POSITION THE RECOVERY. Can good design help with healing? A growing number of new hospital. architects think so. 110 : HOSPITALS

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1 110 : HOSPITALS landscape designer and painter Maggie Keswick, who died of cancer in 1993, has grown from a one-off project to a growing UK-wide network of centres, many of them designed by renowned architects such as Richard Rogers, Frank Gehry, Zaha Hadid and Rem Koolhaas (not as surprising as it sounds, given that all of them were friends of Maggie s and her husband s: she was married to THE RECOVERY writer and landscape architect Charles Jencks). Before her death, Keswick came up with the idea of a cancer caring centre, which she worked on closely with her oncology nurse, Laura Lee. The idea of living and dying as well as possible became a central part of our plans for the [first] centre and has remained at the heart of the organization that grew out of it, says POSITION Lee, who has since become CEO of the Maggie s Centres Trust and who commissions architects for new centres. The brief she gives them is specific in terms of users needs, she says, but does not limit the architect creatively. That is why all the Maggie s Centres buildings are different externally, while sharing many commonalities inside. They are all very welcoming and have lots of natural light, she explains. At the heart of every centre is the warmest, most inviting of domestic spaces, a kitchen: It is amazing how a boiling kettle and being asked how you take your tea can Can good design help with healing? make people feel at ease. If it sounds simple, that s because it is. A growing number of new hospital Maggie's Centres are defined by light, openness architects think so. (patients find no reception desk to report to), intimacy (they are domestic in scale), views WORDSGIOVANNA DUNMALL and, in most cases, a proximity to nature: the Hospitals. We know them by their sterile monolithic architecture: dark, endless corridors, dull green and beige colour schemes, clinically bright lighting, and the smell of overcooked food and disinfectant. Not surprisingly, they are among the places that we least want to visit. We associate them with illness rather than recovery. There are exceptions, however. A few ground-breaking new facilities in Europe and elsewhere are contributing to a brighter vision of the future of healthcare. One high-profile example is the private Circle Hospital in Bath, designed by Normal Foster + Partners, open since March 2010 and partly owned and run by the staff. In the words of architect Spencer de Grey, a senior partner at the firm, nothing about the Circle Hospital is like the conventional institutional stereotype, starting with the fact that surgeons and staff had a hand in designing the hospital. The overall atmosphere is completely different there are none of the colours, sounds or smells that you would usually associate with a medical centre, he says. From the design of the building down to the detail of the interiors and individual furnishings, the effect created is more like that of a luxury hotel. De Grey is not exaggerating. The Circle Hospital displays a warm, ochre-based palette in its interiors, has large-scale contemporary paintings on its walls, and offers views of the surrounding countryside and greenery from almost every window. On the ground floor are the consultation and treatment rooms, while the patient bedrooms are arranged above. Each patient you feel tempted to call them guests has an individual bedroom replete with oak floors, a pull-down bed for visitors and fragrant herb boxes outside every window. As you walk around the structure, you note a distinct lack of signage: instead, real people guide you to your destination. Along with the absence of corridors, every room, including the operating theatres, receives natural light. At the heart of the building is a light-filled atrium, where the nurses station, reception and sophisticated-looking café are located. The scale is human: No part of the building is more than a four minutes walk away, at a slow pace, from the furthest point, explains De Grey. It looks wonderful, but what do the hospital s users make of it? Surgeons say the pleasant environment results in patients who are more relaxed, which in turn has numerous positive knock-on effects. Ophthalmologist Jonathan Boulton finds it easier to perform a number of surgical procedures under local anaesthesia at the Circle. Neil Bradbury, an orthopaedic surgeon, claims that his patients require less anaesthesia and wake up feeling fresher and more comfortable. Other staff report that calmer patients mean lower heart rates and less bleeding during surgery, and that Circle s patients tend to go home earlier than those in conventional hospitals. What s more, says De Grey, many outpatients choose to stay for lunch in the fancy organic café, quite an achievement given the reputation of traditional hospital food. The Circle Hospital isn t the only project, however, that celebrates natural light, an accessible environment and the importance of making patients feel like people. Nor is it the only one hiring big-name architects to do so. The Maggie's Centres initiative, named after polar opposite of a standard-issue hospital environment. As Lee says, Maggie said a diagnosis of cancer is like being punched in the stomach, and that s true. It knocks the air out of people, their family and friends. Our centres and our staff help them to come up for air. Making the medical experience as reassuring and comfortable as possible is something London s Evelina Children s Hospital knows a lot about. Five years ago it relocated to a spanking-new, seven-storey, glass-fronted building designed by London-based Hopkins Architects. As with the Circle Hospital, those most affected were consulted during the design process. A children s board of patients and local schoolchildren gave the client and design team their views on everything from meals to furniture. This resulted in feedback, such as children wanting not too private rooms and no scary long corridors, recalls project architect Ken Hood, a partner at Hopkins. To avoid the latter, the design team came up with snakelike floor plans that separate the open, multi-bed wards from utility spaces and single bedrooms; break up the size and shape of the bed bays; and create a more informal environment. Its massive four-storey conservatory has become a central feature the heart and lungs of the hospital, evoking the impression that, although inside, you are outdoors in the fresh air. The design aimed to borrow the adjacent green space of Archbishop s Park, Lambeth Palace Gardens and the River Thames to give each ward the acknowledged healing benefits of uplifting views, explains Hood. The ground floor of the conservatory, appealingly called the Beach, is the social centre of the building, with a café and waiting and play areas. The collaboration with children meant that a natural theme pervades the building s interiors (and

2 HOSPITALS : 111 doubles as a non-verbal orientation system); each floor has been painted a different colour, named after a natural habitat such as Ocean, Savannah and Mountains and adorned with inlaid floor designs and wall paintings. Patients and staff seem happy here. Vacancies for nurses in the paediatric intensive-care unit fell from 30 to two per cent, and applications for consultant posts doubled, says Hood. The new Evelina Children s Hospital was also designed with energy efficiency in mind. The south-facing building makes maximum use of solar gain, thus reducing energy consumption, and receives a great deal of daylight. Another children s hospital that takes both sustainability and patient psychology seriously is the stunning Meyer Hospital just outside Florence, Italy, where the proposals of 500 children became an intrinsic part of the brief. In the past, hospitals were conceived as a machine for recovery says Paolo Felli, a founding director of CSPE, the practice that designed the hospital complex (with some input at the outset from Anshen + Allen, international specialists in the design of healthcare and research buildings). Today, says Felli, we believe humanizing putting the patient at the centre should be one of the fundamental priorities of any hospital. The project uses and expands on an existing building (a former TB clinic) dating from 1930, which is set in a parkland of mature trees and has the rolling Tuscan hills as its attractive backdrop. The new additions include a glazed passageway and a large atrium that connects the old villa and the new pavilion. The atrium, or greenhouse, is covered in photovoltaic panels (which also filter natural light), while the new pavilion has a green roof (partly transformed into a shaded healing garden for its diminutive guests and their families) and features 47 so-called Pinocchio Hats, or conical skylights, that let light into the building. This, along with other measures, means the complex has reduced its energy consumption by a whopping 45 per cent. The interiors are bathed in natural light, adorned with art and filled with countless areas for recreation and play. Felli says the most telling anecdotal evidence of how little this hospital subscribes to the aesthetic and atmosphere of other healthcare structures is the story of a boy who returned home after a long stay at the Meyer, apparently unaware of the fact that he d been in a hospital. In the Netherlands, a recently completed pioneering hospital complex transforms the concept even further. This project is not just about the construction of new buildings. The Orbis Medical Park in Sittard is the brainchild of Erik Veldhoen, a strategic consultant and trendsetter in the field of workplace innovation. Despite his lack of experience in the medical sector, he developed an entirely new hospital complex based on a radical rethink of layout, organization, IT and other relevant processes. Key innovations include the absence of private consulting rooms for doctors, who work in Orbis s knowledge and expertise centre, where they have access to patients dossiers stored on computers throughout the building. All patients have private rooms with divans for overnight use by family members (Veldhoen points out the dual function of helping patients and taking part of the burden off the nursing staff), sliding glass doors (for facilitating regular checks by staff) and curtains (for privacy). Veldhoen emphasizes that this hospital is considered a meeting place, where the patient is the owner of the facility during the meeting. That means the doctor visits the patient instead of the patient the doctor. The Hospital of the Future, another name for the Orbis Medical Park, comprises six centres, of which four are devoted to patients and one, the Logistics Centre, handles goods and supplies. Patients, staff and supplies converge only where necessary, a set-up that eliminates time-consuming walks and searches. The forward-thinking buildings and patient-focused projects mentioned here have revolutionized our vision of a hospital and, above all, the sort of experience it offers its users. But perhaps one of the more significant hospital designs of the future is an as-yetunrealized scheme by Priestmangoode, a practice specializing in 3D branding and known for designing luxury airline cabins and economy hotel rooms. The firm has come up with a concept for taking the strain off overloaded national-healthcare systems. The Recovery Lounge questions the very need for rooms and offers an option to recover from a procedure without an overnight stay, says Paul Priestman, a founding director of the company. It offers privacy and yet visibility for staff to check on your wellbeing during your recovery. In the Recovery Lounge, reclining daybeds are staggered, like those in first-class airline cabins, and individual private patient zones are designed to offer maximum comfort, improve cleanliness and speed up turnaround times (the mantra of most modern airlines and hotels). With an ageing population and people living longer, our healthcare facilities have to adapt to more frequent visits for shorter stays as patients return for regular treatment of chronic conditions rather than major illnesses, says Priestman. What s more, Recovery Lounges would not be expensive to roll out if produced in adequate numbers. And our experience in the hotel industry has shown us that it is possible to reduce costs whilst maintaining quality, says Priestman. An opinion shared by the Circle healthcare group, which is planning an ambitious 25 more hospitals around the UK in the next five years. De Grey says the budget of Circle s first hospital was similar to that of a state hospital. Which leads to one obvious conclusion: if happy, humane hospitals are affordable, surely we should have more of them. We believe humanizing putting the patient at the centre should be one of the fundamental priorities of any hospital Paolo Felli With an ageing population, our healthcare facilities have to adapt to more frequent visits for shorter stays Paul Priestman

3 112 : HOSPITALS THE BUILDING IS BASED ON THE CONCEPT OF THREE SEPARATE STREAMS FOR PATIENTS, PROFESSIONALS AND LOGISTICS. PHOTOS HUGO THOMASSEN

4 HOSPITALS : 113 THE DESIGN IS ORCHESTRATED AROUND CONVERGENCE POINTS OR MEETING SPACES. This hospital is a meeting place, where the doctor visits the patient instead of the patient the doctor Erik Veldhoen CARE MEDICAL STAFF DIAGNOSIS TREATMENT PATIENT TREATMENT CONSULTATION MEDICAL STAFF CARE DIAGRAM SHOWING PATIENT-CENTRED APPROACH. DURING TREATMENT AND CARE, THE PATIENT IS THE OWNER OF THE SPACE. ORBIS MEDICAL PARK The new Orbis Medical Park in Sittard is based on the ideas of Erik Veldhoen, a strategic consultant in workplace innovation. He brought a fresh approach to bear on the hospital, rethinking its organization, IT and other processes. There are two design focus points: the patient and technology. During consultation, treatment and care, the patient is the owner of the space. The professionals visit the patient, not vice versa. Doctors and staff work together in activity-based knowledge centres (no private desk or rooms anymore) and the patient has a private room. Technology is optimized and information is digital and accessible via mobile devices and wireless networks. In the building there are three separate streams: patients, professionals and logistics. These converge at meeting points. TYPE OF FACILITY General hospital (65,000 m 2 ), rehabilitation clinic (20,000 m 2 ), prevention and medical education centre (20,000 m 2 ) LOCATION Sittard, Netherlands DESIGNER Concept: Erik Veldhoen For Change (erikveldhoen.nl); building: Jan van der Leij van Bonnema architecten (bonnema.com) DATE OPENED January 2009

5 114 : HOSPITALS COLOUR IS INTEGRAL TO THE DESIGN. PHOTOS MIKE BINK THE FLOORPLAN ILLUSTRATES THE GUIDING PRINCIPLE OF A PARADE OR MAIN CORRIDOR THAT CONNECTS EVERY SPACE IN THE FACILITY. EMMA CHILDREN S HOSPITAL (EKZ) The EKZ aims to provide the best treatment for sick children while creating a normal environment. The newly renovated neonatal unit and staff area by OPERA are based on the metaphor of the high street as the guiding principle. A parade, or main corridor, runs through the hospital, leading to all public areas and to each child s private bedroom. Wayfinding which employs a specific language of icons and colours is integral to the design. TYPE OF FACILITY Hospital with neonatal care unit and staff area. Other facilities (older kids, etc) to be completed 2013 LOCATION AMC, Amsterdam, Netherlands DESIGNER Architectural design: OD205 (od205.nl); interior design: OPERA Amsterdam (opera-amsterdam.nl) DATE OPENED January 2010 WAYFINDING EMPLOYS SPECIFIC ICONS AND COLOURS.

6 HOSPITALS : 115 THEMATIC GRAPHICS ON GLASS WALLS ILLUSTRATE THE TREATMENT AREAS OF EACH DEPARTMENT. Different artists created illustrations to complement the themes of the various departments THE PARENTS LOUNGE INCORPORATES A WALL OF JUNGLE, AN IMAGINATIVE CONNECTION TO THE OUTSIDE WORLD.

7 116 : HOSPITALS THE INTERIOR IS DESIGNED TO RADIATE THE IDEA OF WELLNESS, SO THE USUAL VOCABULARY OF HOSPITALS IS STUDIOUSLY AVOIDED. PHOTOS RENÉ DE WIT

8 HOSPITALS : 117 THE REHABILITATION CENTRE IS OPEN TO ITS PARKLAND SETTING, WHICH WAS CREATED BY GREATLY SIMPLIFYING THE STRUCTURES ONSITE. The new complex replaces a confused profusion of buildings with trees THE ORIGINAL COMPLEX (ABOVE LEFT) HAD MANY BUILDINGS, WHICH THE NEW CENTRE CONDENSES INTO THREE AREAS (RIGHT). EXPOSING THE INTERIOR TO THE SURROUNDING GREENERY TAPS INTO THE HEALING POWER OF NATURE: LANDSCAPE VIEWS HAVE BEEN SHOWN TO SPEED RECOVERY. GROOT KLIMMENDAAL REHABILITATION CENTRE An existing facility consisting of numerous small buildings was replaced by three larger structures: a rehabilitation centre, a school and an apartment building. The interiors deliberately avoid icons of sickness, such as fluorescent lighting, linoleum, and modular ceilings. Instead, they radiate the idea, I want to get better. So a festive vocabulary was chosen: bright colour, mirrors, and extensive windows and skylights form a kind of chandelier in the rehabilitation space. This in a nod to the healing power of nature is open to its parkland setting and, thanks to the façade s anodized aluminium and green glass, blends in with it. One of the goals was to strengthen the relationship with the neighbourhood. Some of the buildings facilities pool, theatre, fitness centre are open to the local community. If rehabilitation aims to include people in society again, the thinking goes, why not start that process during treatment? TYPE OF FACILTY Rehabilitation centre LOCATION Arnhem, the Netherlands DESIGNER Koen van Velsen (koenvanvelsen.com) DATE OPENED September 2009

9 118 : HOSPITALS HIGH-TECH FACILITIES ARE PLACED IN THE SIMPLEST OF SETTINGS. PHOTOS COURTESY OF FOSTER + PARTNERS AS THE FLOORPLAN SHOWS, THE OPEN AND DEMOCRATIC DESIGN DISPENSES WITH THE USUAL OFFPUTTING DIVISIONS BETWEEN DEPARTMENTS AND ROOMS. CIRCLE HOSPITAL The Circle Hospital in Bath is partly owned and run by staff, who had a hand in designing it. The interior features a warm palette, contemporary art and views of the surrounding countryside. Instead of relying on signage, real people guide patients to their destination. The democratic design, with minimal divisions separating departments, aims to put the patient at the centre of the hospital while minimizing stress. The compact scale encourages a sense of community, and facilities suggest a boutique hotel rather than a healthcare institution. THE BUILDING MAKES THE MOST OF ITS SCENIC SURROUNDINGS. TYPE OF FACILITY General hospital LOCATION Bath, UK DESIGNER Foster + Partners DATE OPENED March 2010

10 HOSPITALS : 119 THE RESTFUL ATMOSPHERE OF THE INTERIOR EVOKES A BOUTIQUE HOTEL. There are none of the colours, sounds or smells of a usual medical centre the effect is more like that of a luxury hotel Spencer de Grey SOOTHING NATURAL LIGHT PERVADES MOST OF THE ROOMS IN THE HOSPITAL.