A new generation of hospitals is making civic sustainability and the user experience central to the design vision, says BDP’s Benedict Zucchi
As a measure of how far hospital design has come in recent years, one only has to look back at the legacy of the 1960s and 70s – my local London hospital being a prime example. As I walk past, it always seems to me to be bearing down on its much smaller grained local context, its external appearance dominated by the unadulterated expression of its ‘system-built’ concrete, which looks grey and unrelenting. Inside, its deep-plan floor plates (conceived for maximum efficiency) preclude good daylighting to many areas, make wayfinding a challenge, and create an internalised, corridor-dominated environment, which feels very institutional. Departmental silos subdivide the hospital into a series of ‘boxes within boxes’, further complicating circulation and undermining both the working environment for staff and the experience of patients and public. Poor energy statistics complete the picture of a building that no longer meets society’s expectations of ‘sustainable civic architecture’.
A new generation of hospitals in the UK is making sustainability and the patient and staff experience central to the design vision – recognising that the hospital’s long-term success depends on the creation of a ‘caring environment’ that responds to its physical and social context, as well as creates a memorable sense of place. This was evident in the design brief given to BDP by Alder Hey Children’s Hospital in Liverpool. The Trust omitted ‘hospital’ altogether from the project name, preferring to call it the ‘Children’s Health Park’. This emphasised the importance it gave to the integration of the new replacement building with adjacent Springfield Park, but also the wider ambition to create ‘a hospital that doesn’t feel like a hospital’.
Alder Hey Children’s Health Park, Liverpool (ph: Nick Caville)
Both at Alder Hey and in our developing design for the New Children’s Hospital in Dublin, a key focus has been on the choreography of public spaces and the progression from the front door to the threshold of individual clinical areas to break up the perceived scale and make the hospitals feel as ‘open’ and free of conventional corridors as possible. This is achieved by maximising the relationship between inside and outside to take full advantage of daylight, views and access to gardens. These might seem obvious architectural strategies, but in the past they tended to be given a low priority. Only recently has the rationale been given the kind of scientific footing that makes the case unassailable; a ‘therapeutically designed environment’ has proven benefits for patient wellbeing and recovery times.
Both in Liverpool and Dublin, landscape is central to the building’s identity, ensuring that the majority of rooms enjoy views over gardens and that wherever possible these are accessible for use by patients and staff. Proximity to the outside, in contrast to the traditional deep-plan approach of the older generation of hospitals, also underpins the drive for improved sustainability, with increased potential for natural ventilation, particularly in wards.
Due to complete in 2019, New Children’s Hospital, Dublin, employs a distinctive oval plan and rooftop gardens
Achieving this kind of openness and legibility relies on a more nuanced approach to the arrangement of clinical areas. Large generic floor plates may still be a valid approach for the acute diagnostic and treatment areas (the ‘hot block’) but are not per se a guarantee of universal flexibility for all areas. Apart from the ‘hot’ areas we differentiate three other main categories of space: wards, outpatients and public concourse, each of which has a natural grain suited to its function. This may add a degree of complexity in the initial planning of the overall concept but its great benefit lies in simplifying the later stages of clinical engagement by creating an appropriately scaled and flexible environment for groups of related clinical activities.
This is exemplified by the recently completed Southmead Hospital in Bristol, where the outpatient clinics and wards are housed in a shallow-plan ribbon wrapped around garden courtyards, while the acute diagnostic and treatment spaces are housed on the other side of the public concourse in a highly functional ‘high-tech’ zone. One of the obstacles to achieving this kind of clarity is the plethora of existing health codes and guidance documents. Despite the considerable expertise and good intentions that they represent, more often than not they are the enemy of good design because they become a lowest common quality benchmark rather than a baseline to be exceeded. To counter this we advise our clients to set up a high-level clinical review group at the start of the project to condense the multitude of highly bespoke room types, contained in guidance documents, into a much smaller number of standard ‘room families’. This not only makes sense in terms of long-term flexibility and construction cost but it also helps to break down the silo effect, encouraging more effective sharing of ‘multi-purpose’ spaces.
Aerial view of the Brunel Building at Southmead Hospital in Bristol
In some instances ‘multi-purpose’ is being extended at the macro level to mean non-hospital activities as well. In high-value inner city sites, like London, hospitals are beginning to evaluate the potential for mixed-use developments with the hospital itself acting as ‘anchor tenant’. Apart from commercial retail opportunities at ground level, the aim is to encourage closer ties with research, education and pharmaceutical activity throughout the campus, while also providing a reservoir of flexible space that can be colonised if needed by the hospital at a later date.
The urban mixed-use health campus could be said to epitomise the contemporary impulse towards a more civically minded and sustainable vision. It is more sustainable, not only in terms of revenue streams, efficiency and cost-in-use, but also architecturally, recognising that the ultimate success and longevity of a hospital, like any other building type, depends on more intangible qualities like its sense of place and the affection it inspires in its community.
