul. At the tip of the loop, the visitor will find a pergola, proving a place to rest and stay still that provides visual and auditory separation from the rest of the site. This creates space for the more traditional healing garden to exist at the Kaiser Permanente Medical complex, providing visitors with its benefits for stress reduction. 63 64 Design Introduction to Green Roof Design 65 66 The Coastal Bluff Rooftops Green Roof Classifications: Green roofs are classified as extensive, semi- Semi-Intensive: Purpose- stormwater mitigation, Introduction to Green Roof Design intensive, or intensive based on layer thickness and biodiversity. Vegetation- mosses, herbs, grasses, weight per square foot. These classes of green roof sedums, shrubs. Overall depth- 6-10inches. Weight Green Roof Material Layers: have different ramifications for their construction costs, range- 25-60 lb/sf. Ecological compensation- very good. requiring additional engineering and reinforcement Intensive: Purpose- stormwater mitigation, 1 Plant Layer of the building structure as the weight of the green biodiversity. Vegetation- mosses, herbs, grasses, roof increases, with intensive rooftop installations Irrigation System sedums, shrubs, perennials, trees. Overall depth- requiring the most structural intervention. However, 8-30+ inches. Weight range- 45-160+ lb/sf. Ecological - Temporary, for plant establishment including green rooftops can provide both ecological compensation- excellent. 3 Jute Mat and aesthetic value, with greater intensiveness in their - 0.25” thick design allowing for more diverse and layered plantings. - Erosion control, biodegradable Classification specifics are as follows (Green Roof 4 Growing Media Technologies, n.d.): - Thickness varies. <6” extensive, >6”-10” semi, >10” intensive Extensive: Purpose- stormwater mitigation. Vegetation- mosses, herbs, grasses, sedums. Overall -Expanded clay, compost, additional soil amendments depth- 4-7 inches. Weight range- 20-40 lb/sf. Ecological (varies) compensation - good. - Lightweight, water retention, aeration, resists compaction 5 Filtration Layer - Included layer in drainage layer - Removes particles, prevents system clogging 6 Drainage/Retention Layer 1 15 - 60mm thick HDPE panels 2’ - Lightweight, protective, improves water flow, retains water 7 Root Barrier - 20-40 mm thick roll, dependent on installation intensity 23 - Lightweight, non biodegradable, durable 8 Insulation Layer 4 13 14 12 - Thickness varies, 4”-48” dependent on design, - Lightweight, closed cell, non biodegradable, thermal stability 9 Waterproofing Layer 5 - <2mm thick, PVC membrane roll 6 - Lightweight, non biodegradable, recyclable 7 10 Leak Detection System 8 - <2mm thick, liquid application - Pinpoint leak detection using Electric Field Vector Mapping 9 10 11 Roof Deck - Presumed concrete with steel rebar 12 Parapet 13 Aluminum Edging 14 Gravel Ballast 11 - Supports edging 15 Required Setback ArchiExpo, n.d.; Asphaltech, n.d.; Briley, n.d.; Bronz, 2017; Chris Van Uffelen, et al., 2017; Diadem, n.d.; Eastgate Supply, n.d.; Green Roof Solutions, n.d.; Gr*eNeno Rt otof sTcecahlenology, n.d.; Henry - Access, maintenance, protection Carlisle Company, n.d.; International Leak Detection, n.d.; ODU, 2018; River Sand Incorporated, n.d; Velux Commercial, n.d.; Weston Solutions, 2015. 67 68 Design The Wildflower Field 69 70 The Wildflower Field Plant Palette: Black Sage, Salvia mellifera Planting Plan The Wildflower Field is inspired by the threatened, Coyote Bush, Baccharis pilularisregional coastal bluff grassland and local dry grassland (aka wildflower fields). All plants are native, Coastal Bush Lupine, Lupinus arboreus highly drought-tolerant, and add ecological benefit; Seed Mix, native grasses and wildflowers they supports birds, pollinators, and more than 50 moth California Melicgrass, Melica Californica and butterfly species (Calscape, n.d.). Although shrubs Purple Needlegrass, Stipa pulchra will be planted on this rooftop, the majority of the Red Fescue, Festuca rubra plant-able area will be seeded with a mix of grasses and Giant Wildrye. Elymus condensatus wildflowers endemic to each of the plant communities California Poppy, Escholzia californica informing this design. This will allow for the plants best Common Yarrow, Achillea millefolium suited for the micro climate on the roof to establish, Miniature Lupine, Lupinus bicolor while some species may not thrive. Common Tidy Tips, Layia platyglossa Due to their high drought-tolerance when established, this green roof design is intended to be low maintenance and to not require irrigation once established. Plant Palette Concept (above). Planting Plan (right). Showing Showing the forms, textures, the layout and selection of plants and blooms that might be seen for the wildflower Field green growing on the Wildflower Field roof. green roof. 0’ 25’ 50’ Carmel River Watershed Stewardship Manuel, n.d.; Holland, 1986; Keator and Middlebrook, 2007; Santa Cruz County Native Plant Society, n.d.). 71 72 The Wildflower Field Classification and Elevation Due to differences in the height of the green roof Green Roof Intensiveness. Showing the areas in this green and varying planting needs, the Wildflower Field roof design that are extensive or contains a mix of intensiveness classifications. The semi-intensive. eastern side of the installation, including all of the plant-able space surrounding the skylights, is extensive. These areas will only support grasses and drought- tolerant herbaceous plants. Surrounding the hill at the southern end of the roof is semi-intensive, reflecting the built-up height and a deeper growing media that can also support shrubs. Extensive Intensive Green Roof Elevations. Showing the relative height of the green roof installation in relation to the elevation of the rooftop. 57.5’ 52’ +1’ +6’ 0’ 40’ 80’ 73 74 The Wildflower Field Section 1: Adding to Biophilia Perspective of the hill The design for the Wildflower Field, while not and skylights. Skylights intended for human programming, is intended to installed into this ecological improve access to nature within the building. Skylights green roof allow for sunlight to flood into the built into the redesigned rooftop bring natural sunlight clinics below. This improves into the underlying clinics, adding to the biophilic access to nature at the experience within the Kaiser Permanente Medical Kaiser Permanente Medical Complex. Complex, contributing to its biophilic and healing design. Legend: 1 Native Plants 2 Growing Media 3 Overlaying Green Roof Layers 4 Insulation Layer 5 Roof Deck 6 Roof Parapet 7 2’ Access Buffer 8 Aluminum Edging 9 Visual Screen 10 1’ Access Buffer 11 Skylight 9 1 6 3 2 8 8 4 8 11 7 10 5 0’ 8’ 16’ 75 76 The Wildflower Field Section 2: A Scenic Landmark Perspective of the planted hill A common complaint in Santa Cruz was the negative from the Highway 1. The native, planted hill creates a point of impact this structure would have to the aesthetics interest along the scenic Highway of the county. In particular, to the view off of the scenic 1 and blocks the view of necessary mechanical equipment. This new Highway 1. The rooftop of the southern side of the landmark might tempt passerbys medical complex, proximal to the highway, is full of to visit the site to investigate this unusual landmark. mechanical equipment. In the original design, a 12’ visual screen blocks the rooftop mechanical equipment from view. However, in my design, the footprint of the screen is reduced, and instead viewers from the highway will see a scenic, native hillside. The elevation and plantings on the hill of the green roof partially hides this screen, and also creates a landmark in the Santa Cruz landscape. Legend: 1 Native Plants 2 Growing Media 3 Overlaying Green Roof Layers 4 Insulation Layer 5 Roof Deck 6 Roof Parapet 7 2’ Access Buffer 8 Aluminum Edging 9 Visual Screen 1 9 2 3 6 4 8 8 7 5 0’ 4’ 8’ 77 78 Design The Coastal Bluff Healing Garden 79 80 The Coastal Bluff Healing Garden Plant Palette: Planting Plan Santa Cruz Cypress, Cupressus abramsiana Coyote Bush, Baccharis pilularis The plant choices and placement for the Coastal Coastal Bush Lupine, Lupinus arboreus Bluff Healing Garden was decided based on three core concepts: first, using highly drought-tolerant, California Sagebrush, Artemisia californica native plants that either naturally or ornamentally Flannel Bush, Fremontodendron californica occur on coastal bluffs, with the regional coastal bluff Woolly Sunflower, Eriophyllum staechadifolium scrub serving as inspiration; second, creating emotional experiences informed by neurological responses to Deer Grass, Muhlenbergia rigens color (Ghuman, 2023; Ry et al., 2021); and lastly, using Coast Silktassel, Garrya eliptica plants heights, forms, and colors to create distinct California Fuscia, Epilobium canum rooms or experiences as one progresses along the boardwalk path. The Coastal Bluff Healing Garden Seaside Buckwheat, Erigonum latifolium begins with a joyful, yellow color palette and then Seaside Daisy, Erigeron glaucus ‘Wayne Roderick’ transitions to a tranquil, blue and pink palette as one California Lilac, Ceanothus thyrsiflorus Sea Thrift, Armeria maritima rubrifolia travels south. This garden design also adds to the ecological impact of this Garden Hospital element, Orchid Vine, Callaeum macropterumPt Reyes Ceanothus, Ceanothus gloriosus creating habitat for birds, pollinators, and more than 60 Bluff Lettuce, Dudleya farinosa species of moth and butterfly, including the endangered Fender’s Blue Butterfly (Calscape, n.d). Black Sage, Salvia mellifera Northern plant palette Southern plant palette 0’ 30’ 60’ Carmel River Watershed Stewardship Manuel, n.d.; Holland, 1986; Keator and Middlebrook, 2007; Santa Cruz County Native Plant Society, n.d.). 81 82 The Coastal Bluff Healing Garden Classification and Elevation In order to support several species of large shrubs, Green Roof Intensiveness. Showing the areas in this green trees, and perennials, as well as to create an roof design that are extensive or immersive, garden experience, the entire planted area semi-intensive. of the Coastal Bluff Healing Garden is classified as intensive. Taking inspiration from coastal bluffs, gently curving corten steel walls support raised topography. This crates moments in which trailing plants might cascade over these miniaturized bluffs. The topography also contributes to establishing both garden “rooms” and a sense of hide-and-reveal, making the healing garden feel more expansive and providing different experiences as one meanders down the boardwalk path. Extensive Intensive Green Roof Elevations. Showing the relative height of the green roof installation in relation to the elevation of the rooftop. Corten steel retaining walls are used to support the varying topography and are also shown. 70’ 67’ 66’ Corten Steel Retaining Wall +1’ +6’ 0’ 70’ 140’ 83 84 The Coastal Bluff Healing Garden Section 1: A Joyful, Quiet Room Once the visitor reaches the Coastal Bluff Healing Garden using Perspective of the entry room. Yellow blooms from Orchid Vine the elevator or stairs, they will enter the first room of the space. and Woolly Sunflowers contrast Dominated by a calming, seafoam blue wall and sunny yellow flowers, against seafoam blue walls, contributing to a calm, happiness. this room exudes a sense of tranquil joy. Here, the sounds of the nearby This sun-dappled entrance to highway are muffled by walls, as well as foliage that surrounds the visitor the healing garden also acts as additional cafe seating for the on a wooden trellis. Dappled sun provides light to this sheltered space, Verve Coffee on the ground floor. tempting the visitor to sit with a coffee or lunch from the cafe at the ground floor and unwind. Legend: 1 Native Plants 10 Tables and Chairs 2 Growing Media 11 Pergola 3 Overlaying Green Roof Layers 12 Stairway Entrance 4 Insulation Layer 13 Anchored Post Base 5 Roof Deck 6 Roof Parapet 7 2’ Access Buffer 8 Aluminum Edging 9 Elevator 11 6 12 9 1 10 8 7 2 83 4 5 13 0’ 4’ 8’ 85 86 The Coastal Bluff Healing Garden Section 2: Entering the Coastal Bluff As one enters the Coastal Bluff Healing Garden, the initial plant palette Perspective of the boardwalk has sunny yellows contrasted against a seafoam blue wall, creating leading into the healing a joyful and peaceful space. In this first experience within this healing garden. A formal line of deer grass lines the boardwalk as is garden, the visitor will find themselves in a lush meadow of Woolly goes through a lush meadow Sunflowers abuzz with a host of native insects. Use of contrasting purples of Woolly Sunflowers. Majestic, windswept Santa Cruz Cypress and hide-and-reveal spur the user to stroll along a scenic boardwalk. create a dark contrast and tempt the visitor to move along the path. Legend: 1 Native Plants 8 Aluminum Edging 2 Growing Media 9 Visual Screen 3 Overlaying Green Roof Layers 10 Corten Steel Retaining Wall 4 Insulation Layer 11 Boardwalk 5 Roof Deck 12 Curb 6 Roof Parapet 13 Smart Drain 7 2’ Access Buffer 14 Waterproofing continues 1 9 8 12 8 6 13 107 11 2 7 8 3 7 14 4 5 0’ 4’ 8’ 87 88 The Coastal Bluff Healing Garden Section 3: The Cypress Seating Circle At the center of the Coastal Bluff Healing Garden is the Cypress Seating Perspective of Cypress Seating Circle. Showing a small gathering Circle. Benches and lounge spaces sit under the majestic, windswept of visitors enjoying the lounge forms of Santa Cruz Cypress, proving a pleasant space to socialize or space and the now colorful and diverse native planting. relax. This seating circle also doubles as a turnout or resting space, At the center of the healing complying with ADA regulations and making the garden more usable for garden, the greatest variety of plant species are visible in this elderly and disabled visitors. space, surrounding the user in a prismatic display of purples, pinks, blues, yellows, and greens. Legend: 1 Native Plants 9 Visual Screen 2 Growing Media 10 Corten Steel Retaining Wall 3 Overlaying Green Roof Layers 11 Boardwalk 4 Insulation Layer 12 Curb 5 Roof Deck 13 Boardwalk Turnout 6 Roof Parapet 14 Lounge Seating 7 2’ Access Buffer 15 Seating 8 Aluminum Edging 1 9 6 14 15 8 1213 11 2 8 8 8 107 3 7 4 5 0’ 4’ 8’ 89 90 The Coastal Bluff Healing Garden Section 4: Approaching the Bluff’s Edge Once the visitor reaches the southern portion of the Coastal Bluff Perspective of the boardwalk along the bluff’s edge. Showing Healing Garden, the plantings become lower and the topography the blue and pink dominated becomes more flat. This new visual experience prepares the visitor for this plantings and flatter topography. garden’s final surprise! Legend: 1 Native Plants 9 Visual Screen 2 Growing Media 10 Corten Steel Retaining Wall 3 Overlaying Green Roof Layers 11 Boardwalk 4 Insulation Layer 12 Curb 5 Roof Deck 13 Smart Drain 6 Roof Parapet 14 Waterproofing continues 7 2’ Access Buffer 8 Aluminum Edging 1 9 6 8 11 12 8 7 13 10 8 2 7 3 714 4 5 0’ 4’ 8’ 91 92 The Coastal Bluff Healing Garden Section 5: A Stunning Ocean View At the edge of the Coastal Bluff Healing Garden is a Perspective of the view point and its ocean view. Showing the stunning ocean view! By taking advantage of the view of the Monterey Bay from height of this structure, which towers above all other the rooftop elevation of the Kaiser Permanent Medical Complex. buildings in the area, the roof of the Kaiser Permanente Medical Complex becomes like a bluff overlooking the Monterey Bay. Legend: 1 Native Plants 9 Visual Screen 2 Growing Media 10 Corten Steel Retaining Wall 3 Overlaying Green Roof Layers 11 Boardwalk 4 Insulation Layer 12 Curb 5 Roof Deck 13 Smart Drain 6 Roof Parapet 14 Waterproofing continues 7 2’ Access Buffer 15 Pergola 8 Aluminum Edging 16 8’ Glass Viewing Wall 15 16 1 9 8 12 611 7 2 8 10 8 133 74 75 0’ 4’ 8’ 93 94 Closing Remarks The Experience at the Garden Hospital 95 96 Discussion The Garden Hospital Typology in the Design While this design is not rooted in feasibility, this project hopes to create a new vision of what healthcare spaces could be, and can inspire a new chapter of their design. The Garden Hospital Typology revolves around 5 core concepts that are intended to bolster healing and the wellbeing of the community. These core concepts include community space, healing space, sustainability, biophilic design, and response to local context. Looking back at some of the designed spaces at this re-imagined Kaiser Permanente Medical Complex, here are some examples of how the Garden Hospital typology is included in the design: Legend: Healing Space Sustainability Community Space Biophilia Response to Local Context “The Garden Hospital as a biophilic design for medical landscapes that creates a space of gathering and community. For while nature is healing, normalcy and community too are pillars of individual health. The intent of the Garden Hospital is to design a site so that it responds to the ecological, environmental, and cultural systems of a site, bringing the spirit of the landscape and its people into healthcare infrastructure in a way that encourages it to become a part of everyday life, and not just when life is interrupted by illness.” 97 98 Conclusion The Garden Hospital Experience Upon entering this landscape, the visitor is greeted The elevator doors open and the visitor is stunned week later, the elevator doors open, and the visitor by lush, billowing grass and wildflowers, and tall by a gorgeous garden. Vibrant, yellow flowers fill A steps inside. A group of people step in with them, redwood trees. Birds and insects might flit past their their vision, and they excitedly walk along a wooden surrounding the visitor. The visitor smiles at all of their vision, tempted by native blooms or pockets of habitat. boardwalk that is reminiscent of those they had walked wide eyed friends, all warm from a game of bocce As they near the main entrance, they might hear the on across bluffs and beach sand. The group the visitor ball outside. It was all their first time at the new Kaiser cheerful chatter of people or the rambunctious yells came up with steps off the trail. They all stretch out on Permanente Medical Complex, and the visitor was of players on the bocce ball courts just a little further long lounge benches in the dappled sun under Santa looking forward to seeing their reaction to the surprise south. The visitor pushes open the doors to enter the Cruz Cypress trees. The visitor carries on, and notices awaiting them at the bluff’s edge. As they made their medical complex and can hardly believe they have how the healing garden begins to change, becoming way there, the visitor smiled at the doctor who treated stepped inside. Vibrant vegetation and the tantalizing low and dominated by the blues and pinks of plants them at their last visit, and the doctor waved back as smell of coffee and pastries captures the visitor’s senses. they know from ocean bluffs. Once they finally reach they settled at a cafe table near the glowing meadow of A gentle sound of flowing water from a small fountain in the end, the visitor gasps in surprise. In front of them Woolly Sunflowers. the entry lobby calms them, and the visitor decides they they can see the Monterey Bay, and for a moment it might stay for a while after their appointment is done. seemed to the visitor that they could be standing on his medical complex was so different, the visitor As they turn to find the clinic they are scheduled to visit, the bluff’s edge to marvel at this view. While before the Tthought. The usual sense of anxiety and overwhelm they notice signage about the Coastal Bluff Healing visitor disliked the medical complex’s height, standing was nowhere to be seen. It was hard to separate who Garden on the roof, and make a point of going there several stories above the other buildings in the area, was there to receive care from those just there for fun, first once their visit is done. they thought this was such a neat way to create an and even those dressed as staff seemed equally happy. experience that everyone could enjoy. Certainly, the Why couldn’t all hospitals and clinics be like this? The The visitor feels at peace when leaving their visitor realized, many of the people there were visiting visitor shrugged, and supposed that a change might appointment. Usually they can’t shake off their the Kaiser Permanente Medical Complex to socialize be coming to healthcare landscapes. They hoped that discomfort and anxiety, but throughout their experience and relax, and not to receive medical care. someday, they all might become gardens too. they could see trees and the gentle illumination of sunlight. Their provider seemed to be at ease too, and A flash of red draws the visitors gaze downward the visitor felt that their needs were heard and that they towards a vibrantly colored bocce ball rolling received amazing care. down the court. The visitor notices that not only the recreational space, but a meandering path through Although they had now finished their appointment, coastal live oaks and familiar shrubs, similar to their this visitor is in no hurry to leave. Excited to favorite trails at the Pogonip or Wilder Ranch. The continue exploring this beautiful landscape, they step visitor notes how well the plantings mimic the local onto the elevator. The space around them is soon filled landscape, and it reminds them of their visits to the by a group of friends who looked more like they were redwoods, coastlines, oak forests and savannas across there for fun than to visit the various clinics at the Kaiser the Monterey Bay Area. The experience today was fun, Permanente Medical Complex. The visitor had almost the visitor realizes with some surprise. 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