“Thank God for hospitals,” I said to myself a few weeks ago while speeding to the local emergency room, doubled over in the back of an ambulance. Only after the painkillers had deadened a hitherto-undetected kidney stone could I begin to think about hospitals from an urban-design standpoint.

As thankful as I am for hospitals, I have to acknowledge they do not make good neighbors. Hospitals are multi-headed beasts—an ungraceful amalgam of hotel, clinic, restaurant and catering service, public areas for visitors, emergency facilities, nursing stations, testing laboratories and big loading docks that are constantly receiving shipments of food, drugs and equipment. Not to speak of a stream of patients being checked in and out at all times of day and night.

Beyond consuming enormous amounts of land, hospitals need a lot of parking, nearly as much as a regional mall, so hospitals traditionally are surrounded by asphalt lots or parking structures on all sides, sometimes disguised half-heartedly by planting. The perimeters of hospitals tend to be burnt-out zones, exacerbated by traffic.

Having completed its entitlement process recently, the $456 million Sutter Health campus planned for midtown Sacramento is trying not to be a typical urban hospital. Rather than taking the mega-structure approach to designing an urban hospital, Sutter is showing some fresh thinking in the way that hospitals fit into cities.

Unlike the single-purpose character of traditional hospitals, the Sutter campus is an inclusive place that finds room for historic structures, a new church, a children’s theater, a new medical office building and even 32 new units of housing on a site that Sutter is selling to a local homebuilder. (The housing has no direct relationship to health care and was included in the plan as a good-will gesture to the neighborhood, according to Tom O’Leary, the hospital’s project manager.) In short, Sutter Medical Center is an attempt to rethink the hospital as urban infill and mixed use.

Unusual projects often arise from unusual conditions. “The plan represents the confluence of three projects,” said architect Jim Diaz, managing partner of KMD Architects, which designed the site plan and the Sutter Health buildings. Beyond the expansion of the existing medical complex, those projects were an expansion of the nearby Trinity Church, which the local Episcopal diocese wants to enlarge into a cathedral, and a new location for the non-profit B Street Theater, which was combing the city in search of a venue for its stage productions for children.

After city officials asked Sutter Health to be mindful of the other projects in the vicinity, the hospital operator decided to include the cathedral and the theater in the planning process; eventually, the Episcopal diocese and the health-care provider filed a single EIR for the combined hospital and cathedral construction.

Although it’s a little hard to see from the illustrations plan printed here, one ingenious aspect of the plan is the way the hospital complex threads itself delicately among existing buildings on the site, including the Old Pioneer Church, at least two existing retail structures with popular restaurants, and an old brewery building dating from the 1850s that Sutter is restoring to something close to its Nineteenth Century state.

Parking, the eternal fly in the ointment of urban design, is also cleverly handled here. Sutter is building a new parking structure directly beneath the elevated highway, next to an existing Sutter Health garage, “on land that otherwise has little value,” according to Diaz. The 1,100-space garage is intended as a community parking structure, with a flex-parking strategy. During the day, the hospital is expected to use 700 parking spaces. At night and weekends, when traffic is heaviest for the churches, the restaurants and the theater, the majority of the spaces will be available for those uses.

KMD has worked hard to make the hospital look like something other than what it is: an enormous, graceless office building with enormous floors. The firm, renowned for its careful detailing, goes to town here, trying to carve some sculptural interest out of this giant refrigerator, and with some success. KMD also understands that architecture, in the sense of gorgeous facades, would not solve all problems by itself.

Equally praiseworthy as architecture, if less flashy, is the way the HMO and the architects have handled scale, stepping down from tall buildings to shorter ones. Sutter Health located its tallest building, the 150-foot-tall hospital tower, directly next to the elevated highway, where a tall building would seem least intrusive in the low-rise neighborhood.

The high-rise scale of the tower steps down to four stories, to the new medical office building, which steps down, terrace-style, to two stories, so that it does not overshadow Sutter’s Fort, located in a park directly across the street. Materials also transition, from the high-tech metal and glass of the hospital tower to a historically friendly copper façade of the medical office building.

In Diaz’s surmise, Sutter Medical Center will be “the most comprehensively designed hospital in an urban context.”

Given the variety of different businesses operating over this six-block site, it might not be surprising to find some kind of “synergies” among some of the users. One synergy that O’Leary finds is amenities for children. The B Street Theater puts on plays for young audiences, and that might make a good match with the children’s hospital that will be part of the larger medical campus.

He also hopes that changing exhibits at Sutter’s Fort, now a museum, can address an audience of children. He sees the hospital area becoming a destination for children, with school buses arriving regularly to bring audiences to the theater and visitors to the historic birthplace of Sacramento.

Making Sutter Medical Center into an attraction for children, however desirable, would be icing, not cake. The cake, so to speak, would be a full-scale medical center that has found a way to co-exist with a mixed-use neighborhood without becoming a nagging pain. Thank God for hospitals that can heal — and even provide adequate parking — without scorching the earth all around them.