No one wants to go to the hospital. But when you must, what kind of facility would give patients, visitors, and medical staff the best possible experience? What should the ideal city hospital look like in a post-pandemic, 21st-century world? These questions were so big that when IU Health decided to replace the aging Methodist and University hospitals with a new facility under one roof, leaders turned not to one architecture firm but three, a team of local rivals, who agreed to collaborate instead of compete.
Creating a new firm, CURIS Design—a collaboration between BSA LifeStructures, CSO Architects, and RATIO Design—the state’s three largest architecture firms have teamed up to design a hospital to last a half century or more. The numbers are staggering: Four towers, 16 stories, 44 acres, 864 beds, 2 million square feet. That’s equivalent to a pair of Indianapolis airports or Lucas Oil Stadiums. Surrounding the hospital will be a medical office building, parking garages, utility spaces, and classrooms for the Indiana School of Medicine to relocate from IUPUI. The plan also incorporates a rooftop terrace, dual helipads, retail shops, outdoor seating with landscaping, and a series of walkways and tunnels that connect to nearby buildings. All designs will be LEED Silver–certified with transparent street-level entries.
Sound expensive? It is. The initial price tag of $2.68 billion was ramped up 60 percent in January when the design was expanded from three towers to four and costs were adjusted for inflation and skilled-labor shortages, raising the price tag to $4.29 billion—making it one of the biggest construction projects in the state’s history. This budget does not include the cost of the medical school move, estimated at another $230 million, or demolishing and upgrading parts of Methodist Hospital.
IU Health says streamlining and modernizing the facility will ultimately save $50 million annually by reducing duplication, an important bonus as Indiana was ranked seventh in the country for hospital costs.
But there’s even more at stake than medical care and costs when the glass doors slide open in 2027. Urban planners predict that the complex will become a lively hub of commerce, traffic, and employment that creates a powerful ripple effect of urban renewal in the surrounding neighborhood—flower shops, restaurant, condos, hotel, everyday services. In this way, the new hospital may cure more than its patients, offering fresh hope, energy, and investment for the northwest corner of downtown.
To learn more about the project, we sat down with the lead architects of CURIS Design: Bill Browne, Jr. of RATIO Design; Keith Smith with BSA Lifestructures; and Alan Tucker of CSO Architects.
Your three firms are used to competing against each other. How did you come to collaborate?
Browne: Each of us was contacted individually to look into whether we would be willing to team with each other on this project. IU Health had an interest in keeping this as local as possible. They reached out to the three largest firms in the state and asked us to come together and see if we could form ourselves together as a team.
Tucker: To the outsider, it seems like something unique, but we work in a highly collaborative industry. We compete with each other but, as our industry has developed in the last 30 years, we often find ourselves collaborating more and more with other professionals. When we come together, our whole focus is on the best interest of the project, the best team, and the best outcome.
Smith: BSA has worked with RATIO and CSO in the past. At our core, the three of us are very similar—we care about the profession, the community, our clients, and successful projects. Despite the fact that we live in different firms, our core values are very similar.
Did IU’s health decisions surprise you?
Browne: We knew that this dialogue was already out there, but that doesn’t mean that’s what they’re going to act on. I commend them for letting this happen. So many clients would go to some 2,500-person firm to deliver the project. Our firms are demonstrating that this can happen here.
Smith: It’s to IU Health’s credit to let firms come together in the community they already live in and do a project of this significance. I find that innovative in itself.
How did you divide the work?
Browne: We wanted to build on the strengths of each group. Keith’s firm has done lots of hospital work. Alan’s firm has led a lot of very large projects, like the airport, with more than 30 consultants, so that administrative and production capability is what their firm brought to the table. Our firm is seen as a design leader. We’ve pooled all our resources and put it into a single team.
Tucker: With joint ventures, we need team members to lose their individual identity, leave RATIO, BSA or CSO behind and become CURIS, where they are really working as a new firm. Once you get everybody in that mindset, it puts the real focus on the project. Another 25 percent of our team is made up of eight diverse partners, what we call XBEs—minority-, woman- or veteran-owned.
Smith: The three of us firmly believed that the capacity and expertise existed in the Indianapolis community. Three firms together were stronger than three separate firms.
Have you enjoyed the process?
Browne: It’s been wonderful getting to know them in this way. We’ve become partners on this project, unlike we would have anticipated.
Tucker: Three years ago, if someone told people that the three of us would come together in this joint venture, they probably would have said, “Nah, that’s not going to happen,” but it has been a wonderful process. We can all learn to build better individual professionals and firms so when we leave the project, we can serve the community better.
Smith: In some ways, a joint venture is like a marriage. A project of this magnitude and this duration and time, sometimes you need your partner to pick up a piece for you. The other firms are very quick and very willing to do that. I’ve always appreciated that.
Have there been any disagreements? How do you solve them?
Browne: Dueling pistols! We haven’t really had any. We’ve developed a consensus approach to answering questions or moving in a particular direction. It has not been adversarial.
That’s impressive at a time when people can’t even listen to each other.
Tucker: We see opportunities. CSO and RATIO formed a joint venture to pursue the Elanco project after this. It opened everybody’s eyes that at times we view each other as competitors, but we can also be allies. This town has had that history, going way back to Circle Centre, the airport. Bill, you on convention centers—getting local partners together and doing these large community projects.
Smith: I hope as people watch this, they realize the expertise and talent that’s in the Indy community for other projects. There are other good firms in town. Hopefully, people notice that.
Browne: When we formed the joint venture with Elanco, we ended up competing with national firms, and it was heartening to see that we could keep the project locally based. To Keith’s point, we want people to see that we have this kind of capability locally, to do high-quality, high-powered, big projects and deliver in a very responsible way. There’s a tendency for people to think, “I have to go 50 miles and get a new briefcase to do the work,” instead of just going across the street.
Let’s talk about the scope and vision for the project.
Browne: IU Health had been working on this for a number of years. They have been working with an executive architect, HOK (the largest U.S.–based architecture firm), for some 20 years. There was a framework established for the size, scope, and scale of this hospital. We were brought in to start from that baseline. The hospital is over 2 million square feet. There are three towers that are 16 stories tall. These are large floor-to-floor heights so this building ends up being taller than just counting the number of stories. Its footprint is close to two city blocks.
Tucker: It’s probably two airports or two Lucas Oil stadiums. It’s double what those projects were from a manpower requirement.
Smith: If you put our footprint on top of the existing Methodist campus, you’ll see that it’s much more compact. It’s going to bring efficiency to the medical operations. It’s a huge building, but it’s a contraction over the patient/staff experiences that exist today.
Will current Methodist buildings be demolished?
Browne: That is yet to be determined. The way the plan was conceived, they were going to go south of 16th Street and purchase 40 acres and build a brand-new campus. The neurosciences building, the research building, and a parking garage on that side of the street will remain. They are building the hospital, parking facility, a school of medicine, and a central utility plant, and there is space for more buildings in the future. As far as north of 16th, they are still evaluating what buildings are going to serviceable and what buildings are past their useful life. We’ll have to see how that plays out.
Can you describe some of the visionary aspects of the hospital?
Smith: So much of what goes on in healthcare today is around staff and patient experience. The hospital has been laid out in a fashion that’s very efficient, but also very pleasing from a design standpoint. A lot of the technological aspects are cutting-edge—even evolving as we are designing. This will be a medical facility that is unlike anything else in the community today.
Browne: The current Methodist campus is a rabbit warren of buildings and spaces, and it’s challenging from a wayfinding standpoint. This building is highly organized and intuitive. We’re also consolidating a lot of clinical services into one location. If a patient needs to access several different services, they won’t have to jump around a widely spread-out campus.
Tucker: Flexibility of future use is top of mind to everyone so that as healthcare evolves over the next 40 or 50 years, this space can adapt with trends.
What are some aspects inside?
Browne: We’re trying to make this an approachable building, where people feel comfortable. We’ve tried to make sure it has a lot of daylight and that it’s not imposing, despite its scale. We’ve tried to create warmth and intimacy and make it easy to get around. Obviously, the operation is a big part of it: How are you greeted and handled? IU Health is working that out carefully so patients are handled in a hospitality instead of institutional manner.
Smith: Sometimes good healthcare design requires simplicity—wayfinding, registration, helping your family participate in your healing process. No one wants to be here, but if you have to, let’s make it as enjoyable and easy as possible.
Will this redefine hospitals like Indy’s airport reimagined its kind?
Smith: This is healthcare at the highest level of acuity. It’s not your local doctor down the street from your house. It’s an academic medical center. People will find it easy to use and a pleasant facility, like the airport, but due to the fact that it’s a hospital, there will be some complexity to it that’s different.
Tucker: I’m excited about the way that this thing has been designed, especially from the exterior. It will respect privacy and medical needs, but much like the airport, it is well-day-lit, transparent, and focused on views. This will be a little different take on a hospital, much more transparent and pleasant than what has been done in traditional architecture.
How many people will come into the building on an average day?
Browne: I was told 4,500 staff and 5,500 other people coming in on a daily basis. It’s a lot of movement.
Tucker: To put it in perspective, 2 million square feet is the equivalent of a 70-story office building that we’ve got in 16 floors. You have similar problems as you do with an airport—people, traffic,
parking, people movement, vertical transportation, escalators, product movement, service, restaurants, deliveries. It’s a mini-city.
What kind of ripple effect will it have on the community?
Browne: It will have a huge impact on the neighborhood around Methodist. You’re talking about almost 80 acres with the two parcels north and south of 16th. Many city blocks all effectively owned by IU Health. People in the hospitality business will want to build a hotel because people will be coming from all over the region. Housing is already going up. If the staff can live close, walk to work, and get groceries and dry-cleaning services, those are the kind of things that will likely happen in the future.
Tucker: The backfill of the old hospital is going to produce (free) ground as they take some of those buildings down. To get continuous ground for redevelopment in a key part of downtown is a one-time opportunity to make a difference.
Smith: When this facility is done, it will attract high-quality researchers and physicians to the city and state that maybe are not here yet today. Yes, the community will benefit, but the whole state will benefit.
Browne: IU Health thinks about this “health district,” they don’t want to gentrify it. They want to maintain some neighborhoods that are there now and improve it to support those people and those coming in. There is a real dance that needs to occur so development is responsive to both the future community and existing community.
Can each of you say something that you’re proud of about the work you’ve done?
Tucker: This is such a community asset. As an architect, you try to leave a physical legacy. These are the projects you want to do when you go to architecture school. That’s why I got into the profession.
Browne: The thing that’s always important to an architect is leaving a beautiful building in place, one that does what it’s supposed to do, but also creates a lasting landmark. A lot of the landmarks in our city are made of Indiana limestone, and that’s the material that will be gracing this building. All of us are doing the very level best we can to make sure this legacy will last and have that kind of impact in our community.
Smith: We talked about 10,000 people coming to this building every day. There are a lot of people that will be in this facility that I’ll never know. But I hope they are comforted, healed, somehow their life is better because they came in this facility and then went back home.