Johns Hopkins Medicine: Building out from the inside

The cranes have come down. Jackhammers are quiet. Sidewalks are paved, and the landscaping has filled in nicely since Johns Hopkins Medicine three years ago opened the biggest project in its history, the Sheikh Zayed Tower and the Charlotte R. Bloomberg Children's Center.

But that doesn't mean the medical campus has stopped growing.

Although it may not be readily apparent to casual passersby, Hopkins has continued to expand since it opened the $1.1 billion towers on May 1, 2012. But instead of building more structures from the ground up, Hopkins is growing in a different way: by renovating and retrofitting older structures that were partly or entirely vacated when their occupants moved into Zayed, a 12-story tower designed for adults, and Bloomberg, a 12-story tower for children. In all, leaders of the medical campus have been working to recycle more than 300,000 square feet of space freed up by the moves into those buildings. That's as much space as can be found in one of Baltimore's large downtown office towers.

The work involves a complicated series of checkerboard moves, with space in numerous older buildings being repurposed or otherwise upgraded as Hopkins works to carry out a physical reorganization plan that began in 2009. Affected buildings include the Armstrong Medical Education Building, Blalock, Carnegie, the Children's Medical and Surgical Center, Halsted/Osler, Marburg, Meyer, Nelson/Harvey, the Outpatient Center, Park, the Welch Medical Library, and the Wilmer Eye Institute.

As of this spring, Hopkins has more than $250 million worth of construction projects underway or in the planning stages on the East Baltimore campus. Taken together, they represent one of the largest building efforts in Baltimore during 2015, and one of the most complex multibuilding renovation projects in the country.

The buildings undergoing conversion date from the 1920s to the 1980s. In some cases, they are being readied for long-term uses; in others, they are being modified for relatively short-term use. At least three buildings—Halsted/Osler and Carnegie—likely will be torn down eventually to make way for new buildings, but probably not for 10 years or so.

When this current phase of the work is done, the medical campus will have approximately 5 million square feet of space for teaching and research and 5 million square feet for patient care. New spaces will range from faculty offices and clinics to a state-of-the-art simulation center for teaching and training purposes.

The opening of the Zayed and Bloomberg buildings provided a one-time opportunity for redeploying freed-up space, says Sally MacConnell, director of Real Estate and Planning for the Johns Hopkins Medical Institutions. (In addition, the lung cancer treatment program moved from East Baltimore to a new $40 million wing at Johns Hopkins Bayview Medical Center, opening up even more space.)

"We had been doing backfill planning practically the whole time that we were planning Zayed-Bloomberg," MacConnell says. "We occupied Zayed-Bloomberg in 2012, and [senior director of Architecture and Planning] Michael [Iati] and I were seriously working on a backfill plan in 2009. We were meeting with each of the departments, asking, What are your projections and what are your deficits? and trying to put together a plan for how we might reuse the spaces."

Not surprisingly, she says, the greatest needs were for research space and faculty offices.

MacConnell says the chief goal of the building effort was to make Hopkins a medical center with all "private-bedded" rooms for inpatients, meaning one patient per room. Although Zayed and Bloomberg now account for the majority of beds at the hospital, with a total of 560, Hopkins continues to care for patients elsewhere, including the Nelson, Meyer, Marburg, and Harry and Jeanette Weinberg buildings, she says. The goal of having all private rooms, she says, will be met in 2016, when work is completed on retrofitting vacated space in the Meyer building.

At that time, MacConnell says, planners will be able to focus on creating offices and other facilities rather than moving patients around.

Here is an overview of work on affected buildings:

  • Armstrong Medical Education Building: Planning is underway for a $45 million Center for Innovation in Graduate Biomedical Education, with state-of-the-art lab and classroom spaces and collaborative studio classrooms intended to enhance and promote group inquiry, problem solving, and discovery.

  • Carnegie: The building donated by Andrew Carnegie dates from the 1920s and contains the Moore Clinic and Pharmacy, which will move to Park.

  • Children's Medical and Surgical Center: The building dates from 1963 and was largely vacated in 2012, with the opening of the Bloomberg tower. The hospital cafeteria and kitchen remain on two of the levels; others now house or are being readied for a variety of uses, including an adult dialysis unit, offices for Pediatrics, and labs for Radiology. Two floors will become the home of the JHMI Interprofessional Simulation Center, replacing a 16,000-square-foot facility now in the Outpatient Center. The new 33,000-square-foot teaching and training center has been designed as something of a mini hospital, with areas replicating conditions in a patient's private room, an operating room, and an intensive care unit, among other settings.

  • Halsted/Osler: Dating from 1926, Halsted and Osler have housed Physical Medicine and Rehabilitation and Palliative Care and will serve as a temporary home for the Psychiatry and Behavioral Sciences Department, which is scheduled to move out of, and then back into, four floors of renovated space in Meyer. (Psychiatry and Behavioral Sciences patients are currently in Meyer and are being moved out temporarily, MacConnell says, so they won't have to be subjected to construction work around them.) When the work is finished on Meyer, Halsted and Osler will be turned into offices.

  • Meyer: Floors seven, eight, and nine, which before 2012 housed space for Neurology and Neurosurgery, will be converted to private-bedded rooms for Physical Medicine and Rehabilitation and the Department of Medicine, including the Palliative Care unit. Floors three to six will be renovated for continued use by Psychiatry and Behavioral Sciences. Work on the top three floors will begin this year and be completed by the end of 2016. >

  • Nelson/Harvey: Spaces in the towers, which opened in the late 1970s, have been converted from 151 semiprivate to 136 private rooms, and Nelson's exterior has been rebuilt to make it more energy-efficient. All the patients were consolidated in Nelson, while Harvey was converted to support space. This work was completed in fall 2014.

  • Outpatient Center: After the simulation center moves to CMSC, its 16,000-square-foot space will be converted to additional areas for outpatient care and faculty offices. Work is expected to begin in 2017.

  • Park Building: The former location of the adult and pediatric emergency departments will become home to the Moore Clinic and its Outpatient Pharmacy (now in the Carnegie Building) and other outpatient services such as infusion. Planning is underway.

  • Welch Medical Library: Welch served for decades as Johns Hopkins' bricks and mortar medical library and home of the Alan Mason Chesney Medical Archives. The archives moved to Johns Hopkins' Mount Washington campus, and much of the information the library contained has been put online and is now available digitally throughout the medical campus, at nurses' stations and other locations. The library has been renovated to serve primarily as reading rooms, meeting space, and reference areas for certain materials that have not been put online.

MacConnell says that three buildings on the campus—Marburg, Billings, and Wilmer—are listed on the National Register of Historic Places and would not be torn down. Phipps, once home of Psychiatry and Behavioral Sciences and now primarily faculty offices, also has been preserved for long-term use, even though it's not on the National Register, and its garden has become a popular outdoor space with patients, staffers, and visitors.

Capital funds to complete the backfill plan are coming from a variety of sources, including $96.4 million from the Rising to the Challenge fundraising campaign (of a $2.4 billion goal for JHM) to benefit the simulation center and the Center for Innovation.

Once the backfill plan is exe­cuted, MacConnell says, Johns Hopkins will be in a position to expand by building again from the ground up, and it has a variety of options for doing so.

In terms of a general strategy, MacConnell says, the aim is to build more research space on the west side of Broadway and to locate faculty offices as close as possible to inpatient areas so that physicians don't have to walk long distances to and from their offices.

Potential sites for faculty offices include using the air rights above the Orleans Street garage, which was constructed to support a future office tower; a parcel on Bond Street; and the footprint of Halsted/Osler and Carnegie.

In addition to land for possible construction of research space on the west side of Broadway, Hopkins has land along Wolfe Street that could be used for expansion of the Bloomberg School of Public Health or the School of Nursing, or both.

In addition, the 88-acre East Baltimore Development Initiative renewal area, directly north of the medical campus, is a prime candidate for various kinds of expansion, MacConnell says. Examples include certain health system administrative offices, incubator space, companies related to intellectual property and tech transfer initiatives, and other uses that don't need to be close to patient care areas.

The next building planned for the EBDI area is a 167,000-square-foot structure called 1812 Ashland, on Ashland Avenue. Its seven levels will contain offices, laboratory space, and incubator space for startup companies. Already targeted for relocation there is the Health System Legal Department, which is now on the medical campus.

"EBDI is enormously important to us," MacConnell says. "Its importance is shown by the fact that we put our graduate student housing there. It's very much a way that you commit yourself to a project. What better way than to have your students populate the area?"

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